通淋排石法对“石街”治疗的临床观察

通淋排石法对“石街”治疗的临床观察聂赛清（广东省深圳市中医院碎石中心５１８００８）关键词通淋排石法，临床应用，石街，中医药疗法“石街”是泌尿系结石经体外冲击波碎石后排到输尿管所形成的碎石串，临床上以肾或输尿管较大结石碎石后多见。笔者运用通淋排石法治疗...     

经输尿管尿管低压水流结合ESWL治疗输尿管石街11例

体外冲击波碎石 (ESWL)治疗肾结石已被肯定 ,但由于治疗中容易引起石街、输尿管堵塞和肾盂肾炎乃至脓肾等并发症而使泌尿外科医师感到棘手 ,尤其是石街梗阻易造成患肾功能丧失 ,肾萎缩。我院 1998年 12月至 2 0 0 0年 10月对 ESWL 造成的输尿管石街 11例采用经膀胱输尿管插管低压水流灌注下行 ESWL 方法治疗 ,取得较好的疗效 ,现报道如下。1　临床资料1.1　一般资料 :本组男性 10例 ,女性 1例。年龄 2 9～ 5 8岁 ,均为肾结石 ESWL 术后 ,原发结石 1.8～ 3.2 cm,右肾结石8例 ,左肾结石 3例 ,石街形成长度 3～ 14 cm,石街形成后 ,患者…     

经输尿管导管低压水流结合ESWL治疗输尿管石街11例

体外冲击波碎石(ESWL)治疗肾结石已被肯定,但由于治疗中容易引起石街、输尿管堵塞和肾盂肾炎乃至脓肾等并发症而使泌尿外科医师感到棘手,尤其是石街梗阻易造成患肾功能丧失,肾萎缩.我院1998年12月至2000年10月对ESWL造成的输尿管石街11例采用经膀胱输尿管插管低压水流灌注下行ESWL方法治疗,取得较好的疗效,现报道如下. 1 临床资料 1.1 一般资料:本组男性10例,女性1例.年龄29～58岁,均为肾结石ESWL术后,原发结石1.8～3.2 cm,右肾结石8例,左肾结石3例,石街形成长度3～14 cm,石街形成后,患者大多伴有患侧腰背部或下腹部胀痛,偶有血尿.     

泌尿系统结石3218例综合观察

目的探讨治疗泌尿系结石的最佳方案。方法对3218例泌尿系结石患者的临床分类和治疗方法作回顾性分析。本组单纯性肾结石1365例，复杂性肾结石651例，输尿管结石Ⅰ类558例，Ⅱ类452例，Ⅲ类192例。结果本组手术取石1164例，行ESWL治疗1923例，行输尿管镜直视下碎石131例。复杂性肾结石手术组残余结石57例（8.8％），行肾切除12例（1．8％）。ESWL组3个月排石率为81．6％，转手术率为18．4％，切肾率为0％。输尿管镜下气压弹道碎石效果不佳改行手术取石8例（61％）。结论ESWL、输尿管镜直视下碎石、术中应用气压弹道式碎石或两种以上方法联合应用治疗泌尿系结石可减轻患者痛苦或降低手术难度。开放性手术放置内引流可减少术后并发症。ESWL治疗后应积极处理石街、控制感染和最大限度减轻医源性肾功能损害。输尿管镜直视下碎石要有熟练的内腔镜操作技术。     

输尿管镜下气压弹道碎石联合中药治疗ESWL后输尿管石街8例

体外冲击波碎石术（ESWL）是上尿路结石主要治疗方法。石街形成是ESWL治疗复杂上尿路结石常见并发症之一,严重者可引起输尿管梗阻,肾功能损伤,输尿管完全梗阻6周后肾功能将会完全丧失。2007年1月-2012年7月,本院应用输尿管镜下气压弹道碎石联合中药排石治疗ESWL后输尿管石街患者8例,成功率较高,创伤性小,现报道如下。     

ESWL后输尿管石街形成86例分析

石街又称输尿管淤积综合征，是由于体外震波碎石(ESWL)后，结石颗粒在排出过程中阻塞输尿管所引起，我院碎石中心在1988年9月-2002年12月期间，共治疗肾结石患者7166例，并发输尿管石街86例，占1．2％。     

体外冲击波碎石术治疗282例肾结石的体会

目的总结体外冲击波碎石(ESWL)治疗282例肾结石的经验。方法使用深圳惠康医疗器械有限公司生产的HK.ESWL-5型电磁式体外冲击波碎石机治疗282例肾结石,碎石电压10～14KV,频率60次∕分,冲击次数1000～2000次,术后7～14天拍腹部平片,术后排出的结石粉末做常规成分分析,巨大多发结石者（12例）术前均放内支架管（双J管）。结果282例患者一次ESWL治疗成功为204例（72.3%）,二次成功为69例（24.5%）,有9例肾结石长径＞2.8c m者二次碎石后出现残留结石（石街）梗阻于输尿管中、下段,再行输尿管镜碎石取石术后结石排净。结论 ESWL治疗肾结石损伤小,疗效好,应用输尿管镜处理ESWL治疗残留结石是一种有效的辅助手段。     

ESWL输尿管石街形成因素分析

目的 探讨ESWL后石街形成的影响因素。方法 回顾性分析1999年1月-2005年10月该院2300例ESWL患者临床资料并进行统计学分析。结果 该组患者肾结石1703例，榆尿管结石597例，84例石街形成，输尿管石街发生率为3．65％，石街形成主要因素：结石大小和位置，肾积水及工作电压。结论对于可能形成石街的患者密切随访，早期干预或预防性双J管置入是必要的。     

逆行输尿管插入双J管在ESWL治疗复杂肾结石的应用

目的探讨双J管内引流在体外震波碎石(ESWL)治疗复杂肾结石及双肾结石、防止石街形成、防止急性肾功衰的作用.方法对单侧较大肾结石或双肾结石不愿手术者,采取留置双"J"管后行ESWL治疗.结果一次性碎石,完全排出191例占74.4%;需二次ESWL36例占14.4%;形成石阶23例占9.2%.最终结石全部排出,无急性肾后性肾功衰.结论双J管作为较大肾结石ESWL治疗的辅助治疗,能有效防止石街形成,有利于结石排出,特别对双侧肾结石治疗时避免双侧输尿管梗阻引发急性肾功表.操作简单,并发症少,适于推广应用.     

肾结石两种ESWL碎石方法的对比研究

目的 分析和研究ESWL两种碎石方法治疗肾结石的排石情况.方法 肾结石病例1 000例,ESWL前B超或彩超、IVU、KUB、CTU等影像学检查明确本病且排外结石以下尿路有梗阻存在者,使用不同定位、碎石方法ESWL后观察结石排空或残留、甚至引起同侧输尿管石街的发生率.结果 不同大小的肾结石采用两种不同的ESWL碎石方法治疗后发生结石残留和输尿管石街的发生率有明显差异.结论 肾结石直径<1.5 cm者,采用结石中心定位、一次性碎石方法进行ESWL治疗较好;肾结石直径≥1.5cm者,采用结石边缘定位、少量、分次碎石方法进行ESWL治疗较好.     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.