乙型肝炎肝硬化患者幽门螺杆菌感染情况分析

目的 探讨乙型肝炎肝硬化患者幽门螺杆菌(Helicobacter pylori,Hp)感染现状及与消化性溃疡及肝功能的关系.方法 回顾性分析110例乙型肝炎肝硬化患者消化内镜表现及Hp感染情况.结果 Hp阳性组和阴性组的性别、年龄的差异均无统计学意义(P＞0.05).不同程度的食管静脉曲张、门脉高压性胃病Hp阳性率比较,差异均无统计学意义(P＞0.05).肝硬化患者Hp现症感染检出率为59.1％ (65/110),Hp阳性组消化性溃疡的检出率为73.8％ (48/65),高于Hp阴性组(55.6％,25/45),差异有统计学意义(P＜0.05).Child-Pugh A、B、C级患者的Hp阳性率分别为54.4％、61.5％、64.0％,但无统计学意义(P＞0.05).结论 肝硬化患者Hp感染与食管静脉曲张、门脉高压性胃病均无关,但是为消化性溃疡的重要原因.     

门脉高压性胃病的相关因素分析

目的 探讨门脉高压性胃病发生和发展的相关因素.方法 回顾性分析84例门脉高压患者的临床资料.结果 门脉高压性胃病的病变程度与幽门螺杆菌感染(P<0.01)、食管静脉曲张程度(P<0.01)和肝功能分级(P<0.05)显著相关.结论 幽门螺杆菌感染可加重门脉高压性胃病病情,病变程度与食管静脉曲张、肝功能密切相关.     

肝硬化并上消化道出血的胃镜表现及其临床意义(附156例分析)

目的对肝硬化并上消化道出血患者的食管静脉曲张程度、胃粘膜病损程度以及幽门螺杆菌（Hp）感染情况进行相关性分析。方法肝硬化并上消化道出血患者行急诊胃镜检查,食管静脉曲张根据其内镜表现分无、轻、中、重度;门脉高压性胃病（PHG）按McCormack内镜诊断标准分类;Hp检测采用快速尿素酶试验和14C尿素呼气试验。结果156例上消化道出血患者中,食管静脉曲张破裂出血82例,占52.8%（82/156）;PHG出血40例,占26.3%（40/156）;消化性溃疡16例,占11.3%（16/156）;胃癌2例;急性胃黏膜病变4例;其他不明原因12例。且食管静脉曲张程度与PHG病变程度呈明显正相关（P〈0.01）。Hp检测阳性62例,其中食管静脉曲张破裂出血中29例,PHG中19例,消化性溃疡中9例,其他5例,且Hp感染与食管静脉曲张及PHG的病变程度无关（P〉0.05）。结论食管静脉曲张破裂出血与门脉高压性胃病出血是引起肝硬化并上消化道出血的两大主要原因,且随着食管静脉曲张程度的加重,门脉高压性胃病逐渐增多和加重;Hp感染与肝硬化并上消化道出血无关,是否给予根除Hp治疗尚有待商榷。     

脉高压性胃病并出血的相关因素探讨

目的:探讨肝硬化门脉高压性胃病并上消化道出血的相关因素。方法:将118例肝硬化并上消化道出血患者按Child-pugh肝功能分级评分,在48h内行急诊胃镜检查并记录食管静脉曲张程度,诊断门脉高压性胃病49例,并做病理查幽门螺杆菌、14C-尿素呼吸试验等检查。结果:118例肝硬化并上消化道出血患者,食管静脉出血54例、门脉高压性胃病49例、肝性溃疡15例。门脉高压性胃病49例按Tanoue分级标准,第3级组Child-pugh肝功能分级属C级者占87.5%,而第2级组Child-pugh肝功能分级属C级者仅占12.5%,第1级组Child-pugh肝功能分级属C级者为0,前两者比较差异有统计学意义(P<0.001),食管静脉曲张程度、肝功能Child-pugh分级与门脉高压性胃病分类有关(P<0.001或P<0.05)。门脉高压性胃病幽门螺杆菌感染率为67.3%,阳性组与阴性组比较差异有统计学意义(P<0.05)。结论:门脉高压性胃病并出血与食管静脉曲张程度、肝功能分级及幽门螺杆菌感染等因素有关。     

门脉高压性胃病的多因素分析

目的探讨门脉高压性胃病发生和发展的相关因素。方法回顾性分析166例门脉高压患者的临床资料。结果门脉高压性胃病的发生率为46.99%,不同原因引起门脉高压性胃病的发病率差异无显著性(P>0.05),有无幽门螺杆菌感染也无差异(P>0.05),但门脉高压性胃病的病变程度与幽门螺杆菌感染(r=0.202,P<0.05)和脾静脉内径(r=0.397,P<0.01)、肝功能分级(r=0.267,P<0.05)、门静脉内径(r=0.202,P<0.05)和脾静脉内径(r=0.198,P<0.05)显著相关。结论门脉高压性胃病的发生与引起门脉高压的病因和有无幽门螺杆菌感染无关,但幽门螺杆菌感染可加重病情,病变程度与食管静脉曲张、肝功能以及门静脉和脾静脉内径相关。     

门脉高压性胃病并发出血的临床观察

目的探讨食管静脉曲张程度、肝功能、脾功能及食管静脉套扎术后对门脉高压性胃病(PHG)并出血的影响.方法将PHG并出血患者作胃镜.镜下见到重型PHG,在排除食管胃底静脉曲张破裂出血和消化性溃疡出血后,则考虑PHG出血.结果PHG并出血患者中,以轻中度食管静脉曲张为主,中度与重度之间有显著性差异(P＜0.05);肝功能越差,PHG并出血发生率越高,A级与C级比较有显著性差异(P＜0.05);脾功能亢进程度越重,PHG并出血的机率也增加,轻度与重度脾亢之间存在显著性差异(P＜0.05).结论在肝硬化合并上消化道出血中,门脉高压性胃病所致的出血是一个不容忽视的重要原因,PHG并出血患者以轻中度食管静脉曲张为主,一般出血量少,以黑便为主.当肝功能越差,脾功能亢进程度越重,PHG并出血的发生率越高,降门脉治疗可取得良好效果.     

幽门螺杆菌感染与肝源性溃疡及其肝功能的相关性

对５６例肝硬化患者行胃镜及幽门螺杆菌（Ｈｐ）检测,结果发现２５例伴有消化性溃疡的患者及３１例无消化性溃疡的患者,其Ｈｐ感染率分别为７６％与７０．９％,两组比较差异无显著性（Ｐ＞０．０５）。且两组中有肝功能损害者的Ｈｐ感染较肝功能正常者高,分别为８０．８５％与３３．３％（Ｐ＜０．０５）。同时食管静脉曲张程度越高,其消化性溃疡发生率越高（Ｐ＜０．０５）,表明肝硬化患者消化性溃疡的发生与门脉高压有关而与Ｈｐ感染无关。     

幽门螺杆菌与门脉高压性胃病关系探讨

幽门螺杆菌(Hp)感染是慢性胃炎、消化性溃疡的主要致病因素,与胃癌的发生也关系密切.本文分析了1996年1月至2000年12月在我院住院肝硬化门脉高压性胃病患者Hp感染的情况,探讨Hp感染与门脉高压性胃病的关系和临床意义.     

门脉高压性胃病患者幽门螺杆菌感染情况分析

幽门螺杆菌(Hp)是消化道感染率最高的细菌,大量研究证明Hp是慢性胃炎和消化性溃疡的重要致病因子.肝硬化患者门脉高压性胃病(PHG)发生率高,其发病机制异于一般人群的慢性胃炎和消化性溃疡.笔者通过PHG患者Hp感染率分析以了解其Hp感染的特点.     

门静脉高压性胃病80例分析

目的探讨门静脉高压性胃病的严重程度与肝功能Child-pugh分级、食管静脉曲张程度、幽门螺杆菌(Hp)感染阳性率的关系。方法对2004～2010年诊治的80例门静脉高压性胃病患者进行回顾性分析。结果门静脉高压性胃病的严重程度与肝功能Child-pugh分级、食管静脉曲张程度、Hp感染阳性率及上消化道出血的发生率呈正相关(P<0.05)。结论门静脉高压性胃病治疗过程中应注意改善肝功能,预防消化道出血和食管静脉曲张,以及抗Hp感染。     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

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.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Dr.Zhang Ren's Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

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.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.