小剂量尿激酶联合低分子肝素钙治疗急性进展性脑梗死的临床研究

目的探讨进展性脑梗死的有效治疗措施。方法将180例急性进展性脑梗死患者随机分为4组:联合治疗组45例,采用尿激酶20万u+0.9%氯化钠溶液100 ml静滴,每日2次,连5 d,同时低分子肝素钙0.4 ml腹部皮下注射,每日2次,连用7 d,余治疗同对照组;尿激酶组45例,采用尿激酶20万u+0.9%氯化钠溶液100 ml静滴,每日2次,连5天,余治疗同对照组;抗凝组45例,低分子肝素钙5000IU腹部皮下注射,每日2次,连用7 d,余治疗同对照组;对照组45例,血栓通300 mg+0.9%氯化钠溶液250 ml静滴,每日1次,共14 d。结果联合治疗组疗效明显优于抗凝组和对照组P<0.01(91.1%、77.8%、68.9%),抗凝组疗效高于对照组P<0.05。结论应用小剂量尿激酶和低分子肝素治疗急性进展性脑梗死均有明显的疗效,两者具有协同作用。     

50例急性肺栓塞2周后小剂量溶栓和单纯抗凝疗效观察

目的：观察急性肺栓塞病程2周以后，溶栓加抗凝和单纯抗凝临床效果比较。方法：将50例肺栓塞病程〉2周的病人分为A、B两组。A组用250ml。生理盐水加尿激酶200000～500000u，低分子肝素钙5000u皮下注射，1次／12h，连用7d，于停用低分子肝素钙前3d开始口服华法令，疗程6个月；B组仅应用低分子肝素钙及华法令，方法同A组。观察临床症状、体征、心脏彩超、肺通气灌注显像及螺旋CT检查的变化。结果：A组总有效率为50％，B组总有效率为40％，两者比较P〉0．05。结论：急性肺栓塞病程〉2周，小剂量溶栓加抗凝与单纯抗凝无显著差别，为减少出血风险选择单纯抗凝治疗。     

低分子肝素钙联合小剂量尿激酶治疗不稳定型心绞痛的临床观察

目的 观察低分子肝素钙联合小剂量尿激酶治疗不稳定型心绞痛的临床疗效.方法 95例不稳定型心绞痛患者随机分为尿激酶组和常规治疗组.常规治疗组45例,给予硝酸异山梨醇脂10mg,每日3次口服;阿司匹林300mg每日1次口服,3 d后改为100mg每日1次口服;低分子肝素钙4000U每12小时1次皮下注射,连用7 d.尿激酶组50例,在常规治疗基础上加用尿激酶50万U加入0.9%氯化钠注射液100ml半小时内静脉滴入,每日1次连用5 d,观察患者的临床疗效和心电图疗效.结果 尿激酶组临床总有效率96.0%(48/50),心电图总有效率88.0%(44/50);常规治疗组临床总有效率73.3%(33/45),心电图总有效率68.9%(31/45),组间差异均有统计学意义(χ2值分别为60.78、57.56,P均＜0.05).结论 肝素抗凝后联合小剂量尿激酶溶栓治疗不稳定型心绞痛患者,其临床症状及心电图变化均获得明显改善,心绞痛的发作次数明显减少.     

小剂量尿激酶静脉溶栓治疗急性脑梗死临床分析

目的为了探讨小剂量尿激酶对急性脑梗死的溶栓效果、用药时间窗及安全性.方法将120例急性脑梗死患者随机分为尿激酶组和对照组各60例,尿激酶组给于小剂量尿激酶连续静滴一周,对照组合于低分子右旋糖酐静滴一周.结果尿激酶组疗效明显优于对照组(P＜0.01～0.05).48h内溶栓均有效果,6h内疗效最佳.尿激酶组仅有3例出现皮下瘀斑,未见颅内出血及消化道出血等严重并发症.结论提示小剂量尿激酶连续静脉溶栓治疗急性脑梗死是安全有效的,用药时间窗应个体化.     

尿激酶静脉溶栓联合低分子量肝素治疗超急期脑梗死—附24例报告

目的研究尿激酶静脉滴注溶栓联合低分子量肝素钙皮下注射治疗超急期脑梗死的疗效与安全性;观察治疗时间窗对疗效与出血性事件发生率的影响.方法以24例发病12小时以内的脑梗死为静脉溶栓治疗组,并与具有可比性的20例常规治疗对照组作对照研究.治疗组给予低分子量肝素0.4mL,皮下注射,每日3次,持续10日,第一日给予尿激酶150万单位至200万单位,静脉滴注,其余治疗与对照组基本相同.结果溶栓治疗组治愈率67%(16/24),总有效率88%(21/24),明显高于对照组.治疗组住院时间(11±4)日、对照组(21±5)日(P<0.05).治疗组出血性事件发生率25%(6/24),对照组10%.治疗组6小时以内治疗的病人的治愈率明显高于6小时至12小时内治疗者,而出血发生率则相反.结论低分子量肝素与尿激酶联合静脉溶栓治疗急性脑梗死有肯定疗效.溶栓治疗的时间窗宜为发病后6小时以内.     

静脉溶栓治疗急性脑梗死的临床观察

目的观察大剂量尿激酶治疗脑梗死超早期的静脉溶栓效果。方法对40例符合溶栓条件的急性脑梗死病人在发病6h内给予尿激酶100万U静滴,辅以低分子右旋糖酐500ml／d,内加脉络宁针20ml,连用15d,溶栓有效者,次日起给予低分子肝素2500U,Bid,iH连用5—7d。对照组不用尿激酶,只用低分子右旋糖酐、脉络宁及低分子肝素等药物,用法及用量同溶栓组,适当给予甘露醇脱水降颅压治疗。结果溶栓治疗40例,第21d基本痊愈12例,占30．0％,显著进步21例,占52．5％,总显效率为82．5％（33／40）。对照组42例,基本痊愈10例,显著进步10例,各占23．8％,总显效率为47．6％。两组间比较差异有统计学意义（P〈0．05）,溶栓组出血率为10％（4／40）,脑内出血占5％（2／40）,对照组出血率为5％（2／40）,全为颅内出血。结论大剂量尿激酶超早期（6h以内）静脉溶栓治疗急性脑梗死有效。     

尿激酶联合低分子肝素钙治疗进展性脑梗死60例临床观察

目的观察尿激酶联合低分子肝素钙治疗进展性脑梗死患者的临床疗效。方法将60例患者随机分为两组,对照组采用常规缺血性脑血管病治疗;治疗组采用小剂量尿激酶30万U溶于生理盐水100 ml,30 min滴完,1次/d,7 d为1个疗程,低分子肝素钙5000 U皮下注射,1次/d,10 d为1个疗程。结果治疗组患者治疗3周后基本治愈率、显著进步率均高于对照组。结论低分子肝素钙联合小剂量尿激酶治疗进展性脑梗死安全、有效。     

小剂量溶栓结合抗凝治疗不稳定型心绞痛疗效观察

不稳定型心绞痛(UAP)是冠心病中一组介于急性心梗(AMI)与稳定性心绞痛(SAP)之间的临床症候群,其治疗手段近年不断发展,对UAP采用低分子肝素抗凝方法治疗已基本得到确认,但是否采用溶栓治疗至今意见不一。本文对我院近2年来UAP患者38例采用常规治疗加小剂量尿激酶(天普洛欣)溶栓(?)低分子肝素钙抗凝与UAP患者42例单采用常规治(?)法对比观察,现报告如下。     

低分子肝素钙治疗急性脑梗死的疗效观察及护理

急性脑梗死是神经内科常见脑血管疾病,目前急性脑梗死治疗以溶栓、降纤、抗凝等药物综合治疗为主,低分子肝素钙作为抗凝剂广泛用于血管闭塞性疾病[1].南京医科大学第一附属医院神经内科2005年1月～2005年5月采用低分子肝素钙治疗急性脑梗死60例,效果满意,现报告如下. 　　……     

急性脑梗死尿激酶动脉溶栓术后早期抗凝治疗临床研究

目的：探讨急性脑梗死尿激酶溶栓术后早期抗凝治疗的安全性和有效性。方法选择急性脑梗死予动脉溶栓患者117例,随机分为治疗组与对照组,治疗组在溶栓术后6小时予低分子肝素钙5000 IU 皮下注射2次/d,2周为1疗程;对照组在溶栓术后24小时予以抗凝治疗。两组降压、降糖、强化降脂、神经保护、防治并发症等基础治疗相同,监测活化凝血酶原时间(ACT)值。依据美国国立卫生院卒中量表(NIHSS)及日常生活能力(BI)评定两组神经功能缺损程度。结果两组治疗7、14天后 NIHSS 分和 BI 分均较治疗前有明显改善,但治疗组改善程度优于对照组(P <0.01),而发生致死性颅内出血事件并未增加(P >0.05)。结论急性脑梗死尿激酶溶栓术后早期抗凝治疗效果明显,未发生致死性颅内出血,安全有效,值得临床推广。     

儿童低视力康复与助视器

目的：探讨助视器在儿童低视力门诊的应用效果。方法：143例6～14岁低视力患儿分别配戴远用和近用助视器。结果：低视力患儿配戴远用和近用助视器后，24．5％远视力≥0．5；54．5％的近视力≥0．5。结论：低视力患儿助视器的应用，不仅能提高视力，改善视功能，而且视觉康复推动了特教事业的发展。     

低频超声药物透入实验研究

通过实验比较了两种频率的超声经ＳＤ大鼠皮肤透入１３１Ｉ的量和深度，放射免疫技术测定结果，显示低频超声透入药物的量多且深，说明低频超声有利于药物的透入。     

Headaches Associated with Low Spinal Fluid Pressure

Post-lumbar puncture headache (PLPHA) and spontaneous hypoliquorrheic headache are both associated with low spinal fluid pressure. A dull or throbbing occipital ache characteristically worsened by sitting or standing and eased by lying down is peculiar to both. Additional symptoms and signs may accompany the headache. In PLPHA the pain is triggered by leakage of cerebrospinal fluid through the dural rent, but the cause of the pain is probably due to intracranial arterial and venous dilatation. The same mechanism probably applies to spontaneous hypoliquorrheic headache in which the site of leakage is rarely found. The majority of cases subside without treatment over several days. Those that persist may be treated with epidural blood patch or saline infusion with good results. A simple, innocuous, yet underutilized form of treatment is caffeine sodium benzoate. This review will discuss the incidence, pathogenesis, prevention and treatment of these headaches.     

Pain Threshold for Low Energy Intracardiac Cardioversion of Atrial Fibrillation with Low or No Sedation

Recent studies have shown that internal cardioversion of atrial fibrillation is safe and effective. In this randomized prospective study, we have tried to evaluate the influence of different waveforms on the perception of pain during internal cardioversion in patients with chronic atrial fibrillation. Methods: Internal cardioversion was performed with minimal or no sedation in 31 consecutive patients, R wave triggered, biphasic shocks of 6 ms/6 ms or 3 ms/3 ms duration (randomly selected) and approximately 65% tilt were used starting with a 50-V test shock. The shock intensity was increased in 40-V steps up to a maximum voltage of 520 V. Shocks were applied via two custom-made catheters (Elecath, Rahway, NJ). In 16 patients (3 females, age 61 ± 11 years, left atrium diameter 58 ± 5 mm, duration of atrial fibrillation 4 ± 4 months), 6/6 waveforms were used, and in 15 patients (1 female, age 62 ± 5 years, left atrium diameter 59 ± 4 mm, duration of atrial fibrillation 5 ± 2 months), 3/3 waveforms were used. After cardioversion, each patient was asked to quantify their pain on a scale from 0–10 (0 = no pain, 10 = intolerable). Fourteen of the 15 patients in the 3/3 ms and 15 of the 16 patients in the 6/6 ms group were successfully cardioverted. Patients from the 6/6 waveform group were cardioverted with a lower mean voltage of 254/92 versus 355/127 V (P < 0.02), at lower pain score 1.8 ± 1.3 versus 4.2 ± 2.2 (P < 0.05) with equivalent energy (6.8 ± 2.8 versus 6.2 ± 1.5 J, n.s.) and required lower doses of midazolam of 2.2 ± 1.9 versus 4.0 ± 1.8 mg IV (P < 0.02). The waveform used in internal cardioversion seems to have a major impact on the patients’ perception of pain. These results imply that energy determines the success of a shock, but voltage determines the pain perceived by the patient. The use of waveforms that deliver greater energy at lower peak voltages offers the possibility of internal cardioversion with less sedation and greater patient tolerance.     

Low back pain with lower extremity referred pain

Low back pain with referred leg pain may be caused by the intervertebral disk without a disk herniation. Anatomic studies have shown the disk to be innervated. Although controversial, diskography has reproduced back and leg pain with provocative studies.The majority of patients will respond to nonoperative management.The socioeconomic and psychologic issues have to be adequately explored as much as the pathologic anatomy.     

Alternative Pop-Up for Surfers with Low Back Pain

Surfing is enjoyed by many people around the world. A common problem in surfers is back pain during the “take-off,” specifically the “pop-up.” This article describes each part of the “take-off, and introduces an alternative to the “prone pop up” - called the “knee pop-up.” This alternative is a suggested technique to alleviate the stress in the lumbar spine during surfing.     

Ultrafiltration Characteristics of Glucose Polymers with Low Polydispersity

♦ Background: Icodextrin, a glucose polymer with a polydispersity [ratio of weight-average molecular weight (Mw) to number-average molecular weight] of approximately 2.6, has been shown, compared with glucose, to provide superior ultrafiltration (UF) efficiency [ratio of UF to carbohydrate (CHO) absorbed] when used as an osmotic agent during a long-dwell peritoneal dialysis exchange. In an experimental rabbit model, we evaluated the effect of Mw on the UF and UF efficiency of glucose polymers with low polydispersity.♦ Methods: A crossover trial in female New Zealand White rabbits (2.20 - 2.65 kg) with surgically implanted peritoneal catheters evaluated two glucose polymers at nominal concentrations of 7.5 g/dL: a 6K polymer (Mw: 6.4 kDa; polydispersity: 2.3) and a 19K polymer (Mw: 18.8 kDa; polydispersity: 2.0). Rabbits were randomized to receive either the 6K (n = 11) or the 19K (n = 12) solution during the first exchange (40 mL/kg body weight). The alternative solution was evaluated in a second exchange 3 days later. During each 4-hour dwell, the UF and total glucose polymer CHO absorbed were determined.♦ Results: The UF was higher for the 6K (p < 0.0001) than for the 19K polymer (mean ± standard deviation: 73.6 ± 30.8 mL vs. 43.0 ± 20.2 mL), as was the amount of CHO absorbed (42.5% ± 9.8% vs. 35.7% ± 11.0%, p = 0.021). In spite of higher CHO absorption, an approximately 50% higher (p = 0.029) UF efficiency was achieved with the 6K polymer (28.3 ± 18.8 mL/g) than with the 19K polymer (19.0 ± 11.3 mL/g). The results were independent of the order of the experimental exchanges.♦ Conclusions: Glucose polymers with low polydispersity are effective osmotic agents in a rabbit model. The low-Mw polymer was more effective at generating UF and had a higher UF efficiency, but those results came at the expense of the polymer being more readily absorbed from the peritoneal cavity.Key words: Carbohydrate absorption, glucose polymer, molecular weight, polydispersity, rabbit, ultrafiltrationIcodextrin is an osmotic agent that is used in peritoneal dialysis (PD) solutions during a long-dwell exchange (1). This osmotic agent is not a single molecular entity; rather, it consists of a mixture of glucose polymers with a weight-average molecular weight between 12 kDa and 20 kDa and a number-average molecular weight between 5 kDa and 6.5 kDa. The ratio of the weight-average to the number-average molecular weight is a useful measure of the spread of polymer distribution (2). This ratio is often referred to as the polymer’s polydispersity, and it has been reported to be 2.6 for icodextrin (3). Early clinical studies by Mistry (4,5) demonstrated that a high-molecular-weight glucose polymer osmotic agent, similar to icodextrin, was superior to other glucose polymer osmotic agents of lower molecular weight and higher polydispersity.Improved osmotic agents for long-dwell PD solutions have previously been proposed by several investigators. Some have advocated the use of a combination of icodextrin with glucose (6,7); others have suggested the use of monodisperse large-molecular-weight colloids based on theoretical calculations from the three-pore model of the peritoneum (8,9). For example, Rippe et al. (8) predicted that a 2-kDa monodisperse polymer osmotic agent at a concentration of 4% (g/dL) and a 10-kDa monodisperse polymer osmotic agent at a concentration of 6.5% would achieve ultrafiltration (UF) equivalent to that achieved with 3.86% glucose during a 10-hour dwell, and superior UF at dwell times greater than 10 hours. In a subsequent analysis, Rippe and Levin (9) predicted that the use of a 7.5% monodisperse glucose polymer (or dextrin) osmotic agent would provide approximately twice the amount of UF provided by commercial 7.5% icodextrin-based solution. Those theoretical analyses thus suggest that other glucose polymers may be superior to icodextrin as osmotic agents for PD solutions.We hypothesized that glucose polymers with low polydispersity would be effective osmotic agents for use in PD solutions. In this report, we evaluate the effect of weight-average molecular weight on the UF characteristics of glucose polymers with low polydispersity (≤2.3) in an experimental rabbit model (10).     

腹腔镜直肠全系膜切除保肛术治疗中下段直肠癌

目的：探索腹腔镜全直肠系膜切除（TME）与低位／超低位结直肠吻合保肛门术治疗中下段直肠癌的可行性,方法与优缺点,方法：按开放手术的TME切除原则,应用双钉合技术,在腹腔镜下对12例肿瘤下缘距离肛缘3－10cm的中下段直肠癌患者实施了TME与低位／超低位结直肠吻合保肛手术。1例切除部分受侵犯的阴道后壁,1例同时行了结肠J型贮袋直肠吻合术。结果12例患者手术顺利,无中转开腹,手术时间190（160－230）min,术中出血20（10－100）ml,术后1－2d恢复胃肠功能并进食流质,下床活动,术后住院时间10（6－18）d,术中术后无并发症发生。结论：腹腔镜TME与低位／超低位结直肠吻合保肛术治疗下段直肠癌安全可行,具有创伤小,手术视野清楚,出血小,术后疼痛轻恢复快等优点。