胸膜疾病临床诊断及治疗分析

目的探讨胸膜疾病临床诊断及治疗方法。方法选取2005年12月—2011年12月该院收治的结核性胸膜炎患者100例,随机分为两组,两组患者均进行常规检查,甲组患者50例,联合CT进行诊断,单纯采用常规性药物治疗;乙组患者50例,联合MRI进行诊断,采用常规性药物治疗联合中医方剂进行治疗,对其诊断及治疗方法进行统计和分析。结果甲组患者采用CT进行诊断,明确诊断患者50例,准确诊断率为100%,对比乙组患者的准确诊断MRI例,准确诊断率为100%,差异无统计学意义（P〉0.05）。所有患者经过组织病理学检查证实均为准确诊断;乙组患者的临床治疗效果对显著优越于甲组患者的临床治疗效果,差异有统计学意义（P〈0.05）。结论采用常规性检查联合CT或是MRI,均能进行有效的诊断,准确率高,采用常规性药物治疗联合中医方剂药物口服,能获得良好的临床治疗效果,适宜临床上广泛应用和开展。     

纤维支气管镜诊断胸膜疾病的临床应用

近年来纤维支气管镜(纤支镜)在诊断胸膜疾病中的应用日益广泛。本文报告1995年来对31例胸膜疾病患者纤支镜检查的结果。1　对象和方法1.1　对象　31例均系住院患者,其中男19例,女12例,年龄36～68岁,平均53岁。3例为单侧难治性气胸。28例为中等到大量胸腔积液,其中左侧病变13例,     

B超诊断胸膜疾病分析

Ｂ超诊断胸膜疾病分析陈桂清，张淑莲，常芬（青岛市立医院，２６６０１１青岛市第二人民医院青岛市第五人民医院）关键词Ｂ型超声；胸膜疾病；胸膜肥厚；胸腔积液１资料与方法总结近２年中１１０例病人，均为住院治疗、手术切除、Ｘ线诊断、病理证实的病人。其中男７４例...     

结缔组织疾病的胸膜表现

<正> 结缔组织疾病(Connective Tissue Disease,CTD)是一组可累及全身多个器官系统的疾病,由于肺和胸膜含有丰富的结缔组织和血管,因而常是CTD的主要靶器官之一.本文仅就CTD的胸膜表现综述如下.1 系统性红斑狼疮(Systemic Lupus Erythemato-sus,SLE)浆膜炎是SLE常见和典型的临床征象.因而胸膜炎是SLE最常见的临床表现.据报道约50～70%的SLE患者在其病程过程中出现胸膜受累、胸腔积液或胸膜炎性疼痛.Vladutiu曾复习文献,SLE有胸膜腔渗出发生率为16～74%不等.其中尸检2/3的患者胸膜累及的类型是粘连、增厚或胸腔积液.X线     

NCCN止吐临床指引(2005.1版)

1 目录 NCCN止吐专家组成员(附后) 肿瘤患者的止吐原则(AE-1) 化疗方面: 具有高度催吐反应的化疗-预防呕吐(AE-2) 具有中度催吐反应的化疗-预防呕吐(AE-3) 具有轻度和轻微催吐反应的化疗-预防呕吐(AE-4) 化疗引起的恶心呕吐的解救性治疗(AE-5) 化疗药的催吐潜能(AE-6) 持续多天化疗的止吐原则(AE-A) 治疗恶心呕吐的新药(AE-B) 解救性止吐治疗原则(AE-C)     

胸膜间皮瘤17例临床分析

胸膜间皮瘤少见,容易误诊。我院1970～1989年9月收治确诊的17例,现就其临床特点和诊断过程进行分析。临床资料一、一般情况:17例中男7例,女10例。年龄,20岁1例,40—60岁5例,61岁以上11例。职业,农民13例,工人2例,渔 民1例,教师1例。17例均无石锦接触史。二、症状体征:主要症状为胸痛15例(88.2％),咳嗽12例(70.5％),气促11例(64.7％)消瘦7例(41.2％),发热7     

NCCN结肠癌临床指引(2005.4版)

1目录临床表现和主要治疗方法:!有蒂息肉伴侵袭性肿瘤(COL-1)!无蒂腺瘤性息肉伴侵袭性肿瘤或绒毛状腺瘤伴侵袭性肿瘤或绒毛腺体腺瘤伴侵袭性肿瘤(COL-1)!适合切除的结肠癌(COL-2)!怀疑或确诊的转移性大肠腺癌(COL-5)病理分期、辅助治疗及监测(COL-3)复发和检查(COL-9)手术治疗的原则(COL-A)进展或转移的化学治疗(COL-B)Ⅱ期结肠癌危险性评估的原则(COL-C)辅助治疗的原则(COL-D)放射治疗的原则(COL-E)马冬.NCCN结肠癌临床指引(2005.4版)a所有结肠癌患者要询问家族史,患者怀疑有遗传性非息肉性结肠癌、家族性腺瘤性息肉和已…     

NCCN乳腺癌临床指引(2005.1版)

1目录非浸润性乳腺癌:!小叶原位癌LCIS(LCIS-1)!导管原位癌DCIS(DCIS-1)浸润性乳腺癌:!临床分期、检查(BINV-1)!临床Ⅰ、ⅡA或ⅡB期或T3,N1,M0的局部治疗(BINV-2)!系统辅助治疗(BINV-4)!术前化疗指引!复发或Ⅳ期浸润性乳腺癌(BINV-12)!外科腋窝分期(BINV-A)!腋窝清扫(BINV-B)!浸润性乳腺癌切缘(BINV-C)!需要放疗的保乳治疗的禁忌证(BINV-D)!辅助内分泌治疗(BINV-E)!辅助化疗(BINV-F)!绝经的定义(BINV-G)!转移性乳腺癌的二线内分泌治疗(BINV-H)!复发或转移性乳腺癌推荐化疗方案(BINV-I)2美国肿瘤联合委员会…     

内科胸腔镜在胸膜疾病中的临床应用价值分析

目的分析探讨内科胸腔镜在胸膜疾病中的临床应用价值。方法筛选2013年1月至2014年1月于我院就诊的胸腔积液、自发性气胸患者76例,作为研究对象。对所有患者采用内科胸腔镜下取病理活检并进行诊断,与临床常规影像学及病理学等检查手段确诊结果进行比较分析,判断内科胸腔镜在胸膜疾病检查中的临床应用价值。结果胸腔镜检查确诊胸膜疾病例数70（92.11%,70/76）,其中结核性胸膜炎51例（94.44%,51/54）,小细胞癌1例（100%,1/1）,肺腺癌9例（81.82%,9/11）,肺鳞癌4例（80.00%,4/5）,胸膜间皮瘤5例（100%,5/5）,与临床证实结果比较无显著差异（P＆gt；0.05）。结论应用内科胸腔镜检查并诊断胸膜疾病具有准确率、有效评估病情并且检查较为安全,腔镜并发症发生率较低的优势,存在临床应用及推广价值。     

国际肺癌研究协会/美国胸科学会/欧洲呼吸学会肺腺癌的国际多学科分类

前言:腺癌是肺癌中最常见的组织学类型.为应对肺腺癌在肿瘤学、分子生物学、病理学、放射学及外科手术的进展,国际肺癌研究协会(International Association for the Study of Lung Cancer,IASLC)、美国胸科学会(American Thoracic Society,ATS)...     

《2018 ESC妊娠期心血管疾病管理指南》解读

妊娠期心血管疾病严重危害孕产妇健康,是导致孕产妇死亡的重要原因之一。自2011年欧洲心脏病学会（ESC）发布《妊娠期心血管疾病的管理指南》以来,又出现了很多新的证据,尤其是诊断技术、风险评估以及心血管药物使用方面。因此ESC修订了该指南,并于2018年8月发表,即《2018 ESC妊娠期心血管疾病管理指南》,对妊娠期心血管疾病的妊娠前咨询、风险评估、妊娠期管理及诊治、妊娠期药物使用等方面进行了详细阐述,更加强调风险评估。我国尚缺乏相应的临床指南,但合并有心血管疾病的妊娠患者越来越多,本文就该指南的主要更新要点进行解读,旨在为我国妊娠期心血管疾病临床诊疗提供参考。     

Appraisal of the Quality and Contents of Clinical Practice Guidelines for Hypertension Management in Chinese Medicine: A Systematic Review

Objective: To evaluate the quality and consistency of recommendations in the clinical practice guidelines(CPGs) for hypertension in Chinese medicine(CM). Methods: CM CPGs were identified from 5 electronic databases and hand searches through related handbooks published from January 1990 to December 2013. Three reviewers independently appraised the CPGs based on the Appraisal of Guidelines for Research and Evaluation(AGREE Ⅱ) instrument, and compared the CPGs' recommendations on CM syndrome pattern classification and treatment. Results: Five CM CPGs for hypertension were included. The quality score of the evidence-based(EB) guideline was higher than those of the consensus-based with no explicit consideration of evidence-based(CB-EB) and the consensus-based(CB) guidelines. Three out of five patterns in the CPGs were recommended by the EB guideline. Tianma Gouteng Formula(天麻钩藤复方) in the EB guideline was recommended mostly for hypertension patients with pattern of ascendant hyperactivity of Gan(Liver)-yang and pattern of yin deficiency with yang hyperactivity in the CPGs. Acupuncture and massage were recommended for Grade Ⅰ and Grade Ⅱ hypertension with severe symptoms weakening the quality of life in the EB guideline. For Grade Ⅰ and Grade Ⅱ hypertension, CM could be used alone, while for Grade Ⅲ hypertension, they should be used in combination with Western medicines. Conclusion: The quality of EB guideline was higher than those of CB and CB-EB CPGs in CM for hypertension and CM should be prescribed alone or combined with Western medicines based on the grade of hypertension.     

Appraisal of Clinical Practice Guidelines for Ischemic Stroke Management in Chinese Medicine with Appraisal of Guidelines for Research and Evaluation Instrument: A Systematic Review

Objective: To systematically review the clinical practice guidelines (CPGs) for ischemic stroke in Chinese medicine (CM) with the Appraisal of Guidelines for Research and Evaluation (AGREE Ⅱ) instrument. Methods: CM CPGs for ischemic stroke were searched in 5 online databases and hand-searches in CPG-related handbooks published from January 1990 to December 2012. The CPGs were categorized into evidence based (EB) guideline, consensus based with no explicit consideration of evidence based (CB-EB) guideline and consensus based (CB) guideline according to the development method. Three reviewers independently appraised the CPGs based on AGREE Ⅱ instrument, and compared the CPGs'' recommendations on CM pattern classification and treatment. Results: Five CM CPGs for ischemic stroke were identified and included. Among them, one CPG was EB guideline, two were CB guidelines and two were CB-EB guidelines. The quality score of the EB guideline was higher than those of the CB-EB and CB guidelines. Five CM patterns in the CPGs were recommended in the EB CPG. The comprehensive protocol of integrative Chinese and Western medicine recommended in the EB CPG was mostly recommended for ischemic stroke in the CPGs. The recommendations varied based on the CM patterns. Conclusion: The quality of EB CPG was higher than those of CB and CB-EB CPGs in CM for ischemic stroke and integrative approaches were included in CPGs as major interventions.     

胸腔内注射阿霉素并闭式引流治疗恶性胸水

目的 探讨胸腔内注射阿霉素并闭式引流对肺癌恶性胸水的疗效.方法 41例恶性胸水患者采用胸腔置管闭式引流并经胸管胸腔内注入阿霉素,观察近期疗效.结果 全组均为单次胸腔插管注药,其中CR 26例、PR12例、NC 3例,总有效率92.7%.结论 采用胸腔内注射阿霉素并闭式引流能够有效控制胸水生长,改善症状并提高患者的生活质量.     

Guidelines for the Diagnosis and Management of Herb-Induced Liver Injury

Herb-induced liver injury(HILI) is a type of adverse drug reactions related to using Chinese medicine(CM) or herbal medicine(HM), and is now a growing segment of drug-induced liver injury(DILI) worldwide. Owing to the complicated compositions and miscellaneous risk factors associated with the clinical usage of CM or HM, it is more challenging to diagnose and manage HILI than DILI. In the present guideline issued by the China Association of Chinese Medicine(CACM), the authors present an evidence chain-based workflow with 9 structured judgment criteria for diagnosing HILI. The 3 diagnostic ending points—suspected diagnosis, clinical diagnosis, and confirmed diagnosis—could be reached according to the length of the evidence chain acquired in the structured diagnostic workflow. Either identifying the species of CM or HM or excluding adulterations and toxin contaminants was strongly recommended to improve the level of evidence for a clinical diagnosis of HILI. In addition, the authors report that the improper use of CM, which violates the general law of CM theory, is one of the most important factors that contributes to HILI and should be avoided. By contrast, based on syndrome differentiation, some CM can also be used to treat HILI if used in accordance with the general law of CM theory. Therefore, 9 recommendations are put forward in this guideline.     

中心静脉导管行胸腔闭式引流在结核性胸腔积液中的应用观察

目的探讨中心静脉导管行胸腔闭式引流在结核性胸腔积液中的应用效果。方法选择东方市第二人民医院2009年2月至2011年2月结核性胸腔积液患者80例,患者被随机分为观察组和对照组。观察组采用中心静脉导管行胸腔闭式引流,对照组采用胸腔穿刺抽液。记录两组患者退热、胸闷气促缓解时间;记录两组患者胸腔积液吸收时间。结果观察组退热、胸闷气促缓解、胸腔积液吸收时间分别与对照组比较,差异有统计学意义(P<0.05);观察组总有效率为97.5%,对照组总有效率为77.5%,观察组疗效显著高于对照组,差异有统计学意义(P<0.05)。结论中心静脉导管行胸腔闭式引流能够缩短退热、胸闷气促等临床症状缓解时间,促进胸腔积液吸收,临床效果显著,值得借鉴。     

软式内镜外科技术在胸部疾病中的临床应用

目的 探讨软式内镜外科技术在胸部疾病中的临床应用价值. 方法 回顾性分析78例行软式内镜手术的患者临床资料,其中手汗症35例（均行超细胃镜下经脐胸交感神经切断术）,食管疾病43例[26例行内镜黏膜切除术（EMR）,9例行内镜黏膜下剥离术（ESD）,4例行内镜经黏膜下隧道肿瘤切除术（STER）,4例行内镜下食管括约肌切开术（POEM）],随访观察治疗效果及安全性. 结果 78例患者均顺利完成软式内镜下胸部疾病手术,术后所有患者恢复良好,未见明显出血、穿孔等并发症.随访1年,所有食管黏膜下隆起性病变均未见病变残留或复发;所有贲门失弛缓症患者吞咽梗阻感消失,可正常进食;所有手汗症患者,手部多汗症状明显改善.结论 软式内镜外科技术对胸部疾病有较好的治疗效果,且安全、有效、微创.     

肿瘤相关性高血糖管理指南（2021年版）解读

糖尿病是我国患病率最高的慢性代谢性疾病,恶性肿瘤发病率也逐年上升。研究发现,这2种疾病关系密切。临床上恶性肿瘤防治过程中相关的高血糖管理问题缺乏系统化、规范化指导。因此,在中国抗癌协会肿瘤内分泌专业委员会和重庆市中西医结合学会肿瘤内分泌分会的支持下,国内多位肿瘤学和内分泌学专家以循证医学为证据,起草了肿瘤相关性高血糖的管理指南（2021年版）,对肿瘤相关性高血糖的概念、临床诊治和随访等问题进行系统详尽的介绍。本文针对该指南部分内容进行解读。