Effects of uvulopalatopharyngoplasty in obstructive sleep apnea syndrome]

Thirty-one patients with obstructive sleep apnea syndrome underwent uvulopalatopharyngoplasty (UPPP). After three months, the average apnea/hypopnea index (AHI) decreased from 352.2 +/- 138.2 (mean +/- SD) to 182.2 +/- 140.4 episodes/hr and the duration of oxygen desaturation (less than 85%) decreased from 38.4 +/- 48.6 to 13.2 +/- 25.8 minutes. Although only 51.6% patients had a reduction of AHI greater than 50%, a questionnaire study revealed that most patients had subjective improvement of clinical symptoms and only mild complications were noted. We tried to find out the correlation between the efficacy of UPPP and the severity of obstructive sleep apnea and obese but failed. It is concluded that UPPP is the treatment of choice for obstructive sleep apnea syndrome in selective patients.     

悬雍垂软腭咽成形术治疗单纯性鼾症

[目的 ]探讨采用不同悬雍垂软腭咽成形术术式治疗单纯性鼾症的并发症和远期疗效 .[方法 ]给 13 5例临床诊断为单纯性鼾症的病人随机行Ⅰ ,Ⅱ ,Ⅲ型悬雍垂软腭咽成形术 ,观察术后疗效 ,并进行回顾性分析 .[结果 ]Ⅰ型悬雍垂软腭咽成形术的有效率为 53 6% ,Ⅱ型为 67 2 % ,Ⅲ型为 72 5% .[结论 ]术式Ⅲ型在切除部分软腭的同时进行悬雍垂成形 ,术后发生鼻咽返流症状的机率明显降低 ,远期疗效较好     

两种改良UPPP对重度OSAHS患者的疗效观察

目的 :比较不保留悬雍垂改良悬雍垂腭咽成形术 (UPPP)和保留全部或部分悬雍垂改良UPPP对无下咽阻塞的重度阻塞性睡眠呼吸暂停低通气综合征 (OSAHS)患者短期和长期的疗效。方法 :选择重度OS AHS患者 2 7例 ,采用改良UPPP为主的综合治疗 ,全部病例术后随访 6个月及 2年 ,比较其疗效。结果 :不保留悬雍垂改良UPPP组 15例 ,保留全部或部分悬雍垂改良UPPP组 12例 ,术后 6个月 ,后者总有效率为 6 6 .7% ,前者总有效率为 86 .7% ,但差异无显著性 (P >0 .0 5 )。术后 2年 ,不保留悬雍垂改良UPPP组总有效率为 73.3% ,明显高于保留全部或部分悬雍垂改良UPPP组总有效率的 33.3% ,两组总有效率差异有显著性(P <0 .0 5 )。 结论 :根据不同的阻塞部位采用不同的改良UPPP术式是取得满意疗效的关键。     

不同药物PCIA用于悬雍垂腭咽成型术后镇痛效果的比较

目的:对比悬雍垂腭咽成型术后使用布托啡诺和使用芬太尼进行PCIA的镇痛效果。方法:选择ASAⅠ～Ⅱ级,拟择期行悬雍垂腭咽成型术的患者38例,采用全身麻醉完成手术,术后随机分成布托啡诺组和芬太尼组,每组19例,两组患者术后均接自控镇痛泵,布托啡诺组患者术后持续泵入布托啡诺,芬太尼组持续泵入芬太尼。对所有患者进行连续ECG、HR、R、PETCO2、SpO2监护,记录术毕、术后6 h、12 h、24 h及48 h各时点BP、HR、VAS评分,并记录不良反应。结果:布托啡诺组与芬太尼组比较术后48 h内各时点视觉模拟评分(VAS)、HR、Bp值两组间比较,差异均无统计学意义(P>0.05)。但布托啡诺组不良反应发生率比芬太尼组显著降低(P<0.05)。结论:布托啡诺PCIA用于悬雍垂腭咽成型术后镇痛效果确切,对呼吸和循环影响小,不良反应轻,值得推广。     

Uvulopalatopharyngoplasty as a treatment for snoring

Uvulopalatopharyngoplaty was performed in 18 consecutive patients (15 men and three women; mean +/- standard deviation [SD] age, 46.3 +/- 7.5 years) who presented for the treatment of heavy habitual snoring. No attempt was made to select patients who were ideal anatomically for palatal modification. The loudness of snoring was measured during sleep by integrating the output of a calibrated microphone. An assessment before operation showed that nine patients had obstructive sleep apnoea; four patients had an apnoea index of greater than or equal to 25 apnoeas per hour. The patients were overweight and consumed, on average, 38 g of alcohol per day, but these variables did not change after the operation. The postoperative assessment was performed 138 +/- 44 days after uvulopalatopharyngoplasty. Fourteen patients showed a reduction in the loudness of their snoring, although snoring was abolished in one patient only (average snoring loudness in arbitrary units/min of sleep, 2.8 +/- 2.1 before operation compared with 1.4 +/- 1.5 units/min of sleep after the operation; P less than 0.05. The loudest snore in arbitrary units measured 7.1 +/- 3.3 units compared with 4.8 +/- 3.3 units, respectively; P less than 0.05). The percentage of the sleep time that was spent at an arterial oxygen saturation of less than 90% was reduced after uvulopalatopharyngoplasty (28% +/- 32% of total sleep time compared with 17% +/- 24% of total sleep time, respectively; P less than 0.05). There was no change in the apnoea index. The diastolic blood pressure was lower at the postoperative assessment (94 +/- 11 mmHg compared with 87 +/- 8 mmHg; P less than 0.05); six of 10 subjects whose diastolic blood pressures were greater than or equal to 95 mmHg before the operation had a diastolic blood pressure of less than 95 mmHg after uvulopalatopharyngoplasty (P less than 0.02). Computed tomographic scans showed an increase in the upper airway cross-sectional area at 3 cm and 4 cm above the hyoid bone after uvulopalatopharyngoplasty (P less than 0.05). We conclude that uvulopalatopharyngoplasty is an effective treatment for habitual, heavy snoring in many patients, but it is not the treatment of choice for patients with clinically-significant obstructive sleep apnoea.     

持续性心房颤动犬交感神经活性及β1受体表达的改变

目的 研究持续性心房颤动（房颤）对自主神经的影响。方法 快速起搏制备持续性房颤犬模型。停止起搏后待转复为窦性心律,评价其心率变异（HRV）的波动。然后测定左、右心耳,左、右心房游离壁和房间隔心肌中去甲肾上腺素的含量。同时研究心肌中神经生长因子蛋白和β1受体的表达。并与正常犬对照。结果 持续性房颤形成后,交感神经张力增高。长期房颤组（1682±362）ms^2和短期房颤组（1247±219）ms^2的低频成分（LF）高于正常对照组（798±154）ms^2（P〈0．01）。而长期房颤组（232±75）ms^2和短期房颤组（310±165）ms^2高频成分（HF）低于正常对照组（1041±195）ms^2（P〈0．01）。房颤犬正常RR间期标准差（SDNN）和HRV三角指数低于正常对照组（P〈0.01）。房颤犬心房肌交感神经递质含量增多,心房各部位的去甲肾上腺素含量均高于对照组的相应部位（P〈0．01）。而且心房不同部位的递质含量存在变异,差异有统计学意义（P〈0．01）。房颤组心房肌神经生长因子蛋白表达增多,β1受体表达下调。结论持续性房颤造成心脏交感神经张力增高,心房肌去甲肾上腺素不均一积聚。这种变化可能是通过NGF介导的。     

睡眠呼吸暂停生活质量指数问卷在悬雍垂腭咽成形术近期评估中的应用

目的：评价睡眠呼吸暂停生活质量指数(the sleep apnea quality of life index，SAQLI)问卷对悬雍垂腭咽成形术（uvulopalatopharyngoplasty， UPPP）治疗阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome, OSAHS)的意义。方法：30例诊断为OSAHS并接受UPPP治疗的患者，术前行多导睡眠描记术（polysomnography, PSG）监测和SAQLI问卷调查，分析二者的相关性；手术4周后再进行SAQLI问卷调查，对2次结果进行比较。结果：术前OSAHS患者生活质量明显下降,主观问卷指标与呼吸暂停低通气指数（apnea hypopnea index， AHI)和最低血氧饱和度（lowest saturation， LSaO₂)存在明显的相关性（P＜0.01），SAQLI总分与AHI的相关系数为0.54，与LSaO₂的相关系数为0.56。病情程度不同患者各个维度及总分得分在治疗前差异有统计学意义（P＜0.01）;术后患者SAQLI问卷各个维度及总得分均明显升高，差异有统计学意义（P＜0.001），有86.7%的患者生活质量总体上得到改善。结论：UPPP手术能明显提高OSAHS患者近期内的生活质量。 SAQLI问卷各个维度及总得分在不同病情程度患者治疗前后差异统计学意义，总得分与客观监测之间存在明显的相关关系,可用于中国成人OSAHS患者的生活质量评估，作为临床诊断和疗效观察的评价指标。     

胸腔镜胸腺扩大切除治疗重症肌无力的远期疗效分析

目的评价胸腔镜胸腺切除术治疗重症肌无力的长期效果。方法对5年来同一医院行胸腔镜胸腺切除术治疗重症肌无力的患者的资料进行回顾性研究。资料收集来自病历记录和电话随访。自2001年11月至2005年5月,连续18例重症肌无力患者接受了同一手术小组完成的胸腔镜胸腺切除术。其中男7例,女11例,年龄19～48岁,平均33.4岁±9.4岁。多数经右侧入路完成胸腔镜下胸腺切除和前纵隔脂肪组织清除术。结果术后平均闭式引流2.1d±1.2d,平均术后住院6.3d±3.1d。围术期呼吸机辅助通气占28%(5/18),其中3例为术后短时间呼吸机辅助通气(不超过72h),另2例由于胆碱能或肌无力危象导致二次气管插管。全组失访2例,无死亡。随访时间26.4个月±10.9个月。根据美国重症肌无力基金会(MGFA)制定的标准进行疗效判定,9例(50%)完全稳定缓解(CSR),6例(33.3%)部分缓解,1例稳定(5.6%)。本组总有效率为83.3%。结论胸腔镜胸腺切除治疗重症肌无力安全可靠,长期效果肯定,疗效等同于其他传统方法。     

改良悬雍垂腭咽成形术治疗阻塞性睡眠呼吸暂停低通气综合征

目的 探讨改良悬雍垂腭咽成形术治疗阻塞性睡眠呼吸暂停低通气综合征(Obstructive sleep apneahypopnea syndrome,OSAHS)的疗效.方法 回顾性分析2003-2005年OSAHS患者98例临床资料,均在插管全身静脉复合麻醉下,行改良悬雍垂腭咽成形术(UPPP).结果 术后随访0.5年～2年,治愈24例(24.5%),显效47例(48.0%),有效17例(17.3%),无效10例(10.2%),总有效率89.8%.结论 全麻下改良悬雍垂腭咽成形术治疗阻塞部位位于口咽部的OSAHS患者安全可靠,疗效肯定.     

晚期胃肠道肿瘤治疗的临床研究

目的：探索提高晚期胃肠道恶性肿瘤疗效的方法。方法：70 例随机分为两组,分别进行腹腔化疗和姑息治疗,记录观察近期疗效和毒副反应,比较生存期;采用 KaplayMeier 法估计生存函数,Logrank 检验两组生存函数的差异。结果：腹腔化疗组中位生存期和一年生存率显著高于姑息治疗组（P＜0.05）。结论：对于晚期胃肠道肿瘤患者进行腹腔内化疗,有益于提高生存质量、延长生存期。     

Combined oral and parenteral iron chelation in beta thalassaemia major

Thalassaemics in Malaysia are poorly chelated because desferrioxamine is too expensive and cumbersome for long term compliance. The efficacy and tolerability of the oral chelator deferiprone, and the effects of using a combination therapy in our patients were studied. Ten patients completed the study and the mean serum ferritin reduced from 7066.11 ug/L (2577-12,896 ug/L) to 3242.24 ug/L (955-6120 ug/L). The liver iron concentration did not show a significant drop (19.6 vs 18.2 mg/g dry weight) although 3 patients showed reductions ranging from 30-40%. Concomitant use of desferrioxamine increased the urinary excretion from a mean of 13.66 mg/day to 27.38 mg/day. Main side effects seen were nausea and rashes.     

Do we have to hyperventilate during laparoscopic surgery?

Purpose: The purpose of this study was to assess the effects of hyperventilation on patients undergoing laparoscopic surgeries on haemodynamics, partial pressure of carbon dioxide and acid base status. Methods: 60 patients undergoing laparoscopic surgeries under General Anaesthesia were randomized into two groups, "control group" ventilated with tidal volume of 10 ml/kg and respiratory rate of 12/minute and "study group" same tidal volume with respiratory rate of 15/ minute. Hemodynamic variables (heart rate and mean arterial pressure) recorded and End tidal C02, PaC02, pH and Bicarbonate estimation done before, during and after C02 pneumoperitoneum and analyzed. Results: There was no significant difference in hemodynamic variables but there was linear increase in ETC02 and PaC02 measurements in higher normal levels in control group (ETC02 33.3 +/- 3.20, 37.93 +/- 3.95 and 43.20 +/- 3.40; PaC02 30.08 +/- 2.35, 34.80 +/- 4.01 and 41.94 +/- 3.66 mmHg before, during, and after pneumoperitoneum respectively) compared to study group in which these parameters were in lower normal levels (ETC02 33.33 +/- 4.11, 28.00 +/- 4.10 and 36.73 +/- 2.49 mmHg and PaC02 31.80 +/- 2.73, 29.36 +/- 3.16 and 35.15 +/- 1.32 mmHg before, during, and after pneumoperitoneum respectively). There was highly significant difference in these parameters when intergroup comparison was done during and after pneumoperitoneum period. pH and bicarbonate levels were within normal limits but there was decreasing tendency towards acidosis side in control group. Conclusion: 10- 15% increment in Minute Volume is beneficial during C02 pneumoperitoneum to prevent adverse effects of hypercarbia and acidosis. Key words: Hyperventilation, pneumoperitoneum, end tidal carbon dioxide (ETC02), partial pressure of carbon dioxide (PaC02), Laparoscopy.     

盐酸吗啡缓释片治疗癌症疼痛的临床疗效分析

目的　探讨癌症疼痛病人接受盐酸吗啡缓释片治疗的效果及其安全性。方法　全国13个省市 2 5家医院参加此项多中心开放性临床试验 ,共 5 6 7例癌症疼痛病人接受盐酸吗啡缓释片镇痛治疗 ,平均年龄 5 7 8岁 (16～ 91岁 )。结果　镇痛疗效 :治疗前病人疼痛程度 (NRS)为 7 0± 1 8,其中重度疼痛 382例 (6 7 4 % ) ,中度疼痛 16 0例 (2 8 2 % ) ,轻度疼痛 2 5例 (4 4 % )。治疗 1、5、10、15、2 0、2 5、30d疼痛程度分别降至 4 6± 2 4 ,2 8± 1 8,2 7± 1 8,2 6± 1 7,2 5± 1 6 ,2 3± 1 4 ,2 2± 1 4。与治疗前疼痛程度比较差异有显著意义 (均P =0 0 0 0 )。治疗 30d疼痛缓解总有效率89 8%。用药剂量 :盐酸吗啡缓释片的初始、15d和 30d剂量分别为 :10～ 6 90 (6 6± 5 6 )mg/d ,10～ 80 0 (84± 6 4 )mg/d和 10～ 80 0 (92± 6 7)mg/d ;治疗 30d剂量≤ 6 0mg/d的病人占 5 5 1% ,6 1～12 0mg/d占 35 1% ,12 1～ 2 4 0mg/d占 7 6 % ,≥ 2 4 1mg/d占 2 2 %。每日实际给药 2次的病人的百分比平均值为 91 6 % (89 4 %～ 95 8% )。生活质量 :治疗前生活质量差的病人占 90 5 % ,治疗 15d和 30d生活质量差的病人分别降至 5 6 8%和 4 9 6 % ,差异有显著意义 (P =0 0 0 0 0 ;P =0 0 0 0 9)。治疗 1d     

孕激素联合化疗治疗卵巢上皮性癌

目的 分析孕激素联合以铂类为主的常规化疗对卵巢上皮性癌1～4期患者的临床疗效。方法 以已行瘤体减灭术的卵巢上皮性癌患者1～4期为研究对象，分为单纯化疗组、己酸孕酮组和普维拉组。随访、统计各组各期患者的生存率及复发率、血清激素水平、骨密度变化以及化疗副反应。结果 孕激素联合以铂类为主的化疗对早期卵巢上皮性癌的预后无明显影响，但对晚期(3期)卵巢上皮性癌的术后近期以及远期(2～5年)生存率及复发率均有改善趋势。单纯化疗组、己酸孕酮组、普维拉组3期患者术后3年生存率分别为34．8％、66．2％、73．9％，复发率分别为72．2％、47．3％、40．6％；单纯化疗组、己酸孕酮组术后5年生存率分别为17．4％、48．4％，复发率分别为81．5％、62．4％。孕激素的使用不影响患者血清激素水平，也不增加化疗的毒、副作用。联合孕激素治疗的患者术后骨密度下降较一般绝经后妇女慢。结论 孕激素联合以铂类为主的常规化疗可改善晚期卵巢上皮性癌的预后，并且不增加化疗的毒副作用，可改善患者的骨量丢失。     

悬雍垂腭咽成形术联合鼻部手术治疗OSAHS疗效分析

目的：探讨悬雍垂腭咽成形术(uvulopalatopharyngoplasty,UPPP)联合鼻部手术治疗阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome, OSAHS)的临床疗效。方法：所有患者术前均行多导睡眠呼吸监测（polysomonography,PSG）确诊,在行UPPP手术同期行鼻中隔偏曲粘膜下切除术18例,双侧下鼻甲粘膜下部分切除术20例,腺样体切除术2例。其中5例重度患者术前先在局麻下行气管切开,然后在全麻下行UPPP和鼻部手术,其中2例患者选择了气管切开后6～7d再行UPPP和鼻部手术。术后随访1～2年。结果：患者均有不同程度的症状减轻,其中症状基本消失者5例,明显减轻者14例,症状缓解者6例。无术后并发症发生,术后6～13d（平均8.3d）拔除了气管套管。结论：UPPP联合鼻中隔偏曲矫正、下鼻甲部分切除术治疗OSAHS可取得良好的手术疗效,对于重度OSAHS患者,行前置性气管切开术,能够有效预防手术并发症的发生。     

Treatment of primary hypercholesterolaemia with simvastatin. New Zealand multicentre evaluation

OBJECTIVE: To assess the efficacy of simvastatin in a large patient cohort. DESIGN: In an open multicentre study, after a four week placebo phase, patients were treated with simvastatin for 24 weeks; a subgroup continued therapy for a further 24 weeks. Efficacy of simvastatin (a) with prolonged use over three years, and (b) in combination with bezafibrate was assessed in an open single site study. SETTING: Lipid or cardiology specialist hospital outpatient clinics. PATIENTS: For the open multicentre study, 228 patients with primary hypercholesterolaemia (total cholesterol level greater than 6.5 mmol/L) were recruited, of whom 224 met entry criteria and completed the study. Forty-seven of these patients continued therapy for one year. In the open single site study, 22 patients (with low density lipoprotein [LDL] cholesterol levels greater than 4.3 mmol/L) participated in studies of long term use (n = 9) or of combined therapy (n = 13). INTERVENTION: Therapy in the open multicentre study began with 10 mg of simvastatin per day, doubling to 20 mg after six weeks and then 40 mg after 12 weeks of therapy if total cholesterol levels persisted above 5.2 mmol/L. In the study of long term use, simvastatin (40 mg daily) was taken continuously over three years. In the study of combination therapy, bezafibrate (600 mg daily) was taken in addition to simvastatin (40 mg daily) for 10 months. MAIN OUTCOME MEASURES: Plasma lipid and lipoprotein concentrations. RESULTS: In the multicentre study, total plasma cholesterol levels were reduced by 32.8% from 9.11 +/- 1.84 (in mmol/L, mean +/- SD) to 6.12 +/- 1.25 (P less than 0.001), and LDL cholesterol levels by 41.4% from 6.90 +/- 1.92 to 4.04 +/- 0.31 (P less than 0.001). The effect of therapy was sustained in those patients continuing therapy to 48 weeks. The study of long term use found no significant attenuation of effect over three years of monotherapy. Combined simvastatin/bezafibrate therapy reduced the LDL cholesterol concentration by a further 19.9% (P less than 0.001) from levels achieved on simvastatin alone. CONCLUSIONS: Simvastatin is an effective, well tolerated lipid lowering drug, without significant attenuation of effect with prolonged use. Simvastatin plus bezafibrate appears to be a potentially useful drug combination.     

Effect of metabolic syndrome on prognosis and clinical characteristics of revascularization in patients with coronary artery disease

Background People with metabolic syndrome are at higher risk for developing coronary artery disease (CAD). The effect of the metabolic syndrome on outcomes in patients with preexisting CAD has not been well studied. This study was conducted to assess the prevalence, characteristics, in hospital and long term prognosis of CAD with metabolic syndrome and to determine the factors influencing the prognosis of the disease. Methods The DESIRE registry contains data of 3696 patients with CAD between 2001 and 2004. Mean long term followup was (829±373) days. Diagnosis of metabolic syndrome was based on modified International Diabetes Federation (IDF) Worldwide Definition of the Metabolic Syndrome，using body mass index (BMI) instead of waist circumference. Results Of 2596 patients with complete records of height, weight, and so on, 1280 (49.3%) were identified with metabolic syndrome. The patients with metabolic syndrome had higher level of body mass index, systolic blood pressure, diastolic blood pressure, fasting glucose and disordered blood lipid (all P&lt;0.0001), with higher creatinine [(10.5±4.3) mg/L vs (9.9±2.9) mg/L, P&lt;0.0001] and the number of white blood cells [(7.49±2.86)×10(9)/L vs (7.19±2.62) ×10(9)/L, P=0.008) compared with those without metabolic syndrome. The patients with metabolic syndrome showed severer coronary angiographic alterations (left main artery and/or ≥2-vessel) (73.6% vs 69.6%, P=0.031). There were no significant differences of major adverse cardiac and cerebral events (MACCE) or mortality in hospital between the two groups. During followup, the ratio of MACCE in CAD with metabolic syndrome patients increased significantly (11.8% vs 10.0%, P=0.044). Fasting blood glucose (≥1000 mg/L) and triglyceride (TG, ≥1500 mg/L) were responsible for most of the increased risk associated with the metabolic syndrome (adjusted OR 1.465, 95% CI 1.037－1.874, P=0.032; OR 1.378, 95% CI 1.014－1.768, P=0.044). Conclusions The prevalence of metabolic syndrome was very high in CAD patients. The metabolic syndrome confers a higher risk of long term MACCE in patients with CAD, and dysglycaemia and hypertriglycaemia appear to be responsible for most of the associated risk.     

阻塞性睡眠呼吸暂停低通气综合征的改良术式

目的改良悬雍垂腭咽成形术方法,保留悬雍垂,对软腭和咽侧壁进行处理和成形。方法手术治疗阻塞性睡眠呼吸暂停低通气综合征患者263例。手术改良方法要点:维持咽腔正常解剖生理形态,保留悬雍垂,切除腭帆间隙脂肪组织,对软腭和咽侧壁进行成形,以充分扩大咽峡和鼻咽峡。应用多导睡眠图分析,术后随访6个月以上,对术前和术后资料进行统计学分析。结果263例患者均进入结果分析。(1)术后不需镇痛药197例(74.9%),需要镇痛药66例(25.1%),咽侧壁光滑168例(63.9%),部分裂开95例(36.1%),术后均无憋气及鼻腔返流等并发症;(2)均随访6个月以上,无吞咽返呛、开放性鼻音等并发症。95例(36.1%)有咽部异物感,189例(71.9%)睡眠呼吸暂停症状消失,74例(28.1%)仍有症状,但均较术前改善。术后口腔形态满意252例(95.8%),不满意11例(4.2%);(3)术前与术后多导睡眠监测结果各项指标比较,差异均有统计学意义(P均<0.05)。结论改良悬雍垂腭咽成形术可充分扩大咽腔空间,避免并发症,提高手术疗效。     

Ⅰ型精神分裂症远期疗效随访研究

氯氮平组治疗Ⅰ型精神分裂症患者４０例，氯丙嗪组３６例，对疗效和副作用进行远期随访对照研究。结果：氯氮平对Ⅰ型精神分裂症的临床疗效优于氯丙嗪（Ｐ＜０．０５），复发率明显小于氯丙嗪，副反应各具特征。提示：氯氮平对Ⅰ型精神分裂症长期维持治疗安全有效。