腰椎间盘突出症围手术期的护理

腰椎间盘突出症围手术期的护理郝建军我院自１９８９年４月～１９９５年１０月间对５２例腰椎间盘突出症围手术期的护理体会报告如下。１临床资料本组共５２例，男４２例，女１０例，平均年龄４１岁。发病至手术时间为４个月～３年。平均１８个月。所有患者均有１侧或双侧...     

肌电图检测在腰椎间盘突出症手术前后的应用

腰椎间盘突出症手术的目的是解除突出的腰椎间盘对脊神经根的压迫,而肌电图检测可了解脊神经根受压程度的变化。我们对34例临床确诊为腰间盘突出症的患者进行了手术前后肌电图检查,现将结果报道如下。 临床资料 1.一般资料:有腰痛伴一侧或双侧下肢放射痛且确诊为腰椎间盘突出症需手术治疗的患者34例,其中男21例,女13例;年龄22～65岁,平均41.5岁。病程6个月以内3例,6个月～2年以内14例,2～5年7例,5年以上10例。全部患者于术前及术后21d～3个月内进行肌电图检查。检查部位及参数均相同。     

腰椎间盘突出症128例术后护理体会

腰椎间盘突出症是骨科常见疾病[1] 。近 2年来我科共手术治疗本病 12 8例 ,现将护理体会报告如下。临床资料　　本组 12 8例 ,为 2 0 0 1年 1月至 2 0 0 3年 10月间在我院住院并行手术治疗的腰椎间盘突出症患者。其中男 81例 ,女4 7例 ,年龄 2 8～ 6 9岁 ,平均 4 1.8岁。住院时间 12～ 2 3天 ,平均 16 .2天。腰椎间盘突出部位 :腰 4～ 5共 92例 ,腰 5骶1共 2 2例 ,腰 4～ 5和腰 5骶 1均突出 12例 ,腰 3～ 4突出 2例。腰椎间盘突出合并椎管狭窄 2 2例 ,髓核破入椎管 31例。病程 2个月～ 13年 ,平均 1年 6个月。手术方式 :开窗式 6 1例 ,半椎…     

腰椎间盘突出症手术治疗体会

目的:通过对腰椎间盘突出症患者行切除术治疗后的随访观察,评价其治疗效果。方法:我院行腰椎间盘突出症手术治疗的患者80例,对80例患者进行随访,随访时间6个月～4年,平均14个月。结果:按照MacNab分级标准评定术后疗效疗效,优45例(56%),良22例(27%),可10例(12%),差3例(3%)。优良率为83%。结论:腰椎间盘突出症切除术治疗椎间盘突出症中远期效果肯定。     

腰椎间盘突出症切吸术后疗效不佳原因分析

目的 探讨经皮穿刺切吸术治疗腰椎间盘突出症的临床疗效。方法 自1993年5月～1996年11月对377例腰椎间盘突出症患者采用自动式经皮腰间盘切吸仪（APLD）治疗，随访时间10个月～3．5年（平均2．1年），按Macanb疗效标准进行评定。结果 差30例。其中21例经再次切吸手术，8例获优良疗效。另9例行手术探查。结论 经皮穿刺切吸术是治疗腰椎间盘突出症的一种有效方法，但应严格掌握手术适应症。     

老年性腰椎间盘突出症18例治疗体会

腰椎间盘突出症是骨科常见病和多发病,多见于中青年。我们将60岁以上的腰椎间盘突出症称为老年性腰椎间盘突出症,有其独特的临床特征。本院自1997～2004年共手术治疗老年性腰椎间盘突出症18例,现就临床特征及手术治疗体会,报告如下。1临床资料1.1一般资料本组18例,男性10例,女性8例。年龄60～71岁,平均年龄66岁。病程1个月～8年,平均52个月。1.2临床表现所有病例均有腰痛伴坐骨神经放射痛及间歇性跛行。静息状态时,下肢麻木15例,下肢肌肉萎缩12例,剧烈疼痛坐卧不安11例,直腿抬高试验阳性14例,第1趾背伸肌力减弱16例,下肢皮肤感觉减退17例,膝…     

腰椎间盘突出症术后复发再次手术疗效分析

目的:探讨复发性腰椎间盘突出症的再次手术治疗效果。方法:对2006年5月～2011年6月收治的复发性腰椎间盘突出症患者30例进行回顾性研究,用后路腰椎减压植骨融合内固定手术方式进行翻修手术,比较患者手术前、后的症状、体征及影像学上的变化,了解手术治疗效果及是否有手术并发症的产生。结果:30例患者均顺利完成手术,患者随访3个月～3年半,平均随访时间为1.5年,26例患者症状体征完全消失,基本恢复正常。2例随访时间不长,仍诉患侧肢体麻木、乏力;另2例因压迫时间长,术后恢复缓慢。结论:临床上需严格掌握复发性腰椎间盘突出症的手术指征,对于手术适应证明确的患者,后路腰椎减压植骨融合内固定手术有效。     

腰椎间盘突出症再手术治疗

目的探讨腰椎间盘突出症术后再次手术治疗的原因、方法和疗效.方法我院自1995年1月～2004年1月共手术治疗腰椎间盘突出症928例,再次手术者43例(4.6%).40例获得随访,平均随访时间30个月(3～84个月).按Macnab评分法进行术后疗效评定.结果优:11例(27.5%)、良:16例(40%)、可:8例(20%)、差:5例(12.5%).结论腰椎间盘突出症再次手术的主要原因为间盘组织摘除不彻底,同一间隙间盘组织再突出、继发性椎管狭窄以及神经根粘连等;腰椎间盘突出症初次手术前严格把握手术指征,正确选择手术术式,提高手术操作技术水平,将有效减少腰椎间盘突出症的再次手术治疗;对需要再次手术的患者仍可以获得较为满意的疗效.     

腰椎间盘突出症再次手术9例的经验与教训

腰椎间盘突出症手术有一定的并发症和再手术率 ,现根据本组资料 ,分析再次手术发生的原因、预防措施及相关问题。1　临床资料1.1　一般资料　腰椎间盘突出症再次手术患者 9例 ,男 4例 ,女 5例 ,年龄 31～ 52岁 ,两次手术相距时间最短 2周 ,最长 5ａ ,平均 17个月。1.2　再次手术原因1.2 .1　误伤神经根　本组 2例 ,1例在外院行腰椎间盘突出症手术后立即出现患肢足下垂、感觉减退 ,再次手术未找到神经根 ,追问原手术情况 :见神经瘤样变 ,行手术切除 ,病理切片为正常神经节。另 1例术前患肢已下垂 ,行走困难 ,系外院转来 ,3个月后 ,再次手术未…     

高位腰椎间盘突出症12例报告

1983～1989年我院施行的400余例椎间盘手术中,有12例腰3～4以上腰椎间盘突出,现报道如下。 1.高位腰椎间盘突出症的临床特点和诊断 除与一般腰椎间盘突出症相同之外,还有以下特点:(1)大腿前区疼痛8例;(2)股四头肌明显萎缩6例:(3)突发性瘫痪,有2例病人在推拿治疗后发生不全性瘫痪;(4)病人膝反射减弱10例;(5)双大腿外侧皮肤感觉减退9例,     

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.