下肢静脉性溃疡的微创治疗

目的 研究和评价静脉腔内激光联合腔镜深筋膜下结扎交通静脉(SEPS)治疗下肢静脉性溃疡的临床疗效。方法 10例下肢静脉性溃疡患者共10条患肢行静脉腔内激光联合SEPS术,对深静脉瓣膜功能不全伴Ⅲ。返流的4条肢体联合行股浅静脉瓣膜外修复成形术。结果 10条患肢溃疡在10~60d内愈合,所有病人随访6月以上未发现局部溃疡复发。结论 静脉腔内激光联合SEPS术可以微创、有效地治疗下肢静脉性溃疡,联合股浅静脉瓣膜外修复成形术可以减少下肢静脉性溃疡的复发。     

下肢静脉性溃疡的微创治疗

目的研究和评价静脉腔内激光联合腔镜深筋膜下结扎交通静脉（SEPS）治疗下肢静脉性溃疡的临床疗效.方法10例下肢静脉性溃疡患者共10条患肢行静脉腔内激光联合SEPS术,对深静脉瓣膜功能不全伴Ⅲ.返流的4条肢体联合行股浅静脉瓣膜外修复成形术.结果10条患肢溃疡在10～60 d内愈合,所有病人随访6月以上未发现局部溃疡复发.结论静脉腔内激光联合SEPS术可以微创、有效地治疗下肢静脉性溃疡,联合股浅静脉瓣膜外修复成形术可以减少下肢静脉性溃疡的复发.     

腔镜深筋膜下交通支离断治疗下肢静脉性溃疡

目的探讨腔镜深筋膜下交通静脉离断术（SEPS）治疗下肢静脉性溃疡的优点、疗效和临床意义。方法 2008年1月-2010年1月,12例下肢静脉性溃疡患者（16条患肢,按CEAP临床分级均为C6）实施SEPS加大隐静脉高位结扎并抽剥术（12条患肢伴有下肢大隐静脉曲张行高扎＋抽剥术,4条患肢入院前已行大隐静脉抽剥术）,低分子肝素钙抗凝2～3 d。结果 16条患肢经手术治疗后肢体症状及浅静脉曲张消失,溃疡愈合,未出现并发症,随访2～12个月,未出现新生溃疡及浅静脉曲张复发。结论腔镜深筋膜下交通静脉离断术是治疗下肢静脉性溃疡的重要环节,治疗下肢静脉性溃疡安全有效,损伤少,并发症少,可减少下肢静脉性溃疡的复发,改善皮肤营养障碍。     

微创刨吸术治疗下肢静脉曲张初步研究

目的探讨微创刨吸术治疗下肢静脉曲张的初步疗效.方法对2003年6～9月40例(53条肢体)下肢静脉曲张病人进行手术治疗.53条患肢均存在浅静脉曲张,16条患肢同时伴交通支静脉功能不全,10条患肢同时伴慢性静脉性溃疡,5条患肢同时伴重度深静脉返流.根据病情需要分别或同时行内镜深筋膜下交通支静脉结扎、大隐静脉高位结扎和剥脱飞股浅静脉瓣膜外修复成形术和下肢曲张浅静脉微创刨吸术.结果术后53条患肢肢体症状和浅静脉曲张消失,10条患慢性静脉性溃疡肢体短期内愈合.术后短期随访,无新生的渍疡,无静脉曲张复发,小腿外观无明显手术疤痕.结论微创刨吸术治疗下肢静脉曲张安全有效,损伤少,并发症少,达到了微创和显效的目的,可能是治疗下肢慢性静脉功能不全的重要组成部分.     

大隐静脉电凝术结合高压氧治疗下肢静脉性溃疡

目的:探索电凝术结合高压氧治疗下肢静脉性溃疡的方法。方法:将患有下肢静脉性溃疡32例(34条患肢),随机分为实验组16例(18条患肢)和对照组16例(16条患肢),实验组采用大隐静脉高位结扎电凝术结合高压氧治疗,先行大隐静脉高位结扎电凝术,术后第1天开始高压氧治疗,1次/d,治疗7 d～21 d。对照组16例(16条患肢)行大隐静脉高位结扎电凝术,8例患肢深静脉返流(按Kistner分类法)为Ⅲ～Ⅳ级,加做戴戒术。结果:实验组溃疡愈合时间7 d～21 d,平均(14±3.9)d;对照组溃疡愈合时间18 d～66 d,平均(31±5.8)d,两组溃疡愈合时间具有高度显著性差异(P<0.01)。实验组随访6个月～40个月,溃疡无复发。结论:大隐静脉电凝术结合高压氧治疗下肢静脉性溃疡可以促进溃疡愈合,缩短溃疡愈合时间,且溃疡不易复发。     

内镜筋膜下交通静脉结扎术治疗静脉性溃疡

目的:探讨内镜筋膜下交通静脉结扎术(SEPS)对慢性下肢静脉性溃疡的疗效和安全性.方法:对12例(13条肢体)慢性下肢静脉性溃疡患者的临床资料进行回顾性分析.13条肢体中,7条为已愈合溃疡(C5),6条为活动性溃疡(C6),均行大隐静脉高位结扎 抽剥术 内镜筋膜下交通静脉结扎术.结果:①所有患者随访2～12个月,6例活动性溃疡术后全部愈合,随访期内.所有患者溃疡无复发.②术后并发症:1例小腿筋膜下血肿、1例切口延迟愈合.结论:内镜筋膜下交通静脉结扎术治疗慢性下肢静脉性溃疡是安全、可行的;与大隐静脉高位结扎加剥脱术联合应用可有效地提高慢性下肢静脉性溃疡的疗效.     

腔镜下静脉交通支离断术治疗下肢静脉交通支瓣膜功能不全(附17例分析)

目的:探讨腔镜下静脉交通支离断术(SEPS)治疗下肢静脉交通支瓣膜功能不全的可行性。方法:2007年4月-2008年12月,经静脉造影诊断下肢静脉交通支瓣膜功能不全患肢17条,行SEPS术在深筋膜下断离病变交通支,联合Muller术抽剥浅表静脉以及行传统大隐静脉高位结扎+抽剥术。结果:17条患肢术后创口生长良好,无感染及出血,术后所有患肢曲张静脉团消失,局部疼痛缓解,7条患肢内踝沉着色素减轻,5条患肢溃疡在2~4周内完全愈合,无溃疡复发及新溃疡形成,术后无组织水肿。结论:腔镜下静脉交通支离断术(SEPS)治疗下肢静脉交通支瓣膜功能不全、下肢静脉溃疡具有创伤小、手术彻底、患者住院时间短的优点。     

SEPS联合曲张静脉剥脱、同期植皮治疗慢性下肢静脉性溃疡

目的：探讨腔镜深筋膜下交通支静脉离断术（subfascial endoscopic perforator vein surgery,SEPS）联合曲张静脉剥脱、同期自体植皮治疗下肢静脉性溃疡的效果。方法：对24例患者共27条静脉性溃疡的肢体,施行SEPS、曲张静脉剥脱加自体植皮术。随访3～18个月（平均12.4个月）。结果：术后肢体症状改善,溃疡植皮成功,随访期间共2条（占7.4%）肢体溃疡复发;无静脉曲张复发;无腔镜戳孔感染,2例浅静脉剥脱切口感染。结论：SEPS联合曲张静脉剥脱、同期植皮是治疗下肢静脉性溃疡的有效方法。     

下肢静脉性溃疡的微创治疗

目的 探讨下肢静脉性溃疡外科微创治疗的临床效果.方法 对40例(48侧患肢)下肢静脉性溃疡患者通过静脉造影检查明确引起溃疡的原发病变,根据患肢血流动力学异常的种类和程度对24例(28侧患肢)行大隐静脉高位结扎+静脉腔内激光治疗(EVLT)+交通静脉离断术(SEPS);16例(20侧患肢)行大隐静脉高位结扎+EVLT.溃疡一律行周缘环行缝扎.结果 术后48侧患肢浅静脉曲张均消失,色素沉着、湿疹样病变均明显减轻;44侧小腿酸胀沉重感、疼痛、水肿12～18 d消失;所有患者溃疡均在14～40 d内愈合.随访4～24个月,平均18.6个月,4侧(8.3%)患肢溃疡复发.结论 纠正浅静脉、交通支静脉和重视溃疡创面的处理是治疗下肢静脉性溃疡的有效疗法,EVLT和SEPS术操作简便、微创、安全.     

大隐静脉高位结扎和剥脱术后浅静脉曲张复发24例分析

大隐静脉高位结扎和剥脱术的手术疗效：在文献报道中各家的意见尚不一致，术后浅静脉曲张复发率最低者在10％以下，最高可达40％至50％。我院2001年3月至2003年3月对24例大隐静脉高位结扎和剥脱术后浅静脉曲张复发；共计28条患肢进行下肢深静脉顺行造影术，对其复发病因加以分析，现将分析结果报告如下：     

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.