癌症病人直肠给药止痛观察

缓解癌症病人的疼痛是现代医学的重要课题,为探讨进食困难、顽固性恶心、呕吐伴有癌性疼痛病人的治疗,通过对20例晚期癌症病人应用消炎痛栓、曲马多缓释胶囊、美施康定等药物采用直肠给药进行止痛观察,发现用药时间、剂量不变,病人能取得与其它用药方法同样的治疗效果,而且无明显局部副作用,因此,直肠给药对其他方法给药有困难的癌症患者是一个安全有效的止痛方法。     

PCA泵自控镇痛治疗晚期癌症患者的临床护理观察

目的:使用PCA泵自控镇痛,晚期癌症重度疼痛的病人可以自行决定给药的时机和剂量,有效维持血药浓度,从而提供较满意的止痛效果.使患者最终能尽可能舒适、无痛苦地走完人生的最后一阶段.方法:对21例晚期癌症3级疼痛病人全部在静脉下采用PCA泵持续自控镇痛.结果:与一般的三级阶梯止痛相比,使用PCA泵持续自控镇痛,病人疼痛全部得到有效的缓解,比同时间内使用麻醉药及有成瘾性的止痛药剂量要小.结论:对于晚期癌症病人的疼痛处理,可以静脉使用PCA泵持续自控镇痛,护理人员从各方面给予支持、关心病人,无痛苦并教会病人使用自控装置,使晚期癌症患者安详地离开人间.     

40例晚期癌症病人PCA镇痛皮下给药的临床观察

目的观察晚期癌症病人自控镇痛(PCA)皮下给药的临床效果。方法选择晚期癌痛病人40例,采用PCA皮下连续输注芬太尼+氟哌啶醇混合液+PCA间断给药,观察镇痛效果、睡眠质量、镇痛前后并发症以及镇痛前后生活自理能力改善等情况。结果PCA皮下给药有效镇痛率97.5%,并发症较少,病人睡眠和生活质量明显改善。结论PCA皮下给药可持续有效控制晚期癌症病人疼痛,提高患者的生存质量。     

颈外静脉留置针在临终病人中的应用体会

目的 :探讨颈外静脉留置在临终病人中应用的效果。方法 :将 92例病人随机分成观察组 (颈外静脉留置针 )和对照组 (外周静脉留置针 )。结果 :颈外静脉留置针在对临终病人的应用中可以保留较长的时间 ,减轻了反复静脉穿刺给病人带来的痛苦 ,提高了护理质量。结论 :颈外静脉留置针的使用效果明显优于对照组 (P<0 .0 5 )     

颈外静脉留置针在呼吸内科危重病人抢救中的应用及护理

目的：探讨颈外静脉留置针在呼吸内科危重病人抢救中应用的效果评价。方法：对52例呼吸科危重病人应用颈外静脉留置针进行观察。结果：颈外静脉留置针在抢救危重病人中,快速静脉给药,静脉穿刺时间及成功率明显优于周围静脉穿刺及其它深静脉置管。结论：颈外静脉留置针在呼吸科危重病人抢救中应用效果满意,值得推广。     

三级阶梯治疗癌痛的疗效观察(附60例报告)

癌症病人中,约40％病例有剧烈疼痛。有效的止痛治疗,尤其是解除晚期癌症病人的痛苦是世界卫生组织癌症综合治疗规划中四项重点之一。正确应用止痛药物(正确的药物、剂量、间隔)可使90％以上病人疼痛得以缓解。作者采用三级阶梯疗法止痛,定时定量联合交替给止痛药,与传统给药方法(非定时定量按需单一给药)进行了比较,现报告如下。     

硬脊膜外腔注射丝裂霉素对椎管内转移癌止痛的探讨

对恶性肿瘤晚期病人的止痛,自1979年Wang氏和Behar氏提出吗啡注入椎管内止痛获得成功之后,硬膜外腔注射小剂量阿片类和局麻药止痛已较多的用于临床。为了探讨恶性肿瘤骨转移病人硬膜外止痛问题,我们采用了丝裂霉素硬膜外腔注射对恶性肿瘤晚期椎管内转移病人的止痛,此方法国内外尚未见有报道。我科自建立疼痛病房共收治14例晚期癌症病人,其中3例为椎管内转移癌病人,用硬膜外腔留置导管,注射丝裂霉素止痛和1例肝癌晚期;右侧坐骨转移癌瘤内留置导管,注射丝裂霉素止痛均获得满意效果,现报告如下:     

静脉留置针在围手术期患者中的临床护理

目的总结静脉留置针进行输液给药的方法和护理体会。方法回顾性分析外科围手术期使用静脉留置针186例患者的临床护理资料。结果临床使用留置针可有效保证药物有效输入,治疗效果满意。结论在静脉给药中正确使用静脉留置针,充分发挥其优点,能降低对患者浅表静脉的损伤,便于抢救和快速给药,使患者舒畅的接受输液治疗,提高医护患满意度和医疗质量,减少医患不安全因素的发生。     

应用三阶梯止痛治疗晚期癌症53例疗效观察

目的：观察三阶梯止痛对晚期癌症病人的止痛效果。方法：应用世界卫生组织推荐的三阶梯止痛法,即第一阶梯给非激素消炎镇痛药,第二阶梯给弱阿片类止痛药,第三阶梯给强阿片类止痛药。结果：本组53例有效率94．3％,其中：CR43例,占81．1％;PR6例,占11.3%;NR3例,占5．7％,结论：三阶梯止痛法为晚期癌症病人解除疼痛,提高生活质量提供了有效的手段。     

盐酸吗啡控释片镇痛效果临床分析

癌症疼痛给恶性肿瘤病人带来很多痛苦，严重影响肿瘤病人的生存质量，世界卫生组织关于缓解癌症疼痛的病人的三阶梯治疗，以期达到缓解疼痛，提高癌症病人的生存质量，三阶梯止痛法最重要的内容之一是对晚期重度疼痛的癌症患者“按时”（3—6h）给药，而不是“按需”（只在疼痛时）给药，按量（止痛剂量直至病人疼痛消失）给药，而不是“定量”给药。[第一段]     

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.