穴位注射配合手法治疗颈椎病195例临床观察

从 198 5年 4月至 1998年 9月 ,对 195例颈椎病人采取穴位注射当归、维生素Ｂ12 配合手法治疗 ,取得较好的疗效。1　临床资料本组男 73例 ,女 12 2例 ;年龄 40～ 6 5岁 ,平均 5 2 5岁 ;病程 6～ 180个月 ,平均 42个月 ;神经根型 117例 ,椎动脉型2 5例 ,交感型 18例 ,脊髓型 2例 ,混合型 33例 ;Ｘ线表现钩椎关节增生者 87例 ,钩椎关节不对称者 31例 ,颈曲变直 75例 ,颈曲反张 15例 ,颈曲成角 7例 ,颈椎体增生 176例 ,椎间隙变窄 37例 ,颈椎韧带钙化或骨化 2 5例。2　治疗方法当归注射液 6ｍｌ,维生素Ｂ12 0 5ｍｇ ,氟美松 5ｍｇ(氟美松只在…     

颈前路多椎节开槽式减压：（附20例报告）

目前国内已广泛开展颈椎前路手术,其方法颇多。我院于1983～1990年8月对脊髓型颈椎病、颈椎结核、颈椎肿瘤及颈椎损伤患者施行颈前路多椎节开槽式减压及大块植骨融合术20例,随访3个月～6年,效果满意。 临床资料 本组20例,男16例,女4例,年龄22～60岁,平均40.3岁;脊髓型颈椎病10例(伴后纵韧带骨化1例),颈椎结核3例;颈5椎体肿瘤病变1例;颈椎损伤伴截瘫6例(新鲜、陈旧性各3例)。病变部位:颈4　1例、颈6　12例、颈5～7　7例;完全性瘫痪2例,不完全瘫痪18例。症状体征:颈椎病10例中按Fagger氏分级:严重型2例,中度严重型4例,中度型3例,混合型1例。…     

进行性加重型脊髓型颈椎病手术疗效影响因素分析

自 1995～ 2 0 0 2年收治的 31例进行性加重型脊髓型颈椎病 (CervicalSpondyloticMyelopathy ,CSM)进行综合分析以期对疾病的手术干预时机提供依据。1　临床资料1 1　一般资料　本组共 31例 ,共中男 2 7例 ,女 4例 ,年龄 5 1～ 77岁 ;平均 6 3 6岁。全部行颈前路环锯法减压及自体植骨融合术。其中C3～ 46例、C4～ 58例、C5～ 612例、C6～ 75例。术后下颌带牵引或颈围固定 3个月。术后随访 4个月～ 3年 5个月 ,平均 16个月。1 2　方法　病例选择 :以出现手指麻木、行走不稳、深反射亢进作为起病特征 ;症状、体征进行性加重 ;无缓解期者作…     

颈椎前路间盘切除植骨术7例体会

20 0 1年 2月～ 2 0 0 2年 12月 ,本院开展颈椎前路间盘切除植骨术 7例 ,取得很好疗效。报告如下。1　临床资料1.1　一般资料　本组 7例 ,男 5例 ,女 2例 ,年龄 38～ 6 6岁 ,平均 4 6岁。病程 :2～ 4个月 ,平均 7个月 ,均诊断为颈椎病脊髓型 ;病变节段 :颈4～ 51例 ,颈5～ 63例 ,颈6～ 72例 ,颈3～ 4并颈5～ 61例。其中 2例为椎体后缘骨赘 ,5例为间盘突出压迫颈髓 ,均经MRI证实。其中Ⅳ型间盘突出 2例 2节段。1.2　手术方法　颈丛阻滞麻醉。患者平卧 ,肩胛间垫薄枕 ,颈部略后伸。颈右前方横切口 ,切开皮肤、颈阔肌 ,从内脏鞘和血管鞘之间…     

前路减压植骨钢板内固定治疗脊髓型颈椎病（32例报告）

[目的]分析经前路减压椎间植骨融合结合钢板内固定治疗脊髓型颈椎病的临床疗效.[方法]2002年2月～2008年4月,本院对32例脊髓型颈椎病患者行颈前路减压椎间植骨融合钢板内固定术.术后对临床结果进行JOA 评分;观察并发症情况;1、2、3、6、9、12个月摄片,观察植骨融合效果.[结果]32例获得6～24个月(平均15个月)的随访.JOA评分,术后症状明显缓解和消失,由术前7～10分(平均8.6分)恢复至术后12～14分(平均12.8分);平均植骨融合时间12周,植骨融合率100 %;1例术后3 h颈部血肿形成,切开引流后,症状缓解;1例术后1个月螺钉松动,延长颈围外固定时间至术后6个月,固定节段融合.[结论]颈前路减压椎间植骨融合结合钢板内固定治疗脊髓型颈椎病疗效确切,可以有效解除脊髓前方所受的压迫;显著提高植骨融合率,临床疗效满意.     

扩大颈前路椎管减压治疗脊髓型颈椎病

目的 探讨扩大颈前路椎管减压治疗脊髓型颈椎病的临床疗效.方法 2002年2月-2006年8月,收治脊髓型颈椎病患者45例,采用扩大颈前路椎管减压、自体髂骨植骨、钛板内固定术治疗.其中男28例,女17例;年龄55～77岁,平均61.5岁.病程6～45个月,平均19.2个月.单节段36例,双节段9例,其中相邻节段不稳11例.JOA脊髓功能评分为(10.60±0.32)分,其中5～8分24例,9～12分18例,13～16分3例.结果 所有患者围手术期安全.未发生椎动脉损伤、神经损伤、脑脊液漏、血肿、感染、钛板螺钉折断、植入物滑脱等并发症.45例获10～51个月随访,平均24.6个月.植骨均于术后6～9个月骨性融合,融合率100%.JOA脊髓功能评分为(15.20±0.17)分,其中5～8分3例,9～12分10例,13～16分28例,17分4例,与术前比较差异有统计学意义(P＜0.01).结论 扩大颈前路椎管减压治疗脊髓型颈椎病具有操作简便、减压彻底、并发症少、临床效果满意等优点.     

脊髓型颈椎病经前路减压手术的临床效果

目的探讨脊髓型颈椎病的手术效果。方法回顾性分析2003-2007年间在我院因脊髓型颈椎病行手术治疗的20例患者,男11例,女9例,病程平均21个月（10d～7年）,随访时间平均32个月（11个月～5年）。本组20例行前路颈椎间盘摘除、植骨融合和钢板固定术。结果按COA标准评定,优15例,良4例,一般1例,优良率95％。结论手术干预是治疗重症或进行性加重的脊髓型颈椎病的有效手段,颈前路的彻底减压和可靠的脊椎稳定有利于脊髓功能的恢复。     

颈椎人工椎间盘置换术治疗颈椎间盘疾患的早期临床观察

目的：探讨应用颈椎人工椎间盘置换术治疗颈椎间盘疾患的效果.方法：对45例颈椎间盘疾病患者（脊髓型颈椎病35例、神经根型颈椎病5例、急性颈椎间盘突出症5例）实施前路减压、Bryan人工椎间盘置换术.其中单节段置换35例,双节段9例,3节段1例.结果：所有患者随访1～12个月,平均8个月.脊髓型颈椎病患者术前JOA评分平均8.5分,术后平均15.5分,平均改善率为88%.神经根型颈椎病和急性颈椎间盘突出症患者的临床症状均消失.平均术后住院时间为4.8d（2～6d）,38例术后4周内恢复正常生活和工作,7例在术后2个月内恢复工作.所有病例未见假体移位及神经系统症状加重.有2例分别在术后3个月和11个月时出现假体周围骨桥形成无活动,其余43例在最终随访时各置换节段均保留了活动度.结论：应用Bryan人工椎间盘系统置换治疗颈椎间盘疾患早期效果良好.     

颈前路椎体次全切减压纳米羟基磷灰石/聚酰胺植骨融合内固定治疗脊髓型颈椎病

目的 探讨颈前路椎体次全切减压纳米羟基磷灰石/聚酰胺（n-HA/P66）植骨融合内固定治疗脊髓型颈椎病临床疗效.方法 对2009年6月至2011年6月采用颈前路椎体次全切减压纳米羟基磷灰石/聚酰胺植骨融合内固定手术,治疗40 例脊髓型颈椎病患者的临床资料进行分析,男24 例,女16 例;年龄37～75 岁,平均50.5 岁.病程3个月～9年,平均3年.结果 本组40 例患者于术后6～8个月椎间植骨均达骨性融合,融合率为100%.随访3～12个月,平均8个月.全部患者植骨未出现椎间高度的再丢失,颈椎生理曲度恢复良好,无植骨块松动移位、断板、断钉和滑脱现象发生.40 例患者中,优17 例（42.5%）,良18 例（45%）,可3 例（7.5%）,差2 例（5%）,总有效率为95%.结论 颈前路椎体次全切减压纳米羟基磷灰石/聚酰胺植骨融合内固定手术治疗脊髓型颈椎病安全可行,近期疗效肯定.     

手法治疗颈椎病

从 1995年 8月以来 ,在临床上应用手法对 35 0例颈椎病病人进行了系统地治疗 ,现总结汇报如下 :1　临床资料　　本组 35 0例病人 ,其中男性 16 4例 ,女性 186例 ;年龄 19～ 6 5岁 ,平均年龄 38 6岁 ;病程最短 <1个月 ,最长 >10年 ;所有病人均参照《中华人民共和国中医药行业标准》“中医病证诊断疗效标准”及中华人民共和国卫生部制定发布的《中药新药临床研究指导原则》“颈椎病的诊断疗效标准”等进行诊断 ,其中颈型 48例 ,神经根型 12 0例 ,椎动脉型 84例 ,脊髓型2 9例 ,交感型 32例 ,混合型 37例。2　治疗方法2 1　预备手法　①揉捻法 …     

Vasopressor hormone response following mesenteric traction during major abdominal surgery

Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI₂) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI₂), TXB₂ (stabile metabolite of thromboxane A₂) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI₂ release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF_1α (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB² (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI₂ release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A₂, presumably contributing to hemodynamic stability within 30 min after MT.     

A Teaspoon Pump for Pumping Blood with High Hydraulic Efficiency and Low Hemolysis Potential

Abstract: Virtually all blood pumps contain some kind of rubbing, sliding, closely moving machinery surfaces that are exposed to the blood being pumped. These valves, internal bearings, magnetic bearing position sensors, and shaft seals cause most of the problems with blood pumps. The original teaspoon pump design prevented the rubbing, sliding machinery surfaces from contacting the blood. However, the hydraulic efficiency was low because the blood was able to "slip around" the rotating impeller so that the blood itself never rotated fast enough to develop adequate pressure. An improved teaspoon blood pump has been designed and tested and has shown acceptable hydraulic performance and low hemolysis potential. The new pump uses a nonrotating "swinging" hose as the pump impeller. The fluid enters the pump through the center of the swinging hose; therefore, there can be no fluid slip between the revolving blood and the revolving impeller. The new pump uses an impeller that is comparable to a flexible garden hose. If the free end of the hose were swung around in a circle like half of a jump rope, the fluid inside the hose would rotate and develop pressure even though the hose impeller itself did not "rotate"; therefore, no rotating shaft seal or internal bearings are required.     

Microspheres Based Detoxification System: A New Method in Convective Blood Purification

Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.     

Tissue perfusion in relation to cardiac output during continuous positive-pressure ventilation and administration of propranolol or verapamil

Background : Our objective was to determine whether administration of propranolol or verapamil modifies the hemodynamic adaptation to continuous positive-pressure ventilation (CPPV), in particular the regional distribution of cardiac output (CO).
Methods : General hemodynamics and regional blood flows assessed by microsphere technique (15 (μm) were recorded in 16 anesthetized pigs during spontaneous breathing (SB) and CPPV with 8 cm H₂O end-expiratory pressure (CPPV8) before and after intravenous administration of propranolol (0.3 mg · kg⁻¹ followed by 0.15 mg · kg⁻¹ · h⁻¹, n=8) or verapamil (0.1 mg · kg⁻¹ followed by 0.3 mg · kg⁻¹ · h⁻¹, n=8).
Results : CPPV8 depressed CO by 25% without shifts in its relative distribution with the exception of a noteworthy increase in adrenal perfusion. Propranolol increased arterial blood pressure, and due to a fall in heart rate, CO dropped by 25%. The kidneys and, to a lesser extent, the splanchic region and central nervous system received increased fractions of the remaining CO at the expense of skeletal muscle flow. Similar patterns were seen during SB and CPPV8 such that the combination of propranolol and CPPV8 depressed CO by 50%. The circulatory effects of verapamil were less evident but myocardial perfusion tended to increase.
Conclusions : The combination of propranolol or verapamil with CPPV does not result in any specific hemodynamic interaction in anesthetized pigs, except that the combined effect of propranolol and CPPV may severely reduce CO.     

Bariatric Surgery in Some "Central and East-European (former Eastern bloc)"Countries - Current Status and Prediction for the Next Millennium

Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.     

Volatile anaesthetics reduce adhesion of blood platelets under low-flow conditions in the coronary system of isolated guinea pig hearts

Background : Inhibitory effects of volatile anaesthetics on platelet aggregation have been demonstrated in several studies. However, the influence of volatile anaesthetics on intracoronary platelet adhesion has not been elucidated so far.
Methods : Isolated hearts of guinea pigs were perfused with buffer in the absence or presence of volatile anaesthetics (0.5 and 1 MAC) at constant coronary flow rates of 5 ml/min for 25 min, then 1 ml/min for 30 min and again 5 ml/min for 10 min. Before, during and after low-flow perfusion, a bolus of human platelets was applied into the coronary system. To simulate thrombogenic conditions, 0.3 U/ml human thrombin was infused during low-flow perfusion and reperfusion. The number of platelets sequestered to the endothelium was calculated from the difference between coronary in- and output of platelets. The myocardial production of lactate and consumption of pyruvate and coronary perfusion pressure were also determined.
Results : At a flow rate of 5 ml/min only about 3% of the applied platelets did not emerge from the coronary system, in any group. In contrast, 13.1±1.2% (mean±SEM) of infused platelets became adherent in low-flow perfusion in the control group without anaesthetic. The adherence was reduced with each 1 MAC isoflurane (to 6.2±1.2%), sevoflurane (to 4.4±0.9%) or halothane (to 3.2±1.5%) (each P <0.05 vs. control). Volatile anaesthetic, 0.5 MAC, did not inhibit platelet adhesion to a statistically significant extent in any case. Perfusion pressure and metabolic parameters were not statistically different between the control and the hearts exposed to anaesthetics.
Conclusion : Volatile anaesthetics in a concentration of 1 MAC can reduce the adhesion of platelets in the coronary system under reduced flow conditions. This action does not arise from vasodilation or inhibition of ischaemic stress.     

Synergistic interaction between the effects of propofol and midazolam with fentanyl on phrenic nerve activity in rabbits

Background: It has been shown that the depressive effects of both propofol and midazolam on consciousness are synergistic with opioids, but the nature of their interactions on other physiological systems, e. g. respiration, has not been fully investigated. The present study examined the effect of propofol and midazolam alone and in combination with fentanyl on phrenic nerve activity (PNA) and whether such interactions are additive or synergistic. Methods: PNA was recorded in 27 anaesthetised and artificially ventilated rabbits. In three groups, propofol, fentanyl and midazolam were administered intravenously in incremental doses to construct dose-response curves for the depressant effects of each one on PNA. In another two groups, the effect of pretreatment with either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. on the effects of propofol and fentanyl respectively on PNA were studied. Results: Propofol and fentanyl caused a dose-dependent depression of PNA with complete abolition at the highest total doses of 16 mg · kg^?1 i. v. and 32 μg · kg^?1 i. v., respectively. In contrast, midazolam in incremental doses to a total of 0.8 mg · kg^?1 reduced mean PNA by 63%, but approximately 12% of PNA remained at a total dose as high as 6.4 mg · kg^?1. The mean ED₅₀s, calculated from dose-response curves, were 5.4 mg · kg^?1, 3.9 μg · kg^?1 and 0.4 mg · kg^?1 for propofol, fentanyl and midazolam, respectively. Initial doses of either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. acted synergistically with subsequent doses of either propofol or fentanyl to abolish PNA at total doses of 8 mg · kg^?1 and 8 μg · kg^?1, respectively. Conclusion: Fentanyl has a synergistic interaction with both propofol and midazolam on PNA and hence potentially on respiration.     

Influence of dopexamine hydrochloride on haemodynamics and regulators of circulation in patients undergoing major abdominal surgery

Background: Catecholaminergic support is often used to improve haemodynamics in patients undergoing major abdominal surgery. Dopexamine is a synthetic vasoactive catecholamine with beneficial microcirculatory properties. Methods: The influence of perioperative administration of dopexamine on cardiorespiratory data and important regulators of macro- and microcirculation were studied in 30 patients undergoing Whipple pancreaticduodenectomy. The patients received randomized and blinded either 2 μg · kg^?1 · min^?1 of dopexamine (n=15) or placebo (n=15, control group). The infusion was started after induction of anaesthesia and continued until the morning of the first postoperative day. Endothelin-1 (ET-1), vasopressin, atrial natriuretic peptide (ANP), and catecholamine plasma levels were measured from arterial blood samples. Measurements were carried out after induction of anaesthesia, 2 h after onset of surgery, at the end of surgery, 2 h after surgery, and on the morning of the first postoperative day. Results: Cardiac index (CI) increased significantly in the dopexamine group (from 2.61±0.41 to 4.57±0.78 1 · min^?1 · m^?2) and remained elevated until the morning of the first postoperative day. Oxygen delivery index (DO₂I) and oxygen consumption index (VO₂I) were also significantly increased in the dopexamine group (DO₂I: from 416±91 to 717±110 ml/m² · m²; VO₂I: from 98±25 to 157±22 ml/m² · m²), being significantly higher than in the control group. pHi remained stable only in the dopexamine patients, indicating adequate splanchnic perfusion. Vasopressive regulators of circulation increased significantly only in the untreated control patients (vasopressin: from 4.37±1.1 to 35.9±12.1 pg/ml; ET-1: from 2.88±0.91 to 6.91±1.20 pg/ml). Conclusion: Patients undergoing major abdominal surgery may profit from prophylactic perioperative administration of dopexamine hydrochloride in the form of improved haemodynamics and oxygenation as well as beneficial influence on important regulators of organ blood flow.     

Systemic analgesia adapted to the children's condition

A concept of balanced analgesia using nonsteroidal anti-inflammatory drugs (NSAIDs), paracetamol (acetaminophen), opioids, and corticosteroids can also be used in patients with pre-existing illnesses. NSAIDs are the most effective treatment for acute pain of moderate intensity in children; however, these drugs should be avoided in patients at increased risk for serious side effects, e.g. patients with renal impairment, bleeding tendency, or extreme prematurity. NSAIDs can be given with minimal risks to the younger child with mild to moderate asthma, and, in these patients, the use of steroids can be encouraged; in addition to their antiemetic and analgesic action, a beneficial effect on asthma symptoms can be expected. In the non-intubated child with cerebral trauma, exaggerated sedation caused by opioids and increased bleeding tendency caused by NSAIDs must be avoided. In neonates and small infants, the oral administration of sucrose or glucose is helpful to minimize pain reaction during short uncomfortable interventions.     

A comparison of the inhibitory effects of four volatile anaesthetics on the metabolism of chlorzoxazone, a substrate for CYP2E1, in rabbits

Background: Halothane inhibits in vitro and in vivo activity of cytochrome P-450 (CYP) 2E1. There are several fluorinated volatile anaesthetics besides halothane, and most of them are defluorinated by CYP2E1. It is unclear whether other fluorinated anaesthetics inhibit the in vivo activity of CYP2E1.
Methods: We compared the inhibitory effects of therapeutic concentrations of four inhalational anaesthetics, halothane, enflurane, isoflurane, and sevoflurane, on chlorzoxazone metabolism in rabbits receiving artificial ventilation.
Results: All four inhalational anaesthetics decreased arterial blood pressure and increased plasma chlorzoxazone concentration. However, no significant differences in the plasma chlorzoxazone concentration were found between the four anaesthetics. The estimated chlorzoxazone clearance increased after beginning inhalation with all four agents, but no significant difference in clearance was noted between agents.
Conclusions: At therapeutic concentrations, the in vivo inhibitory effect on chlorzoxazone metabolism was similar for all four inhalational anaesthetics examined, even though their chemical characteristics and extent of hepatic metabolism differ considerably.