迟云志主任医师临证经验

1针灸配合中药外治法治疗面瘫 迟云志老师自70年代就致力于面瘫综合治疗的临床研究,目前已形成自成一体的针刺与中药外治相结合的治疗方案.曾撰写并发表了<口针治疗面神经麻痹临床观察>、<辨证分型治疗周围性面瘫的体会>等文.     

中西医结合治疗溃疡病穿孔远期疗效观察

目的：观察中西医结合治疗溃疡病穿孔的远期疗效。方法：采用自拟问卷对126例经中西医结合治疗痊愈出院的胃、十二指肠溃疡急性穿孔患者进行远期疗效随访。结果：良好89例（70．6％），尚好28例（22．2％），不良9例（7．2％），总有效率92．8％。结论：中西医结合治疗溃疡病穿孔远期疗效肯定，但是否坚持服药治疗可直接影响到远期疗效。     

Fast-track cardiac anesthesia: use of remifentanil combined with intrathecal morphine as an alternative to sufentanil during desflurane anesthesia

The purpose of this cardiac fast-track study was to evaluate the use of remifentanil (R) combined with intrathecal (IT) morphine as an alternative to sufentanil (S) during desflurane anesthesia with respect to postoperative pain control. Prior to entering the operating room, patients in the R group (n = 20) received morphine, 8 microg/kg IT. Anesthesia was induced using a standardized anesthetic technique in all patients. In the R group, anesthesia was maintained with R, 0.1 microg. kg(-1). min(-1) in combination with desflurane 3-10%. In the S group (n = 20), patients received S 0.3 microg. kg(-1). h(-1) and desflurane 3-10%. There were no differences between the two groups with respect to time from arrival in the intensive care unit to tracheal extubation (5.1 +/- 4.3 h vs 5.8 +/- 6.7 h for R and S groups, respectively). After extubation, patients in the R group had significantly lower visual analog pain scores, reduced patient-controlled analgesic requirements, and greater satisfaction with their perioperative pain management, compared with patients in the S group. We conclude that R combined with IT morphine provided superior pain control after cardiac surgery compared with a S-based general anesthetic technique. Implications: As part of a cardiac fast-tracking program involving desflurane anesthesia, the use of intrathecal morphine in combination with a remifentanil infusion provided improved postoperative pain control, compared with IV sufentanil alone.     

Less of insulin desensitization in sympathetic nerve terminals from wistar rats with insulin resistance

In an attempt to determine the effect of hyperinsulinemia on sympathetic function, release of norepinephrine (NE) from isolated aorta by insulin was measured in Wistar rats with insulin resistance. Insulin resistance was produced when the hypoglycemic action of glibenclamide at a dose of 10 mg/kg was almost abolished in rats that received daily injections of long-acting insulin for 15 days. Moreover, the stimulatory effect of insulin on glucose uptake was markedly reduced in both skeletal muscle strips and white adipocytes obtained from these rats with insulin resistance. However, the stimulatory effects of insulin at concentrations from 5 to 15 U/l on the release of NE from the aortic strip of insulin-resistant rats were not modified in the same manner but only slightly reduced compared with that of normal rats. These results suggest that insulin desensitization was produced later in sympathetic nerve terminals than in other organs in insulin-resistant rats and this may be helpful to explain the sympathetic hyperactivity associated with diabetes in clinics.     

Randomized phase II study of two doses of gefitinib in hormone-refractory prostate cancer: a trial of the National Cancer Institute of Canada-Clinical Trials Group.

PURPOSE: Overexpression of the epidermal growth factor receptor has been demonstrated in advanced prostate cancer and is associated with a poor outcome. A multi-institutional, randomized, phase II study was undertaken by the National Cancer Institute of Canada-Clinical Trials Group to evaluate the efficacy and toxicity of two doses of oral gefitinib in patients with minimally symptomatic, hormone-refractory prostate cancer (HRPC). PATIENTS AND METHODS: Between July and November 2001, 40 patients with HRPC and increasing prostate-specific antigen (PSA) or progression in measurable disease who had not received prior chemotherapy were randomly assigned to 250 mg (n = 19) or 500 mg (n = 21) oral gefitinib daily continuously. The primary end points were PSA response rate and objective measurable response. Functional Assessment of Cancer Therapy Prostate Cancer Subscale (FACT-P) quality-of-life questionnaires were completed at baseline and during treatment. RESULTS: None of the patients demonstrated a PSA or objective measurable response. Five (14.3%) of 35 assessable patients had stable PSA (one patient at 250 mg and four patients at 500 mg), and five patients (14.3%) had a best response of stable disease (duration, 2.5 to 16.8 months). No significant effect on the rate of increase in PSA was seen. The most common drug-related nonhematologic toxicities observed were grade 1 to 2 diarrhea (250 mg, 65%; 500 mg, 56%), fatigue (250 mg, 29%; 500 mg, 33%), and grade 1 to 2 skin rash (250 mg, 24%; 500 mg, 39%). FACT-P scores decreased during treatment, indicating worsening of symptoms compared with baseline. CONCLUSION: Gefitinib did not result in any responses in PSA or objective measurable disease at either dose level. Gefitinib has minimal single-agent activity in HRPC.     

前纵裂入路切除鞍区巨大肿瘤

背景与目的：鞍区巨大肿瘤手术难度较大，本文探索前纵裂入路切除鞍内、鞍上向单双侧海绵窦、第三脑室、蝶窦及伴颞叶发展的巨大肿瘤的手术适应症、方法与优缺点方法：总结分析2002年1月至2004年5月我科经前纵裂入路切除鞍区各部位发展的肿瘤17例。结果：肿瘤全切14例，近全切2例．部分切除1例；术后视力改善12例，无改变5例，尿崩或电解质紊乱8例，死亡1例，随访时间3～32个月，有1例复发，系巨大侵袭性垂体瘤术后，行γ-刀治疗后肿瘤基本得到控制。结论：前纵裂入路是切除鞍内、鞍上向单双侧海绵安、第三脑室、蝶窦及伴颞叶发展的肿瘤较理想的入路，利用自然脑裂的分离，手术视野、操作角度好、肓区少，有利于显露重要血管、神经及双侧海绵窦内侧壁，肿瘤全切率高。     

氟伐他汀对糖尿病大鼠肾组织病理改变的影响

目的：观察氟伐他汀对实验性糖尿病大鼠肾脏病理形态改变的影响。方法：建立雄性SD大鼠糖尿病模型，随机分为正常对照组（A组）、糖尿病模型组（B组）、氟伐他汀治疗组（C组），分别于4、6周末称体重，收集各组大鼠24小时尿液、血清及肾脏组织标本，测定血胆固醇、甘油三脂、尿白蛋白．肾重／体重比值，并在普通光镜及电镜下对肾组织进行形态学观察。结果：B组大鼠血胆固醇、甘油三脂、尿白蛋白、肾重／体重比值均明显高于同期A组，C组较B组明显下降（P〈0．05）；肾脏组织形态学观察B组银染区及PAS红染区明显扩大，基底膜不规则增厚，足突部分融合，系膜区基质增多，C组较B组减轻。结论：氟伐他汀可能通过降脂、减轻肾脏病理改变发挥肾脏保护作用。     

NO-1886降低脂负荷新西兰兔血清甘油三酯和游离脂肪酸

目的观察NO1886(ibrolipim)对脂肪餐后血脂水平的影响。方法将25只♂新西兰兔随机分为5组正常对照组、脂负荷组、脂负荷+NO1886(05g·kg-1)组、脂负荷+NO1886(10g·kg-1)组、脂负荷+NO1886(15g·kg-1)组;分别在给予20%脂肪乳和相应剂量NO1886前后第1、2、4、6、8、24h从兔耳缘静脉采血,离心收集血清,测定血清甘油三酯和游离脂肪酸。结果NO1886能有效地降低脂负荷后新西兰兔血清甘油三酯和游离脂肪酸水平,呈剂量依赖性,并能使游离脂肪酸恢复到正常。结论NO1886具有调节脂肪餐后血脂水平的作用。     

我国老年人肥胖和抑郁关系研究

  目的  了解我国老年人肥胖和抑郁的关系,并探究不同性别之间是否存在差异。  方法  数据来源为2015年中国健康与养老全国追踪调查(China Health and Retirement Longitudinal Study,CHARLS)数据。根据抑郁状态将受访对象进行分组,采用卡方检验比较不同性别和抑郁状况老年人之间的差异;利用二分类logistic回归分析抑郁和肥胖以及其他社会学因素的关系。  结果  有效样本4 019例,其中男性2 109例(52.48%),女性1 910例(47.52%),均为60岁及以上老年人。中心性肥胖474例(11.79%), 腹型肥胖2 418例(60.16%)。男女之间中心性肥胖以及腹型肥胖等因素差异有统计学意义(P均＜0.001)。1 304例患抑郁症,占32.45%,其中男性539例(41.33%),女性765例(58.67%)。性别、中心性肥胖以及腹型肥胖因素在患抑郁症方面差异有统计学意义(P均＜0.001)。单因素分析发现,女性、离异/丧偶/未婚、农村、患有慢性病和身体功能损失都是发生抑郁的危险因素。多因素logistic回归分析发现,总体而言,调整混杂因素后,中心性肥胖人群和腹型肥胖人群患抑郁症的可能性均更小;进行性别分层后,中心性肥胖和腹型肥胖仍与抑郁呈负相关。  结论  无论男女,中心性肥胖和腹型肥胖人群患抑郁的可能性更小。