先天性多脏器缺如及发育不全1例报告

1临床资料患儿,男,1d,因生后腹胀不排气排便20h,于2002年2月9日3pm入院。体检:T36.5℃,R45次/min,P160次/min,面色灰暗,发育及营养差,反应弱,呈嗜睡状。胸廓无畸形,左肺呼吸音粗糙,右肺呼吸音低。心率160次/min,律齐,各瓣膜区未闻及杂音。腹部膨隆,未见肠型及蠕动波,全腹有压痛,肝脾均未触及,下腹部叩诊浊音,肠鸣音弱。肛门外观正常。肛诊:进入4cm后为盲端,不能插入细肛管,无胎便,仅有少量白色粘液。实验室检查:血WBC25.0×109/L,N0.75,L0.25,Hb182g/L,RBC5.70×1012/L。B超:腹腔内有大片液性暗区,内有散在斑点及斑片状强回声,肠管内…     

新生儿气胸20例临床分析

目的探讨新生儿气胸的治疗问题。方法回顾性分析20例新生儿气胸的诊断、治疗。结果8例少量闭合性气胸(肺压缩<30%)给予保守治疗,其中5例无肺部感染患儿2～3d病情好转;3例有肺部感染患儿6～9d病情好转。12例中量以上气胸(肺压缩>30%)及张力性气胸胸腔闭式引流,平均4～5d病情好转拔管。其中,应用机械通气过程中发生的气胸3例,2例闭合性气胸,1例张力性气胸,给予胸腔闭式引流,平均6d病情好转拔管。结论不同程度及不同类型的气胸采取相应的治疗方法,并注意新生儿的生理特点及注意避免可能出现的并发症,患儿多能恢复良好。     

一清胶囊治疗急、慢性咽炎的临床观察

急性咽炎和慢性咽炎都是临床常见多发疾病,祖国医学认为急性咽炎属外邪侵犯的实证,临床分风热外侵、风寒袭肺、肺胃热盛三个证型,但热者十居八九;慢性咽炎多在脏腑阴阳气血虚损基础上发生,临床分为肺。肾阴虚、脾肾阳虚、痰火郁结三个证型,临床所见以阴虚为多,阴虚则火旺,虚火上扰[1]。根据这一思路,我们从1997年10月至2001年10月,选用成都康弘制药有限公司研制的一清胶囊治疗急、慢性咽炎,并进行临床研究,报告如下。     

胃癌患者血清肝细胞生长因子的检测及意义

Objective To explore the clinical significance of serum HGF level changes in gastric cancer pa-tients. Methods 60 cases of patients who operatied and clinicopathological confirmed gastric cancer, were detected serum HGF level by enzyme linked immunosorbent assay(ELISA) .40 cases were administered radical gastrectomy,20 cases of patients who had distant metastasis and loss operative chance were detected 7 days and 3 months preopera-tive,postoperative serum HGF level respectively. At the same time 40 cases of chronic gastritis patients and 40 cases of healthy examination people were selected as control group. Results Serum HGF level in patients with gastric canc-er was significantly higher than that of chronic gastritis and normal controls(P <0. 01). The serum HGF level of pa-tients with tumor vascular invasion significantly increased(P <0. 05). The patients with lymph node metastasis,serum HGF level was significantly higher than that patients with no lymph node metastasis(P <0. 05). The serum HGF level of patients with liver metastasis was significantly higher than that patients with no liver metastasis(P <0. 05). The se-rum HGF level of gastric cancer patients whose maximum diameter of the tumor ≥3cm were significantly higher than that maximum diameter of the tumor <3cm(P<0. 05). According to TNM staging of gastric cancer,the serum HGF level of Ⅰ phase and Ⅱ phase patients were significantly lower than that Ⅲ phase and Ⅳ phase patients(P <0.05).The serum HGF level of gastric cancer patients had no significant correlation with sex ,age and histological type(P <0.05). The serum HGF level of 40 cases of patients who were 1 week after surgery were significantly decreased,the patients who were 3 months after surgery were more obvious(P <0. 05 and P <0. 001). Conclusion HGF may play an important role in gastric cancer occurrence and development. The detection of serum HGF level can become an im-portant index for monitoring the degree of gastric cancer and prognosis of patients.     

瘘后移肛门成型术治疗无肛会阴瘘

先天性肛门闭锁是小儿常见的消化道畸形，需手术治疗，而无肛会阴瘘又是其中的一种类型，女孩多见，痿口多在舟状窝处，大部分属于中低位无肛，由于瘘口与外阴接近，容易造成污染。目前国内外常用的几种术式各有优缺点，而不管那种术式，术后排便功能都是评定疗效的重要指标。我们于2000年以来对55例无肛会阴瘘患儿采用瘘后移肛门成型术治疗，效果满意，报道如下。     

针刺对实验性变态反应性神经炎TNF-α和IL-4的影响

目的 探讨肿瘤坏死因子-α(TNF-α)和白细胞介素-4(IL-4)与实验性变态反应性神经炎(EAN)发病的关系，从细胞因子水平研究针刺疗法对本病的免疫调节作用。方法 40只大鼠分为正常对照组、模型组、针刺组、药物组，建立大鼠EAN动物模型，观察大鼠发病率及致病程度，针刺组取腰。夹脊、足三里、悬钟穴，药物组用泼尼松灌胃给药。采用双抗体夹心ELISA法，检测大鼠血清的TNF-αa和IL-4的含量变化。结果 模型组TNF-α含量较正常组明显升高。针刺组和药物组均能降低TNF-α的含量，使其水平接近正常，尤以药物组抑制作用明显。IL-4的含量各组间均无明显差异。结论 提示本病存在Th1／Th2细胞因子间的失衡，其中以Th1型细胞占优势。针刺主要是通过抑制TNF-α等Th1细胞，来重建细胞因子间的平衡。     

以肺部症状为首发表现的食管癌二例

例1女，68岁。因咳嗽、咳痰1月于1996年5月31日入院。近1月来，病人无原因出现咳嗽，咳少量白色粘痰，无发热及吞咽困难，在家口服抗生素治疗无效。发病后，病人饮食可，消瘦明显。查体：体温36．2℃，脉搏80次／分，呼吸16次／分，血压16／10kPa，神志清，浅表淋巴结未触及肿大。双肺呼吸音低，未闻及干湿性罗音，心腹未见异常。入院疑诊肺癌，行胸部CT扫描：双肺未见异常，食管壁增厚，其内见软组织影，疑诊食管癌，行X线钡餐检查：食管中下段示约12cm的充盈缺损，粘膜破坏，有小龛影；食管镜咬检病理示：鳞癌，确诊食管癌。例2男，63岁…     

柴莪退热栓治疗急性病毒性上呼吸道感染临床研究

目的观察柴莪退热栓治疗急性病毒性上呼吸道感染中医辨证属卫分证、卫气同病证的临床疗效,并探讨外感高热卫分证、卫气同病证证候与疗效间的关系.方法将患者 80例随机分为治疗组与对照组,分别予柴莪退热栓和消炎痛栓塞肛,并进行安全性评价.结果两组总体疗效相当,且未发现明显毒副作用.结论 柴莪退热栓治疗急性病毒性上呼吸道感染疗效满意.     

分娩镇痛的研究进展

分娩镇痛争议较多，其方法、用药趋向多样化，灵活化。硬膜外镇痛效果好，运动阻滞轻；蛛网膜下腔一硬膜外联合镇痛用药量小，起效快，可灵活掌握镇痛时问；产妇自控硬膜外镇痛可按需给药，降低医护工作量。硬膜穿破是最常见并发症，某些因素可降低其风险及危害。分娩镇痛对产程和分娩结果的影响仍有争议，多数研究认为分娩镇痛延长产程，但不增加剖宫产及器械助产率。良好的分娩镇痛可以改善新生儿酸碱状态。