胫骨干骨折带锁髓内钉固定和钢板螺钉固定的对比研究

目的：对照回顾性分析带锁髓内钉和钢板内固定两种方法治疗胫骨干骨折的效果。方法：髓内钉组32例（35处骨折）,根据AO分型,42A型11处,42B型18处,42C型6处;钢板组42例（45处骨折）,42A型10处,42B型22处,42C型13处。平均伤后手术时间在髓内钉和钢板组分别为3d和3.5d。随访评估患者手术时间,活动度,愈合时间,术后并发症之间的差别。结果：术后平均随访13个月（8～26个月）。髓内钉组平均手术时间为84min,钢板螺钉组平均为93min。髓内钉组踝关节平均背屈度为13°（0°～20°）,钢板组为11°（0°～20°）;跖屈分别为41°（30°～50°）,47°（30°～50°）。愈合时间髓内钉组平均为3.3个月,钢板螺钉平均为3.5个月。术后X线片显示髓内钉固定有1例出现旋转畸形,钢板组有3例出现成角畸形,均为胫骨远端1/3骨折。结论：在治疗胫骨骨折方面,带锁髓内钉和钢板内固定两种方法都可以取得理想的效果。     

多层螺旋CT在肝癌介入治疗中的价值

目的　评价多层螺旋CT(MSCT)在肝癌(HCC)介入治疗中的指导作用,着重研究对肝动脉化疗栓塞的价值。方法　对54例HCC患者先行MSCT检查,分别观察肝动脉期、门静脉期和肝静脉期肿瘤及其并发症的影像表现;其中12例行CTA检查,42例应用MIP或MPR观察腹腔动脉的解剖和走行,根据影像表现拟订治疗方案。结果　54 例患者MSCT发现HCC病灶225个,门静脉瘤栓10例,动静脉瘘14例。MSCT对肿瘤数目、门静脉瘤栓显示率与 DSA无显著差异 (P>0.05)。CTA对于显示腹腔动脉及其主要分支的解剖三维结构优于后前位 DSA,观察与腹主动脉夹角较 DSA更方便。MSCT发现肝动脉起源变异5例,与DSA完全符合。结论　MSCT对于肝癌肝动脉化疗栓塞有重要指导意义。     

泰素蒂加顺铂治疗进展期NSCLC的临床研究

目的观察泰素蒂加顺铂方案治疗进展期非小细胞肺癌的临床疗效、毒副作用。方法收集可评价疗效的进展期非小细胞肺癌50例,以泰素蒂加顺铂方案进行化疗,泰素蒂75 mg/m2静脉滴注,第1天;顺铂25 mg/m2～30 mg/m2静脉滴注,第2天～第5天,每3周为一个周期,2～3周期后评价疗效和毒副反应并随访。结果50例患者中,总有效率为50.0 %,其中初治病例为53.1 %,复治病例为44.4 %,初复治病例间差异无显著性(P >0.05)。中位缓解期为5个月。中位生存期为9.5个月,1年生存率为61.0 %。毒副反应主要为骨髓抑制,白细胞下降达Ⅲ度、Ⅳ度者52.0 %,血小板下降达Ⅲ度、Ⅳ度者为14.0 %。血红蛋白下降不严重。其他毒副反应还有脱发、过敏反应、水钠潴留、静脉炎、末梢神经炎、口腔炎、腹泻等,但发生率均较低。结论泰素蒂加顺铂方案治疗进展期非小细胞肺癌,特别是复发病例,临床疗效比较满意,毒副反应能够耐受。辅以G蛳CSF可防治重度的骨髓抑制,有较好的临床应用价值。     

直肠肛管恶性黑色素瘤的临床特征分析

目的了解原发性直肠肛管恶性黑色素瘤的临床特点。方法回顾性分析9例原发性直肠肛管恶性黑色素瘤的临床资料,并复习文献。结果直肠肛管恶性黑色素瘤以女性多见,平均发病年龄56岁,病程5.8个月;首发症状以血便为最常见,其次为肛门肿物突出。94.7%的直肠肛管恶性黑色素瘤在距离肛缘5.0cm范围内;肿瘤最大径(3.3±2.1)cm;其中54.5%可活动;有19.1%的肿瘤表面光滑;6.6%的肿瘤质地软;14.0%同期发现转移,肝转移最常见,腹股沟淋巴结转移其次;的病例出现误诊,超过者被误诊为良性疾病;手术治疗中以Miles术为主,经肛门局部切除术其次。结论直肠肛管恶性黑色素瘤极易误诊。手术治疗为主。     

Association between cord blood IgE and genetic polymorphisms of interleukin-4, the β-subunit of the high-affinity receptor for IgE, lymphotoxin-α, and tumor Necrosis factor-α

High cord blood immunoglobulin E (cbIgE) is known to be associated with increased risks of atopic diseases in childhood. The relationship between genetic polymorphisms and high cbIgE has not been well documented. A cross-sectional study was conducted to assess the association between cbIgE and genetic polymorphisms of interleukin (IL)-4 -590C/T, the beta-subunit of the high-affinity receptor for IgE (FcepsilonRI-beta) E237G, lymphotoxin (LT)-alphaNcoI alleles, and tumor necrosis factor (TNF)-alpha -308G/A. A total of 320 mother-neonate pairs were recruited from four maternity hospitals from different locations of Taiwan. Cord blood was obtained and assayed for cbIgE. Polymerase chain reaction followed by restriction fragment length polymorphism was used to assess the genotypes. Three hundred pairs of mothers and neonates were included in the final analysis. Infants with IL-4 -590 C allele were found to have higher risk of elevated cbIgE (> or =0.35 IU/ml, 24.3%) (p = 0.004). After adjusting for gender, birth order, maternal age, and history of allergic disease in maternal and paternal families, odds ratios for CC and CT genotypes were 4.41 and 3.16 (95% confidence interval 0.78-22.67, and 1.66-6.13), respectively, using TT genotype as reference. The genotypes of FcepsilonRI-beta, LT-alpha, and TNF-alpha were not associated with cbIgE before or after the adjustment. Our finding suggested a significant association of cbIgE with genetic polymorphism of IL-4 -590C/T, but not with the genotypes of FcepsilonRI-beta, LT-alpha, and TNF-alpha.     

小剂量尿激酶溶栓治疗老年高龄急性心肌梗死65例临床观察

目的尝试用小剂量尿激酶治疗老年高龄急性心肌梗死,旨在使老年高龄患者亦从溶栓治疗中获益.方法采用WHO关于急性心肌梗死(AMI)的诊断标准,收治老年高龄患者65例.随机分为两组,溶栓组31例,给予小剂量尿激酶(50×104U)30min 静脉滴入;并与非溶栓组34例对照观察.结果溶栓组冠脉再通率、五周病死率、休克、心衰分别为54.8%、6.4%、3.2%、9.7%;而对照组分别为14.7%、23.5%、26.5%:41.2%,有明显差异(P<0.01).结论有条件的基层医院依然有可能实施小剂量尿激酶对老年高龄患者的溶栓治疗,且可挽救更多老年高龄患者的生命.     

中药槐黄软膏治疗局部溃疡药效学实验研究

槐黄软膏是由槐角、地榆、黄芩、积壳、当归、防风等药物组成的治疗痔疮的良药,为了为临床用药提供实验依据,我们对槐黄软膏的体外抗菌活性及对局部溃疡的作用进行了实验研究,现报告如下。1材料与方法1.1药物槐黄软膏由山东中医药大学制备(批号:20020801),赋形剂为凡士林。马应龙麝香痔疮膏由武汉马应龙药业集团股份有限公司出品(批号:010832)。1.2动物家兔购于山东大学实验动物中心。1.3实验菌株金黄色葡萄球菌5株(010428,010416,010426,011223,011223)、铜绿假单孢菌5株(010408,010421,010423,010427,010430)、大肠杆菌5株(010411,010420,…     

小剂量阿司匹林与银可络联用对老年患者血液流变学异常的影响

目的探讨小剂量阿司匹林与银可络联用对老年患者血液流变学异常的影响。方法57例老年病人并伴有高凝、高粘血症者采用小剂量阿司匹林50mg,口服,1次/d,银可络80mg,口服,3次/d。疗程为1个月。并测定治疗前后血液流变学各项参数。结果病例组治疗后血小板粘附率(PadT)、血栓长度、重量与对照组比较均有显著性差异(P均<0.01);治疗后红细胞刚性指数(IR)、血沉(ESR)、红细胞电泳时间(EFT)、全血表现粘度(BAV)与治疗前比较均有显著性差异(P均<0.001);病例组治疗后红细胞比积(HCT)、纤维蛋白原(Fib)、血浆比粘度(PV)与对照组比较均无显著性差异(P均>0.05)。结论小剂量阿司匹林与银可络联合治疗对血栓形成过程有抑制作用,红细胞变形能力和聚集性有所改善。但对Fib,PV,HCT无影响。     

氟伐他汀对缺血性脑卒中患者的疗效观察及护理措施

Objective To explore the effect and nursing main points of fluvastatin on the patients with cerebral arterial thrombosis. Methods Eighty-five patients with cerebral arterial thrombosis were randomly divided into three groups. Group Ⅰ was the negative control group. Group Ⅱ was the conventional-dose therapy group and group Ⅲ was the high-dose therapy group. Each group was treated with related therapy and care. The blood lipids in all groups were tested before the treatment, 4 weeks, 12 weeks and 24 weeks after the treatment; the carotid intima-media thickness (IMT) were measured by the Germany SEQUOIAS-512-B ultra machine before the treatment and 24 weeks after the treatment; At the same time, the side effects of fluvastatin were recorded. Results The results of blood lipid tests showed that the LDL, TC and TG in two treated groups were significantly decreased compared to negative control group (P<0.05). After treated for 24 weeks, the carotid intima-media thickness (IMT) in two treated groups were significantly reduced (P<0.05); the side effects of fluvastatin were infrequent and there was no significant different among the three groups (P>0.05). Conclusion The effects of different doses of fluvastatin on cerebral arterial thrombosis were significantly different. With the dose of fluvastatin increased, the serum LDL-L and TC reduced more obvious and the inhibition on carotid atherosclerosis shows more obvious, and the side effects did not increased.     

无创通气不同呼吸界面对COPD患者的生理学影响

目的 探讨无创正压通气(NPPV)时不同呼吸界面对慢性阻塞性肺疾病(COPD)急性加重期并呼吸衰竭患者的生理学影响.方法 选择30例COPD急性加重期并呼吸衰竭患者.无创正压通气时患者随机先后接受不同呼吸界面(面罩、鼻罩和鼻塞).动态观察不同呼吸界面时患者呼吸方式、血气分析和对呼吸界面耐受性等的差异.结果 (1)与自主呼吸相比,无创正压通气时三种不同呼吸界面均可改善患者的潮气量、分钟通气量和呼吸频率(P＜0.01),三种不同呼吸界面时的呼吸频率相似(P＞0.05),但面罩时的潮气量和分钟通气量比鼻罩时更高(P＜0.05);(2)与自主呼吸相比,无创正压通气时三种不同呼吸界面均可改善患者的动脉血气(P＜0.05),面罩和鼻塞时的PCO2比鼻罩时更低(P＜0.05);(3)患者均可耐受三种不同的呼吸界面,但患者对鼻罩的耐受性比面罩和鼻塞更好(P＜0.01).结论 本生理学研究证实了无创正压通气可改善COPD急性加重期并呼吸衰竭患者的呼吸方式和动脉血气,面罩和鼻塞时的疗效更佳,而鼻罩时的耐受性更好.