程丑夫教授运用黄连温胆汤经验举隅

黄连温胆汤以《备急千金要方》中的温胆汤为基础方加黄连,其主要功效是清热燥湿,理气化痰,和胃利胆,为临床治疗痰热证的经典方.程丑夫教授认为痰热病邪致病广泛,痰火扰心,心神不安则见心烦失眠;痰热中阻,清阳不升,则见眩晕耳鸣;情志不遂,痰热郁积,则见郁病;痰热中阻脾胃,升降逆乱则见胃痛.众疾病虽病名和临床表现不同,但其病理机制总归为痰热内扰.本文旨在通过验案举隅总结探讨程教授运用黄连温胆汤的临床经验.     

应用综合护理措施对经股动脉冠脉介入术后患者腰背酸痛的临床效果观察

总结了综合护理措施对经股动脉介入术后患者腰背酸痛的应用效果。主要包括腰背痛的现况、原因及综合护理措施,认为经股动脉冠状动脉介入术后应用综合护理措施能有效改善患者腰背痛症状,值得推广应用。     

原发性先天性青光眼患者术后生活质量的评价

Objective To evaluate the 23-item scale of Quality of Life (QOL) for patients with primary congenital glaucoma (PCG). Methods It was a cross-sectional study. The QOL scale specific for patients with PCG was firstly evaluated on 51 patients with PCG following antiglaucomat surgery at last follow-up visit (7.80 years±2.93 years with a median at 7 years) and 50 participants with normal visual acuity (VA) as control. All participants were aged 5-20 years old. The QOL of PCG was evaluated with type of disease, severity, surgical outcome, postoperative VA, age, gender and personality by using single-factor correlation analysis and multiple-factor stepwise regression analysis. Results The PCG-QOL scale achieved good reliability, validity and responsibility for PCG and 23-item were all qualified for QOL evaluation of PCG. The total scores of QOL in patients with PCG were significantly lower than those of normal individuals (PCG 60.22±10.02,normal individuals 71.41±10.11;t=5.682, P=0.000). Single-factor correlation analysis showed that the total scores of QOL were associated significantly with the severity of glaucoma (F=24.026, P=0.000), surgical outcome (t=2.638, P=0.009) and postoperative VA (F=11.248, P=0.000) ; The visual function scores were associated significantly with the severity (F=12.677, P=0. 000) and postoperative VA (F=10.369, P=0.000) ; The self-care ability scores were associated significantly with the severity (F=11.064, P=0.000) and surgical outcome (t=2.297, P=0.042) ; The social and mental scores were all correlated significantly with the severity (F=6.869, P=0.020; F=5.721, P=0.019) and personality (t=4.352, P=0.009 ; t=2.297, P=0.042). Multiple-factor stepwise regression analysis showed that there were significant correlations between total scores and the severity (β=-6.985, P=0.001 ), postoperative VA (β=-4.978, P=0.003 ) and personality (β=-5.201, P=0.020). Conclusions The PCG-QOL scale could be used for evaluating the QOL of PCG patients aged 5-20 years. The main factors that influence on the QOL of patients with PCG are severity of the disease, postoperative VA and personality. Preventing progression of glaucoma, improving VA and giving right psychological guidance may improve the QOL of patients with PCG.     

闭合性眼外伤致黄斑裂孔的光相干断层扫描图像分析

Objective To observe the features of the images of optical coherence tomograpy (OCT) in patients with traumatic macular hole (TMH), and detect the clinical significance of OCT. Methods Consecutive 74 patients (74 eyes) diagnosed with TMH by examinations of visual acuity, slit lamp, and direct or indirect ophthalmoscopy underwent optical coherence tomography (OCT), The analysis software of OCT was used to make the quantitative measurements of TMH. And the TMH were classified according to the morphological characteristics of the images of OCT. 50°color fundus photography was performed on the patients after OCT. The relationship of TMH with the average visual acuity, disease duration, average neuroepithelial thickness on the margin of hole, and the base diameter and the apex diameter of macular hole were retrospectively analyzed. Results The characterisctics of the images of 74 cases (74 eyes) of TMH were classified into 5 types: macular holes with symmetric edema of the neurosensory retina at the margin in 27 eyes (36.5%), macular holes with asymmetric edema of the neurosensory retina at the margin in 12 eyes (16.2%), macular hole with full-thickness defect of neurosensory retina without edema or detachment at the margin in 14 eyes (18.9 %), macular hole with localized detachment of the neurosensory retina at the margin without edema in 17 eyes (23.0 %), and macular hole with thinning neurosensory retina in 4 eyes (5. 4 %).There was no significant difference of visual acuity among different types of TMH (F=1. 574, P=0. 191).The visual acuity was positively related with the marginal retinal thickness (r=0. 342, P=0. 003), but not related to age, diameter of macular hole or the disease duration(r value was from-0. 022 to-0. 134, P value was from 0. 863 to 0. 261). The disease duration of Type IV TMH was shorter than that of other TMH types. In the patients with the disease duration over 90 days, Type I TMH was predominant. The average retinal thicknesses at the margin of the hole showed significant differences among different TMH types (F= 13.921, P= 0.000). Conclusions TMH could be divided into 5 types according to the characteristics of images of OCT; the clinical characteristics of different types of TMH varies.     

改良显微小梁切除术治疗葡萄膜炎继发性青光眼

Objective To investigate the effect of trabeculectomy combined with segmental iridectomy, mitomycin C (MMC) and viscoelastic agents usage on the treatment of glaucoma secondary in uveitis. Methods According to the age, degree of inflammation and the condition of Tenon capsule of patients, differ-ent concentration of MMC (0.25-0.33 mg/ml) was used during the operation, with separation of the anterior and posterior synechia, resection of pupillary organization membrane using viscoelastic agents. Segmental iridec-tomy and releasable sutures were also performed on the patients. The visual acuity of preoperation and postoper-ation, intraocular pressure, inflammation and the complication were record. Results Forty-two eyes of 38 cases with glaucoma secondary in uveitis were studied, the mean follow-up time was (12.01±3.56) months. The postoperative visual acuity improved in 14 eyes, didn't change in 28 eyes. The postoperative inflammation of anterior chamber disappeared in 35 eyes, relieved in 7 eyes. And the average postoperative intraocular pres-sure (15.20± 4.64) mmHg was significantly lower than the preoperative intraocular pressure (38.37±12.93) mmHg (t = 8.255, P = 0.000). The total success rate was 92.9%. There were no severe complication. Conclusion Trabeculeetomy combined with MMC, viscoelastic agents usage, separation of anterior and poste-rior syneehia, segmental iridectomy and releasable suture could increase the success rate of operation on pa tients with glaucoma secondary in uveitis, decrease the complication and inflammation reaction of operation, and the recurrence of uveitis.     

羊膜在小梁切除术中应用的临床研究

[目的]探讨羊膜在青光眼滤过手术中应用的降压效果及安全性.[方法]将各类型青光眼38例44只眼分为3组,A组为巩膜瓣下羊膜移植术(AMT)组(20只眼);B组为巩膜瓣下联合应用丝裂霉素组(12只眼);C组为对照组(12只眼),行单纯小梁切除术.观察手术前、术后第1、2、3、7、14、21天、第1、3、6个月各组的视力、眼压、滤过泡类型和充血程度、前房深度、眼底情况及并发症,用前房激光蛋白细胞检测仪(LFCM)测量术前和术后第1、3、7天和1个月的前房蛋白含量,进行统计学分析.[结果]3组术后平均眼压均控制在21 mmHg以下,术后7～14 d眼压最低;3组各观察点之间比较P值均大于0.05,差异无显著性.44只眼中40只眼为Ⅱ型滤过泡,4只眼为包裹性囊状滤过泡.羊膜组滤过泡术后2 d较扁平,第3天起隆起呈弥散的Ⅱ型泡;羊膜组早期滤过泡充血较轻,与其它两组比较差异有显著性(P＜0.05).羊膜组前房蛋白含量术前、术后第1天、第30天均高于其他两组,差异有显著性(P＜0.05).[结论]羊膜运用于青光眼滤过手术中可以有效地降低眼压,减轻炎症反应,并发症较少.羊膜移植术后前房房水蛋白含量增加,可能与羊膜本身蛋白溶解有关.     

包裹囊状滤过泡的发生机制及治疗进展

包裹囊状滤过泡(包裹泡)是青光眼滤过手术后出现的一种并不少见的滤过泡类型,对患者滤过术后的眼压控制以及滤过手术远期成功率有显著影响,因此自1982年正式报道以来[1],人们一直试图明确它的发生机制、了解与发生有关的危险因素以及探寻有效的治疗方法,并取得了一定进展。本文就上述各方面进行综述,为临床处理包裹泡提供参考依据。一、包裹囊状滤过泡的定义、发生机制1982年,Van Buskirk[1]对8例青光眼滤过手术后形成的一种特殊类型的圆顶状、较坚实的滤过泡并伴随眼压升高的病症进行了描述,将其命名为包裹性囊状滤过泡,这是对包裹泡的首…     

改良显微小梁切除术治疗葡萄膜炎继发性青光眼

Objective To investigate the effect of trabeculectomy combined with segmental iridectomy, mitomycin C (MMC) and viscoelastic agents usage on the treatment of glaucoma secondary in uveitis. Methods According to the age, degree of inflammation and the condition of Tenon capsule of patients, differ-ent concentration of MMC (0.25-0.33 mg/ml) was used during the operation, with separation of the anterior and posterior synechia, resection of pupillary organization membrane using viscoelastic agents. Segmental iridec-tomy and releasable sutures were also performed on the patients. The visual acuity of preoperation and postoper-ation, intraocular pressure, inflammation and the complication were record. Results Forty-two eyes of 38 cases with glaucoma secondary in uveitis were studied, the mean follow-up time was (12.01±3.56) months. The postoperative visual acuity improved in 14 eyes, didn't change in 28 eyes. The postoperative inflammation of anterior chamber disappeared in 35 eyes, relieved in 7 eyes. And the average postoperative intraocular pres-sure (15.20± 4.64) mmHg was significantly lower than the preoperative intraocular pressure (38.37±12.93) mmHg (t = 8.255, P = 0.000). The total success rate was 92.9%. There were no severe complication. Conclusion Trabeculeetomy combined with MMC, viscoelastic agents usage, separation of anterior and poste-rior syneehia, segmental iridectomy and releasable suture could increase the success rate of operation on pa tients with glaucoma secondary in uveitis, decrease the complication and inflammation reaction of operation, and the recurrence of uveitis.     

HCG日雌二醇和获卵数的比值对IVF长方案妊娠结局的影响

目的:研究hCG日雌二醇(E2)和获卵数的比值对IVF长方案妊娠结局的影响,并且确定最佳的E2/获卵数比值。方法:回顾性分析2009年6月～12月543例进行长方案IVF/ICSI患者的临床资料。根据患者hCG日E2浓度和取卵日获卵数的比值,分为3组,A组:E2/获卵数<200 pg/ml;B组:E2/获卵数200～500 pg/ml;C组:E2/获卵数>500 pg/ml。比较3组患者进行IVF/ICSI过程中的临床参数和妊娠结局。结果:hCG日E2浓度随着E2/获卵数比值的增高而升高。但是,获卵数却随着比值的增高而下降,受精率3组无统计学差异,着床率和妊娠率在B组最高,分别为30.73%和45.27%,而C组的着床率和妊娠率都是最低,分别为18.45%和31.03%。结论:E2/获卵数的确会影响长方案IVF的妊娠结局,此值的最佳范围为200～500 pg/ml。