高危前列腺增生56例围术期护理

2004年1月-2006年12月，我院对40例婴儿痉挛症患儿使用促肾上腺皮质激素（ACTH）治疗，经精心护理，效果满意。现将护理体会报告如下。     

电针聚泉、廉泉对假性延髓麻痹临床疗效的影响

目的：观察电针聚泉、廉泉对假性延髓麻痹的疗效。方法：将60例中风后假性延髓麻痹患者随机分为治疗组和对照组各30例,两组均在基础治疗的基础之上,治疗组予电针聚泉、廉泉、双翳风、双风池;对照组针刺上廉泉、金津、玉液、双风池、双翳风。两组治疗3周后观察疗效。结果：治疗组疗效明显优于对照组,两组总有效率比较差异有显著性（P＜0．05）。结论：电针聚泉、廉泉穴治疗假性延髓麻痹具有良好疗效。     

急性心肌梗死治疗指南对我国住院患者治疗及预后的影响

Objective To investigate the relationship between the guidelines issued by the American College of Cardiology/American Heart Association (ACC/AHA) in 2004 and the changes in early reperfusion, drug treatment and outcome of inpatients -with acute myocardial infarction (AMI) in China, and to explore what extent the guidelines are followed in the management of AMI in China, and the differences in managements and patients' outcome after its issue.Methods A retrospective study of clinical data of 1 278 patients with AMI admitted to 12 Chinese Hospitals from January 2002 to December 2006 was carried out.They were divided into two groups: group A included 734 patients admitted from January 2002 to August 2004, and group B comprised 544 patients admitted from August 2004 to December 2006.The baseline characteristics, early reperfusion, drug treatment, reinfarction, angina pectoris, heart failure,cardiogenic shock, bleeding and death were compared between two groups.The correlation between therapeutic measure and mortality was analyzed to estimate the difference between two groups, and relationship between the differences and the guidelines issued in 2004 was also analyzed.Results ①The age, sex, systolic blood pressure, history of past illness excepting old myocardial infarction of patients with AMI bore no significant difference between two groups.The incidence of Killip≥ Ⅲ in group B was lower significantly than that in group A (7.5% vs.14.7%, P＜0.01).②Reperfusion therapy was used more often in group B than in group A (78.5% vs.71.2%, P＜0.05).And percutaneous coronary intervention (PCI)therapy was used more often in group B than in group A (71.5% vs.61.0%, P＜0.01).However, the rate of lytic treatment was lower in group B than that in group A (8.6% vs.16.3%, P＜0.01).③ The percentage of use of antiplatelet drug and aspirin was both over 97.0%.The tidopidine was used more frequently in group A than in group B (54.9% vs.8.3%), and the clopidogrel and glycoprotein Ⅲ a/Ⅰ b antagonists was used more frequently in group B than in group A (83.8% vs.27.4%, 4.8% vs.0.7%,both P ＜ 0.01 ).The angiotensin-converting enzyme inhibitor/angiotensin Ⅰ receptor antagonist (ACEI/ARB) were administered more frequently in groupB than in group A (98.2% vs.93.5%, P＜0.01), and the increasing trend of ARB was obvious (13.6% vs.4.4%, P＜0.05), but the decreasing trend of ACEI was obvious also (84.6% vs.89.1%, P＜0.01).Heparin/low molecular heparin, β-blocker and statin were used more often in group B than in group A (97.4% vs.94.8%, 80.1% vs.74.8%, 87.7% vs.82.4%, P＜0.05 or P＜0.01).④ In-hospital mortality, reinfarction, angina pectoris were lower in group B than in group A (4.6% vs.7.6%, 2.8% vs.4.8%, 8.4% vs.12.4%, all P＜0.05).⑤ Multivariate Logistic regression analysis showed that reperfusion, antiplatelet drug, statin and heparin/low molecular heparin were associated significantly with in-hospital mortality (all P＜0.05).Conclusion After guideline was issued by ACC/AHA in 2004, the regime of early reperfusion and drug treatment in China had followed more closely the recommendations of the guidelines.At the same time, in-hospital mortality,reinfarctions,angina pectoris were decreased.And the changes in strategy of early reperfusion, antiplatelet drug, statin and heparin/low molecular heparin are closely related with in-hospital mortality.However, current management of AMI in China has not followed the recommendations of guidelines closely.It is essential to promote the use of β-blocker and ACEI/ARB drug treatment in China in accordance with the guidelines.     

急性心肌梗死治疗指南对我国住院患者治疗及预后的影响

目的 分析美国心脏病学会/美国心脏协会(ACC/AHA)2004年修订的急性心肌梗死(AMI)治疗指南对我国住院患者早期再灌注治疗、药物治疗和预后的影响,以及目前我国执行指南中存在的差距.方法 应用回顾性研究方法,选择2002年1月至2006年12月在全国12家医院心内科明确诊断为AMI的患者共1 278例,依据指南公布时间,将入选患者分为指南公布前组(2002年1月至2004年8月,A组,734例)和指南公布后组(2004年8月至2006年12月,B组,544例).比较两组基线特征、住院治疗措施(早期再灌注和药物治疗)、并发症(再发心肌梗死、梗死后心绞痛、充血性心力衰竭、心源性休克和出血)及病死率情况;并分别对两组住院期间治疗措施与病死率进行相关性分析.结果 ①两组AMI患者年龄、性别、收缩压、除陈旧性心肌梗死外的既往史比较差异无统计学意义;B组心功能Killip≥Ⅲ级比例低于A组(7.5%比14.7%,P＜0.01).②B组早期再灌注治疗总比例高于A组(78.5%比71.2%,P＜0.05);其中经皮冠状动脉介入治疗(PCI)比例较A组明显升高(71.5%比61.0%,P＜0.01),而溶栓治疗比例较A组明显降低(8.6%比16.3%,P＜0.01).⑧两组抗血小板药物总体使用率及其中阿司匹林使用率均大于97.0%,其中B组盐酸噻氯匹定使用率较A组明显下降(8.3%比54.9%),氯吡格雷和血小板膜糖蛋白Ⅲa/Ⅰ b(GP Ⅲ a/Ⅰ b)类药物使用率均较A组明显升高(83.8%比27.4%,4.8%比0.7%,均P＜0.01);B组血管紧张素转换酶抑制剂(ACEI)或血管紧张素Ⅰ受体拮抗剂(ARB)类药物总体使用率明显高于A组(98.2%比93.5%,P＜0.01),其中ARB类药物使用率较A组明显升高(13.6%比4.4%,P＜0.05),而ACEI类药物使用率较A组明显下降(84.6%比89.1%,P＜0.01);B组肝素或低分子肝素、β受体阻滞剂、他汀类药物使用率均高于A组(97.4%比94.8%,80.1%比74.8%,87.7%比82.4%,P＜0.05或P＜0.01).④B组住院期间病死率及再发心肌梗死、梗死后心绞痛发生率均明显低于A组(4.6%比7.6%,2.8%比4.8%,8.4%比12.4%,均P＜0.05).⑤多因素分析显示:A、B组早期再灌注、抗血小板药物及B组他汀类药物、肝素或低分子肝素与住院期间病死率有独立的显著联系(均P＜0.05).结论 2004年指南公布后我国AMI患者早期再灌注率和药物治疗的规范化程度明显提高,住院期间病死率及再发心肌梗死和梗死后心绞痛发生率明显降低,且早期再灌注、抗血小板药物、他汀类药物、肝素或低分子肝素与住院期间病死率存在独立的显著联系,与指南要求一致;但目前我国在β受体阻滞剂、ACEI/ARB类药物治疗方面仍然存在着较大提升空间.     

人股骨头表面微观形貌的表征提取及分析

目的对多个人股骨头微观形貌进行表征并提取形貌参数进行分析,为设计与制备仿生骨修复材料奠定理论基础。 方法收集43例2016至2017年度在昆明医科大学第一附属医院骨科需行人工股骨头或全髋关节置换术患者的股骨头标本,纳入标准为术前已完善骨密度检查,血液检验无异常内并签署知情同意书的患者;排除标准为存在陈旧性骨折,或患有骨代谢疾病、肿瘤、局部炎症、结核、遗传性疾病史的患者。分别按照年龄、性别、骨密度分为3组：(1)青中年组(42～59)岁(n ＝7)/老年组(60～83)岁(n ＝36);(2)男性组(n ＝21)/女性组(n ＝22);(3)骨量正常组(n ＝9),骨量减少组(n ＝13),骨质疏松组(n ＝21)。利用扫描电镜表征其表面微观形貌并用Image J软件提取形貌参数,用多因素方差分析对得到的微观形貌参数数据(直径、角度、长度)进行统计学分析。 结果不同组别的骨表面微观形貌存在着不同现象。(1)骨质疏松组：矿化胶原纤维束直径(1.57±0.46)μm、长度(19.14±7.98)μm、角度(66.67±9.40)°;骨量减少组：矿化胶原纤维束直径(2.02±0.71)μm、长度(23.10±7.89)μm、角度(51.66±14.78)°;骨量正常组：矿化胶原纤维束直径(2.22±0.25)μm、长度(27.02±12.25)μm、角度(46.85±7.53)°。3组之间直径差异有统计学意义(F ＝33.687,P<0.01),LSD-t两两比较,骨质疏松组和骨量正常组直径组间差异有统计学意义(P<0.05);3组之间及组间的角度、长度参数差异有统计学意义(F ＝19.614,P<0.05)。(2)老年组与中青年组胶原纤维束数据分别为：直径(1.76±0.62)μm和(2.22±0.25)μm(t ＝－2.896,P<0.01)、角度(60.51±13.99)°和(46.85±7.53)°(t ＝7.674,P<0.01)、长度(20.89±8.11)μm和(27.02±12.25)μm(t ＝－2.653,P<0.05)。(3)不同性别两组间的角度差异较大(t＝2.375,P<0.05),其余组数据差异无统计学意义(P>0.05)。 结论扫描电镜技术可对股骨头骨表面微观形貌进行表征,运用Image J软件处理电镜图像可以准确可靠地提取微观形貌参数。不同的骨状态会导致骨表面微观形貌发生变化,即矿化胶原纤维束的直径、长度、取向分布的不同。     

Fire-needle therapy for deglutition disorders in post-stroke pseudobulbar palsy: a randomized controlled trial

Objective

To observe the clinical efficacy of fire-needle therapy in treating deglutition disorders due to pseudobulbar palsy in the remission stage of stroke.

Methods

Sixty-two eligible subjects were divided into a fire-needle group and a rehabilitation group by a simple randomization method at a ratio of 1:1. The two groups received same basic intervention; in addition, the fire-needle group received fire-needle treatment, while the rehabilitation group received rehabilitation training. The two groups of subjects all received a 3-week treatment and were evaluated by the dysphagia severity rating scale (DSRS), modified Mann assessment of swallow ability (MMASA) and Kubota Toshio swallow test (KTST) before and after the intervention. The complications and adverse events occurred during the trial were recorded. The data were statistically analyzed.

Results

At the third week, the DSRS, MMASA and KTST scores changed significantly compared with the baseline in both groups (P<0.05), and the changes in the fire-needle group were more significant than those in the rehabilitation group (P<0.05). The between-group comparison at the third week showed that the therapeutic efficacy in the fireneedle group was superior to that in the rehabilitation group (P<0.05).

Conclusion

Fire-needle therapy can obviously change the DSRS, MMASA and KTST scores in pseudobulbar palsy in the remission stage of stroke, and significantly enhance the therapeutic efficacy of the treatment of deglutition disorders in this stage.

     

雨蛙肽对胃运动的影响及其机制的研究

雨蛙肽(Caerulein)系澳大利亚产的蛙HYla Caerulea的皮肤提取物,由10个氨基酸组成。其氨基酸的排列顺序和生物学效应与八肽胆囊牧缩素相似。雨蛙肽已能人工合成,并应用于胆囊功能的检查。但它对胃肠运动的影响及其作用机制尚不清楚。阐明这个问题,有生理学的理论意义和临床的实践意义。实验选用大鼠,分在体和离体两种方     

齐刺治疗不宁腿综合征的临床观察

目的：观察针灸齐刺足运感区的临床疗效。方法：选取不宁腿综合征患者31例。采用足运感区加局部取穴,以足运感区为主穴,配合关节局部选穴及循经取穴,针灸齐刺后予以电针。结果：31例中治愈0例、显效10例、好转15例、无效6例,总有效率为80.65%。结论：针灸齐刺治疗不宁腿综合征有较好的疗效,能减轻患者的异常不适感,提高生活质量。     

0.25?mg低剂量硝酸甘油激发直立倾斜试验在血管迷走性晕厥诊断中的应用

目的评价0.25 mg低剂量硝酸甘油激发直立倾斜试验(head-uptilttesting,HUTT)诊断血管迷走性晕厥(vasovagal syncope,VVS)的临床可行性。方法入选疑似VVS患者进行0.25 mg低剂量硝酸甘油激发HUTT检查,通过无创连续逐搏血压监测数据的脱机分析,获取阳性率和达到阳性反应时间,并与既往国内外研究相比较。结果共入组疑似VVS患者343例,241例(70.3%)在HUTT过程中出现了阳性结果,其中混合型83例(34.4%),心脏抑制型2例(0.8%),血管减压型156例(64.7%)。低剂量硝酸甘油药物激发阶段阳性率与国外既往研究差异无统计学意义,整体阳性率与国外既往研究差异无统计学意义,但高于国内既往研究(70.3%vs 64%,P=0.016)。低剂量硝酸甘油激发阶段出现阳性反应的时间低于国外既往使用0.3 mg片剂舌下含服激发的研究(5.0±2.2 min vs 7±8 min,P=0.001),与使用0.4 mg硝酸甘油舌下喷雾研究结果的差异无统计学意义(P0.99)。结论 0.25 mg低剂量硝酸甘油激发HUTT的阳性率和达到阳性反应时间与国外0.4 mg硝酸甘油激发HUTT的结果无差异,具有临床应用的可行性。     

针刺丘脑底核后帕金森病模型大鼠抗氧化能力的变化

背景:针灸在治疗帕金森病的有效性已为临床及实验所证实,但是临床仍缺乏系统、完整、可遵循的治疗原则和规律。目的:观察针刺丘脑底核对帕金森病大鼠损毁侧纹状体谷胱甘肽、谷胱甘肽过氧化物酶、超氧化物歧化酶、丙二醛、一氧化氮合酶的影响。设计:随机对照动物实验。单位:黑龙江中医药大学第二附属医院。材料:实验于2003-01/06在黑龙江中医药大学实验动物中心实验室进行。取健康清洁级成年Wistar大鼠18只,单纯随机分为3组:电针组、模型组、盐水组,每组6只。方法:①模型组:将6-羟基多巴(12μg溶于5μL含2g/L抗坏血酸的生理盐水中)缓慢注入尾壳核,建立纹状体毁损帕金森病大鼠模型,不干预。②盐水组:将6-羟基多巴改为等剂量的生理盐水,其余处理同模型组。③电针组:同模型组造模,术后6周丘脑底核埋针,1周后进行电针治疗(频率为100Hz,强度1mA左右),1次/d,15min/次,连续治疗2周。主要观察指标:所有大鼠在电针组大鼠电针2周后麻醉状态下断头取脑,比色法检测谷胱甘肽、谷胱甘肽过氧化物酶、超氧化物歧化酶、丙二醛和一氧化氮合酶活性。结果:18只大鼠进入结果分析。①丙二醛浓度:模型组和电针组均高于盐水组[(5.53±0.71),(4.10±0.27),(5.53±0.71)μmol/L,P<0.01],但电针组低于模型组(P<0.05)。②谷胱甘肽和谷胱甘肽过氧化物酶活性:模型组和电针组均低于盐水组(P<0.01),但电针组高于模型组(P<0.05)。③一氧化氮合酶活性:模型组和电针组均高于盐水组[(113.36±2.17),(73.85±5.17),(42.34±1.83)μkat/g,P<0.01],但电针组低于模型组(P<0.01)。结论:针刺后帕金森病模型大鼠抗氧化防御能力得到恢复,神经损伤减轻。说明针刺脑内核团治疗帕金森病的方法是可行的、有效的。