前进中的北京协和医院中医科

<正>北京协和医院是医学的殿堂,也是成就名医的摇篮。近百年来培养了林巧稚、黄家驷、张孝骞等医林巨擘,同时也造就了祝谌予、史济招、张育轩、郭赛珊等一批著名中医、中西医结合大家,成为协和中医及中西医结合领域的奠基人及传承者,他(她)们培养了许多中医及中西医结合的优秀人才,为学科的发展和建设做出了重要的贡献。多年来,协和中医人在继承中创新,在创新中超越。利用西医医院的综合优势,因势利导,扬长避短,自强不息,努力拼搏,发挥中医特色,用疗效来证明中医存     

BiPAP联合硝普钠、吗啡救治急性左心衰临床研究

目的探讨Bi PAP、硝普钠、吗啡联合应用在抢救中老年人急性左心衰的临床疗效及安全性。方法选择80例急性左心衰患者,随机分为两组,即急救治疗组40例,急救对照组40例。两组均在治疗原发病、祛除诱因、强心、利尿等常规治疗基础上,治疗组应用Bi PAP持续正压通气,联合硝普钠、吗啡、扩血管、镇静,对照组应用鼻导管吸氧、硝酸甘油、安定。比较两组疗效及安全性。结果治疗组总有效率97.5%,在PP、RR、SPO2、p H、PO2、PCO2比对照组(对照组总有效率70.0%)有明显改善,差异有统计学意义(P0.05)。结论急性左心衰在常规治疗基础上联合应用Bi PAP、硝普钠、吗啡更快改善患者的生命指标,缓解临床症状,疗效安全可靠。     

抗血栓药物的应用与前列腺穿刺活检术的安全性

前列腺癌的发病率位于男性恶性肿瘤的第一位，前列腺穿刺活检术是目前诊断前列腺癌的金标准，关于前列腺穿刺活检术前是否须停用抗血栓药物尚无定论。总结既往研究提示，口服抗血栓药物对于前列腺穿刺活检术是相对安全的。对于心脑血管意外高风险患者，建议围手术期可以不停用抗血栓药物。     

系统性红斑狼疮治疗新选择

系统性红斑狼疮的治疗现状并不令人满意:部分患者疾病控制欠佳,且药物相关不良反应较多,因此需要治疗狼疮的新型药物,各国研究者正在进行不断的探索和创新。目前药物研究热点包括抑制B淋巴细胞激活因子(B-cell activating factor,BAFF)、抑制干扰素途径、抑制T细胞和B细胞信号传导的药物等。本文对2018年3月在德国举办的第11届欧洲狼疮大会提到的新型药物治疗进行概述。     

急性重症溃疡性结肠炎的诊治

急性重症溃疡性结肠炎(ASUC)为内科急症,需要迅速判断和及时处理。静脉使用激素为其一线治疗方案,但超过30%的患者对激素抵抗。激素治疗3 d,需及时判断疗效,对激素抵抗者需选择转换治疗方案。环孢素和英夫利西单抗作为拯救治疗显示出较好的疗效和安全性。如药物拯救治疗4～7 d仍无效,则需考虑手术治疗。全结直肠切除术加回肠储袋肛管吻合术是标准术式,推荐三期手术方案,并注意术后并发症。ASUC的诊治需要内、外科等多学科协作,以改善疾病预后,降低死亡率。     

卵巢子宫内膜异位囊肿粘连程度及相关因素分析

Objective To investigate the relationship between degree of endometrioma adhesions and clinical feature, surgical treatment and postoperative recurrence. Methods From Jan 2003 to Mar 2008, 662 patients with endometrioma undergoing laparoscopic ovarian endometrioma excision in Peking Union Medical College Hospital were studied retrospectively. All patients were classified into four groups according to the extent of adhesions: 31 cases in none adhesions group, 123 cases in mild adhesions group (filmy thickness, avascular, easily separated adhesions), 310 cases in moderate adhesions group (less than a half of ovary was adjacent to dense thickness adhesions which was difficult to separate, or above a half of ovary were adjacent to filmy thickness adhesions) and 198 cases in severe adhesions group (above a half of ovary was adjacent to dense thickness, well vascularized adhesions which was difficult to separate, and always involved the other pelvic organs, observed angiogenesis). The comparison of degree, characteristics, period of pain, lab test, surgical management and postoperative recurrence was performed among those above groups. In the mean time, risk factors and multinomial logistic regression were analyzed. Results (1)Clinical characteristics: The incidence of patients with dysmenorrhea, dyspareunia, straining feeling in anus, chronic pelvic pain and the level of CA125 (>35 kU/L) was remarkably higher in moderate-to-severe adhesion groups than in none-to-mild adhesions groups (P=0.000, 0.000, 0.001, 0.006 and 0.000, respectively). Infertility rate were significantly higher in severe adhesions group(15.7%,31/198) than none adhesions group(3.2%,1/31), mild adhesions group(11.4%,14/123) and moderate adhesions group(9.7%,30/310, OR=1.728, P<0.05).(2)Operating time and blood loss: Operating time of each groups was as followed: (37±15) min in none adhesions group, (42±19) min in mild adhesions group, (50±20) min in moderate adhesions group and (63±22) min in severe adhesion group. Blood loss was (23±12) ml in none adhesion group, (31±27) ml in mild adhesion group, (40±32) ml in moderate adhesion group and (70±67) ml in severe adhesions group. Thicker adhesions result in longer operation time and more blood loss. (3)Combined with other disease: The ratio of patients who combined with adenomyosis or deeply infiltrating endometriosis in moderate-to-severer adhesion groups was higher than patients in none-to-mild adhesions groups (OR=3.466, P=0.000). (4) Postoperative recurrence: It was categorized into recurrence of pain and cyst. Moderate-to-severe adhesions was related to higher recurrence rate of pain (OR=1.685,P=0.046), but was irrelevant to recurrence of cyst. Conclusion The more extent of endometrioma adhesions was related to severer pelvic pain symptoms, longer operating time and more blood loss. Postoperative pain recurrence rate was observed in moderate-to-severe adhesion group. Extent of adhesions was irrelevant to cyst recurrence.     

脊柱侧凸治疗中相关问题探讨：对胸腰段或腰段特发性脊柱侧凸是行前路手术还是后路手术？

随着脊柱外科的发展，参与脊柱侧凸治疗的医生越来越多，矫形器械不断进步，矫形手段不断增多。在脊柱侧凸的诊治中，也存在一些有争议和值得探讨的问题。如：对胸腰段或腰段侧凸是行前路手术还是行后路手术？对先天性胸腰椎半椎体畸形如何选择手术时机、芳式和入路？怎样使脊柱侧凸微创技术健康发展？如何掌握退变性脊柱侧凸的手术适应证？等等。为此，本刊特邀了有关专家对上述问题进行讨论，供同道们参考。[编者按]