妊娠期口服降糖药评价

对于孕期是否可应用口服降糖药，本次会议也进行了热烈讨论，主要评价了第2代磺脲类降糖药、格列本脲以及二甲双胍类降糖药孕期应用指征、有效性和安全性。尽管近年来多项随机对照研究显示，格列本脲可以在妊娠中、晚期用于治疗GDM，但不建议在孕前期糖尿病患者中应用。二甲双胍类药物在孕期用于治疗GDM与胰岛素同样有效，患者接受性好。接受二甲双胍治疗的孕妇部分需加用胰岛素治疗。     

全肺放疗治疗双肺多发转移癌24例分析

目的:探讨全肺放疗治疗肺转移癌的价值.方法:1999年3月～2003年5月我院肿瘤科收治24例双肺多发肺转移癌患者,均给予全肺放疗.现对这些患者的临床资料进行总结分析.结果:本组放疗结束时转移瘤CR率为37.5%(9/24),PR率为50.0%(12/24),有效率(PR+CR)达87.5%.原发肿瘤为鼻咽癌、乳腺癌、肝癌、结直肠癌的中位生存期分别为13.5、22.0、10.5月、8.5月.1～2级放射性肺炎发生率为25.0%(6/24);3级为16.7%(2/24);4～5级为0.结论:恶性肿瘤肺多发转移可以采用全肺放疗+局部小野补量治疗,尤其适用于原发肿瘤对放疗中高度敏感、化疗无效的患者,可获得较好疗效.毒副作用可耐受.     

止血带双交叉结扎法在浅静脉穿刺中的应用

浅静脉穿刺是临床最基本的护理技术操作之一，在护理工作中占有很重要的位置，是确保病人治疗乃至危重病人抢救成功的关键。因各种原因导致的血管充盈度差的浅静脉穿刺是护理工作中比较棘手的问题之一。在临床护理工作中，我们发现对静脉血管充盈度差者采用常规止血带结扎法，静脉血管充盈度往往不理想。因此，我们自2003年6月始对600例次输液者     

盆腔脂肪增多症1例

1 病历摘要 患者，男，38岁，主因“体检行B超检查发现双肾积水，双输尿管扩张”入院。追问病史，有尿频、夜尿增多10余年。查体：BP130／85mmHg，下腹略膨隆，双肾区无叩痛。耻骨上区饱满，无压痛。肛诊发现前列腺位置抬高，未能触及。ⅣU检查示：两侧肾小盏杯口变钝，双侧输尿管扩张迂曲，均以右侧为甚；膀胱位置异常，位于小骨盆腔上方，     

直肠癌超低位前切除双吻合器吻合术37例护理

2000年1月～2003年1月作者收治37例行超低位前切除双吻合器吻合术的直肠癌患者,探讨其护理需求和重点.     

应用输尿管镜放置双J管早期治疗输尿管阴道瘘

Objective To evaluate the clinical effect of placing double J stent using a ureteroscope in early managing ureterovaginal fistula.Methods Twenty-eight patients cases with ureterovaginal fistula from 2002 to 2008 were treated early with placing double J stent using a ureteroscope and the clinical data were reviewed.Results Twenty-two of 28 cases were treated and double J stent was placed in them by a uretero-scope and 75% (21/28)of cases were cured.Four of 21 cases were treated twice by a ureteroscope and were cured finally.7 cases with failure ureterovaginal treatment underwent ureterocystostomy and were cured.The follow-up from 6 months to 33 months (average 10.1±6.4 months)showed that all of the 28 cases had been cured and had no urinary fistula.Conclusion Placing double J stent using a ureteroscope is the first choice of operative procedure for the early treatment of ureterovaginal fistula.     

胆胰疾病双支架置入适应证的探讨

对部分胆胰疾病的胆胰管置入单支架目前已相当普及,但同时置入双支架还不多见,仅见于胰头癌双管受阻时插入胆胰管双支架。双支架具有能持续加倍扩张的优点。我们对20余例患者采用双支架或多支架引流后获得了更好的效果,现介绍几例典型病例对其适应证作一探讨,以便使更多的患者得益于微创的内镜治疗。     

二甲双胍治疗非酒精性脂肪性肝病23例报告

近年来,我们采用二甲双胍治疗非酒精性脂肪性肝病(NAFLD)患者23例,效果较好。现报告如下。临床资料:本文46例患者均符合中华医学会肝脏病学分会制定的NAFLD的诊断标准,且均合并2型糖尿病和(或)糖耐量异常。其中男19例、女27例,年龄(42±8)岁,丙氨酸氨基转移酶(ALT)(64±28)mU/L。将患者随机分治疗组和对照组各23例,两组临床资料有可比性。方法:在合理饮食、运动、治疗原发病的基础上,治疗组应用二甲双胍0.5~1.5 g/d,对照组不用二甲双胍或其他胰岛素增敏剂。胰岛素或其他类降糖药两组都可以用,均以空腹血糖≤7.2 mmol/L,餐后2 h血糖≤…     

应用输尿管镜放置双J管早期治疗输尿管阴道瘘

Objective To evaluate the clinical effect of placing double J stent using a ureteroscope in early managing ureterovaginal fistula.Methods Twenty-eight patients cases with ureterovaginal fistula from 2002 to 2008 were treated early with placing double J stent using a ureteroscope and the clinical data were reviewed.Results Twenty-two of 28 cases were treated and double J stent was placed in them by a uretero-scope and 75% (21/28)of cases were cured.Four of 21 cases were treated twice by a ureteroscope and were cured finally.7 cases with failure ureterovaginal treatment underwent ureterocystostomy and were cured.The follow-up from 6 months to 33 months (average 10.1±6.4 months)showed that all of the 28 cases had been cured and had no urinary fistula.Conclusion Placing double J stent using a ureteroscope is the first choice of operative procedure for the early treatment of ureterovaginal fistula.     

注射肉毒毒素中毒致呼吸肌麻痹一例

临床资料患者女性，25岁，主因“吞咽困难、双上肢无力2周，呼吸肌麻痹、双下肢无力2d”于2006年6月23日入院。2周前感吞咽困难、呼吸费力和双上肢无力。2d前急诊就诊时突然呼吸停止、意识丧失。即刻经口气管插管、气管切开、机械通气。数分钟后意识恢复，但仍无自主呼吸，四肢无力。既往体健，否认腐乳、腊肠、腌制食品等食入史。查体：意识清楚；双眼裂1．1cm，双瞳孔等大等圆，直径2．5mm，对光反射灵敏；双额纹、面纹浅；耸肩、转颈、抬头不能；双上肢肩关节肌力Ⅱ级，肘关节Ⅲ级，腕、指关节Ⅴ级；双下肢髋关节肌力Ⅱ级，膝关节Ⅲ级，踝、趾关节Ⅴ级；