幕上适时去骨瓣减压治疗重型颅脑损伤的术中应用

目的：探讨幕上适时去骨瓣减压治疗重型颅脑损伤的效果。方法：对笔者所在医院2008年1月-2012年12月幕上适时去骨瓣减压治疗重型颅脑损伤23例进行回顾性分析。结果：良好17例（73．91％）,中残3例（13．04％）,重残2例（8．7％）,植物生存1例（4．35％）,无死亡病例。结论：根据患者的年龄、血肿的情况、术中脑膨出的程度,采取适时去骨瓣减压也是治疗重型颅脑损伤的较好方法。     

多层螺旋CT对胃肠道间质瘤的诊断分析

目的：探讨胃肠道间质瘤在16层螺旋CT平扫及增强的影像学表现。方法：回顾性分析25例经手术病理证实的胃肠道间质瘤的螺旋CT表现。结果：25例胃肠道间质瘤的主要CT表现：向胃肠道腔内、外生长或跨胃肠道壁生长的软组织肿,肿块密度均匀或混杂。增强后,良性肿块密度均匀,强化显著,恶性肿块,周边强化,内见液化坏死及囊边区域,部分可见溃疡形成。结论：16层螺旋CT平扫及增强扫描能够反映肿瘤的特点,有助于胃肠道间质瘤的准确定位,能够反映肿瘤与周围组织结构的关系。     

Pharmacist intervention reduces gastropathy risk in patients using NSAIDs

Objective To establish a detection and intervention strategy in order to reduce the number of non-steroidal anti-inflammatory drug (NSAIDs) users at risk of gastropathy from receiving either inadequate or no gastroprotection. Setting Community Pharmacies in Valencia, Spain. Method Prospective longitudinal intervention study without control group carried out by 79 Community Pharmacies. Patients over 18 who asked for any systemic NSAID were interviewed according to standard procedure. Pharmacist intervention was carried out when a patient at risk of serious NSAID-induced gastrointestinal complications due to inadequate or no gastric protection was identified. The doctor responsible was informed in order to then be able to assess the need to prescribe gastroprotection or change it if inadequate. In the case of over-the-counter (OTC) drugs, pharmacist intervention mainly involved replacing NSAIDs for safer medications. Main outcome measure Firstly, the number of patients who had no prescribed gastroprotection or inadequate gastroprotection was determined. Pharmacist intervention then brought about changes in pharmacotherapy in this situation. Results Of the 6,965 patients who asked for NSAIDs during the study period, 3,054 (43.9%) presented NSAID gastropathy risk factors. 35.6% of the latter (1,089) were not prescribed gastroprotection or were prescribed inadequate gastroprotection. Pharmacist intervention was carried out in 1,075 of these cases. On 391 occasions such risk situations were reported to doctors, who accepted pharmacist intervention on 309 occasions (79.0%) and then either prescribed gastroprotection (77% of cases); changed it (13.9%); withdrew the NSAID (5.8%) or substituted it (3.2%). 235 Pharmacist interventions took place when dispensing OTC NSAIDs. Conclusion Our strategy allowed us to identify a large number of patients who asked for NSAIDs in Community Pharmacies and who were at risk of NSAID gastropathy, as they received either inadequate gastroprotection or no gastroprotection whatsoever. Moreover, the pharmacist intervention carried out has reduced the number of these risk situations.     

抗血小板药物致消化道损伤患者的药学干预

目的探讨对抗血小板药物致消化道损伤患者进行药学监护的方法。方法为1例抗血小板药物致消化道损伤患者制订并实施个体化的药学监护计划,同时根据药物的临床疗效及时调整药学监护方案。结果临床药师以抗血小板药物和质子泵抑制剂的合理使用作为切入点,开展药学监护。结论对抗血小板药物致消化道损伤患者实施全程的药学监护,可及时发现并解决患者的药物治疗问题,促进合理用药,提高治疗水平。     

CT在胃肠道穿孔定位诊断中的价值

目的探讨CT在胃肠道穿孔定位诊断中的价值。方法对16例成人胃肠道穿孔患者进行回顾性分析。结果16例患者中,胃、十二指肠球部穿孔9例,十二指肠腹膜后段穿孔1例,空回肠穿孔4例,阑尾炎穿孔1例,结肠癌伴穿孔1例。CT表现为：气腹、腹膜腔及腹膜后间隙积液、穿孔部位局限性肠壁增厚和周围脂肪间隙模糊。结论CT不仅能确定有无胃肠道穿孔,而且能初步判断其穿孔部位。其中局限性肠壁增厚及周围脂肪间隙密度增高、邻近腹腔、腹膜后间隙积液为诊断穿孔部位较为特异性的征象。     

微血管减压术治疗颅神经根疾病152例临床分析

目的：探讨微血管减压术治疗颅神经根疾病三叉神经痛、面肌痉挛、舌咽神经痛手术方法、特点。方法分析152例颅神经疾病患者,包括原发性三叉神经痛81例,面肌痉挛69例,舌咽神经痛2例的手术方法及并发症。结果原发性三叉神经痛手术有效率为91.36%;面肌痉挛手术效率为89.86%;舌咽神经痛2例,术后均取得满意效果。结论微血管减压手术是有效的,但风险大,良好的手术策略对于提高手术疗效具有重要意义。     

中西医结合治疗成人股骨头缺血坏死120例

采用中西医结合疗法 ,经皮股骨头内减压引流、靶血管脉冲式加压药物灌注、髂内动脉部分血管栓塞灌药和口服中药治疗成人股骨头缺血坏死 12 0例。通过 12～ 36个月的随访观察 ,髋关节疼痛缓解率为 92 5 0 % ,关节活动度改变率为 96 67% ,DSA检查血管增加达 88 33% ,CT、X线片股骨头骨质改变占 5 5 83%。综合疗效优于任何单项治疗     

癌症高发区致癌性多环芳烃的生物监测

目的对河南省沈丘县人群多环芳烃(PAHs)暴露水平进行生物监测,评价PAHs暴露与消化道癌症的关联性。方法采用病例对照研究方法,分别募集自河南省沈丘县肿瘤高聚集区和低聚集区的41例食管癌、26例胃癌、17例肝癌患者和19例健康对照,采用固相萃取-超高效液相色谱-串联质谱法检测血中3种致癌性多环芳烃苯并(a)芘(BaP)、苯并(g,h,i)苝[B(g,h,i)P]、二苯并(a,h)蒽[DB(a,h)A]暴露水平和尿中2-羟基萘(2-OHN)、2-羟基芴(2-OHF)、1-羟基芘(1-OHP)3种羟基多环芳烃代谢水平,用SPSS17.0进行数据分析。结果 66.9%的研究对象尿中1-OHP高于一般居民生物暴露限值(0.11μmol/mol Cr)。肿瘤高聚集区和低聚集区人群间多环芳烃暴露水平差异无统计学意义(P>0.05);高、低聚集区病例组血中B(g,h,i)P暴露水平均高于对照组,差异具有统计学意义(P<0.05)。随着体内B(g,h,i)P暴露水平的增加,消化道癌症的发病风险增加。结论该地区研究人群的PAHs暴露水平普遍较高,食管癌、胃癌及肝癌的发病可能与某些致癌性多环芳烃的暴露有关,需要进一步研究进行证实。     

家兔实验性减压病时血浆中血拴素A_2及前列环素含量的变化

实验观察了“安全”减压和不适当减压条件下家兔减压病(DCS)的发病情况、Doppler超声以及血浆中TxB_2和6-keto-PGF_(1a)的变化;还观察了消炎痛对DCS的预防怍用。结果显示:减压愈不当,DCS发病愈重,Doppler超声气泡探测仪检测到的级别愈高。血浆TxB_2、6-keto-PGF_(1α)值在濒死动物中明显升高(P<0.01);存活动物中,TxB_2经历了下降、再恢复的过程(P<0.01),而6-keto-PGF_(1α)值未见明显变化。消炎痛在抑制血浆TxB_2升高的同时,有效地降低了DCS发病率。此结果表明:TxA_2、PGI_2参与了重型DCS的发病过程,消炎痛的顶防作用与抑制花生四烯酸代谢物的生成有关。     

脑肠肽ghrelin在胃肠功能中的研究进展

脑肠肽激素ghrelin是一种引起生长激素释放的多肽,是迄今发现的唯一生长激素释放激素受体(GHSR)的内源性配体。循环中的生长激素释放肽主要由胃黏膜产生。Ghrelin可促进胃肠运动、调节能量代谢和影响心血管功能等。有很多研究发现,ghrelin与胃肠功能关系密切,以下就这些方面研究进展作一综述。