改良泪道探通术注入素高捷疗眼膏治疗泪道阻塞的临床观察

目的 :探讨改良泪道探通术注入素高捷疗眼膏治疗泪道阻塞的临床效果。方法 :用 7～ 9号腰脊穿刺针针头去尖 ,磨光后制成改良空管式泪道探针。为慢性泪囊炎 98例、10 2眼探通泪道后沿空管注入素高捷疗眼膏 ,使之布满泪道内壁 ,尽快修复探通的泪道内皮 ,达到扩张疏通的目的。以同一疾病 84例、85眼为对照组 ,以 1～ 3号银质泪道扩张针扩通泪道 ,留针 15min ,隔日 1次 ,共扩张 2～ 3次 ,扩张后用 0 .2 5 %氯氟液冲洗。结果 :术后随访 3个月 ,观察组治愈率为 97.0 5 %,对照组治愈率为 9.4 1%,差异有高度显著性 (P<0 .0 1)。 结论 :用改良的泪道探针探通泪道后注入素高捷疗眼膏 ,促使泪道修复 ,是治疗泪道阻塞或狭窄的有效方法。     

预防性联合断流术治疗肝炎后门静脉高压症32例

2000年2月～2005年12月，我们对乙型肝炎后肝硬化门静脉高压症32例行预防性门奇联合断流（Sugiura）术，疗效满意。现报告如下。     

以肺动脉高压为主要表现的肺梗塞1例

肺梗塞患者症状常不典型,呈非特异性,极易误诊。2002年我科诊治1例以肺动脉高压为主要表现的肺梗塞患者,在外院和我院多次被误诊,现报告如下。1临床资料患者女,90岁,活动后气促2个月入院。既往有高血压、高血脂、脑梗塞病史,无心绞痛及心肌梗塞病史。2个月来在外院和我院门诊多次就医,均诊断为冠心病、心力衰竭,治疗效果欠佳。入院查体:体温36.9℃,脉搏90次/min,呼吸26次/min,血压165/105mmHg。颈静脉充盈,双肺底少许湿性啰音脑辔拊右簟8卧辔创ゼ啊K轮枷菪运住Q治觯貉醴盅?0mmHg,氧饱和度0.80。心电图:胸前导联V5～7ST段压低…     

泪道探通注油联合甲硝唑冲洗治疗的应用

目的:讨论泪道探通注油联合甲硝唑冲洗治疗慢性泪囊炎、泪道阻塞的疗效及优点。方法:用普通9号针头(自制:针头磨顿且有一定的弧度)接盛有红霉素眼膏(加热熔化)的皮试管或2 m l注射器,按泪道探通法探通泪道(勿成假道),然后边注油边退针,速度要慢,使油膏充满整个泪道。1周后用甲硝唑冲洗。结果:治疗238例246眼,一次性探通注油冲洗治愈占85%,2次探通冲洗治愈占10%,4次探通注油冲洗治愈占5%。体会:(1)慢性泪囊炎冲洗无脓液时且鼻腔无感染病灶时方按此法进行。(2)红霉素眼膏系油剂注入泪道既可抗菌消炎,又可有效的防止再粘连而控制复发。(3)甲硝唑是抗厌氧菌及革兰阴性菌的特效药,局部用药可直接杀死细菌,且毒性小,无副作用。(4)此法操作容易,器械简单,病人痛苦小,花钱少易接受。     

前列腺素E1对血管内皮生长因子含量的影响及其与肺小动脉病理分级的关系

目的 研究应用前列腺素E1(PGE1)对先天性心脏病合并肺动脉高压(PH)患者血清血管内皮生长因子(VEGF)含量的影响及其与肺小动脉病理分级的关系. 方法 2002年1月至2003年6月共收治先心病合并PH患者53例(MPAP＞20 mmHg),其中有明显紫绀6例(MPAP＞90 mmHg).入院后静脉滴注PGE1 10～15ng/kg*min,每天用药12小时,连续15天.分别于用药0、5、10和15天晨抽取静脉血,采用酶联免疫吸附法(ELISA)测定血清VEGF含量.做肺组织活检,按Heath和Edwards分类进行病理分级,观察肺小动脉的病理改变. 结果病理分级:Ⅰ级9例,Ⅱ级14例,Ⅲ级19例,Ⅳ级5例,≥Ⅴ级 (紫绀者)6例.应用PGE1前,肺小动脉病理分级Ⅲ级时血清VEGF达到峰值,Ⅳ级、特别是≥Ⅴ级后有明显下降的趋势;应用PGE1后,Ⅰ级血清VEGF与用药前比较差别无显著性意义(P>0.05),Ⅱ、Ⅲ级者血清VEGF明显降低(P<0.01),Ⅳ级者有轻度的降低(P<0.05),而≥Ⅴ级患者无明显变化(P>0.05). 结论 PGE1可降低血清VEGF含量, 其降低幅度与肺小动脉病理改变程度有较密切的关系,可作为术前判断肺小动脉病理分级的一个参考指标.     

不同门奇断流术式对门静脉高压症犬食管下段血管再生的影响

Objective To explore the effect on blood vessel regeneration of distal esophagus in ca-nines of portal hypertension with liver cirrhosis after different procedures with paraesophagastrie devascular-ization. Methods Portal hypertension models were produced in canines by subcutaneous injection of 60% CC14 combined with food restriction. Forty eight model canines were randomly divided into 4 groups: group A, traditional paraesophagastrie devascularization;group B, selective paraesophagastric devascularization;group C, paraesophagastric devascularization plus distal esophageal transaction and reanastomosis with sta-pler;group D,control group. Every group had 12 canines which were randomly divided into A1 ,B1 ,C1 ,D1, A2,B2,C2 and D2 groups after the operation. Canines in groups A1 ,B1 ,C1 and D1 were executed at first month after the operation,and those in groups A2, B2, C2 and D2 were executed at the 6th month after the operation. The distal esophagus was segmented when the canines were executed. The upside and downside of the stoma in group C were distinguished and signed as Ca and Cb. Immunohistochemieal methods were used to detect VEGF,CD34 and FVⅧ-Rag,blood vessel-related factors,in lower esophagus. Results The expres-sion levels of VEGF and CD34 MVD,FⅧ-Rag MVD in groups A1 ,B1 and C1 were lower than those in group D1 one month after the operation (P <0.05). All the indices in group B1 were lower than those in groups A1 and Clb,but higher than those in group Cla (P <0.05). The indices in group Cla were lower than those in group C1b (P < 0.05 ). The indices in groups A2 and B2 were higher than those in groups A1 and B1, re-spectively at the 6th month after the operation (P <0.05). They were higer in outer membrane in group C1a than in group C2a (P <0.05). The indices in group C2b were higher than those in group Clb (P<0.05). Conclusion At the first month after operation, the expression of blood vessel-related factors was declined in three different procedures of paraesophagastric devascularization,which indicated that all three different pro-cedures could diminish the vessels in distal esophagus. The effect in group C was most obvious among all groups. At the 6th month after traditional paraesophagastrie devascularization and selective paraesophagastrie devascularization, the expression of blood vessel-related factors in distal esophagus was declined. But there were no significant changes in the expression of blood vessel-related factors in distal esophagus after parae-sophagastric devascularization plus distal esophageal transaction and reanastomosis with stapler. It indicated that the blood vessel regeneration in paraesophagastric devascularization pins distal esophageal transaction and reanastomosis with stapler was inferior to that in other procedures.     

胰源性区域性门脉高压症

区域性门脉高压症(renional portal hypertension，RPH)亦有称为“左侧门脉高压”、“局限性门脉高压”等，占肝外型门脉高压症的5％，但却是唯一可治愈的门脉高压症。据病因RPH可分为胰源性、脾源性和腹膜后源性三类，其中以胰源性最为常见。可能的原因为随着酒类、脂质类消费上升，诊疗技术水平及认识程度的提高，目前对RPH、特别是胰源性RPH的发现率日益增高。     

阻塞型睡眠呼吸暂停低通气综合征患者血管活性肠肽与睡眠质量的关系

为明确阻塞型睡眠呼吸暂停低通气综合征 (OSAHS)患者清醒及不同睡眠期血中血管活性肠肽 (VIP)质量浓度与睡眠质量之间的关系 ,以 1 2例OSAHS患者为研究对象 ,在桡动脉内留置导管监测血压 ,同步进行夜间多导睡眠仪连续记录 ,并分别于睡前清醒时、非快动眼 (NREM)睡眠期、快动眼 (REM )睡眠期及清晨从桡动脉留置的导管内抽取血标本 ,采用放免分析法检测VIP。结果 :1 )睡前清醒时及清晨血VIP质量浓度与总睡眠时间和记录时间之比(TST/TRT ,睡眠效率 )成正相关 (r =0 .5 91 ,P <0 .0 5 ) ,与醒觉时间和记录时间之比 (Arousal/TRT)成负相关 (r =-0 .5 86,P <0 .0 5 ) ;以睡前清醒时作基础值 ,NREM期血VIP质量浓度的变化与快波睡眠和总睡眠时间之比 (Ⅰ +Ⅱ /TST)成负相关 (r=-0 .65 6,P <0 .0 5 ) ,与快动眼睡眠时间和总睡眠时间之比 (REM/TST)成正相关 (r =0 .70 5 ,P <0 .0 1 ) ,REM期血VIP质量浓度的变化与REM/TST成正相关 (r=0 .60 9,P <0 .0 5 ) ;2 )OSAHS患者清醒与不同睡眠期血中VIP质量浓度与最长呼吸暂停时间和睡眠呼吸暂停指数 (AHI)成正相关 ,与血氧的有关指标无相关性。提示 :VIP可能参与OSAHS患者睡眠的调节     

C型利钠肽在低氧性肺动脉高压形成中的作用

在低氧性肺动脉高压形成过程中，肺小动脉收缩和平滑肌细胞增殖起着重要作用。其中因平滑肌细胞增殖引起的肺血管结构重建是不可逆发展的关键因素。目前国内外研究发现多种细胞因子参与了肺血管平滑肌细胞的增生和细胞表型转化的调控，Sudon等于1990年从猪脑中提取的第3个利钠肽家族成员-C型利钠肽(c-type natriuretic peptide，CNP)，     

反相高效液相色谱法测定丹参中丹参酮工和丹参酮ⅡA的含量

[目的]用反相高效液相色谱法(RP-HPLC)同时测定丹参药材中丹参酮Ⅰ和丹参酮ⅡA的含量．[方法]选用mightysil RP-18(H)GP250-4．6(5μm)．流动相为甲醇-水(75：25)，检测波长为270nm，流速为1mL／min，温度为35℃．[结果]丹参酮Ⅰ和丹参酮ⅡA含量分别在0．0952～0．9520μg和0．1222～0．2850μg内呈线性关系；丹参酮Ⅰ和丹参酮ⅡA的平均回收率分另4为99．90％和99．69％．[结论]此方法快速、简便、可靠，为丹参及其制剂质量控制的科学方法。