曲美他嗪联合阿托伐他汀治疗原发性高血压伴阵发性心房颤动的疗效观察

Objective To study the efficacy of trimctazidine combined with atorvastatin for primary hypertension with paroxysmal auricular fibrillation,and its effects on LAD and CRP. Methods 160 patients of pri-mary hypertension with paroxysmal auricular fibrillation were randomly divided into 4 groups. Forty patients were treated with amiodarone (control group),600 mg/d for the first week,400 mg/d for the second week and 200 mg/d later;40 patients were treated with atorvastatin (20 mg/d,3 times per day) in addition to amiodarone (the atorvasat-in group);40 patients were treated with trimetazidine (20 mg/d,3 times per day) in addition to armiodarone (the trimetazidine group);40 patients were treated with combination of trimetazidine and atorvastatin in addition to amiod-atone (the combination group),and the dose was the same as the above groups. The treatment was started within 24 hours of recovering from paroxysmal auricular fibrillation and lasted for 1 year. Results After 1 year there was 1 pa-the control group,and 62.5% (25/40) for the atorvasatin group,64.1% (25/39) for the trimetazidine group,and 84.6% (33/39) for the combination group. Compared to the control group,the effective rate of the 3 treatment groups were all significantly higher (X2=4.56、5.13、17.55,P<0.05). The effective rate of the combination group was significantly higher than that of the atorvasatin group and the trimetazidine group (X2=4.95、4.30,P<0.05),and there was no significant difference of effective rate between the atorvasatin group and the trimetazidine group(X2= >0.05). After treatment LAD was (40.96+1.81) mm in the control group,(38.65±1.90) mm in the atorvasatin group,(39.15±1.85)mm in the trimetazidine group,and (37.22±1.74) mm in the combination group. LAD of the 3 treatment groups were all significantly different from the control group(F=3.42,P<0.05). LAD of the combina-tion group was significantly smaller than that of the atorvasatin group and the trimetazidine group (P<0.05),and there was no significant difference of the LAD between the atorvasatin group and the trimetazidine group(P>0.05). There was no significant difference between the 4 groups on CRP before treatment (F=0.96,P>0.05). After treat-ment CRP was (8.85±1.45) mg/L in the control group,(5.96±1.26) mg/L in the atorvasatin group,(6.81± 1.37) mg/L in the trimetazidine group,and (3.75±1.15) mg/L in the combination group. CRP of the 3 treatment groups were all significantly different from the control group (F=3.63,P<0.05). CRP of the combination group was significantly lower than that of the atorvasatin group and the trimetazidine group (P<0.05),and there was no signif-icant difference of CRP between the atorvasatin group and the trimetazidine group (P>0.05). Conclusion The treatment with trmetazidine combined with atorvastatin could prevent recurrence of paroxysmal auricular fibrillation though anti-inflammatory and inhibiting the remodeling of left atrial.     

润肠通便汤治疗原发性习惯性便秘

原发性习惯性便秘是以排便困难、排便不适感以及排便时间延长为主诉的症候群.表现为大便干结,大便量少,排出困难或合并某些特殊症状,如长时间用力排便后,有坠胀感、排便不尽感,甚至于需要用手帮助排便,在不使用泻剂的情况下,7d内自发排空粪便不超过2次或长期无便意.     

显微血管减压术致Wallenberg综合征一例

患者男,66岁。因左侧面部发作性疼痛1年入院。查体：左侧面部的鼻翼及上唇有明显的扳机点。MRI示左侧三叉神经根部有异常血管压迫。入院诊断为左侧原发性三叉神经痛（Ⅱ、Ⅲ支）。在局麻下由左耳后横切口行三叉神经显微血管减压术。术中分离蛛网膜与血管时不慎小脑后下动脉破裂出血,即给以棉片、明胶海绵压迫止血,因小脑半球向切口外膨出,行小脑半球外上缘吸除后,     

原发性胆囊癌138例诊治体会

原发性胆囊癌(Primary gallbladdercarcinoma,PGC)在胆道系统恶性肿瘤中占首位,在消化道肿瘤中占第5位,且近年统计显示其发病率有增高的趋势[1].胆囊癌恶性程度比较高,早期诊断比较困难,大多数患者就诊时已经处于中晚期,临床治疗效果较差.本文就浙江大学医学院附属第二医院近年来收治的胆囊癌患者进行回顾性分析,并将诊疗体会报告如下.     

青少年原发性输尿管息肉3例报告

青少年输尿管原发性肿瘤临床少见,良性肿瘤仅占1%左右.我们近期收治此类患者3例,现结合文献复习报告如下.     

干扰素治疗骨髓增殖性疾病疗效观察

真性红细胞增多症(PV)和原发性血小板增多症(ET)属于较少见的慢性骨髓增殖性疾病(MPDs),有血栓形成和出血倾向,易于进展为骨髓纤维化合并髓外化生(MMM)或急性髓细胞性白血病(AML),死亡和发病的主要原因是血栓形成.     

诺维本加顺铂和异环磷酰胺治疗晚期非小细胞肺癌临床疗效观察

目的 观察抗肿瘤新药去甲长春花碱(Navelbine，NVB)加顺铂(Cisplatin，DDP)和异环磷酰胺(1fosfamide，IFO)联合治疗晚期非小细胞癌(Nansmall cell lung cancer,NSCLC)的疗效。方法 治疗NSCLC24例，男19例，女5例。病理类型以腺癌与鳞癌为主，6例复治，18例初治。给药方法，NVB25mg／m^2第1、8天静注；DDP30mg／m^2，第2、3、4天静点；IFO1500mg/m^2第1～3天静点。结果 完全缓解1例，部分缓解13例，CR PR58．3％，稳定7例，恶化1例。白细胞在第2疗程后。100％下降，其中Ⅲ、Ⅳ度。72％。注射局部静脉毒性发生率28％。结论 以NVB为主的联合化疗治疗晚期NSCLC有效率高，毒性可以忍受，是一个有前途的抗肿瘤新药。其与顺铂和异环磷酰胺联合治疗晚期非小细胞癌效果非常理想。     

可乐定透皮贴剂联合芬太尼静脉自控镇痛用于原发性高血压病人术后镇痛

目的 观察可乐定透皮贴剂联合芬太尼静脉自控镇痛(PCIA)用于原发性高血压(EH)病人术后镇痛的效果.方法 择期全麻下行腹腔镜胆囊切除术病人60例,均合并EH,依据术后镇痛方法的不同,随机均分为三组,肌注哌替啶组(P组)、芬太尼PCIA组(F组)和可乐定透皮贴剂联合芬太尼PCIA组(CF组).使用芬太尼1.0mg稀释至100ml,PCIA均采用负荷量-持续背景量-PCA量模式,背景剂量芬太尼20 μg/h,PCA追加剂量5 μg,锁定时间15 min.记录病人术后镇痛4、8、24、48 h VAS及Ramsay镇静评分,并记录不良反应和处理措施.监测入院时、术后24、48 h血浆内皮素(ET)及降钙素基因相关肽(CGRP)浓度、血糖(Glu),同时记录MAP、HR.结果 镇痛期间F、CF组VAS低于P组(P<0.01),CF组低于F组(P<0.05).Ramsay镇静评分F组高于P组(P<0.01),CF组高于F组(P<0.05),三组均无过度镇静.CF组MAP、HR术后较入院时明显降低(P<0.01),血浆ET、血浆CGRP浓度与入院时比较差异无统计学意义.术后ET、Glu浓度和MAP、HR F组低于P组,CGRP浓度高于P组(P<0.05).术后ET、Glu浓度和MAP、HR P组>F组>CF组;术后CGRP浓度:CF组>F组>P组(P<0.05).不良反应发生率三组差异无统计学意义.结论 对高血压病人,可乐定透皮贴剂增强芬太尼PCIA镇痛作用,使血流动力学更稳定.     

新城疫病毒对人肺腺癌A549细胞系的作用

目的 观察新城疫病毒对人肺腺癌A549细胞的作用.方法 应用新城疫病毒(NDV)强毒株D90对体内、体外培养人肺腺癌A549细胞进行抗癌实验,通过体外培养A549细胞观察D90对肿瘤细胞的杀伤作用,进而建立14例A549肿瘤细胞裸鼠模型,对实验后裸鼠肿瘤组织进行病理学检查,通过光镜、电镜等方法观察肿瘤细胞形态学改变从而探讨新城疫病毒D90对人肺腺癌A549细胞的杀伤作用,为临床应用奠定基础.结果 NDV强毒株D90可在体外培养条件下溶解、杀伤A549细胞.实验组与对照组比较肿瘤组织体积明显缩小(t'=4.753,P<0.01),光镜和电镜下可见肿瘤组织内血管分布减少,肿瘤细胞坏死与凋亡.结论 新城疫病毒强毒株D90能够抑制体外培养的人肺腺癌A549细胞的增殖并溶解、杀伤肿瘤细胞,能够抑制裸鼠体内肿瘤组织的生长和转移,对正常组织无影响.