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中国医师进修杂志

中国医师进修杂志

CSTPCD

Chinese Journal of Postgraduates of Medicine
1978年创刊，中华人民共和国卫生部主管，中华医学会主办。本刊是综合性临床医学期刊，其主要读者对象为临床中、高级内、外、妇、儿、五官科医务人员。从创刊至今始终坚持以继续医学教育、岗位进修培训为办刊宗旨。现开设的主要栏目：专题辅导、专家论坛、临床论著、进展概述、综述与讲座、教学查房、临床病例讨论、病例报告、探讨与评价、药物与临床、影像与临床、新技术介绍、教训纵横等。其中专题辅导、教学查房等栏目深受读者欢迎。
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  • 国内刊号/CN：11-5455/R
    国际刊号/ISSN：1673-4904
  • 发行周期：旬刊
    邮发代号：8-89
  • 主管单位：中华人民共和国卫生部
    主办单位：中华医学会
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中国医师进修杂志 >2022年第1期

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  • 摘要：目的 探讨改良美国国立卫生研究院神经功能缺损量表(mNIHSS)评分联合床旁经颅彩色多普勒超声(TCD)检查对急性缺血性卒中(AIS)早期预后的评估价值.方法 共纳入136例前循环AIS患者,入院即进行mNIHSS评分,急诊床旁TCD检查评估血管异常情况;经积极治疗出院后,跟进改良Rankin量表(mRS)评分结果,评估发病90 d的预后情况,分析联合应用mNIHSS评分与TCD检查对预后评估的价值.结果 以入院mNIHSS评分＞8分预测临床预后不良,敏感度为0.684,特异度为0.806,阳性预测值为0.578,阴性预测值为0.868;以TCD提示血管异常预测临床预后不良,敏感度为0.736,特异度为0.643,阳性预测值为0.444,阴性预测值为0.863;联合应用mNIHSS评分与TCD检查预测临床预后不良,特异度为0.918,阳性预测值为0.714,阳性似然比为6.41;二者均不具备时,阴性预测值为0.928,阴性似然比为0.20.结论 联合应用mNIHSS评分与TCD检查评估AIS患者的90d预后,可提高阳性和阴性预测值.%Objective To explore the evaluation value of modified USA National Institutes of Health Stroke Scale (mNIHSS) score combined with bedside transcranial Doppler ultrasonography (TCD) on the early prognosis of ischemic stroke (AIS).Methods One hundred and thirty-six anterior circulation AIS patients were collected,mNIHSS score was evaluated on admission,and emergency bedside TCD examination was performed to evaluate vascular anomalies.After active treatment after discharge,the modified Rankin scale (mRS) score was recorded to evaluate 90 d prognosis.The value of mNIHSS score combined with TCD examination analysis on the prognosis was analyzed.Results If the mNIHSS score ＞ 8 scores was judged to be poor prognosis,the sensitivity was 0.684,the specificity was 0.806,the positive predictive value was 0.578,the negative predictive value was 0.868.If related macro vascular abnormalities in bedside TCD examination were evaluated for clinical prognosis,the sensitivity was 0.736,the specificity was 0.643,the positive predictive value was 0.444,the negative predictive value was 0.863.If both,the specificity was 0.918,the positive predictive value was 0.714,the positive likelihood ratio was 6.41 ;and the two were not available,the negative predictive value was 0.928,negative likelihood ratio was 0.20.Conclusion mNIHSS score combined with TCD examination in evaluating the prognosis of AIS patients can improve the positive or negative predictive value.
  • 摘要：目的 探讨注射用头孢他啶联合阿奇霉素治疗老年铜绿假单胞菌呼吸道感染的临床效果.方法 256例老年铜绿假单胞菌呼吸道感染患者按随机数字表法分为对照组和联合组,每组128例,对照组给予注射用头孢他啶联合左氧氟沙星治疗,联合组给予注射用头孢他啶联合阿奇霉素治疗,记录两组患者的治疗效果.结果 联合组细菌清除率为70.3％(90/128),明显高于对照组的45.3％(58/128),差异有统计学意义(P＜0.01).联合组体温降至正常所需时间、白细胞降至正常所需时间以及治疗14d后白细胞计数均明显低于对照组,差异有统计学意义(P＜0.01).同时联合组治疗后T淋巴细胞亚群(CD4+、CD8+以及CD4+/ CD8+)与对照组比较更加平衡.结论 注射用头孢他啶联合阿奇霉素治疗老年铜绿假单胞菌呼吸道感染患者细菌清除率较高,可明显改善患者白细胞数量和维持体温正常,并且能够调节机体细胞免疫功能.
  • 摘要：目的 探讨不同治疗方法在急性ST段抬高型心肌梗死(STEMI)行急诊经皮冠状动脉介入治疗(PCI)的疗效.方法 观察2012年8月至2013年10月因急性STEMI行急诊PCI,并符合纳入条件的梗死相关血管(IRA)高血栓负荷患者67例,按随机数字表法分为治疗组(静脉应用替罗非班,PCI中行血栓抽吸,联合替罗非班经血栓抽吸导管冠状动脉内注射)35例,对照组(单纯行PCI,仅静脉应用替罗非班)32例.观察两组患者术后罪犯血管心肌染色分级(MBG),术后1.5 h心电图最高导联ST段回落百分比(STR)≥50％比率;术后2周及3个月时左心室射血分数(LVEF)和左心室舒张末期内径(LVEDd)的变化;比较两组出血率及主要心脏不良事件(MACE)发生率.结果 术后罪犯血管MBG2～3级比例治疗组多于对照组[60.0％ (21/35)比43.8％(14/32)],差异有统计学意义(P＜0.05);术后1.5 h心电图最高导联STR≥ 50％比率治疗组高于对照组[71.4％(25/35)比46.9％(15/32)],差异有统计学意义(P＜0.05);两组患者术后2周LVEDd比较差异无统计学意义(P＞0.05),但LVEF治疗组高于对照组[(54.2±5.7)％比(44.7±6.1)％],差异有统计学意义(P＜0.05).术后3个月LVEDd治疗组小于对照组[(46.5±4.9) mm比(57.1±5.3) mm],差异有统计学意义(P＜0.05),LVEF治疗组高于对照组[(60.5±4.5)％比(43.6±5.7)％],差异有统计学意义(P＜0.05).两组患者术后出血情况及MACE发生率比较差异无统计学意义(P＞0.05).结论 STEMI患者急诊PCI中应用血栓抽吸并经血栓抽吸导管冠状动脉内给予替罗非班可增加心肌水平的血流灌注,减少心肌损伤,改善近期预后.%Objective To explore the effect of different treatment methods in patients of acute ST-segment elevation myocardial infarction (STEMI) with emergency percutaneous coronary intervention (PCI).Methods Sixty-seven patients with high blood clots load in infarction related artery (IRA) and performed emergent PCI because of STEMI from August 2012 to October 2013 were enrolled.They were divided into treatment group (intravenous tirofiban,PCI boc thrombus suction,tirofiban injection via thrombus suction catheter coronary artery injection,35 cases) and control group (PCI simple,intravenous tirofiban,32 cases).The myocardial dyeing classification (MBG) with postoperative criminal vascular,ST-segment elevation resolution (STR) ≥50％ in electrocardiogram after 1.5 h treatment and the changes of left ventricular ejection fraction (LVEF) and left ventricular end-diastolic diameter (LVEDd) after 2 weeks and 3 months treatment were observed in two groups.The bleeding rate and incidence of major adverse cardiac events (MACE) were compared between two groups.Results The ratio of MBG 2-3 grade of postoperative criminal vascular in treatment group was more than that in control group [60.0％ (21/35) vs.43.8％(14/32)],and there was significant difference (P＜ 0.05).The ratio of STR≥50％ in electrocardiogram after 1.5 h treatment in treatment group was higher than that in control group [71.4％(25/35) vs.46.9％ (15/32)],and there was significant difference(P ＜ 0.05).There was no significant difference in LVEDd after 2 weeks treatment between two groups (P ＞ 0.05),but LVEF in treatment group was higher than that in control group [(54.2 ± 5.7)％ vs.(44.7 ± 6.1)％],and there was significant difference (P ＜ 0.05).LVEDd after 3 months treatment in treatment group was less than that in control group [(46.5 ±4.9) mm vs.(57.1 ± 5.3) mm] and LVEF in treatment group was higher than that in control group [(60.5 ± 4.5)％ vs.(43.6 ± 5.7)％],and there was significant difference (P＜ 0.05).There was no significant difference in the bleeding rate and incidence of MACE between two groups (P ＞ 0.05).Conclusion Thrombosis suction and tirofiban injection through the suction catheter into coronary artery can increase the level of myocardial perfusion,reduce myocardial injury and improve the prognosis in the near future.
  • 摘要：Objective To observe the effect of reduced glutathione on the oxidative stress in type 2 diabetes mellitus with high urinary albumin excretion rate(UAER).Methods Sixty-two patients with type 2 diabetes mellitus were divided into diabetes group(DM group,30 cases) and high UAER group(DM2 group,32 cases).All of the patients were given reduced glutathione on the basis of glucose-lowering treatment.The changes of fasting plasma glucose (FPG),total cholestrol (TC),triacylglycerol (TG),high-density hpoprotein cholesterol (HDL-C),low-density lipoprotein cholesterol (LDL-C),creatinine (Cr),blood urea nitrogen (BUN),UAER,malondialdehyde (MDA),superoxide dismutase (SOD) before and after treament was collected and compared with that of 25 healthy subjects (control group).Results There was no significant difference in TG,HDL-C,LDL-C before treatment among three groups (P ＞ 0.05).TC before treatment in DM2 group was higher than that in control group and DM group,and there was significant difference (P ＜0.05).TC,LDL-C after treatment in DM group and DM2 group was decreased compared with that before treatment,and there was significant difference (P ＜ 0.05),TG had a downward tendency,HDL-C had a rising trend,but there was no significant difference (P ＞ 0.05).Compared with that in control group,SOD in DM group and DM2 group was decreased before treatment,and MDA was increased,and there was significant difference (P＜ 0.05).Compared with that in DM group,SOD was decreased before treatment,and MDA was increased,and there was significant difference (P ＜ 0.05).SOD after treatment was higher than that before treatment and MDA after treatment was lower than that before treatment in DM group and DM2 group,and there was significant difference (P ＜ 0.05).UAER was decreased after treatment compared with that before treatment in DM group and DM2 group,and there was significant difference (P＜ 0.05).With SOD and MDA as dependent variable,UAER as independent variables,correlation analysis showed that SOD was negatively correlated with UAER(r =-0.64,P ＜ 0.05),MDA was positively correlated with UAER(r =0.56,P ＜ 0.05).After adjustment for age,TC,TG,HDL-C,LDL-C,FPG,and so on,SOD and UAER still showed a negative correlation (r =-0.41,P ＜ 0.05),while MDA was positively correlated with UAER (r =0.37,P ＜ 0.05).Conclusion Reduced glutathione can effectively improve the oxidative stress injury of diabetic patients,and has certain improvement of UAER.%目的 观察还原型谷胱甘肽对2型糖尿病以及伴有尿白蛋白排泄率(UAER)升高患者氧化应激水平的影响.方法 选择62例2型糖尿病患者,根据UAER是否升高分为两组,单纯糖尿病组(DM组)30例,糖尿病合并UAER升高组(DM2组)32例,所有患者在降糖治疗的基础上,给予还原型谷胱甘肽治疗.观察还原型谷胱甘肽治疗前后患者空腹血糖(FPG)、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、肌酐(Cr)、血尿素氮(BUN)、UAER、丙二醛(MDA)、超氧化物歧化酶(SOD)等水平的变化,并与同期健康体检者25例(对照组)比较.结果 三组治疗前TG、HDL-C、LDL-C水平比较差异无统计学意义(P＞0.05),DM2组治疗前TC较对照组、DM组有明显升高,差异有统计学意义(P＜ 0.05);DM组和DM2组治疗后TC、LDL-C均较治疗前有明显降低,差异有统计学意义(P＜0.05),TG有下降趋势,而HDL-C有升高趋势,但差异无统计学意义(P＞0.05).与对照组比较,DM组和DM2组治疗前血清SOD水平明显下降,而MDA水平明显升高,差异有统计学意义(P＜0.05);与DM组比较,DM2组治疗前血清SOD水平进一步下降,而MDA水平进一步升高,差异有统计学意义(P＜ 0.05);DM组和DM2组治疗后血清SOD水平有所升高,而MDA水平有所下降,与治疗前比较差异有统计学意义(P＜0.05).DM组和DM2组治疗后UAER水平均较治疗前有不同程度的降低,差异有统计学意义(P＜0.05).以SOD、MDA为应变量,UAER为自变量,经相关分析发现SOD与UAER呈负相关(r=-0.64,P＜0.05),而MDA与UAER呈正相关(r=0.56,P＜ 0.05).在校正年龄、TC、TG、HDL-C、LDL-C、FPG等因素的影响后,SOD与UAER仍呈负相关(r=-0.41,P＜0.05),而MDA与UAER仍呈正相关(r=0.37,P＜0.05).结论 还原型谷胱甘肽可有效改善糖尿病患者的氧化应激损伤,并对患者UAER有一定的改善.
  • 摘要：目的 探讨乳果糖联合枯草杆菌二联活菌治疗便秘型肠易激综合征的临床疗效.方法 选择98例便秘型肠易激综合征患者,根据治疗药物分为3组:乳果糖组33例,枯草杆菌二联活菌组30例,联合治疗组35例,且三组均口服莫沙必利,疗程均为2周,观察患者腹痛、腹胀的症状、大便情况以及治疗前后生活质量改善情况.结果 联合治疗组腹痛和腹胀改善总有效率明显高于乳果糖组和枯草杆菌二联活菌组,乳果糖组明显高于枯草杆菌二联活菌组,差异有统计学意义(P＜0.05).各组间治疗前大便Bristol分级构成比较差异无统计学意义(P＞0.05).各组间治疗后大便Bristol分级构成比较差异有统计学意义(P＜0.05).三组大便Bristol分级构成治疗后与治疗前比较差异有统计学意义(P＜ 0.05).治疗前三组间生活质量评分比较差异无统计学意义(P＞0.05),三组治疗后生活质量评分均高于治疗前,差异有统计学意义(P＜0.05);治疗后联合治疗组生活质量评分明显高于乳果糖组,乳果糖组明显高于枯草杆菌二联活菌组,差异有统计学意义(P＜0.05).结论 乳果糖联合枯草杆菌二联活菌治疗便秘型肠易激综合征明显优于单用乳果糖及枯草杆菌二联活菌,值得临床应用.%Objective To investigate the therapeutic efficacy of lactulose combined with Bacillus subtilis duplex living bacterium in patients with constipation-predominant irritable bowel syndrome.Methods A total of 98 patients with constipation-predominant irritable bowel syndrome were divided into 3 groups according to the therapeutic drugs:lactulose group (33 cases),Bacillus subtilis duplex living bacterium group (30 cases) and combined treatment group (35 cases),and patients in all groups received mosapride.The course of treatment was 2 weeks in all groups.The symptoms of patients with abdominal pain,abdominal distention,defecate condition and quality of life before and after treatment was observed.Results The total efficacy of abdominal pain,abdominal distention in combined treatment group was higher than that in lactulose group and Bacillus subtilis duplex living bacterium group,in lactulose group was higher than that in Bacillus subtilis duplex living bacterium group,and there was significant difference (P ＜ 0.05).There was no significant difference in defecate Bristol grade before treatment among three groups (P ＞ 0.05).There was significant difference in defecate Bristol grade after treatment among three groups(P ＜ 0.05).There was significant difference in defecate Bristol grade before and after treatment in three groups(P ＜ 0.05).There was no significant difference in the quality of life before treatment among three groups (P ＞ 0.05),the quality of life after treatment in three groups was higher than that before treatment,and there was significantdifference (P ＜ 0.05).After treatment,the quality of life in combined treatment group was higher than that in lactulose group,in lactulose group was higher than that in Bacillus subtilis duplex living bacterium group,and there was significant difference (P ＜ 0.05).Conclusions The combined regimen of lactulose and Bacillus subtilis duplex living bacterium is more effective than lactulose or Bacillus subtilis duplex living bacterium alone.Thus the combined regimen of lactulose and Bacillus subtilis duplex living bacterium is an effective therapeutic method for constipation-predominant irritable bowel syndrome.
  • 摘要：目的 明确维生素D受体位点(Apa1、Bsm1、Tq1)基因多态性与自身免疫性肝病易感性的关系.方法 通过Pubmed、Ovid、Medline和Web of science databases数据库检索相关病例对照试验文献,并按照纳入、排除标准纳入本研究.对入选研究中有关试验设计、研究对象的特征、研究结果等内容进行摘录,并用STATA version 12.0软件进行分析,关联强度用比值比(OR)和95％可信区间(CI)表示.结果 共收集到2000年1月至2012年2月国内外公开发表的6篇论著包括9项试验研究符合纳入标准,其中7项研究关于原发性胆汁性肝硬化(PBC),2项研究关于自身免疫性肝炎(AIH),累计病例为844例,对照为1 522例.总研究人群分析显示Apa1位点基因中a等位基因降低自身免疫性肝病的发病风险(等位基因模型a比A:OR值0.85,95％ CI 0.74～0.96,P=0.058;纯合子模型aa比AA:OR值0.75,95％ CI 0.58～0.97,P=0.212;杂合子模型Aa比AA:OR值0.78,95％CI 0.63～ 0.98,P=0.235;显性模型Aa/aa比AA:OR值0.77,95％ CI 0.63～0.94,P=0.231),然而Bsm1和Taq1位点基因并未发现与自身免疫性肝病具有相关性.结论 维生素D受体Apa1位点基因中a等位基因可能是自身免疫性肝病的保护基因,而Bsm1和Taq1位点基因与自身免疫性肝病的易感性无相关性.%Objective To investigate the association of vitamin D receptor gene (Apa1,Bsm1,Taq1) polymorphisms with autoimmune liver diseases risk.Metiods Case control test documents were retrieved through Pubmed,Ovid,Medline,and Web of science databases,according to the inclusion and exclusion criteria included in this study.The design of experiments,the characteristics of the object of study,research results was excerpted,STATA version 12.0 software were used.The correlation intensity was demonstrated with odds ratio (OR) and 95％ confidence interval (CI).Results A total of 6 publications containing 9 studies (7 studies about primary biliary cirrhosis,2 studies about autoimmune hepatitis) published from January 2000 to February 2012 were identified and 844 cases and 1 522 controls were included.The combined results based on all studies showed that there was a statistically significant link between Apa 1 and autoimmune liver diseases (OR =0.85,95％ CI 0.74-0.96,P =0.058,for a vs.A; OR =0.75,95％ CI 0.58-0.97,P =0.212,for aa vs.AA;OR =0.78,95％ CI 0.63-0.98,P =0.235,for Aa vs.AA; OR =0.77,95％ CI 0.63-0.94,P =0.231,for Aa/aa vs.AA),while the Bsm 1 and Taq 1 didn' t show the association with autoimmune liver diseases.Conclusion The current meta-analysis shows that Apal may be a low-penetrant risk factor for autoimmune liver diseases.Bsm1 and Taq1 don't show the association with autoimmune liver diseases.
  • 摘要：Objective To analyze the effect of tiotropium bromide on pulmonary function and airway remodeling in elder chronic obstructive pulmonary disease (COPD) stabilization patients.Methods Ninety-two elder patients diagnosed as COPD stabilization were divided into treatment group (50 patients) and control group (42 patients) by random digits table method.The patients in two groups were given basic treatment such as antimicrobial therapy,spasmolysis,antiasthma,expelling phlegm,and the patients in treatment group were given tiotropium bromide every day for 12 months besides the basic treatment.Meanwhile,40 healthy persons whose ages matched with those of COPD stabilization patients were as healthy control group.High resolution computerized tomography (HRCT) was employed to measure the parameters such as the airway wall thickness,the outer and inner diameter of the airway,airway wall area to assessed the airway remodeling before and after treatment in order to evaluate the drug etficacy.Meanwhile,the lung function,the inflammatory cytokines [interleukin (IL)-8,tumor necrosis factor (TNF)-α] in blood plasma and T lymphocyte subsets were also determined.Results The index of lung function in treatment group was significantly better than that before treatment and control group,and there was significant difference (P ＜ 0.05).The airway wall thickness in treatment group had no significant difference before and after treatment (P ＞0.05),and other index of airway remodeling was significantly improved compared with that before treatment (P ＜ 0.05).After treatment,the distance of 6 min walk test in treatment group was significantly longer than that in control group,and there was significant difference (P ＜ 0.05).The level of serum IL-8 and TNF-αt before treatment had no significant difference between two groups (P ＞0.05),and decreased significantly after treatment and the improvement was more pronounced in treatment group compared with that in control group (P ＜ 0.05).Compared with that in healthy control group,the level of CD3+,CD4+,CD4+/CD8+ was significantly lower and the level of CD8+ was significantly higher before treatment in treatment group and control group (P ＜ 0.05).After treatment,the level of CD3+,CD4+,CD4+/CD8+ was significantly increased and the level of CD8+ was significantly decreased (P ＜ 0.05),and the improvement was more pronounced in treatment group compared with that in control group (P ＜ 0.05).Conclusion Tiotropium bromide can improve airway remodeling and lung function in elder COPD stabilization patients.%目的 探讨噻托溴铵对老年慢性阻塞性肺疾病(COPD)稳定期患者肺功能及气道重塑的影响.方法 将92例老年COPD稳定期患者按随机数字表法分为治疗组(50例)和对照组(42例),两组患者均予以COPD常规治疗,包括止咳、平喘、抗感染等治疗.治疗组在常规治疗基础上给予噻托溴铵吸入,疗程为12个月.同时选择与COPD稳定期患者年龄匹配的健康体检者40例作为健康对照组.应用高分辨率CT (HRCT)测定治疗前后气道壁厚度、气道内外径、气道腔面积等参数以评估气道重塑的程度,同时测定患者肺功能、血清炎性细胞因子[白细胞介素(IL)-8、肿瘤坏死因子(TNF)-α]水平及T淋巴细胞亚群,并与健康对照组进行比较.结果 治疗组治疗后各项肺功能指标明显改善,且改善程度优于对照组,差异均有统计学意义(P＜0.05).治疗组治疗后气道壁厚度与治疗前比较差异无统计学意义(P＞0.05),其余气道重塑指标均较治疗前明显改善,差异有统计学意义(P＜0.05).治疗组治疗后6 min步行试验距离明显高于对照组,差异有统计学意义(P＜0.05).两组COPD患者治疗前血清IL-8、TNF-α水平比较差异无统计学意义(P＞0.05),治疗后两组血清IL-8、TNF-α水平均较治疗前下降(P＜0.05),治疗组治疗后血清IL-8、TNF-α水平明显低于对照组(P＜ 0.05).治疗组和对照组治疗前CDf、CD4+、CDg/CDf较健康对照组明显降低,CD8+较健康对照组明显增高,差异有统计学意义(P＜0.05).治疗后两组CD3+、CD4+、CD4+/CD8+升高,CD8+降低,与治疗前比较差异有统计学意义(P＜ 0.05),并且治疗组变化更为明显(P＜0.05).结论 噻托溴铵对老年COPD稳定期患者的肺功能及气道重塑具有显著的改善作用.
  • 摘要：Objective To summarize the clinical characteristics and management of eosinophilic esophagitis (EoE) in China and improve the recognition of clinical doctor for this disease.Methods Electronic database was searched from 1993 to 2012 for case reports of EoE in Chinese patients.Data were enrolled according to the admission criterion,which included relatively complete medical records and cases confirmed by endoscopic biopsy and/or operation pathology.Results Data of 38 patients with EoE from 6 studies were included and analyzed.There were 24 males and 14 females.The age of onset was (47.2 ± 10.9)years.The process of the disease was (1.5 ± 1.8) years.The main symptoms included dysphagia (24/38,63％) and retrostemal pain (22/38,58％).Total 19 patients (83％,19/23) had allergy history and 20 patients (80％,20/25) had elevated blood eosinophil count.Lesions located at the mid-inferior esophagus mainly.Endoscopic manifestation included hyperaemia,erosion and fragile mucosa,and others such as mucosal nodular,ulcer,plaque and white exudates (18/38,47％).Eosinophil count in esophageal mucosa was (45.8 ± 34.1) numbers/HPF.Main treatment included corticosteroid and acid inhibitory medicine.Conclusions EoE is rare in Chinese people.EoE is more common in middle-aged males with chronic onset.Dysphagia and retrosternal pain is the common symptoms.Endoscopy and biopsy pathology are the methods for definition diagnosis.Corticosteroid and acid inhibitory medicine are the main treatment.%目的 总结国人嗜酸粒细胞性食管炎(EoE)的临床特点及诊治情况,提高临床医生对本病的认识.方法 检索1993-2012年发表的关于国人EoE的病例报道,纳入病例需符合以下标准:(1)病历资料相对完整.(2)病例均经内镜活检和/或手术病理确诊.结果 共检索到符合要求的文献6篇,包含38例经病理确诊的EoE患者,其中男24例,女14例,发病年龄(47.2±10.9)岁.病程(1.5±1.8)年,主要临床表现为吞咽困难和胸骨后痛,发生率分别为63％(24/38)和58％(22/38).19例(83％,19/23)有过敏史,20例(80％,20/25)血嗜酸粒细胞升高.病变主要位于食管中下段,内镜下表现以充血、糜烂、黏膜质地脆多见,发现率为47％(18/38),食管黏膜中嗜酸粒细胞的数目(45.8±34.1)个/高倍视野.治疗主要采用糖皮质激素和抑酸药物.结论 国人EoE少见,以中年男性为主,慢性病程,吞咽困难和胸骨后痛为常见症状,内镜+活检组织病理学检查是确诊方法,治疗以糖皮质激素和抑酸药物为主.
  • 摘要：Objective To investigate the relationship between soluble tumor necrosis factor-like weak inducer of apoptosis levels (sTWEAK) and cardiovascular events in patients with maintenance hemodialysis (MHD).Methods A prospective cohort study was conducted in 64 MHD patients(MHD group).The plasma level of sTWEAK was measured by enzyme-linked immunosorbent assay,N-terminal pro-brain natriuretic peptide (NT-proBNP) and high-sensitive C-reactive protein (hs-CRP) levels were measured by enzyme-linked immunofluorescence method,left ventricular end-diastolic diameter (LVEDd),left ventricular posterior wall thickness (LVPWT),end-diastolic ventricular septal thickness (IVST),left ventricular ejection fraction (LVEF) was determined by echocardiography.The general situation,clinical indicators and occurrence of cardiovascular events of MHD patients were recorded and followed up for 2 years.Fifty healthy people were selected as control group.Results The plasma level of sTWEAK was higher in MHD group than that in control group [(589 ± 122) ng/L vs.(346 ± 127) ng/L],and there was significant difference (P＜ 0.01).During the follow-up period,12 patients underwent cardiovascular events(3 patients died).The plasma level of sTWEAK in cardiovascular event patients was significantly higher than that in non-cardiovascular event patients (695 ng/L vs.458 ng/L),and there was significant difference (P ＜ 0.01).The plasma level of sTWEAK was positively correlated with NT-proBNP in MHD patients(r =0.698,P ＜ 0.05).Logistic repression analysis showed that sTWEAK was the predictor of cardiovascular events of MHD patients.Conclusion The plasma level of sTWEAK probably predicts the ocurrence of cardiovascular event in MHD patients.%目的 探讨血浆可溶性肿瘤坏死因子样凋亡弱诱导因子(sTWEAK)蛋白在维持性血液透析(MHD)患者心血管事件发生过程中的意义.方法 选择MHD患者64例(MHD组),酶联免疫吸附试验法检测血浆sTWEAK蛋白,酶联免疫荧光法检测N-末端脑钠肽前体(NT-proBNP)、高敏C反应蛋白(hs-CRP),超声心动图测定左心室舒张末期内径(LVEDd)、左心室后壁厚度(LVPWT)、室间隔厚度(IVST)、左心室射血分数(LVEF),记录MHD患者的一般情况、临床各项指标及发生的心血管事件,随访观察2年.另选择同期健康体检者50例作为对照组.结果 MHD组血浆sTWEAK蛋白高于对照组[(589±122) ng/L比(346±127) ng/L],差异有统计学意义(P＜0.01).随访期间发生心血管事件12例,其中3例死亡.心血管事件患者血浆sTWEAK蛋白中位数为695 ng/L,非心血管事件患者血浆sTWEAK蛋白中位数为458 ng/L,两者比较差异有统计学意义(P＜0.01).MHD患者血浆sTWEAK蛋白与NT-proBNP呈正相关(r=0.698,P＜0.05).Logistic回归分析提示血浆sTWEAK蛋白是MHD患者心血管事件发生的危险因素.结论 血浆sTWEAK蛋白升高可能预测MHD患者心血管事件发生.
  • 摘要：目的 探讨西格列汀联合二甲双胍治疗2型糖尿病的疗效与安全性.方法 选取100例2型糖尿病患者,按随机数字表法分为两组,每组50例,研究组采用磷酸西格列汀(100 mg日1次口服)联合二甲双胍(500 mg日3次口服)治疗,对照组采用瑞格列奈(1 mg日3次口服)联合二甲双胍(500 mg日3次口服)治疗,两组均治疗12周,治疗前后分别观察两组患者空腹血糖(FPG)、餐后2 h血糖(2 h PG)、糖化血红蛋白(HbA1c)、空腹胰岛素(FINS)、体质量指数(BMI)及低血糖事件发生率等变化.结果 两组治疗后FPG、2hPG、HbA1c均较治疗前显著下降,差异有统计学意义(P＜0.01).研究组治疗后BMI显著减低[(24.45±2.13) kg/m2比(25.46±2.62) kg/m2],FINS显著升高[(13.36±1.89) mU/L比(12.36±1.80) mU/L],与治疗前比较差异有统计学意义(P＜0.05或＜0.01).对照组治疗后BMI、FINS与治疗前比较差异无统计学意义(P＞0.05).研究组和对照组低血糖事件发生率比较差异有统计学意义[0比12％(6/50)](P＜ 0.05).结论 西格列汀联合二甲双胍治疗2型糖尿病的方案是安全有效的,不仅能显著减少低血糖事件的风险,而且具有能控制并减轻体质量等优越性,是治疗2型糖尿病的优选方案.%Objective To discuss the efficacy and safety of sitagliptin combined with metformin in treatment of type 2 diabetes mellitus(T2DM).Methods One hundred patients with T2DM were divided into two groups by random digits table method with 50 cases each.The patients in study group were given phosphate sitagliptin (100 mg,day 1 oral) combined with metformin (500 mg,day 3 oral).The patients in control group were given repaglinide (1 mg,day 3 oral) combined with metformin (500 mg,day 3 oral).They were treated for 12 weeks and fasting plasma glucose(FPG),2 h postprandial blood glucose(2 h PG),glycosylated hemoglobin (HbA1c),fasting insulin (FINS),body mass index (BMI) and the incidence of hypoglycemic events were detected before and after treatment.Results After treatment,the level of FPG,2 h PG,HbA1c was significantly lower than that before treatment in two groups,and there was significant difference (P ＜ 0.01).The level of B MI after treatment was significantly decreased [(24.45 ± 2.13) kg/m2 vs.(25.46 ±2.62) kg/m2] and FINS was significantly increased [(13.36 ± 1.89) mU/L vs.(12.36 ± 1.80)mU/L] compared with that before treatment in study group (P ＜ 0.05 or ＜ 0.01).But the level of BMI and FINS had no significant difference before and after treatment in control group (P＞ 0.05).The incidence of hypoglycemic events had significant difference between study group and control group [0 vs.12％ (6/50)] (P ＜ 0.05).Conclusions Sitagliptin combined with metformin is safe and effective in treatment of type 2 diabetes mellitus,which is the preferred solution treatment.The risk of hypoglycaemia events is obviously reduced,also it can control and reduce weight and other advantages.
  • 摘要：目的 评估肝硬化患者肝性脑病发生率与终末期肝病模型(MELD)评分的关系.方法 对120例失代偿期肝硬化患者进行MELD评分,并观察患者肝性脑病的发生情况.结果 120例失代偿期肝硬化患者中发生肝性脑病53例,发生率为44.17％(53/120).肝性脑病患者MELD评分为(21.69±9.22)分,非肝性脑病患者MELD评分为(9.32±4.63)分,两者比较差异有统计学意义(P＜0.05).肝性脑病发生率随MELD评分的增高而增加(P＜0.01).MELD评分预测患者发生肝性脑病的最佳临界值是14.13分(敏感度86.05％,特异度88.37％),MELD评分≥14.13分患者3个月内肝性脑病发生率显著高于MELD评分＜14.13分患者[63.16％(48/76)比11.36％(5/44)],差异有统计学意义(x2=30.32,P＜0.01).结论 MELD评分有助于预测失代偿期肝硬化患者肝性脑病的发生率.%Objective To evaluate the relationship between the incidence rate of hepatic encephalopathy in patients with cirrhosis and the model for end-stage liver disease (MELD).Methods The total of 120 patients with decompensated cirrhosis were enrolled and followed-up.MELD score was obtained to observe the incidence of hepatic encephalopathy.Results The incidence of hepatic encephalopathy was 44.17％(53/120).MELD score in hepatic encephalopathy patients was significantly higher than that in none hepatic encephalopathy patients[(21.69 ± 9.22) scores vs.(9.32 ± 4.63) scores],and there was significant difference (P ＜ 0.05).With the increase of MELD score,the incidence of hepatic encephalopathy increased (P ＜ 0.01).The best critical value of MELD score was 14.13 scores (the sensitivity of 86.05％ and the specificity of 88.37％),when MELD ≥14.13 scores,the incidence of hepatic encephalopathy within 3 months was significantly higher [63.16％(48/76) vs.11.36％(5/44)] (x2 =30.32,P＜ 0.01).Conclusion MELD can help predicting the incidence of hepatic encephalopathy in decompensated cirrhosis patients.
  • 摘要：Objective To observe the effect of early goal directed therapy (EGDT) on tissue perfusion,microcirculation and oxygen metabolism in patients with septic shock.Methods A prospective observational study was carried out in 69 patients with early septic shock within 24 hours.The eligible patients were treated with the standard procedure of EGDT.The partial pressure of transcutaneous oxygen (PtcO2) and transcutaneous carbon dioxide (PtcCO2) was monitored and the changes of hemodynamic data,tissue oxygen,microcirculation before and after reaching the criteria of EGDT were recorded.Results Compared with that before treatment,PtcO2,tissue oxygenation index (PtcO2/FiO2) after EGDT was increased [(78.1 ± 30.8) mmHg (1 mmHg =0.133 kPa) vs.(62.8 ± 24.1) mmHg and (141.7 ± 78.3) mmHg vs.(110.8 ± 60.5) mmHg],PtcCO2 and percutaneous arterial carbon dioxide partial pressure difference was decreased[(29.0 ±4.1) mmHg vs.(39.1 ±6.4) mmHg and (1.4 ±0.5) mmHg vs.(1.7 ±0.8) mmHg],there was significant difference(P＜ 0.05).There was no significant difference in PtcO2,PtcO2/FiO2,PtcCO2,central venous blood oxygen saturation,lactic acid,oxygen and oxygen consumption (P ＞ 0.05).Conclusion EGDT can improve local tissue perfusion and microcirculation in patients with septic shock,body tissue perfusion index before and after EGDT may not be able to reflect the local tissue perfusion.%目的 探讨早期目标导向治疗(EGDT)对感染性休克患者组织灌注、微循环和氧代谢的影响.方法 选取早期感染性休克(＜24 h)患者69例,按照EGDT流程对患者进行治疗,监测经皮氧分压(PtcO2)和经皮二氧化碳分压(PtcCO2),检测EGDT达标前后血流动力学、组织氧和舌下微循环变化,同时变量相关性采用Pearson相关分析.结果 与治疗前相比,EGDT治疗后PtcO2[(78.1±30.8) mmHg(1mmHg=0.133 kPa)比(62.8±24.1) mmHg]、组织氧合指数(PtcO2/FiO2)[(141.7±78.3) mmHg比(110.8±60.5) mmHg]显著增加,PtcCO2[(29.0±4.1) mmHg比(39.1±6.4)mmHg]和经皮-动脉二氧化碳分压差[(1.4±0.5) mmHg比(1.7±0.8) mmHg]显著降低,差异有统计学意义(P＜0.05).PtcO2、PtcO2/FiO2、PtcCO2与中心静脉血氧饱和度、乳酸、氧输送、氧耗比较差异均无统计学意义(P＞0.05).结论 EGDT能改善感染性休克患者局部组织灌注和微循环,感染性休克EGDT达标前后全身组织灌注的指标可能不能反映局部组织灌注.
  • 摘要：目的 探讨骨化三醇联合长时血液透析对维持性血液透析继发性甲状旁腺功能亢进患者血甲状旁腺激素(PTH)、钙、磷水平的影响.方法 将22例维持性血液透析继发性甲状旁腺功能亢进患者进行长时血液透析治疗,3次/周,每次6h.同时口服骨化三醇1μg/次,3次/周,共治疗3个月.分别于治疗前和治疗后检测血PTH、钙及磷水平.结果 患者治疗后血PTH和血磷较治疗前明显下降[(484.21±230.18) nmol/L比(750.53±327.41) nmol/L、(1.49±0.27) mmol/L比(2.37±0.76) mmol/L],血钙较治疗前明显上升[(235±0.32)mmol/L比(1.81±0.53)mmol/L],差异均有统计学意义(P＜0.05).结论 骨化三醇联合长时血液透析可以降低维持性血液透析继发性甲状旁腺功能亢进患者血磷及血PTH,升高血钙,对治疗维持性血液透析继发性甲状旁腺功能亢进有一定的疗效.%Objective To observe the influence of calcitriol combined with prolonged hemodialysis on parathyroid hormone (PTH),phosphorus and calcium in maintenance hemodialysis patients with refractory secondary hyperparathyroidism.Methods Twenty-two maintenance hemodialysis patients received prolonged hemodialysis (3 times per week and 6 hours each session) and therapy with calcitriol (3 times per week and 1 μ g each time) for 3 months.The levels of serum PTH,calcium and phosphorus of these patients were recorded before and after treatment.Results Compared with that before treatment,the level of serum PTH and phosphorus was decreased significantly[(484.21 ± 230.18) nmol/L vs.(750.53 ± 327.41) nmol/L,(1.49 ±0.27) mmol/L vs.(2.37 ±0.76) mmol/L],but calcium was increased after treatment [(2.35 ±0.32) mmol/L vs.(1.81 ±0.53) mmol/L],and there was significant difference (P ＜0.05).Conclusions The treatment of calcitriol combined with prolonged hemodialysis not only effectively clear phosphorus and PTH but also increase calcium in maintenance hemodialysis patients.The therapeutic schedule is good to maintenance hemodialysis patients with refractory secondary hyperparathyroidism.
  • 摘要：Objective To compare the safety and feasibility of thoracoscope decortication and conventional thoracotomy decortication in treatment of senile chronic empyema.Methods Thirty-two patients with senile chronic empyema were selected,among total there were 10 patients received thoracoscope decortication (thoracoscope group) and 22 patients received conventional thoracotomy decortication (conventional thoracotomy group).The operative time,intraoperative bleeding volume,postoperative total hydrothorax drainage volume,postoperative drainage time,postoperative thoracic rinse time,postoperative length of stay in hospital and postoperative antibiotic application time were compared between 2 groups.Results There was no statistical difference in operative time between 2 groups (P＞ 0.05).The intraoperative bleeding volume,postoperative drainage time,postoperative total hydrothorax drainage volume,postoperative thoracic rinse time,postoperative antibiotic application time,postoperative length of stay in hospital in thoracoscope group were significantly better than those in conventional thoracotomy group [(331.00 ± 84.65)ml vs.(453.18 ±93.47) ml,(8.80 ±2.53) d vs.(11.59 ±3.57) d,(2 357.00 ±649.03) ml vs.(3 166.82 ±613.42) ml,(5.50 ±2.22) d vs.(7.68 ±2.95) d,(7.40 ± 1.65) d vs.(9.45 ±2.58) d,(12.20 ± 3.65) d vs.(15.32 ± 4.04) d],there were statistical differences (P ＜ 0.05).Conclusion Thoracoscope decortication is safe and feasible in treatment of senile chronic empyema.%目的 比较胸腔镜下胸膜纤维板剥脱术与常规开胸胸膜纤维板剥脱术治疗老年慢性脓胸的术中、术后结果.方法 选择32例老年慢性脓胸患者,10例接受胸腔镜下手术治疗(胸腔镜手术组),22例接受开胸手术治疗(常规开胸手术组).比较两组手术时间、术中出血量、术后胸液总引流量、术后胸腔引流管留置时间、术后胸腔内冲洗时间、术后住院时间、术后应用抗生素时间以及术后并发症.结果 两组手术时间比较差异无统计学意义(P＞0.05),胸腔镜手术组术中出血量、术后胸腔引流管留置时间、术后胸液总引流量、术后胸腔内冲洗时间、术后应用抗生素时间、术后住院时间均明显优于常规开胸手术组[(331.00±84.65) ml比(453.18 ±93.47) ml、(8.80 ±2.53)d比(11.59±3.57)d、(2 357.00±649.03) ml比(3 166.82 ±613.42) ml、(5.50±2.22)d比(7.68±2.95)d、(7.40±1.65)d比(9.45 ±2.58)d、(12.20±3.65)d比(15.32±4.04) d],差异有统计学意义(P＜0.05).结论 胸腔镜下胸膜纤维板剥脱术治疗老年慢性脓胸安全、有效.
  • 摘要：Objective To investigate the security and validity of transabdominal preperitoneal prosthetic (TAPP) in treatment of incarcerated hernia.Methods One hundred and twenty-four patients with incarcerated hernia were divided into 2 groups by random pair method:observation group with treatment of laparoscopic reposition and TAPP (56 cases) and control group with treatment of open reduction and tension-free hernioplasty (68 cases).The operative time,hospital stay,bed time,hospital costs,recurrence rate and complication were compared between the 2 groups.Results All patients in observation group were received laparoscopic surgery successfully.The operation time,hospital stay,bed time in observation group were significandy shorter than those in control group [(37.52 ± 7.78) min vs.(44.23 ± 11.32) min,(4.53 ± 0.89) d vs.(6.85 ± 2.03) d,(9.30 ± 2.65) h vs.(12.63 ± 3.97) h],there were statistical differences (P ＜0.05).The hospital costs in observation group was significandy higher than that in control group [(9 324 ± 599) yuan vs.(7 203 ± 507) yuan],there was statistical difference (P ＜ 0.05).There was no statistical difference in complication rate between the 2 groups (P ＞ 0.05).Follow-up 1 year,there was no recurrence patient in observation group and 1 patient was recurrence in control group,there was no statistical difference between the 2 groups (P ＞ 0.05).Conclusions TAPP is safe and effective with advantages of mini-invasion,quicker recovery but more hospital costs in treatment of incarcerated hernia.The recurrence rate of TAPP is similar to tension-free hernioplasty.%目的 探讨经腹腔途径腹膜前补片置入术(TAPP)治疗嵌顿性腹股沟疝的安全性、有效性及优势.方法 将124例成年嵌顿性腹股沟疝患者按随机配对法分为两组,观察组56例,采用腹腔镜下复位+TAPP治疗;对照组68例,采用切开复位+无张力疝修补术治疗.记录两组手术时间、住院时间、下床活动时间、住院费用、复发率及并发症情况,并进行统计学分析.结果 观察组所有病例均在腹腔镜下完成手术,无中转开放手术.观察组手术时间、住院时间、下床活动时间均短于对照组[(37.52±7.78)min比(44.23±11.32) min、(4.53±0.89)d比(6.85±2.03)d、(9.30±2.65)h比(12.63±3.97) h],差异有统计学意义(P＜0.05).观察组住院费用多于对照组[(9 324±599)元比(7203±507)元],差异有统计学意义(P＜0.05).两组并发症发生率比较差异无统计学意义(P＞0.05).术后随访1年,观察组无复发,对照组有1例复发,两组复发率比较差异无统计学意义(P＞0.05).结论 TAPP治疗嵌顿性腹股沟疝微创、恢复快,是安全有效的,住院费用略高,复发率与无张力疝修补术相当.
  • 摘要：目的 分析不明原因结肠出血患者术中灌肠联合术中肠镜检查出血部位的经验.方法 收集不明原因结肠出血的患者31例,经保守治疗效果差,均需行手术治疗,患者均行术中灌肠联合术中肠镜检查以明确出血部位,采用回顾性分析的方法分析不明原因结肠出血患者的病因及检查方法.结果 31例患者均采用术中灌肠联合术中肠镜检查等方法明确出血部位后采用手术治疗,术后15d粪潜血转阴,3例出现切口感染,1例出现肠瘘,无死亡患者.术后病理结果显示缺血性肠病是不明原因结肠出血的主要原因.结论 术中灌肠联合术中肠镜检查可准确检查结肠出血部位,为手术治疗提供有力帮助.
  • 摘要：目的 探讨围手术期肠内营养支持对顽固性便秘并发继发性巨结肠的术后疗效的影响.方法 选择2010年1月至2013年2月收治的73例顽固性便秘并发继发性巨结肠行外科手术患者,均经过胃肠减压和全静脉营养支持治疗,其中37例无法恢复肠道通畅者,未接受肠内营养支持治疗而直接手术(对照组);另外36例患者肠道恢复通畅,再行2周的全肠内营养支持治疗后择期手术(观察组),对比两组预后差异.结果 观察组患者吻合口出血、吻合口瘘、肺炎的发生率明显低于对照组[2.8％(1/36)比21.6％(8/37)、0比13.5％(5/37)、0比13.5％(5/37)],差异有统计学意义(P＜0.05).术后1个月门诊随访时,观察组体质量、去脂体质量、蛋白质量、细胞内液、细胞外液、体质量指数、白蛋白、转铁蛋白均优于对照组[(55.1±6.4)kg比(50.9±4.7) kg、(42.9±3.2) kg比(39.1±1.3) kg、(12.2±1.4) kg比(9.7±3.2)kg、(23.7±5.0)L比(18.8±5.5)L、(10.9±4.5)L比(7.7±0.8)L、(22.3±1.9)k/gm2比(17.5±3.6) kg/m2、(41.9±4.7)g/L比(33.1±2.9) g/L、(3.5±0.7)μg/L比(2.7±0.5)μg/L],差异有统计学意义(P＜0.05).结论 顽固性便秘并发继发性巨结肠需外科治疗,术前应尽可能恢复肠道功能,行肠内营养支持治疗,可显著降低围手术期并发症发生率,改善预后.
  • 摘要：目的 总结闭孔疝的诊断和治疗经验.方法 对8例闭孔疝患者的临床资料进行回顾性分析.8例患者均为老年女性,年龄74～ 86岁,体质量38 ～ 45 kg,平均体质量指数(BMI)17.8 kg/m2.术前均以肠梗阻收治入院.3例患者Howship-Romberg征阳性;7例患者术前CT检查发现闭孔外肌与耻骨肌之间有肠管影.所有患者均行手术治疗,术中证实5例为右侧闭孔疝,3例为左侧闭孔疝,术中见疝内容物均为小肠,6例发生绞窄,其中4例属于小肠壁疝,均行肠切除吻合术,2例解除嵌顿后小肠血运恢复.未行肠切除术,闭孔予4-0丝线间断、内荷包或“8字”内翻缝合.4例患者术中行小肠减压术.所有患者术后均行肠外营养支持.结果 入院至手术时间最长7d,最短为1d,平均住院时间为17.5 d,所有患者切口均行减张缝合,术后未发生切口感染,发生肺部感染2例,术后转入ICU治疗2例.8例均痊愈出院.结论 对于高龄、营养状况差、多产的女性患者,反复出现不完全性肠梗阻,应警惕存在闭孔疝的可能,及时行腹部和盆腔CT检查可以明确诊断,早期确诊并行手术治疗可以显著降低闭孔疝患者的病死率.
  • 摘要：目的 总结在CT血管造影(CTA)指导下急诊手术治疗Hunt-Hess高分级颅内动脉瘤破裂的经验.方法 回顾性分析34例Hunt-Hess高分级的颅内动脉瘤破裂患者的临床资料.患者入院时均行CT和CTA检查.采用显微外科技术临时阻断载瘤动脉,夹闭动脉瘤颈,清除颅内血肿,并去骨瓣减压.结果 按格拉斯哥预后量表评分,出院时恢复良好17例,轻残10例,重残3例,死亡4例.结论 在紧急情况下CTA可作为诊断颅内动脉瘤的首要影像学方法.对于Hunt-Hess高分级颅内动脉瘤破裂的患者应该积极手术治疗,努力挽救患者生命.%Objective To summarize the experience of emergency microsurgery under the guidance of computed tomographic arteriography (CTA) for treatment of Hunt-Hess high grade intracranial aneurysm rupture.Methods The clinical data of 34 patients with Hunt-Hess high grade intracranial aneurysm rupture were retrospectively analyzed.The CT and CTA were detected in the patients on admission.Emergency operation were all performed.The temporal occlusion of the parent artery,removed intracranial hematoma and clipping intracranial aneurysms by microsurgical techniques.All patients were removed skull.Results The prognosis was assessed by Glasgow outcome score (GOS),17 cases were recovered well,10 cases were mildly disabled,3 cases were severely disabled and 4 cases died.Conclusions CTA can be used as the primary diagnosis of intracranial aneurysm imaging methods under the emergency condition.The patients with HuntHess high grade intracranial aneurysm rupture should make positive surgical treatment to save live.
  • 摘要：Objective To evaluate the safety and feasibility of retroperitoneal laparoscopic adrenalectomy for different diameter adrenal tumor.Methods The clinical dam of 61 patients who underwent retroperitoneal laparoscopic adrenalectomy from January 2009 to June 2013 were retrospectively analyzed,the patients were divided into A group (the diameter of adrenal tumor ＞ 6 cm,24 cases) and B group (the diameter of adrenal tumor 3-6 cm,37 cases) according to the diameter of adrenal tumor.The therapeutic effect was compared between 2 groups.Results All procedures were performed successfully.There were statistical differences in operative time and estimated blood loss between A group and B group [(138 ± 66) min vs.(106 ± 45) min and (324 ± 168) ml vs.(165 ± 50) ml] (P ＜ 0.05).There were no statistical differences in the rate of complication and blood transfusion between 2 groups (P ＞ 0.05).There was no statistical difference in hospital stay after operation between 2 groups [(6.7 ± 1.2) d vs.(5.4 ± 0.6)d] (P ＞ 0.05).A group was followed up for (22 ± 10) months,during which time no local recurrence was noted in 19 cases by B-mode ultrasonography,3 cases were missed,and 2 cases were alive with hydronephrosis or pancreatic cyst.B group was followed up for (24 ± 11) months,during which time no local recurrence was noted in 32 cases by B-mode ultrasonography,4 cases were missed,and 1 case was found with renal dysfunction.The pathology of most tumors in A group included medullary lipoma,pheochromocytoma and ganglioneuroma,in B group included adenoma,pheochromocytoma and medullary lipoma.Conclusion Minimally invasive and safe procedure for skillful surgeons in the treatment of tumor diameter larger than 6 cm.%目的 评价后腹腔镜手术切除不同直径肾上腺肿瘤的安全性和可行性.方法 回顾性分析2009年1月至2013年6月61例行后腹腔镜肾上腺肿瘤切除术患者的临床资料,根据肿瘤直径分为A组和B组,A组肿瘤直径＞6 cm(24例),B组肿瘤直径在3～6 cm(37例),比较两组临床疗效.结果 所有手术均较顺利完成,A组和B组手术时间[(138±66) min比(106±45) min]、出血量[(324±168) ml比(165±50) ml]比较差异均有统计学意义(P＜0.05).术中并发症发生率和输血率A组略高于B组,但差异无统计学意义(P＞ 0.05).两组术后住院时间[(6.7±1.2)d比(5.4±0.6)d]比较差异无统计学意义(P＞0.05).A组随访(22±10)个月,19例B超未见局部复发,失访3例,2例发现肾积水或胰腺囊肿;B组随访(24±11)个月,32例B超未见局部复发,失访4例,1例肾功能不全.A组术后病理以髓样脂肪瘤、嗜铬细胞瘤和神经节细胞瘤为主;B组病理以皮脂腺瘤、嗜铬细胞瘤和髓样脂肪瘤为主.结论 后腹腔肾上腺肿瘤切除术治疗肾上腺肿瘤效果良好,对于有一定经验的术者,可以安全地经后腹腔途径切除肿瘤直径在6 cm以上的复杂肾上腺肿瘤.
  • 摘要：目的 探讨经尿道前列腺等离子双极电切术(PKRP)联合尿液引流治疗良性前列腺增生合并肾后性肾功能不全的安全性及临床疗效.方法 回顾性分析41例良性前列腺增生合并肾后性肾功能不全患者的临床资料,通过留置气囊导尿管或耻骨上膀胱造瘘引流尿液,在肾功能改善后应用PKRP进行治疗.结果 41例均安全耐受手术,手术时间55～85 min,切除前列腺组织质量27～ 56 g,失血量100～180 ml,术后留置尿管时间3～7d,拔管后排尿通畅.并发症发生率为7.3％(3/41).结论 尿液引流为手术创造条件,PKRP是良性前列腺增生合并肾后性肾功能不全安全而有效的治疗方法.
  • 摘要：目的 对比分析改良手辅助腹腔镜下与完全腹腔镜下脾切除联合贲门周围血管离断术治疗肝硬化门静脉高压症的临床效果.方法 2008年1月至2013年7月收治肝硬化门静脉高压症患者85例,其中47例行改良手辅助腹腔镜下脾切除联合贲门周围血管离断术(改良组),38例行完全腹腔镜下脾切除联合贲门周围血管离断术(对照组).改良组先在手辅助腹腔镜下完成脾切除术,再改为完全腹腔镜下行贲门周围血管离断术.比较两组患者的手术时间、术中出血量、术后并发症和术后住院时间等指标.结果 改良组47例患者手术顺利,无中转开腹手术;对照组有2例患者因术中脾蒂静脉血管出血而中转开腹手术.改良组的手术时间为(165 ±43) min,术中出血量为(126±62) ml,均显著低于对照组[分别为(223±56) min和(183±46)ml],差异有统计学意义(P＜0.05).两组均无围手术期死亡.两组术后通气时间、术后住院时间和围手术期并发症发生率比较差异无统计学意义(P＞0.05).结论 改良手辅助腹腔镜下脾切除联合贲门周围血管离断术安全性好,操作方便,术中出血少,兼具手辅助腹腔镜和完全腹腔镜手术的优势,值得临床推广.
  • 摘要：Objective To explore the clinical significance of interstitial chemotherapy applied in breast cancer.Methods Sixty breast cancer patients with modified radical mastectomy were divided into treatment group (40 cases) and control group (20 cases) according to whether using fluorouracil implants.The control group was given conventional treatment.In treatment group,distilled water washed the wound after conventional treatment,and fluorouracil implants (0.4 g) was placed below local tumor,between pectoralis major and pectoralis minor,below 0.5 cm axillary vessel.The bone marrow suppression,liver and renal function,gastrointestinal reaction,skin flap necrosis,subcutaeous hydrops,local recurrence were observed in the 2 groups.Results There were no significant differences in the rates of bone marrow suppression,liver and renal function abnormal,skin flap necrosis,subcutaeous hydrops and gastrointestinal reaction between treatment group and control group (P ＞ 0.05).The rate of local recurrence in treatment group was significantly lower than that in control group [0 vs.20.0％ (4/20)],there was statistical difference (P ＜0.05).Conclusion Intraoperative application of fluorouracil implants is safe and effective in modified radical mastectomy of breast cancer.%目的 探讨乳腺癌术中放置氟尿嘧啶植入剂间质化疗的临床意义.方法 60例行乳腺癌改良根治术患者按术中是否使用氟尿嘧啶植入剂分为治疗组(40例)和对照组(20例).对照组常规手术治疗,治疗组在常规手术后,蒸馏水冲洗创面,分别在肿瘤区域下方、胸大小肌间、腋窝血管下0.5 cm均匀放置氟尿嘧啶植入剂(剂量0.4 g).观察两组术后骨髓抑制、肝肾功能、胃肠道反应、皮瓣坏死、皮下积液、局部复发等情况.结果 两组骨髓抑制、肝肾功能异常、皮瓣坏死、皮下积液及胃肠道反应发生率比较差异无统计学意义(P＞0.05).治疗组局部复发率低于对照组[0比20.0％(4/20)],差异有统计学意义(P＜0.05).结论 乳腺癌改良根治术中应用氟尿嘧啶植入剂是安全有效的.
  • 摘要：Objective To obtain reasonable treatment by urodynamic detection and analysis in patients with diabetic cystopathy (DCP) complicated with benign prostatic hyperplasia (BPH).Methods Sixty patients with DCP complicated with BPH were selected,among the total 32 patients (duration of diabetes ＞ 12 years,blood glucose control was not ideal) were recognized as experimental group,and 28 patients (duration of diabetes ≤ 8 years,blood glucose control was stable) were recognized as control group.Using the Laborie UDS-120XLT urodynamic detection instrument,the urodynamic was detected and the international prostate symptom score (IPSS) was evaluate,and the results were compared between the 2 groups.Results There was no statistical difference in residual urine volume between experimental group and control group [(146 ±71) ml vs.(160 ±64) ml,P ＞0.05].The maximum urinary flow-rate in experimental group was significantly lower than that in control group [(5.4 ± 2.0) ml/s vs.(8.0 ± 3.2) ml/s],the symptom total score of IPSS was significantly higher than that in control group [(25.8 ± 4.1) scores vs.(22.6 ±5.0) scores],there were statistical differences (P ＜0.01).The maximum bladder capacity,compliance,incipient micturition desire volume in experimental group were significantly lower than those in control group,there were statistical differences (P ＜ 0.01).Conclusions The influence of DCP on the function of the bladder in BPH patients is significant.Urodynamic detection can provide objective basis for the selection of therapeutic methods,suitable to be operated and forecast the postoperative effect.It has an important reference value in DCP complicated with BPH patients.%目的 通过对糖尿病膀胱病变合并良性前列腺增生症(BPH)患者尿动力学检查及分析,做出合理的治疗与处理.方法 60例已确诊为糖尿病膀胱病变合并BPH患者,其中糖尿病病程＞12年、血糖控制不理想32例(试验组),糖尿病病程≤8年、血糖控制基本平稳28例(对照组),采用莱博瑞UDS-120XLT型尿动力学检查仪,对两组患者进行尿动力学检查和国际前列腺症状评分(IPSS),并根据检查结果进行对比分析.结果 试验组和对照组残余尿量比较差异无统计学意义[(146±71) ml比(160±64) ml,P＞0.05].而试验组最大尿流率明显低于对照组[(5.4±2.0) ml/s比(8.0±3.2)ml/s],IPSS的症状总分明显高于对照组[(25.8±4.1)分比(22.6±5.0)分],差异有统计学意义(P＜ 0.01).试验组最大膀胱容量、顺应性、初始尿意容量均低于对照组,差异有统计学意义(P＜0.01).结论 糖尿病膀胱病变加重了BPH患者的膀胱功能障碍,尿动力学检查对糖尿病膀胱病变合并BPH患者的治疗方法及手术方式选择提供客观依据,具有重要的临床价值.
  • 摘要：Objective To analyze the risk factors of postoperative arrhythmia in severe obstructive pulmonary emphysema patients with thoracoscopic lung volume reduction surgery.Methods The clinical data of 118 severe obstructive pulmonary emphysema patients with thoracoscopic lung volume reduction surgery were retrospectively analyzed.The possible risk factors of postoperative arrhythmia were analyzed using unconditioned multivariate Logistic regression analysis.Results Unconditioned multivariate Logistic regression analysis results showed that:age ≥ 70 years,history of cardiovascular disease,preoperative forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) ＜ 70％,preoperative serum potassium ＜ 4 mmol/L were the independent risk factors of postoperative arrhythmias.Conclusion Control surgical indications,peroperative period management,improved surgical techniques in order to shorten the operation time,the rational use of anti-arrhythmic drugs are the important methods to prevent the postoperative arrhythmia in patients with thoracoscopic lung volume reduction surgery.%目的 分析重度阻塞性肺气肿胸腔镜下行肺减容术患者术后发生心律失常的危险因素.方法 回顾性分析118例胸腔镜下行肺减容术患者的临床资料,对可能致术后心律失常的危险因素采用非条件多元Logistic回归分析.结果 非条件多元Logistic回归分析表明:年龄≥70岁、心血管病史、术前第1秒用力呼气容积(FEV1)/用力肺活量(FVC)＜ 70％、术前血钾＜4 mmol/L是致患者术后心律失常的独立危险因素.结论 控制手术适应证、加强围手术期管理、提高手术技巧缩短手术时间、合理应用抗心律失常药物是防止肺减容术患者术后发生心律失常的重要方法.
  • 摘要：目的 探讨采用后颅窝小骨窗减压及硬脑膜成形术治疗Chiari畸形Ⅰ型的疗效.方法 回顾性分析45例Chiari畸形Ⅰ型患者行后颅窝小骨窗减压及硬脑膜成形术临床资料,其中合并脊髓空洞症31例.结果 按Tator等标准,术后1个月优30例,良15例.随访6个月至6年,其中优37例,良8例.31例合并脊髓空洞症患者中有26例脊髓空洞消退,5例脊髓空洞无明显变化.结论 后颅窝小骨窗减压及硬脑膜成形术可使颅颈交界区充分减压,并对脊髓空洞症有明显的治疗作用,是治疗Chiari畸形Ⅰ型安全有效的治疗方法.%Objective To evaluate the therapeutic effect of small bone flap craniotomy decompression of posterior cranial fossa and duraplasty in the treatment of Chiari malformation type Ⅰ.Methods The clinical data of 45 Chiari malformation type Ⅰ patients who were treated with small bone flap craniotomy decompression of posterior cranial fossa and duraplasty were retrospectively analyzed,31 cases among them with syringomyelia.Results According to Tator etc.standard,1 month after surgery,the excellent in 30 cases,good in 15 cases.Follow up from 6 months to 6 years,the excellent in 37 cases,good in 8 cases.Among 31 patients with syringomyelia,26 cases were syringomyelia subsided,5 cases were not obvious change.Conclusion The small bone flap craniotomy decompression of posterior cranial fossa and duraplasty can make the craniocervical decompression,and has obvious effect of treating syringomyelia,is safe and effective in treatment of Chiari malformation type Ⅰ.

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