腹腔镜在胃溃疡穿孔修补术中的临床应用效果分析

目的：分析腹腔镜在胃溃疡穿孔修补术中的临床应用效果。方法：选取2011年10月～2014年5月于本院进行治疗的82例胃溃疡穿孔患者分为对照组36例和观察组46例,对照组患者采用传统开腹手术进行治疗,观察组患者采用腹腔镜下胃穿孔修补术进行治疗,对比观察2组患者的术中出血量、手术时间、术后肛门排气时间、住院时间、术后疼痛程度及并发症发生情况,分析腹腔镜在胃溃疡穿孔修补术中的临床应用效果。结果：观察组46例患者的术中出血量,肛门排气时间,住院时间,镇静剂使用率,并发症发生率均明显低于对照组36例患者,P＜0．05,有显著性差异,具有统计学意义。手术时间2组比较无显著差异,P＞0．05,无统计学意义。结论：腹腔镜在胃溃疡穿孔修补术中的临床应用效果好,术中出血量少,术后胃肠功能恢复较快,疼痛较轻,并发症发生率低,且住院时间较短,安全可靠,可作为胃溃疡穿孔治疗的首选手术方式,值得临床广泛推广应用。     

胃修补术治疗胃穿孔患者30例临床分析

目的：探讨腹腔镜胃穿孔修补术的临床可行性,观察其临床疗效。方法选择60例胃穿孔患者为研究对象,随机均分为治疗组和对照组。治疗组进行腹腔镜胃穿孔修补术,对照组进行开腹修补术,观察2组患者术中出血量、肛门排气时间、平均住院时间及并发症发生率。结果治疗组在术中出血量、肛门排气时间、平均住院时间及并发症发生率上均优于对照组。结论腹腔镜修补术治疗胃穿孔,具有出血少、疗程短,患者痛苦少的特点,值得临床大力推广。     

改良的四孔腹腔镜穿孔修补术治疗胃十二指肠溃疡穿孔的疗效观察

目的观察改良的四孔腹腔镜穿孔修补术治疗胃十二指肠溃疡穿孔（GDUP）的效果。方法回顾行手术治疗的GDUP患者76例,其中38例患者采用改良的四孔腹腔镜穿孔修补术治疗,为观察组;另38例采用传统开腹修补术治疗,为对照组。观察并比较两组患者手术时间、术中出血量、术后排气时间、住院时间、术后疼痛情况[采用视觉模拟疼痛评分法（VAS）评估]与术后并发症发生情况等。结果观察组患者术中出血量少于对照组,术后排气时间、住院时间均短于对照组,但手术时间长于对照组,两组比较差异均有统计学意义（均P＜0.05）。观察组患者术后48h内疼痛评分均低于对照组（均P＜0.05）,术后并发症发生率低于对照组（P＜0.05）。结论与传统开腹修补术比较,改良的四孔腹腔镜穿孔修补术治疗GDUP具有创伤小、术后疼痛较轻、并发症少、患者恢复快等优势,疗效确切。     

腹腔镜在胃十二指肠穿孔方面的治疗优势分析

目的：与传统开腹手术对比,探讨腹腔镜治疗胃十二指肠穿孔的临床疗效。方法：64例行胃穿孔修补术患者为研究对象,给予不同手术方式治疗,其中腹腔镜治疗记为观察组和开腹手术治疗的对照组,记录术中情况和术后恢复情况。结果：观察组手术时间和术中平均出血量明显低于对照组;而且观察组术后排气时间和住院时间均较对照组明显缩短,疼痛较轻（P＜0．05）;观察组和对照组患者顺利康复出院,并发症发生率为6．2％（2/32）和21．8％（7/32）（ x2＝11．875,P＜0．05）。结论：腹腔镜下行胃十二指肠穿孔修补术可以明显缩短手术时间,减少术中出血,减轻患者术后疼痛,降低术后并发症发生率,较传统开腹修补术有更好的临床疗效。     

传统开腹与腹腔镜穿孔修补术治疗胃十二指肠溃疡穿孔临床疗效对比分析

目的:分析对比传统开腹与腹腔镜穿孔修补术治疗胃十二指肠溃疡穿孔临床疗效。方法:选取84例胃十二指肠溃疡穿孔患者分为观察组和对照组,分别给予传统开腹修补和腹腔镜穿孔修补,比较两组患者手术情况,术后恢复情况、住院时间/费用及并发症发生率。结果:两组患者住院费用和溃疡愈合率,差异无统计学意义(P>0.05),观察组患者手术切口、手术时间、术中出血量、术后肛门排气时间、胃肠功能恢复时间、术后下床活动时间及并发症发生率显著低于对照组,差异均有统计学意义(P<0.05)。结论:腹腔镜穿孔修补术治疗胃十二指肠溃疡穿孔创伤小、出血量少、缩短患者术后恢复时间,降低并发症的发病率,溃疡与愈合率与开腹手术无异,值得进一步推广应用。     

腹腔镜胃穿孔修补术与开腹手术的疗效对比研究

目的探讨腹腔镜胃穿孔修补术与开腹手术下行的疗效。方法将该院2008年1月—2012年3月78例胃穿孔接受修补术的患者资料进行分析,根据手术方式分为腹腔镜组39例和开腹组39例,比较两组患者手术时间、术中出血量、肛门排气时间、恢复日常生活时间、住院费用等。结果腹腔镜组在手术时间、术中出血量、肛门排气时间、住院时间、术后恢复日常生活时间、住院费用与开腹组相比差异有统计学意义(P<0.05),腹腔镜组手术时间、肛门排气时间、住院时间、术后恢复日常生活时间短于开腹组,术中出血量、住院费用少于开腹组。结论腹腔镜下行胃穿孔修补术具有创伤小、术后恢复快、并发症少的特点,建议临床推广运用。     

腹腔镜修补术与开腹修补术治疗胃穿孔的临床疗效比较

目的 比较腹腔镜修补术与开腹修补术治疗胃穿孔的临床疗效.方法 选取我院2014年4月—2016年6月收治的94例胃穿孔患者作为研究对象,随机分为观察组(47例)和对照组(47例).对照组患者给予开腹行胃穿孔修补术治疗,观察组患者给予腹腔镜下行胃穿孔修补术治疗,比较2组患者术中与术后情况.结果 除手术时间外,观察组患者术中出血量、术后排气时间、术后疼痛分级及总住院时间均明显低于对照组,差异有统计学意义(P<0.05).结论 腹腔镜下行胃穿孔修补术术中出血量少,损伤小,有利于患者的康复,值得作为临床治疗胃穿孔的首选术式.     

胃穿孔腹腔镜修补术的临床疗效观察

目的探讨对比胃穿孔腹腔镜修补术与开腹修补术术后胃肠动力的恢复情况。方法回顾性分析我院2008年2月至2010年4月收治的胃溃疡穿孔患者42例（采用腹腔镜修补术治疗）随机选择同期采用开腹修补术42例胃溃疡穿孔患者,2组术中出血量、肛门排气时间及术后平均住院时间等指标。结果腹腔镜修补术组术中出血量、肛门排气时间及平均住院时间与胃穿孔开腹修补组相比差异均有统计学意义（P〈0.05）。结论胃穿孔腹腔镜修补术术后患者胃肠动力恢复快,为临床上胃穿孔腹腔镜修补术术后患者的治疗与康复指导提供了依据。     

腹腔镜手术治疗胃穿孔疗效分析

目的探讨腹腔镜下胃穿孔修补术与开腹胃穿孔修补术的临床疗效。方法回顾分析我院160例胃穿孔患者资料,其中80例采取腹腔镜手术,80例采取传统开腹手术,比较两组手术时间、术中出血量、手术疗效、并发症、术后胃肠动力的差异。结果腹腔镜组的手术时间、术中出血量、肠鸣音恢复时间、术后肛门排气时间、术后6 h视觉模拟量表(VAS)疼痛评分、住院时间明显低于开腹组,差异有统计学意义(P0.05),腹腔镜组术后胃泌素水平均高于开腹组,两组比较差异有统计学意义(P0.05)。结论腹腔镜治疗胃穿孔安全、可行,手术时间短、创伤小、疼痛轻,可改善血清胃泌素水平、缩短肠鸣音恢复时间、肛门排气时间,术后恢复快,值得临床推广应用。     

胃大部切除术与单纯穿孔修补术治疗胃十二指肠溃疡穿孔疗效比较

目的评价胃大部切除术与单纯穿孔修补术治疗胃十二指肠溃疡穿孔的临床疗效。方法 86例胃十二指肠溃疡穿孔患者根据手术方法不同分为胃大部切除术组39例和单纯穿孔修补术组47例,观察比较2组患者术中出血量、手术时间、术后感染率、住院时间、肛门排气时间、术后并发症及溃疡复发率。结果单纯穿孔修补术组患者手术时间、肛门排气时间和住院时间显著短于胃大部切除术组(P<0.05),术中出血量显著少于胃大部切除术组(P<0.05),术后感染率和并发症发生率显著低于胃大部切除术组(P<0.05);腹腔镜手术组患者的手术时间、肛门排气时间和住院时间显著短于开腹手术组(P<0.05),术后感染率显著低于开腹手术组(P<0.05)。单纯穿孔修补术组与胃大部切除术组患者术后6、12个月溃疡复发率比较差异无统计学意义(P>0.05)。结论单纯穿孔修补术和胃大部切除术治疗胃十二指肠溃疡穿孔临床疗效相近,但单纯穿孔修补术手术操作简单,创伤较小;腹腔镜下修补术更具有明显的微创优势,更适用于胃十二指肠急性穿孔患者的手术治疗。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Dr.Zhang Ren's Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.