经子宫动脉介入治疗输卵管妊娠的疗效分析及护理配合

目的：探讨选择性子宫动脉介入治疗输卵管妊娠的可行性及临床疗效。方法：对35例自愿接受介入治疗的患者,采用Seldinger穿刺技术,用4F-5F导管行超选择性患侧子宫动脉灌注甲氨喋呤（MTX）100mg和5-Fu（250~500）mg,灌注后用明胶海绵栓塞子宫动脉,术后观察临床症状、体征、血β-HCG（人绒毛膜促性腺激素）值,B超检测孕囊的变化情况。结果：34例获得成功,成功率为97.14%,无严重不良反应,术后血β-HCG下降至正常,所需时间（7~32）天,平均16天。结论：经子宫动脉介入治疗输卵管妊娠,具有微创、不开腹、恢复快,能保留生育能力的优点,并可预防和控制破裂后致命性大出血,是输卵管妊娠的首选治疗方法。     

经子宫动脉介入治疗异位妊娠的临床应用

目的探讨经子宫动脉介入治疗异位妊娠的临床价值.方法采用seldinger股动脉穿刺置管,导管头端超选至患侧子宫动脉内,灌注MTX(氨甲喋呤)100mg,若血β-HCG值大于12000 mIu/ml 或有胎心搏动,则同时应用5-Fu(5-氟脲嘧啶)500mg,灌注完毕,予以适量明胶海绵颗粒栓塞子宫动脉.结果本组34例,31例治愈出院,血β-HCG下降至正常为4~60天.其中3例,分别于术后3天、4天和8天因大出血行同侧输卵管切除术.B超监测28例,介入治疗后3周孕囊消失21例,其中最长1例为65天.结论经子宫动脉介入治疗异位妊娠是安全的、可行的.     

经子宫动脉介入治疗输卵管妊娠的疗效分析

目的探讨经子宫动脉介入治疗输卵管妊娠的可行性及其疗效和价值.方法采用血管内介入治疗35例输卵管妊娠患者.以Seldinger法穿刺插管,用5 F子宫动脉导管行超选择子宫动脉内灌注甲氨蝶呤(MTX)(100～150)mg加入生理盐水100mL稀释液同时给予5-FU(250～500)mg,灌注完毕后,再用胶海绵颗粒1mm×1mm栓塞患侧子宫动脉.术前术后观察临床症状、体征、血β-HCG值、盆腔包块变化及腹腔内出血吸收情况.结果30例用5 F子宫动脉导管行超选择插入患侧子宫动脉,5例用3FSP导管超选择性插入患侧子宫动脉,均获得一次性插管成功,34例介入治疗一次性成功,一例不成功,成功率为97.14%.手术后输卵管通畅率为83.3%.结论经子宫动脉介入治疗输卵管妊娠安全有效.因其具有微创、副作用小、见效快,不需开腹手术,保留了子宫和输卵管(形态、功能和解剖)的完整性,不影响年轻女性的生育功能,并可预防和控制破裂后致命性大出血,是输卵管妊娠的首选治疗方法.     

高血β-HCG值输卵管妊娠子宫动脉栓塞治疗分析

目的:探讨高血β-HCG值输卵管妊娠子宫动脉栓塞治疗的可行性.方法:选择早期未破裂行高血β-HCG值输卵管妊娠患者120例,在DSA下采用seldinger's技术将5F管结合3F-SP微导管插入患者患侧子宫动脉或上行支,灌注MTX 80～11]0 mg后行明胶海绵栓塞.结果:120例患者中,116例治疗成功,治愈率为96.67%,4例失败改行腹腔镜手术.血β-HCG呈指数函数下降Y=κ(0.8±0.1)X,β-HCG降至正常所需的时间平均是(13±1.5)d,随访的62例患者中.目前已有10例怀孕,其中,8例已经正常分娩健康婴儿,2例正在怀孕.还有2例介入治疗后再次发生输卵管妊娠,1例为同侧,另1例为对侧输卵管,均再次介入治疗成功.治疗后患者几乎无明显化疗不良反应.结论:子宫动脉栓塞治疗对于高血β-HCG值早期未破型输卵管妊娠,是一种简单、安全、微刨、行之有效的方法,值得推广.     

输卵管妊娠介入治疗的临床分析

目的 探讨放射介入治疗输卵管妊娠的临床疗效及适应证.方法 选择临床诊断输卵管妊娠的患者38例,采用介入方法以4.1 F导管行子宫动脉超选择插管后灌注MTX100mg,灌注后用明胶海绵颗粒栓塞子宫动脉.术后观察血β-HCG及B超结果的变化,随访卵巢内分泌功能情况.结果 38例中34例输卵管妊娠经介入治疗成功,治愈率为89.5%.结论 早期输卵管妊娠患者采用放射介入治疗是安全有效的.     

经子宫动脉灌注和栓塞治疗输卵管妊娠临床探讨

目的：探讨经子宫动脉灌注甲氨蝶呤（MTX）后栓塞子宫动脉,治疗输卵管妊娠的可行性和临床疗效。方法：对33例愿意接受介入治疗的患者,经子宫动脉灌注甲氨蝶呤后,再行明胶海绵颗粒栓塞子宫动脉,术后观察临床体征,定期测血清β—HCG值,B超监测孕囊变化情况。结果：33例中30例获得痊愈,痊愈率达90．9％,无严重不良反应发生,β—HCG平均17天降至正常,月经复潮时间平均为49天。结论：子宫动脉是输卵管的主要供血动脉,子宫动脉灌注和栓塞,治疗输卵管妊娠,安全有效,并可预防和控制输卵管妊娠破裂所致的大出血.     

自制导管经宫腔输卵管内注入甲氨喋呤治疗输卵管妊娠15例疗效观察

目的观察应用自制子宫输卵管导管，经宫腔输卵管注射甲氨喋呤（MTX）治疗输卵管妊娠的临床疗效。方法对符合条件的15例输卵管妊娠患者，在超声引导下，应用自制子宫输卵管导管，经官腔输卵管插管注射MTX，术后观察血β-HCG下降情况。结果15例患者在B超引导下用自制宫腔导管输卯管插管均一次成功，12例患者血β-HCG在5～15天均降至正常；1例插管后1周血β-HCG下降％15％；2例转开腹手术治疗。10例在治疗后3个月行子宫输卵管造影示患侧输卵管通畅。结论应用自制子宫输卵管导管，在超声引导下输卵管插管注射MTX治疗输卵管妊娠的方法，在监测生命体征情况下具有经济、操作简单、副作用少的优点。     

甲氨蝶呤联合米非司酮治疗输卵管妊娠38例临床分析

目的:探讨甲氨蝶呤(MTX)联合米非司酮治疗非破裂型异位妊娠患者的临床疗效.方法:对38例未破裂的输卵管妊娠患者,予MTX静脉注射0.4mg/(kg·日),5天为1个疗程,间歇7天,同时加用米非司酮50mg,口服,每12小时1次,共3天.用药后监测生命体征、血清β-HCG及B超.结果:治愈32例,治愈率为84.21%,6例在治疗过程中腹痛加剧、血HCG升高、妊娠包块增大而改手术治疗.结论:MTX联合米非司酮治疗非破裂型输卵管妊娠疗效显著.     

介入治疗异位妊娠68例临床观察

目的探讨微创手术治疗异位妊娠在临床应用的可行性。方法对68例异位妊娠患者行右侧股动脉穿刺插管,超选择至患侧子宫动脉,造影观察病变的范围、血供来源及有无活动性出血,然后将甲氨蝶呤150mg稀释至100ml经导管缓慢注入子宫动脉,再用细小的明胶海绵碎粒适量栓塞子宫动脉,至子宫动脉分支不显影为止。结果全组68例异位妊娠均在实施超选择性子宫动脉灌注栓塞术后获得痊愈,其中42例不全流产或输卵管妊娠破裂伴腹腔活动性出血的患者,出血立即得到有效控制,出血停止;15例胚胎存活患者术后第2天超声观查胚胎死亡。68例患者血β-hCG均在术后3～12d降至5U/L以下,腹腔积血1周后全部吸收。1个月后B超复查宫体旁混合性包块完全吸收消失。术后3个月行子宫输卵管造影26例,15例显示患侧输卵管通畅。结论超选择性子宫动脉灌注栓塞治疗异位妊娠,能有效杀灭胚胎组织,栓塞破裂血管,止血效果明显,避免手术创伤,且能保留输卵管。     

介入技术治疗输卵管妊娠临床体会

目的:探讨经子宫动脉途径治疗输卵管妊娠的可行性和临床疗效。方法:采用介入方法治疗32例输卵管妊娠患者。以4.1~5.0Fr导管行选择性子宫动脉内灌注MTX(氨甲喋呤)50mg,灌注后用明胶海绵栓塞子宫动脉。术后以患者症状、体征、β-HCG水平及孕囊B超值的动态变化作为疗效的监测指标。将MTX(氨甲喋呤)和米非司酮联合治疗病人设为对照组。结果:观察组较对照组能明显缩短血β-HCG(绒毛膜促性腺激素)降至正常范围的时间,减少住院日,提高治疗成功率(P<0.01)。介入治疗输卵管妊娠的成功率为96.88%,明显高于对照组。观察治疗期间病情变化,发现疗效与血β-HCG高低及有无心管搏动有关。结论:介入治疗输卵管妊娠疗效可靠,操作简便,尤其经动脉途径更有价值,介入治疗应成为终止输卵管妊娠的重要手段。     

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.