不同病变特征介入治疗策略选择及其并发症防治进展

近年来,冠心病介入治疗得到快速发展,但仍有诸多问题亟待解决。现就近年来国内外文献中关于冠状动脉介入治疗存在的问题如:复杂病变(左主干病变、慢性闭塞病变、多支血管病变、分叉病变)介入治疗策略的选择,无复流现象,支架内再狭窄,支架术后血栓等问题进行综述。     

抗抑郁治疗对腹泻型肠易激综合征患者肠道敏感性的影响

目的 观察腹泻型肠易激综合征(IBS-D)伴抑郁状态患者抗抑郁治疗前后症状积分、汉密尔顿抑郁量表(HAMD)积分及直肠敏感性的变化,评价抗抑郁药物在IBS-D治疗中的作用.方法 依据RomeⅢ标准和CCMD3标准将符合IBS-D伴抑郁状态的患者随机分为研究组和对照组,前者给予常规治疗加抗抑郁药物及心理疏导,后者给予常规药及对症治疗.治疗前后分别进行症状积分、HAMD积分及直肠敏感性测定,并进行统计学分析.结果 研究组与对照组治疗后及研究组治疗前后症状积分、HAMD积分、直肠敏感性比较差异均有统计学意义(P<均0.01).结论 伴抑郁状态的IBS-D患者加用抗抑郁药物能减轻临床症状,降低肠道敏感性,从而改善与之相关的疼痛,其疗效优于对照组. Abstract： Objective To evaluate the effect of antidepressant treatment for the diarrhea-predominant irritable bowel syndrome(IBS-D),by observing the changes of clinical symptom score,HAMD scale score and the regulation of intestinal sensations in IBS-D with depress patients before and after treatment. Methods Accord to ROMEⅢ standard and CCMD3 standard,all IBS-D with depress patients were randomly divided into two groups. The study group was given antidepressant treatment plus conventional treatment and mental adjustment treatment, and the control group was given conventional treatment.All the cases received symptom score,HAMD scale score evaluating and evaluating the regulation of intestinal sensations before and after antidepressant treatment. Results The study group comparing with the control group after treatment and the study group itself before treatment comparing with after treatment, was significantly different in symptoms score, HAMD score, and the regulation of visceral sensations (all P<0.01). Conclusions For the patients of IBS with depress using antidepressant drug can significantly alleviate the physical symptoms, and antidepressant treatment can improvethe threshold of visceral sensation and alleviate the physical symptom such as pain.     

Effect of Yiqi Yangyin Decoction(益气养阴方) on the Quality of Life of Patients with Unstable Angina Pectoris

<正>Objective:To observe the effect of Yiqi Yangyin Decoction(益气养阴方,YQYYD) on the quality of life(QOL) of patients with unstable angina pectoris(UAP).Methods:A total of 108 patients with UAP of qi-yin deficiency syndrome confirmed by coronary angiography were enrolled and assigned to the treated group(treated with YQYYD and conventional therapy of Western medicine) and the control group(treated with conventional therapy of Western medicine),by the use of the PROC PLAN of the SAS 6.12 software,in a prospective, randomized,controlled design.The clinical total effective rate,symptom score,QOL scale[Seattle Angina Questionnaire(SAQ)]and incidence of important clinical events were defined as the observation indices to evaluate the interventional effect of YQYYD on the QOL of patients with UAP of the qi-yin deficiency syndrome. Results:During the study,three cases dropped out in the treated group,one case dropped out in the control group,and 104 cases,including 51 cases in the treatment group and 53 cases in the control group,finished the trial.After four weeks of treatment,the total clinical effective rates in the treated group and the control group were 80.4%and 75.5%respectively,and there was no obvious difference between them(P0.05).However,the symptom score of the treated group(9.31±2.02) was significantly lesser than that of the control group(11.62±3.04,P0.05),and the total score of the QOL scale of the treated group(68.76±5.74) was significantly higher than that of the control group(61.06±3.31,P0.01).Among those in the treated group physical limitation, angina stability,angina frequency,and treatment satisfaction were significantly ameliorated when compared with the control group after treatment(P0.05,P0.01).The incidence of important clinical events in the treated group(3.9%) was lower than that in the control group(5.7%) during the 8-month follow-up period,but the difference was insignificant(P0.05).Conclusion:YQYYD could improve the clinical symptoms of patients with UAP of qi-yin deficiency syndrome and greatly improve their QOL.     

输尿管镜下国产钬激光碎石取石术治疗输尿管结石（附124例报告）

目的总结输尿管镜下国产钬激光碎石取石术治疗输尿管结石的临床经验。方法应用Wolf8．0／9．8F硬性输尿管镜,国产30W钬激光碎石机治疗124例输尿管结石患者,输尿管中下段结石87咧,上段结石37例。结果124例输尿管结石,108例1次碎石成功,16例失败,单次碎石成功率87％（108／124）：其中,中下段结石单次碎石成功率为95％（83／87）,上段结石67．5％（25／37）,术中无输尿管穿孔、撕裂等并发症。结论输尿管镜下国产钬激光碎石取石术治疗输尿管结石是安全、有效的方法,特别适合在中小医院使用。     

异丙酚复合静脉全麻在颅脑外科及五官科手术中的应用体会

异丙酚是一种新的快速短效静脉全身麻醉药,本文就其在脑外科及五官科手术中的麻醉情况体会如下,供同行讨论。 1 材料及方法 选择脑外科及五官科全麻病人400例,年龄在16～70岁,体重在45～70kg,ASAⅠ～Ⅱ级,随机分为实验组(A组)200例,对照组(B组)200例。术前30分钟常规肌注阿托品0.5mg,鲁米那钠0.1g,入手术室后吸氧去氮20分钟,连接各种监护仪如ECG,BP、HR、SaO_2,SaO_2达100％后开始诱导插管,A组诱导分别用芬太尼2～4mg/kg,异丙酚1～2mg/kg,司考林1～2mg/kg,肌松完善后开始气管插管,听两侧呼吸音正常后妥善固定导管,接呼吸机机械通气,设定呼吸次数为14～20次/分,呼吸之比为1:1.5～2,每分通气量为8～10L,     

当代犯罪心理健康状况的调查研究

本研究运用SCL－90对394名不同类型罪犯的心理健康状况进行了调查研究。结果表明，当代罪犯总体上心理问题的检出率为90．10％，其中有82％的罪犯心理问题与正常群体（常模）相比，达到了异常或严重（Z＞2）的程度。罪犯总体的阳性症状总分及各因子均分皆高于正常群体，且与正常群体有极其显著性差异。不同类型罪犯的心理问题具有高度一致性（P＜0．80），其中不同类型罪犯，男性与女性罪犯，入狱时间不同的罪犯又有某些不同特点。由此得出，当代罪犯具有严重的犯罪心理结构，提出了在当代罪犯改造中开展罪犯心理矫正工作的重要性与现实性。     

乙酰螺旋霉素片溶出度考察

本文采用紫外法对国产五家药厂八个批号乙酰螺霉素片进行溶出度测定,求得的T50,T参数具有显著性差异,提示国产乙酰螺旋霉素片有必要增加溶出度检查,以控制其质量。     

危重型急性感染性多发性神经炎52例临床分析

本文分析了52例危重型急性感染性多发性神经炎气管切开抢救情况。适时的气管切开是抢救本型病人的重要措施，术后合理应用人工辅助呼吸器能降低死亡率。肺部感染是死亡的主要原因，严格加强气管切开术后护理．及时处治并发症，方能提高抢救成功率，降低死亡率。     

8 例新生儿神经母细胞瘤临床特点及预后分析*

目的:提高对新生儿神经母细胞瘤临床特征及预后的认识。方法:对2010年7 月至2015年3 月中国医科大学附属第四医院儿科收治的8 例新生儿神经母细胞瘤患儿的临床表现、组织病理分型、治疗及预后进行回顾性分析。结果:患儿中男性5例,女性3 例,发病年龄孕24周至生后28天,中位数年龄9 天。原发肿瘤4 例位于左肾上腺,2 例位于右肾上腺,1 例位于双肾上腺,1 例位于盆腔。6 例经肿瘤组织病理学确诊,2 例经骨髓细胞学确诊。临床分期:1 期1 例,2 期1 例,4S 期6 例。5 例给予原发肿瘤切除和术后化疗,1 例给予一侧原发肿瘤切除和术后化疗,2 例仅给予化疗。8 例均生存,随访时间6～56个月,6 例均达持续完全缓解,2 例带瘤生存。结论:新生儿神经母细胞瘤具有自身生物学特性,临床分期主要为1 期、2 期和4S 期,病理分型多数是神经母细胞瘤,预后良好。