局麻下行支撑喉镜声带息肉摘除术372例疗效观察

目的观察局麻下行支撑喉镜声带息肉摘除术的可行性、优点及疗效。方法于1%丁卡因咽喉部粘膜表面麻醉和1%利多卡因双侧喉上神经阻滞麻醉下行支撑喉镜手术摘除声带息肉。结果共进行372例支撑喉镜声带息肉摘除手术,顺利成功完成364例(97.8%),5例改为局麻下行纤维喉镜声带息肉摘除手术(1.3%),3例于全麻下完成支撑喉镜下声带息肉摘除手术(0.8%)。结论局麻下进行支撑喉镜手术摘除声带息肉是可行的,具有费用低、安全有效、简便易行、麻醉风险减少、并发症少、康复快、术前无需严格禁食等优点,可作为临床推广的一种术式。     

纤维鼻咽喉镜检查2116例临床体会

我科自1989年至1995年共进行纤维鼻咽喉镜检查和治疗2116例。其中鼻咽部检查152例，喉部检查1964例。通过鼻咽镜检查发现鼻咽癌46例，鼻咽血管瘤1例，喉部检查发现喉癌70例，声带息肉264例，声带小结248例，声带麻痹47例，喉结核Zo例，喉乳头状瘤15例，会厌囊肿15例。其中在纤维喉镜下行声带息肉及小结手术摘除186例，会厌囊肿15例。1．检查步骤及适应症：1．1麻醉方法：一般采用表面麻醉，术前半小时予阿托品0．sing肌注，儿童酌情减量，儿童不合作者予安定5－10mg肌注，表麻采用1％丁卡因及l％利多卡因各一半的混合液。对鼻咽部检查可喷…     

表麻下纤维喉镜手术的体会

纤维喉镜手术麻醉完善与否是手术成功的前提之一。 1997年 8月～ 2 0 0 1年 12月经纤维喉镜手术30 0余例 ,有资料可查者 15 6例 ,现介绍如下。1　临床资料与方法15 6例中 ,男 5 4例 ,女 10 2例 ,年龄 19～ 6 7岁 ,平均年龄为 4 2岁。声带息肉 94例 ,声带小结6 2例。其中采用丁卡因表面麻醉的 82例 ,采用2 %利多卡因超声雾化表面麻醉 74例。　　麻醉方法　术前 6ｈ禁食 ,4ｈ禁饮。麻醉前30ｍｉｎ常规肌注鲁米那钠 0 1ｇ及阿托品 1ｍｇ。采用丁卡因组 ,用 1%丁卡因在咽部及舌根喷 3次 ,再于间接喉镜下对准声门喷丁卡因 1次 ,每次间隔3～ 5ｍ…     

喉上神经阻滞联合利多卡因喷雾对声带息肉手术后应激反应及术后咽喉痛的影响

目的 评价超声引导下喉上神经阻滞联合利多卡因喷雾对声带息肉手术患者应激反应及术后咽喉痛的影响。方法 选择我院择期全麻下行支撑喉镜下声带息肉切除术患者共80例,年龄25～65岁,ASAⅠ级或Ⅱ级,采用随机数字表法将患者分为两组,每组40例：利多卡因喷雾组(A组)和喉上神经阻滞联合利多卡因喷雾组(B组)。A组患者于全麻诱导前5 min在患者咽喉部行利多卡因喷雾两喷,B组患者在超声引导下行双侧喉上神经阻滞,药液为1%利多卡因3 ml,且于麻醉诱导前5 min完成咽喉部利多卡因喷雾两喷。分别记录两组患者入室后(T1)、插管即刻(T2)、支撑喉镜置入时(T3)、拔管时(T4)患者的平均动脉压和心率,记录术中丙泊酚及瑞芬太尼用量、患者苏醒时间、患者拔管后、术后2 h、术后6 h及术后24 h的咽喉痛发生情况。结果 与A组比较,B组患者插管即刻(T2)、支撑喉镜置入时(T3)、拔管时(T4)的心率和平均动脉压都要更低(P<0.05),B组患者术中丙泊酚和瑞芬太尼用量明显少于A组,且苏醒时间更短(P<0.05);术后2 h和术后6 h患者的咽喉痛发生率较A组降低(P<0.05)。结论...     

支撑喉镜下声带息肉切除28例麻醉体会

<正> 本院收治28例声带息肉患者,均在全麻鼻插管下行息肉切除,现将麻醉体会报告如下。 1临床资料 1.1一般资料:本组28例,男9例,女19例,年龄29—42岁。息肉均发生在双侧声带前2/3,最大0.5cm。术前ASA均为Ⅰ级。手术时间16—31min,平均19min。 1.2方法:术前半小时肌注阿托品0.5mg、安定10mg,入室后先开放静脉,静注Innovar合剂半量或全量,随即用1％丁卡因行鼻咽部表麻,环甲膜穿刺注入4％利多卡因2—3ml。插管前再静注安定5mg、     

电子喉镜下巨大声带息肉摘除术

目的:探讨电子喉镜下巨大声带息肉摘除术的可行性及疗效。方法:选择巨大声带息肉患者10例,3例伴有I度呼吸困难,在表面麻醉电子喉镜下行声带息肉摘除术。结果:8例一次性完成手术,2例分两次完成手术,所有患者无手术并发症,术后3个月的嗓音评价及嗓音测试表明,患者嗓音完全恢复正常。结论:电子喉镜下声带巨大息肉摘除可行,但需充分掌握手术技巧,联合应用表麻药,在做好气管切开的准备情况下进行手术。     

纤维喉镜下声带息肉摘除术130例

目的：探讨纤维喉镜下摘除声带息肉的手术治疗。方法：130例声带息肉病例表面麻醉行纤维喉镜下声带息肉摘除术。结果：130例114例1次钳取完成,26例分2～3次钳取完成。术后大多数患者1～2周内声音恢复正常,少数患者1个月左右恢复。全部复查随访未见息肉残留,亦未见声带损伤改变。结论：纤维喉镜声带息肉手术操作简便、术野清晰、疗效确定,是治疗声带息肉的一种比较好的方法。     

纤维喉镜下广基声带息肉手术65例分析

目的探讨纤维喉镜下广基声带息肉的手术方式。方法对65例广基声带息肉病人采用纤维喉镜联合间接喉钳行声带息肉摘除术。结果65例声带息肉病人全部完成手术,治愈54例（治愈率83％）,有效11例（有效率17％）。结论纤维喉镜联合同接喉钳下广基声带息肉摘除术,是一种实用、方便、有效的手术方法,适合临床上推广运用。     

亚麻醉剂量氯胺酮复合喉上神经阻滞用于声带息肉切除术

1998— 2 0 0 3年我院采用亚麻醉剂量氯胺酮复合喉上神经阻滞 ,行支气管喉镜下声带息肉切除术 10 0例 ,取得满意效果 ,现总结如下。1　临床资料1.1. 　一般资料　本组共 10 0例 ,男 5 9例 ,女 4 1例 ,年龄 14～6 0岁 ,ASAⅠ～Ⅱ级 ,其中单个声带息肉 4 0例 ,多发声带息肉 6 0例。1.2.　方法　术前 30min肌注阿托品 0 .5mg ,苯巴比妥 0 .1g ,清醒入室 ,记录基础血压、脉搏、脉搏血氧饱和度 ,建立静脉通道 ,均以 1%丁卡因依次舌面、舌根和咽喉表面麻醉 ,以 2 %利多卡因 6ml行双侧喉上神经阻滞 (舌骨大角附近穿刺 )。患者肩下垫高 10～ 15cm …     

支撑喉镜下手术联合金嗓散结丸治疗声带息肉及声带小结326例疗效分析

目的：观察支持喉镜下手术联合服用金嗓散结丸治疗声带息肉和声带小结的疗效。方法：气管内插管全身麻醉支撑喉镜下行声带息肉摘除术198例，声带小结摘除术128例，术后服用金嗓散结丸，所有患者随访10个月～1年。结果：198例声带息肉中，痊愈186例，占93．94％；显效8例，占4．04％；有效4例，占2．02％。128例声带小结中，治愈122例．占95．31％；显效6例，占4．69％。结论：手术联合金嗓散结丸治疗声带息肉、声带小结治愈率高，临床疗效确切。     

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.     

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.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Electro-Acupuncture Combined with the Trigger Point Needle-Embedding for Treatment of Primary Trigeminal Neuralgia in 31 Cases

In recent years, the author of this essay has applied electro-acupuncture combined with the trigger point needle-embedding for treatment of primary trigeminal neuralgia in 31 cases, yielding satis- factory results as reported in the following.     

Investigation of Matrix Metalloproteinase -1, 2 and tissue inhibitor of matrix metalloproteinases-1 in Endometriosis

Objective： To explore the role of matrix metalloproteinase-1,2 （MMP-1, MMP-2） and tissue inhibitor of matrix metalloproteinases-1 （TIMP-1） in endometriosis. Methods： The eutopic and ectopic endometria from 40 subjects suffering from endometriosis and regular.endometria from 40 subjects （excluding endometriosis） were collected and examined by in situ hybridization technology and western blot assay. Results： Both expressions of MMP-1 and -2 were stronger in ectopic endometrium and eutopic endometrium than in normal endometrium. On the contrary, the expression of TIMP-1 in ectopic endometrium and eutopic endometrium was lower. The differences were significant （P 〈 0.01 ）. Moreover, there was no relationship among the expressions of MMP-1, 2 and TIMP-1 in ectopic endometrium. Conclusion： The expressions of MMP-1, 2 and TIMP-1 lose balance and lack of periodic changes in ectopic endometrium , which explains the biological invasive behavior of endometriosis. It was suggested-that regulating the balance between the MMPs and TIMP-1 should be an ideal therapeutic target to endometriosis.     

Shi Da-zhuo (史大卓) —An outstanding cardiologist of integrative medicine

Prof. SHI Da-zhuo, Ph.D., male, was born on March 20, 1960. Prof. SHI entered the Ph.D. program in 1990 at the China Academy of Chinese Medical Sciences under the supervision of Prof. CHEN Ke-ji, majoring in the treatment of cardiovascular diseases. After receiving his Ph.D. degree in 1993, Prof. SHI started working at the Cardiovascular Center in Xiyuan Hospital affiliated to China Academy of Chinese Medical sciences.     

Persist in and Carry Forward the Integrative Medical Research——Speech at the 6th National General Congress of Chinese Association of Integrative Medicine by Academician CHEN Zhu,Minister of Ministry of Health

The 6th National General Congress of Chinese Association of Integrative Medicine （CALM） was convened at 19-20, April 2008 in Beijing. Academician CHEN Zhu, the minister of Ministry of Health indicated at the congress that the integration of Chinese and Western medicine is very well in keeping with the situation of our country and the general rule of development in medical science; and as a good integration of Chinese medicine and Western medicine, it is mutually beneficial and advantageous to both of them. Seeing the creativity shown in integrative medical investigation in theoretic and methodological sides, we should and must persist in and develop it.