输尿管镜下气压弹道碎石术治疗膀胱尿道结石

目的探讨输尿管镜下气压弹道碎石术(URSL)治疗膀胱尿道结石的方法、效果及安全性。方法对56例膀胱尿道结石患者采用URSL治疗。结果55例碎石成功,成功率为98.2%。手术时间5～170min,平均28min。术后住院1～5天,平均1.5天。结论以膀胱镜鞘作通道,采用URSL治疗膀胱尿道结石安全、有效、省时、损伤小、痛苦少、术后恢复快。     

膀胱镜鞘配合输尿管镜行气压弹道碎石术治疗膀胱结石

目的探讨膀胱镜鞘配合输尿管镜下气压弹道碎石术（URSL）治疗膀胱结石的方法、效果及安全性。方法对38例膀胱结石采用URSL治疗。结果37例碎石成功，成功率为97．4％。手术时间5，170min。平均28min。术后住院1-5d，平均1.5d。结论以膀胱镜鞘作通道，采用URSL治疗膀胱尿道结石安全、有效、省时、损伤小、痛苦少、术后恢复快。     

输尿管镜下气压弹道碎石术治疗后尿道结石

目的：探讨后尿道结石的治疗方法。方法：对18例后尿道结石患者采用输尿管镜下气压弹道碎石术治疗。结果：18例均成功碎石，碎石时间5－35min，平均23min，无尿道撕裂，膀胱穿孔等手术并发症，均能排净结石，随访1－12个月，均无尿道狭窄等并发症。结论：输尿管镜下气压弹道碎石术治疗后尿道结石疗效确切，损伤小，并发症少，是治疗后尿道结石较为满意的方法。     

膀胱镜大力钳碎石术治疗尿道膀胱结石100例

目的探讨膀胱镜大力钳碎石技术治疗后尿道结石和膀胱结石的有效性及方法。方法回顾性分析100例膀胱镜大力钳碎石技术治疗后尿道结石、膀胱结石的临床资料。结果碎石成功率为97%,手术时间5 min~25 min,平均15 min.并发膀胱穿孔1例（1%）,术后轻微肉眼血尿22例（22%）。结论膀胱镜大力钳碎石技术治疗膀胱结石、后尿道结石具有高效、安全、设备简单的优点,可作为首选方法,适宜基层医院推广应用。     

输尿管镜下气压弹道碎石联合膀胱造瘘和吸引器治疗小儿膀胱结石及尿道结石

目的 :探讨经尿道输尿管镜及气压弹道碎石联合膀胱造瘘和吸引器治疗小儿膀胱结石及尿道结石的疗效。方法:采用输尿管镜下气压弹道碎石联合膀胱造瘘及吸引器治疗膀胱结石及尿道结石患儿36例。结果:36例膀胱结石及尿道结石患儿均一次性碎石清石,碎石时间10⁴5 min,平均20.2 min;术中及术后无尿瘘、大出血及水中毒等严重并发症发生。结论 :输尿管镜下气压弹道碎石联合膀胱造瘘和吸引器治疗小儿膀胱结石及尿道结石具有微创、高效和操作简便等特点,可作为膀胱结石及尿道结石尤其合并急性尿潴留患儿的有效手术方法。     

经皮膀胱输尿管镜弹道碎石治疗男性小儿尿道膀胱结石的疗效观察

目的评估经皮膀胱输尿管镜弹道碎石治疗男性小儿尿道膀胱结石的可行性及临床疗效。方法采用德国WOLF F8/9.8输尿管硬镜、广州医学院第一附属医院的APL-2型气压弹道碎石机,对选取的40例男性小儿尿道膀胱结石患儿行经皮膀胱输尿管镜气压弹道碎石治疗,其中8例为后尿道结石,32例为膀胱结石。结果所有患儿均一次性碎石治疗成功,结石清除率100%,碎石时间为(30.0±2.5)min,术后血尿1～3 d,平均1.6 d,留置造瘘管5～7 d,住院5～8 d,平均6 d。术后发热6例,经对症治疗后痊愈,膀胱刺激征3例,药物治疗好转,术后复查B超及X线提示无结石残留,无大出血、感染、穿孔及尿道狭窄、尿瘘等并发症,随访3～20个月无结石复发。结论经皮膀胱输尿管镜弹道碎石术治疗男性小儿尿道膀胱结石安全高效且碎石确切,值得临床推广应用。     

膀胱镜下机械碎石术103例

目的 探讨膀胱镜下机械碎石治疗膀胱及后尿道结石的技术和疗效。方法 以膀胱镜下机械碎石水治疗膀胱结石82例。男性后尿道结石20例和嵌顿于右输尿管膀胱出口结石1例。结果 103例全部治愈，只有23例出现轻度血尿。结论 膀胱镜下机械钳碎石术是一种安全有效、操作简便、损伤小、费用低、恢复快、患者乐于接受的治疗膀胱和男性后尿道结石的方法。     

输尿管镜气压弹道碎石术治疗尿道结石

[目的]探讨应用输尿管镜直视下气压弹道碎石术治疗前、后尿道结石的效果。[方法]回顾性分析96例尿道结石的诊治经过,其中应用直接钳夹法治疗18例前尿道结石患者;采用输尿管镜直视下气压弹道碎石术对20例前尿道结石患者及58例后尿道结石患者进行治疗。[结果]前尿道结石经直接钳夹取出率94.4%,应用输尿管镜直视下气压弹道碎石术治疗结石取出率100%;直接钳夹法致尿道狭窄率16.7%,经输尿管镜下气压弹道碎石治疗未出现尿道狭窄。后尿道结石采用输尿管镜直视下气压弹道碎石术治疗一次原位碎石成功54例,成功率为93.1%、碎石时间为30～50min。并发症发生率为3.4%。[结论]输尿管镜下气压弹道碎石术治疗无论在治疗前尿道结石还是后尿道结石中均其有微创,安全,高效,容易操作的特点,值得推广。     

电切镜鞘结合肾镜微创治疗膀胱结石26例

目的：探讨电切镜鞘结合肾镜微创治疗膀胱结石的临床价值。方法：电切镜鞘结合肾镜微创治疗膀胱结石26例,麻醉显效后患者取截石位,行电切镜鞘与肾镜结合,经尿道顺利置入膀胱,行气压弹道碎石,碎石用Ellick冲洗器从电切镜鞘中冲出。术毕留置导尿管。结果：26例均一次性手术成功,无残余结石,无膀胱穿孔及明显出血,术后排尿通畅手术时间10～50min,平均25min,术中无膀胱穿孔,无发热感染表现,血尿1～3天,平均1.5天,留置导尿管3～5天,平均4天,住院时间4～8天,平均5天。结论：电切镜鞘结合肾镜微创治疗膀胱结石,手术时间短,创伤小,清石率高,并发症少,是治疗膀胱结石的有效方法。     

应用经尿道肾镜下超声/气压弹道碎石治疗膀胱尿道结石

目的探讨经尿道肾镜下超声/气压弹道碎石治疗膀胱尿道复杂性结石的临床疗效。方法采用经尿道肾镜超声/气压弹道碎石术治疗膀胱尿道复杂性结石98例。尿道结石22例,结石大小(0.7cm×0.8cm)～(1.2cm×1.9cm);前列腺部精阜旁结石16例,前尿道结石6例,膀胱结石76例,膀胱结石长径平均(2.5±1.3)cm,其中单发结石21例,两枚结石15例,多发结石40例(最多10枚以上结石)。结果全部结石一次性碎石成功,结石清除率100%。粉碎并清除结石平均时间为(44.6±18.6)min。术后平均住院天数(3.2±1.5)d,无严重并发症发生。结论经尿道肾镜下超声/气压弹道碎石治疗膀胱尿道复杂结石创伤小、安全、高效,可作为下尿路结石治疗的一种好方法。     

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…     

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.     

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.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.