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中国灸穴位贴敷治疗重度肩周炎疗效观察

【摘要】　目的　观察中国灸穴位贴敷为主治疗重度肩周炎的临床疗效。　方法　2006年6月-2010年6月，将66例重度肩周炎患者随机分为治疗组34例，对照组32例。对照组采用运动疗法及物理治疗，治疗组在对照组基础上增加中国灸穴位贴敷。分别观察并比较其临床综合疗效及镇痛、改善关节功能的效果。　结果　治疗组在临床综合疗效及镇痛、改善关节功能方面明显优于对照组（Plt;0.05）。　结论　中国灸穴位贴敷为主治疗重度肩周炎临床疗效显著，适应证广，且副作用少，可在临床推广应用。

The Efficacy of Modified De Vega Technique Compares with the Traditional De Vega Technique for the Correction of Severe Tricuspid Regurgitation

摘要:目的:探讨改良De Vega环缩术与经典De Vega环缩术相比对于治疗重度三尖瓣返流是否具有更好的成形效果。方法: 2007年12月至2009年3月对29例重度三尖瓣返流的患者行De Vega环缩术。其中16例行改良De Vega环缩术,13例行经典De Vega环缩术,随访比较两组患者三尖瓣返流程度,右心室舒张期末内径,EF值及心功能分级。以秩和检验分析研究两组患者三尖瓣返流程度和心功能分级的差异,以t检验研究两组患者右心室舒张末期内径及EF值变化。结果:术前两组患者一般指标无显著差异。两组患者随访时间无显著差异。随访经典De Vega组重度返流1例,中度返流5例,轻度返流5例,微量及无返流2例;改良De Vega组无中、重度返流,轻度返流8例,微量及无返流8例。经分析显示两组患者三尖瓣返流程度结果差异有统计学意义(Plt;0.05)。经典De Vega组心功能分级I级5例,II级7例,III级1例;改良De Vega组I级7例,II级8例,III级1例,两组患者心功能差异无统计学意义(Pgt;0.05)。两组患者右室舒张期末内径及EF值组内比较随访与术前差异均有统计学意义(Plt;0.05),随访时组间比较差异有统计学意义(Plt;0.05), 改良De Vega环缩术随访时右室舒张期末内径缩小更显著,射血分数改善更明显。结论:改良De Vega环缩术治疗重度三尖瓣返流效果优于经典De Vega环缩术。Abstract: Objective: To compare the efficacy of one kind of modified De Vega technique and traditional De Vega technique for the correction of severe tricuspid regurgitation. Methods: From December 2007 to March 2009, 29 patients were treated with tricuspid valve annuloplasty. These were 16 patients in modified De Vega annuloplasty group and the others (13 patients) in traditional De Vega annuloplasty group. The grade of tricuspid regurgitation、New York Heart Association (NYHA) functional class、ejection fraction (EF) and the right ventricular enddiastolic dimension of two groups were followed and reviewed. Results: There was no statistically difference between two groups about preoperative characteristics and followup time. There was 1 patient with severe TR, 5 patients with moderate TR, 5 patients with mild TR and 2 patients without TR in traditional De Vega annuloplasty group after the operations. In modified De Vega annuloplasty group, no patient was observed with severe or moderate TR, 8 patients with mild TR, and 8 patients without TR. At interval time, there was significant difference in the grade of tricuspid regurgitation between two groups (Plt;0. 05). Both tricuspid valve plasty techniques could reduce the right ventricular enddiastolic dimension and improve ejection fraction significantly (Plt; 0. 05), and there was significant difference in the right ventricular enddiastolic dimension and ejection fraction at interval time between two groups (Plt;0.05). Conclusions: The outcome of modified tricuspid De Vega technique is superior to that of traditional De Vega technique in correcting severe tricuspid regurgitation.

Endotracheal Intubation Under Fiberoptic Bronchoscope Through Mouth in Severe Respiratory Failure

摘要:目的：探讨纤支镜经口引导气管插管在慢阻肺合并重度呼吸衰竭救治中的临床应用价值。方法：237例慢阻肺合并重度呼吸衰竭患者,随机分为纤支镜经口引导气管插管组(纤支镜组)125例和喉镜经口引导气管插管组(喉镜组)112例,分别在纤支镜和喉镜引导下按常规进行气管插管术。结果：纤支镜组和喉镜组一次获得插管成功率分别为984%和920%(P＜005),平均插管时间分别为（613±391） min 和（926±415） min(P＜005)。纤支镜组有5例患者出现咽喉部少量出血,并发症发生率为40%;喉镜组共有12例发生并发症,并发症发生率为107%(P＜005),其中齿、舌、咽或喉部损伤6例,反射性呕吐致误吸2例,单侧肺通气1例,插入食管2例,心跳呼吸骤停1例。结论：纤支镜经口引导气管插管在慢阻肺合并重度呼吸衰竭救治中是一种简便快速、成功率高和并发症少的有效方法,值得临床推广应用。Abstract: Objective: To evaluate the efficacy of endotracheal intubation under fiberoptic bronchoscope through mouth in severe respiratory failure. Methods:Two hundreds and thirtyseven cases of severe respiratory failure were divided into two groups at random (fiberoptic bronchoscope group and laryngoscope group), 125 cases were intubated through mouth under fiberoptic bronchoscope, the others were intubated through mouth by laryngoscope. Results: The successful rates of endotracheal intubation were 98.4% and 92.0% in two groups respectively (P ＜005), the mean intubation timewere (613±391) min and (926±415) min respectively ( P ＜ 005), 4 cases in fiberoptic bronchoscope group appeared a little blood in throat, the complication rate was 32% 12 cases in the laryngoscope group had complications, the complication rate was 107%( P＜ 005). Among it, 6 cases had the injury of tooth, tongue, gullet and larynx.The cases of reflexvomiting were 2,pulmonary ventilation by single lung were 1, intubation in esophagus were 2, cardiopulmonary arrest were 1.Conclusions:Endotracheal intubation under fiberoptic bronchoscope through mouth was accurate, the fewer complications and effective for patients, and could be used widely in clinical applications.

MDCT Manifestations of ANP: Relationship Between Pancreatic Glandular Necrosis and Retroperitoneal Spreading and Clinical Disease Severity

【Abstract】ObjectiveTo describe the imaging manifestations of acute necrotizing pancreatitis (ANP) on multidetectorrow spiral CT (MDCT). To investigate the relationship between pancreatic glandular necrosis and retroperitoneal inflammatory spreading and the clinical severity of ANP. MethodsA 16detector row spiral CT was used to perform contrastenhanced abdominal scanning in 90 patients diagnosed as ANP， who were prospectively enrolled into this study. Scoring of the extent of pancreatic glandular necrosis and Balthazar grading based on retroperitoneal inflammatory spreading were done at the same time. For 44 patients who met the criteria of Ranson scoring, both scoring by CT severity index (CTSI) and Ranson criteria. Multiplanar reformation technique was used for image postprocessing. Results①In 40 out of 90 patients, the pancreatic glandular necrosis was less than 30%, in 23 the necrosis was between 30%-50%, and in 27 the necrosis was more than 50%. Peripancreatic fat swelling and thickening of anterior renal fascia were observed in all cases of ANP; Peripancreatic and retroperitoneal phlegmonous fluid collection occurred in 78 patients (86.7%); 12 had fluid collection in lesser sac (13.3%); Thickening and swelling of posterior gastric wall in 71 patients (78.9%); 87 developed intestinal ileus (96.7%) and 35 patients had peritoneal effusion (38.9%); Splenic infarction in 4 patients (4.4%); 82 had pleural effusion (91.1%). ②Twelve patients were classified as Balthazar grade C， 42 as grade D and 36 as grade E. There was a statistically significant positive correlation between the extent of pancreatic glandular necrosis and Balthazar CT grade. ③In 44 ANP patients suitable for Ranson criteria, 12 cases were classified as mild (27.3%), 23 as moderate (52.3%), 9 as severe (20.5%). CTSI grading of these patients was as follows： Mild cases 0, moderate cases 25 (56.8%), severe cases 19 (43.2%). Correlation between the CTSI grades and the clinical severity of ANP was of statistical significance. ConclusionANP can demonstrate a series of imaging manifestations on MDCT. To some extent, the degree of pancreatic glandular necrosis and the extent of retroperitoneal spreading is positively correlated, and CTSI grading based on MDCT imaging features is also positively correlated with the clinical severity of ANP.

Efficacy of Procedure for Prolapse and Hemorrhoids in the Treatment of Large Severe Circumferential Hemorrhoids （Report of 38Cases）

目的 探讨吻合器痔上黏膜环切术(ＰＰＨ)对巨大型Ⅲ、Ⅳ度环状痔的临床应用价值。方法 采用美国强生公司生产的痔疮吻合器对38例巨大型Ⅲ、Ⅳ度环状痔患者进行手术,并分析其临床资料。结果 患者平均手术时间19 min,术后平均住院2.8 d，术后10例肛门疼痛较剧者使用了镇痛剂（其中6例加切了外痔）,13例有轻度疼痛，15例无疼痛。术后9例1～6 d有便血,其中1例为大出血，出血量约1 000 ml，均经保守治疗后好转。随访1～19个月，患者无大便失禁、肛周感染、脓肿及肛门狭窄发生。结论 ＰＰＨ治疗巨大型Ⅲ、Ⅳ度环状痔具有手术时间短、住院时间少、痛苦小、恢复快、疗效显著、并发症少的优势。

切开洗胃抢救重度有机磷中毒11例体会

无创正压通气治疗重度支气管哮喘疗效分析

目的 观察无创双水平气道正压通气( BiPAP) 治疗重度支气管哮喘的疗效。方法 29 例重度支气管哮喘患者随机分为研究组( 15 例) 和对照组( 14 例) 。研究组在常规药物治疗基础上, 早期给予BiPAP 呼吸机治疗。比较两组患者治疗前和治疗4 h、治疗24 h 后动脉血气变化。结果研究组有14 例治疗4 h后临床症状和体征明显好转, 治疗有效率为93. 3% ; 1 例因呼吸衰竭加重, 改用气管插管机械通气治疗。对照组治疗4 h后有10 例临床症状和体征好转, 治疗有效率为71. 4% , 4 例无明显好转, 2 例改用BiPAP 呼吸机治疗。研究组未改变治疗方式的14 例经治疗4 h、治疗24 h 后血气分析的改善均优于未改变治疗方式的10 例对照组( P lt;0. 05) 。结论 早期应用BiPAP 呼吸机治疗重度支气管哮喘能迅速改善动脉血气分析指标, 使用安全有效。

社区获得性肺炎患者血清总皮质醇检测的临床价值

目的 探讨血清总皮质醇检测对社区获得性肺炎( CAP) 患者病情严重程度及预后评估的价值。方法 对78 例确诊的CAP 患者进行前瞻性研究, 根据Fine 危险分层将CAP 患者分成两组: 普通CAP组( n =48) 和重症CAP 组( n =30) 。采用化学发光免疫法测定血清总皮质醇水平。统计分析各组血清总皮质醇水平的差异, 血清总皮质醇与肺炎严重度指数( PSI) 的相关性, 以及PSI 评分、血清总皮质醇、C 反应蛋白( CRP) 及白细胞总数的预后评估价值, 进行ROC 曲线分析。结果 血清总皮质醇水平与PSI 之间存在较强的正相关( r=0. 742, P lt;0. 001) 。重症CAP 组与普通CAP 组比较[ ( 306. 86 ±79. 32) μg/L 比( 164. 61 ±73. 25 ) μg/L] , 治疗失败患者与治疗成功患者比较[ ( 341. 19 ±100. 90) 比( 211. 62 ±97. 91) μg/L] , 血清总皮质醇水平明显升高, 差异均有统计学意义( P 均lt;0. 01) 。血清总皮质醇的预测准确度同PSI 评分较接近, 优于CRP 及白细胞总数。结论 血清总皮质醇检测能较好预测轻、重CAP患者, 血清总皮质醇越高, 病情越严重, 预后越差。

文献导读——重度哮喘患者支气管热成形术治疗的有效性和安全性（ Effectiveness and safety of bronchial thermoplasty in the treatment of severe asthma: a multicenter, randomized, double-blind, sham-controlled clinical trial. ）

重度哮喘患者支气管热成形术治疗的有效性和安全性（Castro M, Rubin AS, Laviolette M, et al. Effectiveness and safety of bronchial thermoplasty in the treatment of severe asthma: a multicenter, randomized, double-blind, sham-controlled clinical trial. Am J Respir Crit Care Med, 2010, 181:116-124.） 【摘要翻译】 研究理由: 支气管热成形术( Bronchial thermoplasty, BT) 是一种通过气管镜将热量作用于气道壁从而减少平滑肌含量的治疗方法。目的: 本研究主要是通过与假手术组对照, 评估BT在虽然经高剂量吸入激素和长效β2受体激动剂治疗仍然有症状的重度哮喘患者中的有效性和安全性。方法: 288 例成人哮喘患者随机分为BT 组和假手术组, 都进行3 次纤支镜检查。主要终点是基础的哮喘生活质量量表( Asthma Quality of Life Questionnaire, AQLQ) 评分与6、9、12 个月的平均评分( 综合AQLQ) 。记录不良事件和医疗资源使用情况以评估安全性。主要终点的统计设计和分析采用贝叶斯统计。BT 与假手术的比较的优越性后验概率设定为95% , 主要终点对比时设定为96. 4%。检测和主要结果: 与假手术组相比, BT组综合AQLQ 评分治疗后较基础值改善明显。79% 的BT 组患者和64% 的假手术患者AQLQ 评分改善达到或超过0.5。治疗期间( BT 治疗后6 周内) BT 组住院的患者较对照组多6% 。在随后的随访中( 6 ～52 周) , BT 组哮喘重度发作次数、急诊就诊次数及因哮喘导致耽误工作或学习的天数均少于对照组。结论: BT 可改善重度哮喘患者的生活质量, 减少急性发作次数和医疗资源占用。 【述评】 哮喘中支气管平滑肌增生和收缩性增强可导致严重支气管狭窄和气流受限。BT通过支气管镜介导进行射频消融, 减少平滑肌的数量从而改善哮喘症状。既往的研究表明BT能改善哮喘症状, 但多为非随机或纳入一个标准化治疗组作为对照。Castro 等采用多中心、随机、双盲假手术的方法研究BT的安全性和有效性。结果虽表明BT 能改善患者生活质量, 但研究中存在以下问题: ①盲法: 虽然采用盲法, 但随访中BT 组患者猜中自己分组的比例高于假手术组, 是否对研究结果有影响不能确定。②在评估的指标中,AQLQ 评分等主观指标变化明显, 但肺功能等客观指标无明显变化。并且, BT 组AQLQ 与基础值比较变化为1. 35 ±1. 10, 假手术组变化也有1. 16 ±1. 23, 两组治疗后与基础值比较均有差异( P lt;0. 05) , 说明有一定的安慰剂效应。③本研究未采用临床研较为常用的t 检验, 而采用贝叶斯统计。以常用的t 检验分析AQLQ表明BT组与假手术组并无明显差异。由于统计学中对贝叶斯统计仍然存在争议, 故需要大样本、长时间的研究进一步证实本研究的结果。

Effects of Smoking on Vibration Response Imaging

Objective To explore the characteristics of vibration response imaging ( VRI) among heavy smokers whose pulmonary function is normal. Methods 67 heavy smokers with normal pulmonary function, 60 healthy non-smokers, and 60 patients with COPD were recruited. History taking, physical examination, lung function test, chest X-ray, and VRI examination were performed. The difference of VRI dynamic imaging between the three groups was analyzed. Results VRI vibration energy curve which appeared low, flat, sunken-in, and single peak accounted for 43.3% , 16.4% , 16.4% , and 14.9% respectively in the heavy smokers, accounted for 6.7% , 3.3% ,0% , and 0% respectively in the healthy nonsmokers, accounted for 60% , 33.3% , 18.3% , and 16.7% respectively in the COPD patients. The results between the heavy smokers and the healthy non-smokers were significantly different. Compared with the heavy smokers, the COPD patients exhibited more low and flat in expiration period. The energy peak value ratio of inspiration and expiration phase in the heavy smokers, the healthy non-smokers, and the COPD patients were 0.56,0.74, and 0.54 respectively. There was no significant difference between the heavy smokers and the COPD patients in peak value ratio of inspiration and expiration phase. Conclusion The vibration energy curve of the VRI in heavy smokers with normal pulmonary function is significantly different fromhealthy nonsmokers, but there is no significant difference between heavy smokers and COPD patients.