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The Clinical Analysis of Pathological Reflex in Acute Cerebral Stroke

目的 了解急性脑卒中患者的病理反射变化与病情变化的关系。 方法 2007年3月-2009年2月对40例急性脑卒中患者进行双下肢病理反射动态观察，结合头部影像学(CT、MRI)跟踪，观察其病情变化。 结果 所有患者病情有不同程度加重，影像学显示脑水肿加重，双下肢病理征阳性。 结论 急性脑卒中患者病理反射变化对病情判断具有重要价值。

Observation of the Clinical Effect of Suxiao Jiuxin Pills on Patients with Acute Coronary Syndrome

ObjectiveTo observe the clinical effect of clopidogrel combined with Suxiao Jiuxin Pills on patients with acute coronary syndrome (ACS). MethodsNinety-seven patients with ACS diagnosed between January 2010 and December 2011 were divided into the treatment group (treated with clopidogrel combined with Suxiao Jiuxin Pills) (n=48) and the control group (treated with single clopidogrel) (n=49). One month was regarded as a treatment course. After one month, we observed the clinical effect, heart attacks frequency, ST segment changes and adverse reactions for the patients. ResultsThe total effective rate was 79.2% in the treatment group and was 51.0% in the control group. There was significant difference between the two groups (P<0.05). Heart attacks frequency and ST segment were reduced significantly in both the two groups after treatment (P<0.05). The curative effect in the treatment group was significantly better than that in the control group after treatment (P<0.05). ConclusionClopidogrel combined with Suxiao Jiuxin Pills have a better clinical effect in the treatment of ACS than single clopidogrel.

Experimental Study of Dexamethasone Treating in Non-freezing Cold Injury of Sciatic Nerves

ObjectiveTo observe the changes of microstructure of rats'sciatic nerves with non-freezing cold injury after treated with dexamethasone. MethodsTwelve male Wistar rats were randomly divided into cooling group and treating group.Unilateral sciatic nerves of the rats in the cooling group received cooling treatment with 3-5℃ for 2 hours;while unilateral sciatic nerves of the rats in the treating group received cooling treatment with 3-5℃ for 2 hours and underwent the celiac injection with dexamethasone in addition.The other sciatic nerves were exposed,as the control.The bilateral sciatic nerves of rats in each group were harvested after 24 hours.The microstructure of nerves was examined under the light microscope and electron microscope. ResultsLight microscopic examination revealed extensive myelinated fibre degeneration in form of giant empty axons or shrunken dark axons on the first day after cooled.And the endoneurial capillary lumen was narrowed because of swollen endothelial cells.After the treatment,myelinated fibre degeneration was still similar to that before the treatment,but the endoneurial capillary lumen and endothelial cells were normal.By electron microscopy,sciatic nerves showed extensive myelinated fiber degeneration,and swollen endothelial cells.But unmyelinated fibers and tight junction were preserved on the first days after cooled.Aggregated red cells and platelet thrombus were not found.After the treatment,myelinated fibre degeneration was still similar to that before the treatment.Unmyelinated fibers and tight junction were preserved.The endoneurial capillary lumen and endothelial cells were normal. ConclusionAfter the treatment,the damage of endoneurial capillary had improved,but myelinated fiber degeneration was similar to that before the treatment.It suggested that dexamethasone may only improve the vascular system in non-freezing cold injury of sciatic nerve.

中国 CTA 与美国 ATA 甲状旁腺功能保护指南的比较

直径≤3 cm的周围型肺腺癌淋巴结转移分析

摘要： 目的 探讨原发性周围型小肺腺癌（直径≤3cm）淋巴结转移的规律,为治疗方案的制定提供参考。 方法 自1990年1月至2009年1月期间，首都医科大学附属北京友谊医院胸外科手术治疗肿瘤最大径（CT测量）≤3 cm的周围型原发性肺腺癌288例，其中男223例，女65例；年龄30～73岁。288例患者诊断均经病理检查证实，临床诊断淋巴结转移的标准为最小直径大于1.0 cm（CT）。手术方式：肺叶切除术264例，肺袖式切除术22例，肺楔形切除术2例；纵隔淋巴结清扫方式为系统纵隔淋巴结清扫或采样。 结果 288例中发生淋巴结转移142例（49.30%），其中术后分期为N1 90例（31.25%），N2 52例（18.06%）。不同原发部位的淋巴结转移率：右肺46.67%(77/165)，左肺56.10%(69/123)；肿瘤直径小于1 cm者淋巴结转移率为22.22%（2/9），1～2 cm之间者为39.44%（28/71），2～3 cm之间者为53.84%（112/208），三者间比较差异有统计学意义（Plt;0.01）。直径小于1 cm者未发现N2转移，1～2 cm之间者N2阳性率为14.08%（10/71），2～3 cm之间者N2阳性率为20.19%（42/208），三者间比较差异有统计学意义（χ2=20.01,Plt;0.01）。 结论 周围型小肺腺癌肺门及纵隔淋巴结转移常见，尤其是右肺上叶肺癌。直径大小对腺癌淋巴结转移发生率有明显的影响，但即便直径小于2 cm，淋巴结转移仍有很大的风险。术前应尽可能获得准确的N分期，如不能在术前确定N分期，对直径1 cm以上的肺腺癌术中应常规进行纵隔淋巴结清扫，否则难以获得准确的分期，亦难以达到根治性切除。

医源性肝外胆管损伤自体组织修复四例

丝绸布修复腹壁肌肉缺损体会

应用丝绸布一期手术修复腹壁肌肉缺损获得成功。本组7例中腹壁硬纤维瘤6例,腹壁切口疝1例。腹壁肌肉缺损面积最小8×8cm,最大12×12cm,平均9×9cm。术后随访1～9年无发生腹壁切口疝及任何不良反应。

烟雾病的现状和最新认识

烟雾病是好发于亚洲，特别是东亚地区的一类血管疾病，随着半个世纪对该病的不断更新认识，使得该病取得了令人振奋的进展，同时它仍在流行病学、发病机制、预防再岀血和治疗上存在许多争议，在此通过对国内外该病的现状和发展进行阐述，以更新对该病的认识，为最终更好诊断、治疗该病作铺垫。

腹腔镜胆囊切除术中转开腹21例原因分析

腹腔镜胆总管切开取石术对患者术后胃肠道功能恢复、应激反应及血流动力学的影响

目的 探讨腹腔镜胆总管切开取石术对患者术后胃肠道功能恢复、应激反应及血流动力学的影响。 方法 回顾性分析笔者所在医院于 2016 年 1 月至 2016 年 12 月期间收治的 78 例胆总管结石患者的临床资料，按照术式分为开腹组（行开腹胆总管切开取石术）与腹腔镜组（行腹腔镜胆总管切开取石术），各 39 例，比较 2 组患者的手术疗效、手术前后的应激反应指标和血流动力学指标。 结果 腹腔镜组患者的术中出血量、术后镇痛次数、胃肠道功能恢复时间及术后住院时间均少于（短于）开腹组（P<0.01）；腹腔镜组手术前后的血清皮质醇水平、血清游离三碘甲状腺原氨酸（FT3）水平及平均动脉压（MAP）的差值均较开腹组低（P<0.05），而手术前后心率（HR）的差值较开腹组高（P<0.05）。 结论 相比开腹胆总管切开取石术，腹腔镜胆总管切开取石术更利于改善患者的血清皮质醇及 FT3 水平，减轻应激反应，改善血流动力学情况，促进术后胃肠道功能的恢复，值得临床推广。