31例功能性腹痛的心理治疗临床观察

目的探讨对功能性腹痛的心理治疗。方法将67例功能性腹痛患者随机分两组,对照组以药物治疗,治疗组在对照组基础上加用心理治疗。在治疗前和治疗4周时观察腹痛评分及精神症状评分。结果治疗组治疗前后的精神症状评分和腹痛评分明显改善,对照组则无显著改善。结论功能性腹痛治疗上应重视精神心理治疗。     

小儿复发性腹痛80例临床分析及治疗观察

目的探讨复发性腹痛的诱因、时间、频率及治疗措施。方法分析我院从2003年1月至2006年12月间80例复发性腹痛并对其采用抗过敏、镇静、调节植物神经功能等治疗的临床资料。结果通过与对照组比较,治疗7d有效率为84%。结论通过采取抑制肠道过敏反应,舒张平滑肌,缓解肠痉挛及镇静、调节植物神经功能可以有效的治疗复发性腹痛。     

无结石急性胆囊炎的临床诊治分析

目的探讨高龄无结石急性胆囊炎(acute acalculous cholecystitis,AAC)的诊治方法,提高其诊治水平。方法系统性分析116例AAC病人的临床资料和急性结石性胆囊炎(ACC)并存病、胆囊病理改变及术后结果,并对不同时期高龄无结石急性胆囊炎病变和术后结果作对比与分析。结果和老年人结石急性胆囊炎病人比,急性非结石性胆囊炎的胆囊坏死和穿孔的发生率高,给临床诊断和治疗带来一定困难;胆囊化脓、胆囊坏疽、穿孔率均增高,且有统计学意义(P<0.05),术后并发症增高。结论 AAC并非罕见。提高对AAC的认识是必要的。早期诊断、完善的术前准备,早期积极的手术治疗可提高本病的治愈率。     

急性胰腺炎86例诊疗分析

目的 分析急性胰腺炎患者的病因,诊断及治疗,为临床的诊断与治疗提供借鉴.方法 总结我院2005年1月至2007年12月问86例急性胰腺炎病例资料.结果 64例急性胰腺炎患者主要病因是饮酒(33例,占38.4%),首发症状以腹痛最多,90.7%患者血淀粉酶升高,治愈81例,死亡5例.结论 急性胰腺炎的病因有地区差异,细致检查有助于提高诊断率,内科治疗效果理想.     

超声诊断在93例急性阑尾炎的临床分析

在外科,急性阑尾炎属于最为常见的一种急腹症,行阑尾超声正常检查通常显示比较难。随着医学技术的发展,超声检查的广泛应用及超声技术的逐渐提高,尤其是高频探头在医院中的广泛应用,超声检查为急性阑尾炎的诊断和鉴别诊断提供更多重要的诊断信息。笔者现就我院2008年1月至2010年2月临床拟诊为急性阑尾炎经超声检查的93例患者资料作回顾性分析,以便探究超声在诊断急性阑尾炎中的价值。     

150例肠易激综合征临床分析及治疗对策

肠易激综合征是指存在消化道症状,但无法用器质性病变或生化异常来解释的消化道功能性疾病。本文通过对2005年1月至2008年1月医院收治的150例IBS患者的分析探讨了IBS的病因、诊断、治疗,以期有益临床。     

胎盘植入16例临床分析

目的探讨胎盘植入病因及治疗方法。方法对本院收治的16例胎盘植入患者的临床资料进行总结。结果5例甲氨蝶呤(MTX)肌注及口服米非司酮保守治疗成功,9例手术保守治疗成功,2例行子宫次全切除。结论胎盘植入与人流、剖宫产史及胎盘位置异常有关,当出血不太多时积极保守治疗,尽力保全子宫,紧急必要时才行子宫切除。     

急性肠梗阻临床治疗的体会

目的探讨急性肠梗阻的临床治疗。方法回顾分析笔者所在医院收治的83例急性肠梗阻的临床资料。结果在本组病例中,粘连性肠梗阻48例,肠肿瘤31例,肠扭转1例,嵌顿疝1例,肠憩室1例,肠套叠1例。均采用保守治疗和手术治疗,其中因晚期肿瘤久治转移呼吸循环衰竭死亡1例。结论急性肠梗阻经保守治疗无效者应立即手术,解除梗阻或切除坏死病变,避免出现严重后果。     

输卵管结扎术后腹痛16例原因分析

目的总结输卵管结扎术后腹痛经验教训,探讨其发生原因,提出有效干预措施。方法对我站2006年2月至2009年8月行女扎术后16例腹痛患者进行回顾性分析。通过询问病史,详细的体格检查及必要的辅助检查。结论除了输卵管结扎术后的损伤和感染是造成此症状主要原因外,还有术后粘连、子宫内膜异位症等。预防措施:严格掌握手术指征,加强基本训练,施术部位精确,术后常规应用抗生素。     

小儿非器质性腹痛的临床分析与对策

目的为探讨学龄期儿童非器质性腹痛引起的原因。方法采用Bender格式塔测试,进行心理学检验。结果患儿普遍存在E值低N值高的内向不稳定型,与情绪、心理、行为有关。结论治疗这类疾病需要家庭、社会、学校三方面共同努力,使学生身心健康。     

小剂量低分子肝素防治脑梗死进展60例临床观察

目的观察小剂量低分子肝素防治急性进展性脑梗死的临床疗效并探讨其机制。方法将120例急性进展性脑梗死患者(起病6～48h内)随机分为两组,治疗组(60例)于常规治疗基础上小剂量低分子肝素治疗和对照组(60例)仅行常规治疗,分别于治疗4周前后作实验室检查及脑卒中患者临床神经功能缺损程度评分,并进行统计分析,比较两组的疗效。结果治疗组在临床神经功能缺损程度评分及疗效方面均较对照组改善明显(P<0.05)。结论低分子肝素治疗进展型脑梗死疗效显著,应用方便,安全可靠,值得临床推广应用。     

54例多层螺旋CT在诊断急性胰腺炎的应用价值

目的探讨多层螺旋CT在诊断急性胰腺炎的应用价值。方法对我院2008年7月至2011年2月收治的经CT确诊的急性胰腺炎患者54例临床资料及CT影像学资料进行回顾分析。结果 54例患者中A级者8例,占14.8%;B级者24例,占44.4%;C级者14例,占25.9%;D级及E级者8例,占14.8%;症状、体征主要包括:上腹部持续性疼痛;恶心、呕吐等胃肠道症状;同时可伴心率加快、发热等症状。CT征象主要包括胰腺体积增大、密度降低、包膜改变等,同时还有胰周渗出、脾肾间隙模糊改变、假性囊肿等。结论多层螺旋CT操作简单、无创有效、敏感性高,在诊断、鉴别诊断及治疗急性胰腺炎上具有重要的指导性应用价值。     

妊娠合并甲状腺功能亢进54例临床分析

目的探讨妊娠合并甲状腺功能亢进(甲亢)对妊娠结局的影响。方法回顾性分析54例妊娠合并甲亢患者的妊娠结局。结果甲亢组妊娠结局妊高症24例;早产9例,平均分娩孕周(36.8±4.6)周,与对照组相比P<0.05;新生儿IUGR者7例,平均新生儿体重(2.8±0.8)kg,与对照组相比P<0.05。结论甲亢患者孕前未控制或孕前、孕期自行停药,均可导致母儿严重并发症。加强甲状腺功能的监测,及时调整用药剂量,可以减少不良妊娠结局的发生。     

Time-Dependent Changes in Protein Composition of Medial Prefrontal Cortex in Rats with Neuropathic Pain

Chronic pain is associated with time-dependent structural and functional reorganization of the prefrontal cortex that may reflect adaptive pain compensatory and/or maladaptive pain-promoting mechanisms. However, the molecular underpinnings of these changes and whether there are time-dependent relationships to pain progression are not well characterized. In this study, we analyzed protein composition in the medial prefrontal cortex (mPFC) of rats at two timepoints after spinal nerve ligation (SNL) using two-dimensional gel electrophoresis (2D-ELFO) and liquid chromatography with tandem mass spectrometry (LC–MS/MS). SNL, but not sham-operated, rats developed persistent tactile allodynia and thermal hyperalgesia, confirming the presence of experimental neuropathic pain. Two weeks after SNL (early timepoint), we identified 11 proteins involved in signal transduction, protein transport, cell homeostasis, metabolism, and apoptosis, as well as heat-shock proteins and chaperones that were upregulated by more than 1.5-fold compared to the sham-operated rats. Interestingly, there were only four significantly altered proteins identified at 8 weeks after SNL (late timepoint). These findings demonstrate extensive time-dependent modifications of protein expression in the rat mPFC under a chronic neuropathic pain state that might underlie the evolution of chronic pain characterized by early pain-compensatory and later aberrant mechanisms.     

80例中老年内科急症的临床分析

目的探讨中老年急症的种类、特点以及影响病死率的因素。方法对我院自2007年2月至2008年2月收治的内科急症患者(>50岁)80例的临床资料进行回顾性分析,总结该组患者急症的种类、特点及病死率的影响因素。结果该组中老年急症以脑血管病最多,占32.5%(27/80),其中大多为脑溢血;其次为心血管疾病,占30.0%(24/80),其中大多为冠心病;第3位为呼吸系统疾病,占17.5%(14/80),其中大多为肺心病。影响内科急症因素为年龄、环境、情绪、生活习惯。结论中老年人脑血管、心血管以及呼吸系统的患病率较高,应较强对该类疾病的预防,保持良好的情绪和生活习惯。     

Local Administration of Low-Dose Nerve Growth Factor Antibody Reduced Pain in a Rat Osteoarthritis Model

Systemic injection of a nerve growth factor (NGF) antibody has been proven to have a significant relevance in relieving osteoarthritis (OA) pain, while its adverse effects remain a safety concern for patients. A local low-dose injection is thought to minimize adverse effects. In this study, OA was induced in an 8-week-old male Sprague–Dawley (SD) rat joint by monoiodoacetate (MIA) injection for 2 weeks, and the effect of weekly injections of low-dose (1, 10, and 100 µg) NGF antibody or saline (control) was evaluated. Behavioral tests were performed, and at the end of week 6, all rats were sacrificed and their knee joints were collected for macroscopic and histological evaluations. Results showed that 100 µg NGF antibody injection relieved pain in OA rats, as evidenced from improved weight-bearing performance but not allodynia. In contrast, no significant differences were observed in macroscopic and histological scores between rats from different groups, demonstrating that intra-articular treatment does not worsen OA progression. These results suggest that local administration yielded a low effective NGF antibody dose that may serve as an alternative approach to systemic injection for the treatment of patients with OA.     

The Acute Antiallodynic Effect of Tolperisone in Rat Neuropathic Pain and Evaluation of Its Mechanism of Action

Current treatment approaches to manage neuropathic pain have a slow onset and their use is largely hampered by side-effects, thus there is a significant need for finding new medications. Tolperisone, a centrally acting muscle relaxant with a favorable side effect profile, has been reported to affect ion channels, which are targets for current first-line medications in neuropathic pain. Our aim was to explore its antinociceptive potency in rats developing neuropathic pain evoked by partial sciatic nerve ligation and the mechanisms involved. Acute oral tolperisone restores both the decreased paw pressure threshold and the elevated glutamate level in cerebrospinal fluid in neuropathic rats. These effects were comparable to those of pregabalin, a first-line medication in neuropathy. Tolperisone also inhibits release of glutamate from rat brain synaptosomes primarily by blockade of voltage-dependent sodium channels, although inhibition of calcium channels may also be involved at higher concentrations. However, pregabalin fails to affect glutamate release under our present conditions, indicating a different mechanism of action. These results lay the foundation of the avenue for repurposing tolperisone as an analgesic drug to relieve neuropathic pain.     

ERCP及EST治疗急性胆源性胰腺炎临床分析

目的探索ERCP及EST取石在治疗急性胆源性胰腺炎中的作用以及其卫生经济学价值。方法 62例急性胆源性胰腺炎按是否于入院24～48h内行急诊ERCP分为治疗组及对照组,比较2组间疾病治愈率、并发症发生率、本次平均住院天数、恢复肠内营养所需时间,疾病经济负担,并对经济学指标行敏感性分析。结果经ERCP和EST治疗组患者并发症发生率、平均住院天数、恢复肠内营养所需时间和疾病经济负担明显低于对照组。结论通过ERCP和EST的处理,有利于减轻胰腺炎患者痛苦,促进恢复,缩短本病需要住院的时间,减少了患者的疾病经济负担。     

Low-Frequency High-Magnitude Mechanical Strain of Articular Chondrocytes Activates p38 MAPK and Induces Phenotypic Changes Associated with Osteoarthritis and Pain

Osteoarthritis (OA) is a debilitating joint disorder resulting from an incompletely understood combination of mechanical, biological, and biochemical processes. OA is often accompanied by inflammation and pain, whereby cytokines associated with chronic OA can up-regulate expression of neurotrophic factors such as nerve growth factor (NGF). Several studies suggest a role for cytokines and NGF in OA pain, however the effects of changing mechanical properties in OA tissue on chondrocyte metabolism remain unclear. Here, we used high-extension silicone rubber membranes to examine if high mechanical strain (HMS) of primary articular chondrocytes increases inflammatory gene expression and promotes neurotrophic factor release. HMS cultured chondrocytes displayed up-regulated NGF, TNFα and ADAMTS4 gene expression while decreasing TLR2 expression, as compared to static controls. HMS culture increased p38 MAPK activity compared to static controls. Conditioned medium from HMS dynamic cultures, but not static cultures, induced significant neurite sprouting in PC12 cells. The increased neurite sprouting was accompanied by consistent increases in PC12 cell death. Low-frequency high-magnitude mechanical strain of primary articular chondrocytes in vitro drives factor secretion associated with degenerative joint disease and joint pain. This study provides evidence for a direct link between cellular strain, secretory factors, neo-innervation, and pain in OA pathology.     

宫腔镜检查诊治宫腔病变238例临床分析

目的探讨宫腔镜检查在宫腔异常疾病诊断及治疗中的应用价值方法通过对2008年1月至2009年12月我院238例宫腔病变患者进行宫腔镜及病理检查,分析检查结果及诊断符合率。结果 238例中197例患者在宫腔镜检查后取组织病检,宫腔镜诊断中仅6例与病理诊断不符,诊断符合率为96.95%。结论宫腔镜检查直视下观察宫腔病变,定位治疗,诊断准确。