电烧伤185例治疗体会

人体为电流的良好导体,触电机体可致损伤。我科2000年9月至2011年9月收治电烧伤病人185例,现将其治疗方法报告如下。

小儿电烧伤23例治疗体会

【目的】对小儿电烧伤外科治疗进行初步的临床分析。【方法】本院自2001年至2009年收治小儿（〈14岁）电烧伤患几23例。行对症、护创处理后，采用清创皮瓣转移修复术14例，清创带真皮下血管网皮片移植3例，切、削痂植皮术3例，换药后中厚皮瓣移植修复术3例。【结果】术后随访1～5年发现皮瓣修复者功能及外观恢复良好，皮片修复者，创面继发疤痕增生，功能恢复差。【结论】认为进行对症、护创处理同时，并根据患儿创面情况及患儿年龄、合作程度选择手术时机和方式，可以获得更好的功能恢复及外观。

静注艾司洛尔预防无抽搐电休克治疗不良反应临床研究

目的:探讨静注艾司洛尔预防无抽搐电休克治疗不良反应的临床应用效果。方法:将120例精神疾病患者随机分为对照组(60例)和观察组(60例),均给予无抽搐电休克治疗。对照组在治疗前顺次静脉推注阿托品0.5mg,丙泊酚1~1.5mg/kg,琥珀胆碱1~1.2mg/kg;观察组在对照组的基础上于电刺激结束30s静脉推注艾司洛尔0.2mg/kg。观察两组患者不良反应发生率和患者家属接受度。结果:观察组在头痛、心慌等不良反应的发生率明显低于对照组(χ~2≥5.714,P<0.05)。观察组患者家属完全接受、总接受度均明显高于对照组(χ2≥11.368,P<0.05);观察组患者家属不接受度明显低于对照组(χ~2=4.138,P<0.05)。结论:静脉推注艾司洛尔明显降低了不良反应的发生率,且有效提高了患者家属对无抽搐电休克治疗的依从度。

经皮穴位电刺激联合西药治疗子宫内膜容受性差不孕症40例

目的:观察经皮穴位电刺激联合西药治疗子宫内膜容受性差不孕症的临床疗效。方法:选择80例因子宫内膜容受性差引起不孕症的患者80例,按1∶1的比例随机分为两组,对照组给予西药治疗,治疗组在对照组治疗基础上于月经第5天开始给予经皮穴位电刺激(关元、中极、双侧子宫、双侧三阴交、双侧天枢穴),1次30 min,1 d 1次,至排卵日结束。两组均以1个月经周期为1个疗程,3个疗程后判定疗效。结果:在内膜形态、子宫内膜血流及3个月后妊娠情况方面,治疗组优于对照组(P<0.05或P<0.01)。结论:经皮穴位电刺激联合西药治疗子宫内膜容受性差不孕症疗效确切。

经尿道汽化电切术加膀胱灌注治疗腺性膀胱炎

目的探讨经尿道汽化电切术加膀胱灌注治疗腺性膀胱炎的临床价值。方法对23例腺性膀胱炎患者采用经尿道汽化电切加卡介苗(BCG)及白细胞介素-2(1L-2)灌注。结果术后23例、原有膀胱刺激症状、血尿及下腹部不适症状均消失。结论经尿道汽化电切术加灌注治疗腺性膀胱炎是一种微创、安全、有效的治疗方法。

戒毒片合并电厌恶疗法治疗酒依赖68例疗效观察

目的 观察戒毒片合并电厌恶疗法对酒依赖的治疗效果。方法 选择符合CCMD - 2 -R酒依赖诊断标准的 68例男性患者 ,入院后先给予促大脑代谢药物和戒毒片治疗一周 ,然后进行电厌恶治疗 ,每日或隔日一次 ,连续 7～ 10次。结果 68例患者经上述方法治疗均达痊愈。一年后随访戒酒成功率为 92 .79 %。结论 戒毒片合并电厌恶疗法治疗酒依赖可加速体内酒精代谢产物排泄 ,改善营养状况 ,建立厌恶条件反射 ,方法可靠。

阑尾切除术中应用电凝处理阑尾残端152例报告

阑尾切除术是临床常见手术，但术中以电凝处理阑尾残端的安全性、合理性目前尚未得到外科权威著作认可。本研究回顾性分析江苏省南京市江宁医院普外科2007年10月至2008年10月收治的行阑尾切除术患者152例临床资料，比较分析阑尾残端分别以传统方法处理及电凝处理两组病例多项指标，探讨电凝处理阑尾残端在阑尾切除术中应用的安全性、可行性。

卡前列素氨丁三醇联合脉冲电刺激预防高危因素所致产后出血的疗效研究

目的探讨卡前列素氨丁三醇联合脉冲电刺激产后出血的影响。方法宫缩乏力性产后出血的600例,随机分为两组,各300例,两组产妇产后即给予卡前列素氨丁三醇0.25 mg肌肉注射,送回产科病房后,对照组采用常规人工按摩宫底的方法进行产后出血预防,观察组给予脉冲电刺激进行产后出血的预防。观察产前产后收缩压、舒张压、心率情况,记录产后出血的例数,出血量、止血时间、产后血红蛋白及红细胞容量下降情况,产后输血例数、子宫切除例数及产后贫血、低血容量休克、输血反应、产褥感染等。所获数据采用方差分析,t检验和2检验。结果产时出血量、产后24 h出血量、止血时间、24 h红细胞下降和血红蛋白下降两组比较,t=9.5392~22.299,P均<0.0005。卡前列素氨丁三醇联合脉冲电刺激组并发症发生11例,占3.67%。对照组并发症发生49例,占16.33%。两组比较,X^2=26.740,P<<0.005,有非常显著性差异。对照组产前与产后2 h血压与心率比较,P>0.05,无显著性差异;产后24h与产前、产后2h血压与心率比较,t=16.171~32.349,P均<0.001,有非常显著性差异。卡前列素氨丁三醇联合脉冲电刺激组产前与产后2h血压与心率比较,P>0.05,无显著性差异;产后24h与产前、产后2h血压与心率比较,t=25.358~50.978,P均<0.001,有非常显著性差异。两组产后24 h心率比较。t=3.7947,P<0.001,均恢复正常。结论卡前列素氨丁三醇联合脉冲电刺激能有效减少高危因素产妇产后出血的发生,并能减少出血量,同时节省了人力资源,减轻产妇痛苦,可以推广应用。

TURP治疗良性前列腺增生症1500例

目的探讨 TURP 对良性前列腺增生症的治疗效果。方法 1500例前列腺增生症患者均行TURP 治疗。结果所有患者手术过程顺利,平均切除前列腺组织36g。平均电切时间40 min。无电切综合征发生。1290例(86%)3个月随访 IPSS 和 QOL 分别由术前的28.8±2.2,和5.7±0.8降至术后的8.9±1.8和2.0±0.4,残余尿量由术前的平均96 ml 降至术后的20±15 ml,平均最大尿流率(Qmax)和平尿流率(Qave)由术前的5.8/s 和4.6/s 增至术后的19.8/s 和13/s。手术前后比较差异均有统计学差异(P<0.05)。术后疗效满意,无严重并发症。结论经尿道前列腺电切治疗前列腺增生症,是一种安全有效的治疗方法。

经尿道前列腺汽化电切术膀胱痉挛的护理

目的探讨经尿道前列腺汽化电切术后膀胱痉挛的护理措施。方法对95例膀胱痉挛的患者进行分析,给予对症处理。结果其膀胱痉挛的原因主要有四个方面:1)患者的心理因素。2)尿管刺激。3)冲洗液的温度和速度。4)腹压增高。结论给予必要的心理支持,病情观察及管道护理是预防术后膀胱痉挛的关键。

电厌恶与呋喃唑酮对戒酒疗效的影响

目的 探讨电厌恶治疗戒酒的疗效。方法 60例病人均符合酒依赖诊断标准,随机分为电厌恶组和呋喃唑酮组各30例对照研究。电厌恶组给予白酒后随机给予的电刺激。呋喃唑酮组,持续口服呋喃唑酮后给白酒,使患者逐渐产生对酒的厌恶,以达到戒酒的目的。分四级评定疗效,用副反应量表(TESS)评定副反应。结果 电厌恶组出院时全部戒酒,随访两年,15例完全戒酒,痊愈率50％,显效率66.67％;呋喃唑酮组出院时29例戒酒,随访2年,12例完全戒酒,痊愈率40％,显效率60％。结论 电厌恶治疗戒酒比使用呋喃唑酮危险性和痛苦性小,副作用轻,更有效且安全。

CLINICAL STUDY ON THE TREATMENT OF POST-STROKE DEPRESSION WITH ELECTROACUPUNCTURE OF “NIWAN BAZHEN” POINTS

Objective To observe the therapeutic effect of electroacupuncture （EA） of ＂Niwan Bazhen＂ points in the treatment of post-stroke depression. Methods A total of 66 post-stroke depression patients were randomized into treatment group （EA＋oral administration of Prozac-20, n =31 ） and control group （o- ral administration of Prozac-20, 20 mg/d, 28 days altogether, n =30）. For patients of treatment group, EA （2/100 Hz, a tolerable stimulation strength） was applied to ＂Niwan Bazhen＂ points [Baihui （百会 GV20）, etc. ] for 30 min, once daily, （except weekends） continuously for one month. Halmiton Rating Scale （HAMD） for Depression and Chinese Scale for Stroke （CSS） were used to evaluate the therapeutic effect. Results After the treatment, of the 30 and 31 cases in control and treatment groups, 4 and 6 were cured, 10 and 14 experienced marked improvement.in their symptoms, 6 and 7 had an improvement, 6 and 4 failed, with the cure＋ markedly effective rates being 46.7% and 64.5% respectively. The therapeutic effect of treatment group was significantly superior to that of control group （ P〈0.05）. The decreased values of both HAMD and C,,SS of treatment group were remarkably lower than those of control group （P〈0.01,0.05） . Conclusion EA of ＂Niwan Bazhen＂ points is an effective remedy for post-stroke depression.

FORTY-EIGHT CASES OF ACUTE GOUTY ARTHRITIS TREATED COMPREHENSIVELY WITH ELECTROACUPUNCTURE AND WARMING MOXIBUSTION

Objective To probe into the effects on acute gouty arthritis treated comprehensively with electroacupuncture (EA) and warming moxibustion. Methods 70 cases were randomized into treatment group (48 cases), in which the EA+warming moxibustion was applied; and controlled group (22 cases), in which, colchicine was prescribed for oral administration. Results The statistical outcomes after 1 course treatment in treatment group: 28 cases were cured (58.33%), 18 cases improved (37.50%) and the total effective rate was 95.83%. In controlled group: 12 cases (54.55%) were cured, 8 cases improved (36.36%) and the total effective rate was 90.91%. The therapeutic effects of two groups were basically consistent, without significant different (P>0.05). But, concerning to side effect, there was no any toxic side effects in the group treated with EA+warming moxibustion, and the occurrence rate in the group treated with colchicine was 40.91%. Conclusion Electroacupuncture+warming moxibustion achieves good therapeutic effects without any side effects.

Ultrasonically activated scalpel versus monopolar electrocautery shovel in laparoscopic total mesorectal excision for rectal cancer

AIM： To investigate the feasibility and safety of monopolar electrocautery shovel （ES） in laparoscopic total mesorectal excision （TME） with anal sphincter preservation for rectal cancer in order to reduce the cost of the laparoscopic operation, and to compare ES with the ultrasonically activated scalpel （US）. METHODS： Forty patients with rectal cancer, who underwent laparoscopic TME with anal sphincter preservation from June 2005 to June 2007, were randomly divided into ultrasonic scalpel group and monopolar ES group, prospectively. White blood cells （WBC） were measured before and after operation, operative time, blood loss, pelvic volume of drainage, time of anal exhaust, visual analogue scales （VAS） and surgery-related complications were recorded. RESULTS： All the operations were successful; no one was converted to open procedure. No significant differences were observed in terms of preoperative and postoperative d I and d 3 WBC counts （P = 0.493, P = 0.375, P = 0.559）, operation time （P = 0.235）, blood loss （P = 0.296）, anal exhaust time （P = 0.431）, pelvic drainage volume and VAS in postoperative d 1 （P = 0.431, P = 0.426） and d 3 （P = 0.844, P = 0.617） between ES group and US group. The occurrence of surgery-related complications such as anastomotic leakage and wound infection was the same in the two groups.CONCLUSION： ES is a safe and feasible tool as same as US used in laparoscopic TME with anal sphincter preservation for rectal cancer on the basis of the skillful laparoscopic technique and the complete understanding of laparoscopic pelvic anatomy. Application of ES can not only reduce the operation costs but also benefit the popularization of laparoscopic operation for rectal cancer patients.

Effect of electro-acupuncture at Foot-Yangming Meridian on somatostatin and expression of somatostatin receptor genes in rabbits with gastric ulcer

AIM： To discuss the protective effect of electroacupuncture at the Foot-Yangming Meridian on gastric mucosal lesion, somatostatin （SS） and the expression of SS receptor genes （SSR1mRNA） in rabbits with gastric ulcer and to further explore the relative specificity of meridians and viscera at gene expression level. METHODS： Forty rabbits were randomly divided into control group （A）, gastric ulcer model group （B）, FootYangming Meridian group （C）, Foot-Shaoyang Meridian group （D） and Foot-Taiyang Meridian group （E）. The gastric ulcer model was prepared by infusing alcohol into stomach. Groups C-E were treated with electroacupuncture at points along the above meridians using meridian stimulating instruments for 7 days respectively. By the end of treatment, the index of gastric ulcer was determined, the amount of epidermal growth factor（EGF） and somatostatin was measured by radioimmunoassay （PJA）. SS-R1mRNA expression in gastric mucosa was determined by RT-PCR. RESULTS： The value of EGF in model group was obviously lower（73.6±14.8 vs 91.3±14.9 pg/mL, P〈 0.01） than that in control group. The index of gastric ulcer, content of SS and expression of SSRtmRNA in gastric mucosa were significantly higher than those in control group （24.88 ± 6.29 vs 8.50 ± 2.98 scores, P〈 0.01; 2978.6 ± 587.6 vs 1852.4 ± 361.7 mIU/mL, P〈 0.01; 2.56±0.25 vs 1.04±0.36, P〈0.01） . The value of EGF in Foot-Yangming Meridian group was higher than that in model group（92.2±6.7 vs 73.6±14.8 pg/mL, P〈 0.01）. The index of gastric ulcer, content of SS and expression of SS-R1mRNA in gastric mucosa were significantlylower than those in control group（10.88±3.23 vs 24.88±6.29 scores, P〈0.01; 1800.2±488 vs 2978.6±587.6 mIU/mL, P 〈 0.01; 1.07±0.08 vs 2.56±0.25mIU/mL, P〈0.01）. Compared to the model group, the content of SS and expression of SSRlmRNA in gastric mucosa in Foot-Shaoyang Meridian group decreased （2441.0±488. vs 2978.6± 587.6 mIU/mL, P〈 0.05; 1.73±0.16 vs 2.56±0.25 mIU/mL, P〈0.01）. But the above parameters in Foot-Taiyang Meridian group did not improve and were significantly different from those in Footoyangming Meridian group （P〈0.05） CONCLUSION： Electro-acupuncture at Foot-Yangming Meridian can protect gastric mocusa against injury. The mechanism may be releted to the regulation of brain-gut peptides and the expression of SSRtmRNA.