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光动力疗法治疗视网膜血管瘤样增生初步报告

光动力疗法治疗中心性渗出性脉络膜视网膜病变疗效观察

Photodynamic therapy combined with intravitreous injection with triamcinolone a cetonide for choroidal neovascularization

Effectiveness of N-acetylcysteine Combined with Low-Dose Glucocorticoid for Patients with IPF: A Meta-Analysis

Objective　To systematically evaluate the effectiveness of N-acetylcysteine (NAC) combined with low-dose glucocorticoid for patients with idiopathic pulmonary fibrosis (IPF). Methods　Such databases as The Cochrane Library (Issue 12, 2012), EMbase (January 1974 to July 2012), PubMed (January 1966 to July 2012), CHEST (January 1995 to July 2012), CNKI (January 1994 to July 2012), CBM (January 1978 to July 2012), VIP (January 1989 to July 2012) and WanFang Data (January 1995 to July 2012) were searched to collect the randomized controlled trials (RCTs) about NAC combined with low-dose glucocorticoid versus glucocorticoid alone for IPF patients. Two reviewers independently screened the literature according to the inclusion and exclusion criteria, extracted the data, and assessed the quality, and then the meta-analysis was performed using RevMan 5.1 software. Results　A total of seven RCTs including 264 IPF patients were included. The results of meta-analysis demonstrated that, compared with the glucocorticoid used alone, a) NAC combined with low-dose glucocorticoid could significantly improve PaO2 (SMD=0.82 mmHg, 95%CI 0.30 to 1.35, P=0.002) and DLco (SMD=0.59 mmHg, 95%CI 0.16 to 1.03, P=0.008) with a significant difference. b) NAC combined with low-dose glucocorticoid could significantly improve all clinical symptoms (RR=1.56, 95%CI 1.26 to 1.92, Plt;0.000 1). Conclusion　NAC combined with low-dose glucocorticoid for IPF patients can significantly improve PaO2, DLco, and the clinical symptoms such as cough, difficulty breathing after activities, cyanosis, and Velcro rales. Due to the quantity and quality limitation of included studies, this conclusion still needs to be further proved by more high quality and double blind RCTs.

Effects of Low-dose Erythromycin on Patients with Stable COPD: A Meta-Analysis

ObjectiveTo systematically review the clinical efficacy of low-dose erythromycin in patients with stable chronic obstructive pulmonary disease (COPD). MethodsRandomized controlled trials (RCTs) about low-dose erythromycin plus routine treatment versus routine treatment/placebo plus routine treatment in treating stable COPD was electronically searched in PubMed, EMbase, CBM, The Cochrane Library (Issue 4, 2013), CNKI, VIP and WanFang Data from the their establishment dates to May 2013. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed methodological quality. The results of meta-analysis was performed using RevMan 5.2 software. ResultsA total of eight RCTs involving 526 patients were finally included. The results of metaanalysis showed that:a) compared with the control group, low-dose erythromycin significantly improved six-minute walk distance (SMD=0.30, 95%CI 0.05 to 0.55, P=0.02), reduced the frequency of acute exacerbation (RR=0.44, 95%CI 0.25 to 0.78, P=0.005), and decreased the concentrations of IL-8 (SMD=-1.63, 95%CI-2.17 to-1.09, P < 0.000 01), TNF-α (SMD=-1.49, 95%CI-2.36 to-0.62, P=0.000 8), and neutrophil elastase (NE) (SMD=-0.94, 95%CI-1.36 to-0.51, P < 0.000 1) in sputum. b) the erythromycin therapy could improve forced expiratory volume in one second (FEV1) (SMD=0.19, 95%CI-0.19 to 0.58, P=0.32) but without significant differences compared with the control group. ConclusionLow-dose erythromycin could improve exercise tolerance, reduce the frequency of acute exacerbation, and help relieve airway inflammation, but in the improvement of FEV1, low-dose erythromycin is not better than routine treatment. Due to limited quantity and quality of the included studies, larger scale, multicenter, high quality RCTs are needed to verify the aforementioned conclusion.

病理性近视黄斑部脉络膜新生血管光动力疗法治疗后光相干断层扫描观察结果分析

Application Methods and Skills of Small-dosage Insulin Therapy for Acute Metabolic Complications in Diabetes Patients

目的　对糖尿病急性代谢并发症小剂量胰岛素的应用方法及技巧进行探讨和分析。 方法　以2009年1月－2012年2月收治的50例糖尿病急性代谢并发症患者为研究对象,按照数字随机表方法分为对照组和试验组，每组25例患者。对照组患者在小剂量胰岛素的使用上采用常规技巧和方法；试验组患者在小剂量胰岛素的使用上结合实际情况和相关规范进行综合治疗，比较两组患者小剂量胰岛素的应用效果。 结果　经治疗，对照组18例患者的临床症状得到明显改善，显效率为72%；试验组25例患者的临床症状均得到有效缓解，显效率为100%，两组患者的显效率比较，差异有统计学意义（P＜0.05）。 结论　使用小剂量胰岛素治疗糖尿病急性代谢并发症患者时，结合实际情况和相关规范进行综合治疗临床效果满意。

The Clinical Usage of Small Dose and Low Pressure Lavage in Gastrointestinal Hemorrhage Induced by Acute Poisoning

ObjectiveTo explore the effects of small dose and low pressure lavage on gastrointestinal hemorrhage induced by acute poisoning. MethodsWe collected the clinical data of all the patients diagnosed as gastrointestinal hemorrhage induced by acute poisoning treated between January 2011 and December 2012. The patients were divided into two groups: control group and treatment group, according to the different treatments they underwent. The control group received traditional treatment only, while the treatment group received small dose and low pressure lavage as well as the traditional treatment. After recording the ages, poisoning dose, pretreatment time, shock and complications, we evaluated the risk of death by calculating ROCKALL scores. ResultsThe differences of ages, sexes, and poisoning dose between these two groups were not significant. However, the death rate in high and middle risk patients of the treatment group was significantly lower than that of the control group (P<0.05). ConclusionThe small dose and low pressure lavage can improve the prognosis of the gastrointestinal hemorrhage induced by acute intoxication.

小剂量利尿剂在中-重度胰腺炎中的作用评价

目的探讨小剂量利尿剂在中-重度胰腺炎治疗中的作用。 方法回顾性分析2012年1月-2013年8月62例中-重度胰腺炎患者病历资料。入院后立即给予积极液体复苏及综合治疗，使24 h尿量达到1 000 mL以上，有46例患者在24～48 h内出现呼吸＞24次/min，心率＞100次/min。根据患者是否使用利尿剂分为2组，对照组22例患者给予限制液体量和滴速，利尿剂组24例患者在上述方案基础上同时给予小剂量利尿剂，并统计分析两组患者的出入量、治愈率、并发症、住院周期。 结果两组平均24 h入量为利尿剂组（1 076.67±88.99）mL、对照组（1 140.45±133.75）mL，差异无统计学意义（P＞0.05）；平均24 h尿量为利尿剂组（1 219.17±242.05）mL、对照组（1 038.18±171.54）mL，差异有统计学意义（P＜0.05）。利尿剂组24例患者短期内心率、呼吸恢复正常，其局部并发症发生率为4.2%，全身并发症的发生率为12.5%，治愈好转率为91.7%,平均住院时间为（13.88±3.79）d； 22例对照组患者其局部并发症发生率为27.3%，全身并发症的发生率为40.9%，治愈好转率为63.9%，平均住院时间为（19.09±4.68）d；除局部并发症发生率差异无统计学意义（P＞0.05），其余指标组间差异均有统计学意义（P＜0.05）。 结论小剂量利尿剂在中-重度胰腺炎治疗中能有效地减少并发症发生，提高疗效，缩短住院周期。

布比卡因复合舒芬太尼蛛网膜下隙阻滞剖宫产术的临床观察

目的观察布比卡因复合不同剂量舒芬太尼蛛网膜下隙阻滞对剖宫产术血流动力学的影响及安全性。 方法将2012年3月-12月收治的美国麻醉医师协会分级Ⅰ级行剖宫产术的75例产妇随机分成A、B、C、D、E 5组，每组各15例，蛛网膜下隙注射药物配制为重比重混合液。A组：布比卡因5 mg+0.2 mL生理盐水，B组：布比卡因5 mg+舒芬太尼5 μg，C组：布比卡因5 mg+舒芬太尼7.5 μg，D组：布比卡因5 mg+舒芬太尼10 μg，E组：布比卡因10 mg。记录麻醉后每分钟收缩压、舒张压、平均动脉压（MAP）、心率、心电监测、动脉血氧浓度情况，同时记录低血压例数（包括麻黄素使用例数）、寒战、恶心、呕吐和牵拉痛等不良反应的发生情况。 结果手术期间最低收缩压、舒张压、MAP值D、E组比A组低（P＜0.05）；D、E组低血压发生率和麻黄素使用率比A、B、C组高（P＜0.05）；B、C、D组镇痛效果好于A、E组（P＜0.05），D组皮肤瘙痒发生率比A、B、C、E组高（P＜0.05）。 结论小剂量布比卡因5 mg复合舒芬太尼5.0～7.5 μg蛛网膜下隙阻滞剖宫产术麻醉效果好，对血流动力学影响小，不良反应发生率低。