Objective:To analyze the clinical characteristics, diagnosis and treatment of acquired uterine arteriovenous malformation (UAVM).Methods:The clinical data of 16 patients with diagnosis of UAVM from January 2014 to March 2021 in Beijing Friendship Hospital, Capital Medical University were enrolled in this retrospective study. The general data of patients were observed and analyzed: age, pregnancy and childbirth, etc. Auxiliary examinations: human chorionic gonadotropin (hCG), B-ultrasound, CT angiography (CTA), magnetic resonance (MRI), digital subtraction angiography (DSA), lesion diameter, resistance index (RI), peak systolic velocity (PSV), treatment and postoperative pathology.Result:Among the 16 patients, hCG was negative in 10 cases and positive in 6 cases. The first abnormal bleeding time was (43.4±36.4) days and (16.0±9.0) days, respectively. The rehospitalization time was (63.3±54.4) days and (48.3±54.0) days. Six patients with massive bleeding were HCG negative. Ultrasound in 16 cases showed mixed echo light mass with rich blood flow in the uterine cavity, and magnetic resonance examination in 14 cases also showed abnormal signals in the uterine cavity or uterine wall. Mass staining was seen in 6 cases by DSA, vein development in advance, contrast medium overflow was seen in 2 cases, and the conclusion of CTA was consistent with DSA in 5 cases. Uterine artery embolization was performed in 5 cases, including 2 cases of massive bleeding, emergency bilateral uterine artery embolization and 3 cases of preventive embolization. Hysteroscopy was performed in 4 cases after embolization, and balloon compression was performed in 1 case because there was no obvious tissue in the uterine cavity. Hysteroscopy were performed in 10 cases without UAE. Mifepristone combined with misoprostol was used in 1 case. Among the 15 patients treated by surgery, 14 cases showed degenerative trophoblasts or villi. During the follow-up, one patient after uterine artery embolization complained of decreased menstruation, and ultrasound considered the possibility of intrauterine adhesion.Conclusion:After termination of pregnancy, imaging examination should be strengthened to guard against the occurrence of UAVM. Once diagnosed, medical intervention should be started as soon as possible to reduce bleeding. There is no standardized treatment for UAVM related to pregnancy. Comprehensive consideration should be given to the clinical manifestations, bleeding situation, lesion location and fertility requirements of the patients.

[目的]分析住院期间跌倒的老年内科病人的临床特点,探讨跌倒相关因素.[方法]选取我院2015年1月—2018年12月内科系统住院的年龄≥60岁老年病人24378例,回顾性分析住院期间发生跌倒的病人的临床特点.[结果]39例病人住院期间发生跌倒,年龄(75.59±9.51)岁,跌倒后发生骨折7例(17.9％)、皮裂伤9例(23.1％)、皮下血肿15例(38.5％)、无明显外伤8例(20.5％);日常生活活动能力(ADL)评分<95分29例(74.4％);跌倒风险评分1～7分病人13例(33.3％),8～12分病人10例(25.6％),13～17分病人13例(33.3％),≥18分病人3例(7.7％);跌倒发生时住院时间≤3 d 17例(43.6％);合并≥2种疾病100％;病人用药种类(10.13±5.66)种.[结论]内科老年病人住院期间发生跌倒是多重因素引起的,功能状态下降、多种疾病共存及多重用药是此类病人的特点,加强跌倒风险评估及防范是降低院内跌倒的关键.

目的 探讨妊娠合并急性胰腺炎的临床特点、诊断和治疗办法,以改善妊娠结局.方法 回顾性分析本院近10年来诊治的15例妊娠合并急性胰腺炎患者的临床资料.结果 (1)患者年龄20-38岁,初产妇14例,1例孕27周发病,12例为晚孕期(孕30+4-39+5周),自然分娩和剖宫产后各1例.重型急性胰腺炎(severe acute pancreatitis,SAP)9例,轻型急性胰腺炎(mild acute pancreatitis,MAP)6例,胆源性7例,脂源性6例,特发性2例.(2)典型临床表现14例,不典型表现1例,13例患者血清淀粉酶(amylase,AMY)明显升高,2例AMY升高未达正常值3倍.2例B超未确诊,9例行腹腔CT诊断明确.(3)1例胆源性SAP促肺治疗期待至34周剖宫产分娩,2例胆源性MAP内科治疗后顺产,余10例患者均剖宫产终止妊娠,术中行胰腺探查加引流7例.2例术后腹腔感染,3例胆源性AP(1例SAP,2例MAP)产后行经内镜逆行胰胆管造影(endoscopic retrograde cholangiopancreatography,ERCP).(4)1例院外子痫转入时已胎死宫内,3例新生儿窒息.1例患者因重度脓毒症,多脏器功能衰竭死亡.结论 急性胰腺炎如能在24小时内确诊及处理可降低不良妊娠结局.CT具有较高诊断价值.治疗上应积极抗炎;胆源性胰腺炎应积极ERCP取石或胆道探查引流;脂源性胰腺炎可行血浆置换以缩短病程.

目的 比较药物诱导睡眠喉镜(DISE)检查与Müller实验在阻塞性睡眠呼吸暂停综合征患者中,哪种方法能更加精准的定位,哪种方法能更加准确的描述上气道塌陷情况.通过睡眠喉镜检查观察患者鼾声来源,解决鼾症患者的问题.方法 回顾性选取98例患者作为研究对象,经PSG检查诊断为阻塞性睡眠呼吸暂停综合征.入院后均行DISE检查和Müller试验,检查结果分两部分记录,堵塞位置和堵塞程度,对比两种方法在各种狭窄中检查结果的一致性,并且记录鼾声来源.结果 两种方法检查结果的一致性具有统计学意义,软腭平面前后径狭窄有62.7％一致性,左右径狭窄有75.0％一致性,环形狭窄有81.8％一致性,口咽平面左右径狭窄78.5％一致性.舌根前后径狭窄有26.7％一致性,会厌平面左右径狭窄有25％一致性,在前后径狭窄有31.5％一致性,而喉部环形狭窄的一致性仅有19.2％.3例患者在DISE检查中出现声带扑动.鼾声来源于软腭平面占74.5％,来源于咽侧壁占30.6％,来源于舌根/会厌平面占28.6％,来源于声门占3.1％.结论 DISE具有安全性、操作简单、可靠性高的优势,比Müller试验更能客观地反映出阻塞性睡眠呼吸暂停综合征患者上气道阻塞的程度及形式,并且能直观的观察到鼾声来源,对于鼾症患者解决鼾声治疗提供有力的临床依据.Müller试验在评估软腭、口咽平面也可以提供充分的临床依据.

目的 认识上气道阻力综合征(upper airway resistance syndrome,UARS)患者睡眠障碍治疗前后的临床心理变化,提高对上气道阻力综合征(UARS)患者治疗中,心理变化的认识,完善治疗方法.方法选择21例经多导睡眠监测和食管测压确诊的UARS患者,分析其主观量表指标,包括:嗜睡量表(Epworth Sleeping Scale,ESS),匹兹堡睡眠调查表(Pittsburgh sleep quality index,PSQI),汉密顿抑郁量表(Hamilton Depression Scale,HAMD)及焦虑量表(Hamilton Anxiety Scale,HAMA)评分进行量化比较;以及客观参数,包括:多导睡眠监测(Polysomnography,PSG)中的睡眠效率,N3时间百分比,呼吸努力相关微觉醒(respiratory effort related arousal,RERA)指数及客观警觉试验(OSLER Test)评估值,经个体化综合治疗3个月后,行前后对比分析.结果治疗前后主客观参数除客观警觉试验(OSLER Test)评估值以外,差异均有统计学意义.结论UARS患者因长期睡眠问题可进一步影响情绪,引起心理改变,个体化综合治疗可以改善其心理状况.

目的 通过药物诱导睡眠喉镜(DISE)检查准确定位后,在悬雍垂腭咽成形术(UPPP)基础上行保留扁桃体窝及低温等离子射频消融咽侧索的手术,探讨手术的远期疗效.方法 回顾性分析2014年1月至2016年1月首都医科大学附属北京友谊医院耳鼻咽喉头颈外科收治的经多导睡眠监测(PSG)确诊为阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的轻、中度患者49例,均进行DISE检查,其中25例患者提示口咽平面左右径狭窄且无咽侧索肥厚(组1),24例患者口咽平面环形狭窄且伴有咽侧索肥厚(组2).组1中行传统UPPP手术14例(组1-1),行保留扁桃体窝的UP-PP手术11例(组1-2);组2中行传统UPPP手术12例(组2-1),行保留扁桃体窝的UPPP及低温等离子消融部分肥厚咽侧索手术12例(组2-2).术后1年患者门诊随访,复查上气道手术部位恢复情况,并行一夜多导睡眠检测,收集术后的Epworth嗜睡量表(Epworth sleeping scale,ESS)评分,呼吸暂停低通气指数(AHI),最低血氧值(LSaO 2).结果 根据《2009年中华医学会耳鼻咽喉头颈外科学分会关于OSAHS的诊断和治疗指南》中疗效评估标准,组1治愈5例,其中组1-2:3例,组1-1:2例;显效和有效共12例,其中组1-2:7例,组1-1:5例;无效8例,其中组1-2:1例,组1-1:7例,总有效率为68％.组2治愈3例,其中组2-2:2例,组2-1:1例;显效和有效共13例,其中组2-2:8例,组2-1:5例;无效8例,其中组2-2:2例,组2-1:6例,总有效率为66.7％.两组患者间年龄、BMI、LSaO 2、术前AHI差异均无统计学意义(P>0.05),术后AHI组1-2和组2-2低于组1-1和组2-1(P<0.05).结论 UPPP手术基础上保留扁桃体窝手术远期疗效较好,对手术治疗OSAHS的远期疗效有重要意义;对于咽侧索肥厚患者使用低温等离子消融部分咽侧索对咽腔的扩大起到极大作用;术前使用DISE定位检查对手术方式的选择起到重要指导作用.

总结了经口气管插管机械通气(MV)患者的口腔护理方法,建议应用:擦洗、冲洗、刷牙法联合应用可以避免口腔死角、牙菌斑清洁不到位和呼吸机相关性肺炎(VAP)的发生;鉴于价格、杀菌效果、口感和患者接受程度考虑,建议用聚维酮碘漱口液进行口腔护理,中药漱口制剂也可考虑;考虑国情因素,口腔护理的频次建议为每6h一次.认为良好的口腔护理可以减少经口气管插管机械通气(MV)患者呼吸机相关性肺炎(VAP)的发生率.

Acute appendicitis is the most common general surgical problem encountered during pregnancy, which may be associated with serious maternal and /or fetal complications such as appendiceal perforation or premature delivery.Clinical presentation and imaging remains vital in the diagnosis of appendicitis.As a general rule,the clinical suspicion of acute appendicitis during pregnancy is an indication for an urgent surgical intervention.Appendectomy is the preferred treatment.Laparoscopic appendicectomy(LA)can also be performed safely and effectively in pregnant patients without bringing additional maternal complications.

目的：探讨原发于下咽部的滑膜肉瘤的诊断及治疗要点。方法回顾性分析一例下咽滑膜肉瘤患者的临床资料、病理诊断、治疗方式及疗效，并复习相关文献。结果患者女，14岁，临床表现为咽部异物感，言语含糊，吞咽梗阻易呛咳。查体可见肿物位于下咽后壁偏右侧，表面光滑，呈分叶状，实性，质软，色灰白，蒂广。颈部M RI示下咽部占位性病变，呈等T1稍长T2信号影，增强扫描后明显强化。经右侧梨状窝入路行肿物切除术，术中见肿物有包膜，与周围组织界限清楚，行肿物切除术。显微镜下见肿瘤组织由上皮细胞和梭形细胞组成，核分裂不易见，基因检测见其具有特征性染色体异位T （X ；18）（P11．2；Q11．2）。病理诊断为滑膜肉瘤（双相型）。术后辅以放疗，一年半后复查未见肿瘤复发。结论下咽滑膜肉瘤较罕见，主要依靠病检确诊，治疗方式以手术为主，辅以放化疗。

目的 观察不同剂量低分子肝素(LMWH)辅助治疗重度子痫前期的有效性及安全性.方法 选取2009年11月至2011年3月在北京友谊医院住院的重度子痫前期患者71例,随机分为常规治疗组(A组20例)、常规疗法+LMWH 25 IU/kg·d组(B组17例)、常规疗法+LMWH 50 IU/kg·d组(C组16例)、常规疗法+LMWH 75 IU/kg·d组(D组18例),连续治疗7d.观察不同剂量LMWH辅助治疗重度子痫前期在改善临床症状、实验室指标(凝血功能、肝肾功能、血常规、尿蛋白)和围产结局的作用.结果 ①AT-Ⅲ在A组治疗后有上升,差异无统计学意义(P＞0.05);应用LMWH的BCD组治疗后均有下降,各组间比较差异均有统计学意义(P＜0.05);但仅B组治疗后显著低于治疗前,差异有统计学意义(P=0.020);D组治疗后24 h尿蛋白定量显著低于治疗前(P=0.028);②不同剂量LMWH组治疗后收缩压均显著低于治疗前(分别为P=0.010、P=0.002、P=0.002、P=0.014).A组和B组治疗后舒张压显著低于治疗前(P=0.007、P=0.003).其余各项指标治疗前后比较差异无统计学意义(P＞0.05).母婴围产结局各组比较差异无统计学意义(P＞0.05).结论 在常规治疗子痫前期的同时加用不同剂量的LMWH对肝肾功能、血常规指标、凝血指标、母婴围产结局未产生明显影响,但大剂量LMWH (75 IU/kg·d)在改善24 h尿蛋白定量上有一定作用,并是安全的.血压改善的主要作用仍然是常规治疗方法.

目的 探讨Mondini畸形患儿人工耳蜗植入术后EABR特点,用客观方法评价 Mondini畸形患儿人工耳蜗植入术后效果.方法 选择我院2007～2009年间行人工耳蜗植入术的Mondini畸形患儿9例(9耳)A组、和内耳发育正常11例(11耳)B组,选取3,10,20 电极分别行阻抗、神经反应遥测(Neural response telemetry, NRT)、电听性脑干反应(Electrically evoked auditory brainstem responses, EABR)检测及听觉主观阈值(T-level,T值)的测定.结果 20例患者的NRT为:A组11例均检测出ECAP波形,B组9例中5例患儿在改变参数下检测出出可辨别ECAP波形,其余4例患儿无法检测出可靠波形.A、B两组均检出EABR波形.结论 ①Mondini畸形患儿的人工耳蜗植入术后EABR检测较NRT检出率更有优势.②EABR检测可以应用在Mondini畸形患儿的人工耳蜗植入术后的客观听觉效果的评价和Mapping调试.

目的 探讨累及呼吸道的复发性多软骨炎的呼吸道的临床症状和影像特点.方法 回顾性分析3例累及呼吸道的复发性多软骨炎的病例的临床资料.结果 复发性多软骨炎的呼吸道症状有声嘶、咽痛、咳嗽、咳痰、喘息、呼吸困难等,CT检查可有喉软骨、气管、支气管软骨的增厚、钙化、软化、气道的狭窄,不同程度的声带、室带水肿.激素联合免疫抑制剂治疗效果尚可.结论 对于反复发作的声嘶以及症状不典型的咳嗽、咳痰、渐进性的呼吸困难等应及时行颈胸部CT检查,并注意系统查体,早期诊断,提高对复发性多软骨炎累及气道的认识.

近年来,随着肾移植患者人数的增加,新型强效的免疫抑制剂的大量使用,使得术后的急性排斥发生率显著降低,移植肾的一年存活率大大提高.但同时也使条件致病真菌感染日益增多.尤其是侵袭性肺曲霉菌感染(invasive pulmonary aspergillosis,IPA)发生率为0.5%～2.2%,如果不及时诊治,病情发展非常迅速,死亡率高达50%～100%,是肾移植术后非常严重的并发症~([1])。

To review the commonly used methods of studying pharmacokinetics of traditional Chinese prescription in recent years which including the methods of studying biological effects and plasma concentration,and all kinds of representative hypothesizes or suppositions proposed by domestic and foreign scholars which including new Hypothesis of “Syndrome and Treatment Pharmacokinetics”,Decoction Effective Components Pharmacokinetics Hypothesis,“Sydrome Differentiation Pharmacokinetics”Hypothesis,gastrointestinal Pharmacokinetics of TCM and Plasma pharmacology,et al.To evaluate objectively their characteristics during pharmacokinetic studies of traditional Chinese prescription.