早期肠内营养应用于神经外科重症患者临床观察

目的:对比神经外科重症患者早期肠内营养和肠外营养的疗效,探讨早期肠内营养应用的最佳时机。方法:选择神经外科住院的重症患者180例,随机分为早期肠内营养组和肠外营养组各90例,分别给予早期肠内营养和肠外营养,观察两组患者术后或入院后的第1、6、14、28天的氮平衡、血清总蛋白、血清白蛋白、GCS评分,并对比腹胀、腹泻、消化道出血等并发症发生情况;同时将早期肠内营养组随机分为A组、B组、C组三个亚组,每组30例,检测三组经治疗后第28天血清生化指标变化、并发症发生情况以及GCS评分。结果:(1)治疗后第1天、第6天,两组在血生化指标及GCS评分上比较,差异无统计学意义(P>0.05),治疗第14天,早期肠内营养组血清总蛋白与血清白蛋白水平明显高于肠外营养组,差异有统计学意义(P<0.05),第28天,早期肠内营养组血清总蛋白、血清白蛋白、氮平衡及GCS评分均明显高于肠外营养组,差异有统计学意义(P<0.05)。(2)相比肠外营养组,早期肠内营养组并发症发生率低,差异有统计学意义(P<0.05)。(3)相比A组和C组,B组患者氮平衡、血清总蛋白、血清白蛋白水平及GCS评分均较高,差异有统计学意义(P<0.05)。(4)相比A组和C组,B组患者并发症发生率均较低,差异有统计学意义(P<0.05)。结论:早期肠内营养能更好的改善患者的营养指标,并发症发生率低,是神经外科重症患者合理的营养支持方式,术后或入院后25~48h开始建立肠内营养支持,或为肠内营养支持开始最佳时机。     

高血压脑出血患者建立肠内营养最佳时机临床研究

目的观察高血压脑出血患者早期肠内营养的效果,探讨肠内营养支持最佳时机。方法80例高血压脑出血患者随机分为两组,各40例。观察组在发病后24～48h即给予肠内营养,对照组在发病后48～96h给予肠内营养。观察两组患者血红蛋白、血清白蛋白等指标的变化及与营养有关的并发症发生率。结果治疗前两组血红蛋白、血清白蛋白水平接近,治疗后较治疗前均有显著增加（P〈0．01）,且观察组较对照组增加更为显著（P〈0．01）;观察组腹泻和应激性溃疡发生率均低于对照组（P〈0．01）。结论对于高血压脑出血患者,发病后早期（24～48h）给予肠内营养支持具有重要意义,能减少胃肠道并发症的发生,有利于患者早期康复。     

重症脑出血患者微创锥颅术后两种肠内营养护理方式的对比研究

目的分析重症脑出血患者微创锥颅术后两种肠内营养护理方式。方法选取我院重症脑出血患者80例,接受治疗的时间为2012年3月至2014年1月期间,随机分为两组(观察组和对照组),对照组采用常规肠内营养护理,观察组采用自制均浆肠内营养护理,比较两组患者肠内营养护理后GCS评分和电解质紊乱发生率。结果观察组重症脑出血患者在肠内营养护理后GCS评分和电解质紊乱发生率明显优于对照组患者(P0.05)。结论给予重症脑出血患者微创锥颅术后自制均浆肠内营养护理,能有效的提高患者的GCS评分。     

围术期应用乌司他丁对高血压脑出血患者的脑保护作用

目的:研究高血压脑出血围术期应用乌司他丁对神经元特异性烯醇化酶的影响和脑保护作用?方法:高血压脑出血发病7 h内的手术患者40例,随机分为乌司他丁组(A组)和对照组(B组)?测定两组术前和术后12?36 h血清神经元特异性烯醇化酶(neuron-specific enolase,NSE)的浓度及术前和术后第8天的格拉斯哥(glasgow coma scale,GCS)的评分?结果:术后12 h和36 h,A组NSE浓度明显低于B组,术后第8天A组GCS评分明显高于B 组?结论:高血压脑出血术中早期应用乌司他丁有利于神经保护?     

早期肠内营养对高血压性颅内出血患者感染风险的影响

目的:探讨早期肠内营养对高血压性颅内出血患者感染风险的影响。方法:回顾性收集高血压性颅内出血患者142例,根据患者肠内营养开始时间,将患者分为早期肠内营养组(肠内营养开始时间≤48 h)和晚期肠内营养组(肠内营养开始时间>48 h)。主要观察指标为入院后院内死亡率、住院时间、颅内感染、泌尿系统感染、败血症、肺炎、总感染率、格拉斯哥昏迷评分(Glasgow Coma score,GCS)。结果:与晚期肠内营养组比较,早期肠内营养组患者泌尿系统感染率显著降低(2.47%vs.12.90%,P=0.036);总感染率显著降低(7.41%vs.37.10%,P=0.000);住院时间显著缩短[(28.85±8.49)vs.(35.83±11.82)]d,P=0.018)。两组患者颅内感染、肺炎与败血症发生率、死亡率和入院30 d时GCS评分差异均无统计学意义(P均>0.05)。结论:早期肠内营养有助于降低高血压性颅内出血患者感染风险,缩短患者住院时间。     

不同手术时机治疗高血压脑出血的临床效果

目的探究不同手术时机治疗高血压脑出血的临床疗效,评价治疗高血压脑出血的临床效果。方法选取我院2017年1月至2018年1月收治的高血压脑出血患者100例,根据高血压脑出血患者的不同手术时机分为A组和B组,A组为发病时间48 h,B组为发病时间48 h,比较两组患者的临床效果和术后的恢复情况。结果 B组患者的清除情况(颅内血肿清除率92.0%)明显优于A组患者的清除情况(颅内血肿清除率78.0%),差异有统计学意义(P0.05);A组患者经过手术治疗后CCS评分(16.5±2.2),GCS评分(11.1±1.2),生存质量评分(43.8±3.9);B组患者经过手术治疗后CCS评分(8.5±1.5),GCS评分(13.6±1.4),生存质量评分(60.5±4.6),B组患者的术后恢复情况明显优于A组患者,差异有统计学意义(P0.05)。结论对于高血压脑出血的患者需要尽快接受手术治疗,应该在48 h内采取治疗手段,对患者的预后有积极作用。     

重症高血压脑出血早期鼻饲肠内营养的临床研究

目的:探讨持续滴注的鼻饲方法作为重症高血压脑出血后早期肠内营养支持的临床应用和效果。方法:早期(发病后48～72h)持续滴注鼻饲要素膳综合治疗重症高血压脑出血患者51例(实验组,GCS评分4～8分)与按传统方法发病后7～8d鼻饲流质综合治疗的同类患者51例(对照组)比较。结果:GCS评分5分以上的病人能较好地耐守持续滴注的鼻饲营养方法。实验组血清白蛋白、体重等营养指标明显优于对照组(P<0.05～P<0.01),胃肠道并发症及其他并发症的发生率显著低于对照组(P<0.05～P<0.01),临床疗效也显著改善。结论:持续滴注的鼻饲营养可安全地用于重症高血压脑出血早期,且对维护胃肠道结构和功能,促进营养状态和预后恢复十分有利。     

术中应用携氧液对高血压脑出血40例脑保护的研究

目的：研究高血压脑出血术中应用携氧液的脑保护作用。方法：高血压脑出血发病7h内的手术患者40例，随机分为2组：携氧液组（A组）和对照组（B组）。测定两组术中不同时段的颅内压（intracranial pressure,ICP)，术前和术后12h血清髓鞘碱性蛋白（myelin-sheagh basicity protein,MBP)的浓度，术前和术后第7天的格拉斯哥（Glasgow coma scale,GCS)评分。结果：术中A组ICP明显低于B组，术后A组MBP浓度明显低于B组，A组GCS评分明显高于B组，结论：高血压脑出血术中应用携氧液有良好的脑保护作用。     

神经导航联合神经内镜技术在脑出血患者中治疗与小骨开窗手术治疗对比优势分析

目的探讨神经导航联合神经内镜技术治疗基底节脑出血患者与小骨开窗手术疗效对比。方法选取2017年2月—2018年3月间收治120例基底节脑出血患者进行研究,根据患者手术方式分为A组(神经导航联合神经内镜技术治疗,72例)和B组(小骨开窗手术治疗,48例),比较两组患者手术指标、术后格拉斯哥昏迷评分(GCS)及并发症发生率。结果A组患者手术时间、住院时间、手术出血量低于B组,GCS评分高于B组。A组患者并发症总发生率显著低于B组。结论神经导航联合神经内镜技术治疗基底节脑出血,相对小骨开窗手术能显著减轻患者手术创伤、降低并发症发生率,提高治疗效果。     

舒芬太尼在剖宫产术后硬膜外镇痛的应用效果分析

[目的]观察舒芬太尼应用于剖宫产术后病人硬膜外自控镇痛(PCEA)的镇痛效果和不良反应.[方法]将孕36~40周剖宫产产妇60例分为A,B,C 3个组,每组各为20例,其中A组PCEA配方为芬太尼0.4 mg(4 mg/L)、罗哌卡因200 mg(2.5 g/L)及地塞米松5 mg,B组为舒芬太尼40μg(0.4 mg/L)、罗哌卡因200 mg(2.5 g/L)及地塞米松5 mg,C组为罗派卡因200 mg(2.5 g/L);另将静脉自控镇痛(PCIA)产妇20例设为D组,PCIA配方为芬太尼1.0 mg.观察各组病人术后不同时段VAS评分、镇痛药用量、PCA按压次数、恶心、呕吐、腹胀、皮肤搔痒发生率及术前、术后48 h血清催乳素水平.[结果]术后4~8 h段B组患者VAS评分显著低于A,C组,术后8~16 h段显著低于D组;术后16~24 h段B组患者镇痛药用量及实际PCA按压次数低于A,C组.术后各时间段A,B,C组患者恶心发生率均明显低于D组;术后4,8,16 h段A,B,C组患者呕吐发生率均明显低于D组;术后4,8 h段D组患者皮肤搔痒发生率明显低于A,B,C组;术后48 h A,B,C组患者血清催乳素水平均明显高于D组.[结论]0.4 mg/L舒芬太尼复合罗哌卡因应用于剖宫产术后PCEA的镇痛效果较好,不良反应发生率较低,对术后患者血清催乳素水平的影响较小.     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.