基于因子分析的疲劳性亚健康人群中医证候及证候要素特点的研究

目的：探讨疲劳性亚健康人群的中医证候及证候要素特点。方法：根据疲劳性亚健康状态中医证候研究调查表收集的资料,对四诊信息进行因子分析,提取符合要求的公因子,并对其进行中医证候诠释。结果：对64个四诊信息变量进行因子分析,共获得64个公因子,提取其中特征根值〉1的18个公因子,根据中医理论对各公因子的症状组合进行初步诠释。提示的证候要素有15个,其中病位类为肝、心、脾、肺、肾、胃、胆;病性类为气滞、热（火）、痰、湿、阴虚、阳虚、气虚、血虚。提示的常见证候有16个,虚证类为肝阴虚、心血虚、心胆气虚、肾阴虚、脾气虚、肺气虚、肾气不固;实证类为肝气郁结、肝郁化火、脾胃气滞、胃火炽盛、湿热内阻、气郁痰阻、痰湿中阻;虚实夹杂类为脾虚湿阻、肝郁脾虚。结论：基于因子分析初步提取的疲劳性亚健康人群的常见证候与证候要素,为今后进一步研究其辨证规范提供一定依据。     

482例亚健康人群90项症状清单测评结果分析

[目的]了解亚健康人群的心理卫生状况。[方法]采用90项症状清单(SCL-90)对482例亚健康人群10个因子评分及总症状指数进行自评。[结果]亚健康人群在总症状指数及躯体化、强迫、抑郁、焦虑、偏执和精神病性等6个因子评分均较常模高(<0.01)。[结论]亚健康人群存在诸多心理症状和不同程度的心理卫生问题。     

基于探索性因子分析的脾系疾病问诊症状分布及证候要素初探

目的:寻找脾系疾病问诊的症状特征与证候间的关联,探讨中医脾系疾病问诊的常见症状群。方法:采用临床流行病学方法制定脾系疾病问诊量表,运用量表在临床中进行脾系疾病样本采集,共纳入病例1 310例。数据经Epidata 3.0双遍录入核对,运用SPSS 18.0统计软件中的因子分析方法对数据进行分析。结果:重点问诊部分共提取6个公因子;一般问诊部分中寒热和汗维度提取2个公因子,头身胸腹维度提取6个公因子,饮食口味维度提取4个公因子,二便维度提取3个公因子,睡眠维度提取2个公因子,妇女维度提取2个公因子。上述不同的公因子分别对应了脾胃虚寒、湿热、肝胃不和等脾系疾病常见的证候要素。结论:脾系疾病临床证候多虚实夹杂,以本虚标实多见,脾胃虚弱、气虚、阳虚等证候要素为本,血瘀、气滞、痰浊内阻、湿热等证候要素为标。     

调查研究亚健康状态人群中心理亚健康类型的特征分析

目的 分析亚健康状态人群中心理亚健康类型的特征,为心理亚健康防治提供依据.方法 采用<个体身心健康调查量表>对广州、成都、杭州、上海等籍体检人群进行调研,对所回收的调查问卷进行数据分析和统计学处理.结果 纳入分析的2 748例亚健康人群中,心理亚健康最为常见,占57.8%,30～39岁年龄段的心理亚健康状态发生率最高,大专以上高学历人群为心理亚健康人群主要组成部分(78.4%).心理亚健康中较常见的临床症状依次是常无缘无故叹气、精神紧张、焦虑不安等,较常见的不适状态依次是急躁易怒、疲劳、抑郁苦闷等,情感问题、个人患病或受伤及劳累过度等应激事件是影响心理亚健康的主要危险因素.心理亚健康人群与健康人群、躯体亚健康人群在症状自评因子的多个因子均分比较差异有统计学意义(P<0.01),而与社会适应性亚健康人群在总症状指数(总分)及10个因子的比较差异无统计学意义(P>0.05).结论 亚健康状态中的心理亚健康以30～39岁年龄段、高学历、脑力劳动者为高发人群,而应激事件的发生是心理亚健康产生的重要诱因,因此在调治亚健康状态时,应重视心理健康教育和必要的心理治疗,减低心理应激导致的不良后果.     

820例亚健康者的SCL-90量表调查及分析

目的 分析亚健康人群的心理卫生状况。方法 采用90项症状清单（SCL-90）对820例亚健康人群（男468例，女352例）进行自评。结果 亚健康人群在总均分及躯体化、强迫、人际关系敏感、抑郁、焦虑、偏执和精神病性7个因子评分均较常模高（P〈0．01）。SCL-90分均值在男女间比较（t=5．17，P〈0．01）、不同症状严重程度组间比较（F=18.54，P〈0.05）。差异均有显著性．结论 亚健康人群存在诸多心理症状和不同程度的心理卫生问题。应用SCL-90对亚健康者心理健康状态的测定，是进行亚健康诊断和评价亚健康严重程度的有效方法。     

亚健康状态肝郁脾虚证常见症状调查研究

目的：分析亚健康状态肝郁脾虚证人群的症状分布特征。方法：运用＂亚健康状态中医证候调查问卷（3版）＂在常规体检人群中进行临床流行病学调查,获取1 397例亚健康人群的基本信息、症状信息和中医舌脉信息,通过频数与程度分析,对亚健康状态肝郁脾虚证的相关症状进行分析。结果：通过对亚健康状态肝郁脾虚证相关18个症状的分析,其中疲劳、情志抑郁、急躁易怒、喜太息、四肢无力5个症状最为常见,疲劳、急躁易怒、喜太息、情志抑郁、食后胃胀等5个症状发生程度最高。结论：疲劳、急躁易怒、喜太息、情志抑郁、食后胃胀等5个症状可作为亚健康状态肝郁脾虚证的基本症状。     

某外资企业工人亚健康状态的临床亚型分析

目的 了解工人亚健康状态的常见临床表现及临床亚型.方法 运用流行病学横断面调查的方法,对东莞市某外资企业的2 580名工人进行整群抽样,采用自行设计的亚健康中医证候调查表,以文献回顾、专家讨论的方法确立亚健康的诊断标准,对调查结果进行频数分析及因子分析.结果 亚健康状态现患率为72.7%,其临床表现涉及到躯体、心理及社会等多种症状,其中疲倦乏力、头痛、头晕、容易感冒、怕热、情绪低落、时常叹气、腰背酸痛、失眠多梦等为亚健康状态的常见临床表现;根据亚健康的临床表现应用因子分析,可将亚健康分为疲劳型亚健康、失眠型亚健康、疼痛型亚健康、二便异常型亚健康、眼涩咽干型亚健康、妇女经带不调型亚健康、性亚健康、体质偏颇型亚健康、社会型亚健康、心理型亚健康等10个亚型.结论 亚健康状态的临床表现非常复杂,存在多种临床亚型.     

冠心病患者中医症状及体征分布特征研究

目的:探讨冠心病患者中医症状及体征的分布特征。方法:通过临床流行病学调查,应用因子分析和聚类分析等方法,对冠心病中医症状、体征分布特征进行研究。结果:本研究对冠心病患者的中医症状、体征进行探索性因子分析,共提取14个公因子;并对14个公因子进行聚类分析,聚为3类特征。结论:因子分析与聚类分析的结果与冠心病中医理论及临床表现基本一致,更直观地反映了冠心病中医证候虚实夹杂,正虚为本,邪实为标的本质,为冠心病中医证候规范化和客观化研究提供有益参考。     

基于多元统计学方法的骨量肌量减少性肥胖综合征的结构特征研究

背景 骨量肌量减少性肥胖综合征（OSO）是一种严重损害老年人健康的疾病,对疾病进行临床分型可为疾病的临床诊治提供指导。基于OSO诊断变量间的相关性对OSO进行分型,并探寻OSO的结构特征,可为OSO的防治提供新的思路。 目的 探索OSO的结构特征,为实现OSO的个体化诊治提供理论依据。 方法 本研究为横断面研究。于2018年1月至2020年10月,采用随机抽样法,选取在哈尔滨医科大学附属第二医院体检中心接受健康体检、年龄≥60岁的老年OSO患者作为研究对象,采集其OSO诊断变量〔四肢骨骼肌指数,握力,体脂百分比（BF%）,腰椎1~4（L1~4）、髋部、股骨颈骨密度（BMD）,体质指数（BMI）,腰围,步速〕、社会人口学特征、生活方式、常见慢性病患病情况等方面的资料。在利用因子分析法对OSO诊断变量数据进行分析前,采用KMO检验、Bartlett's球形检验评价OSO诊断变量数据是否适合进行因子分析。通过主成分分析法,提取特征值≥1.000的成分,并运用最大方差正交旋转法得出方差最大正交旋转矩阵。根据因子正交旋转矩阵,对公因子进行命名。基于公因子得分,利用离差平方和系统聚类法生成树状结构并对患者进行分类,通过比较不同类别患者间诊断变量水平和临床特征的差异,分析OSO的结构特征。 结果 共纳入107例老年OSO患者。KMO值为0.688,Bartlett's球形检验χ2=492.374,P<0.001,表明OSO诊断变量数据适合进行因子分析;按特征根>1.000的标准可提取3个公因子（骨质疏松因子、肌肉+体脂因子、肥胖因子）,3个公因子的累积方差贡献率为81.408%,各诊断变量在所属公因子上的载荷值为0.770~0.918。聚类分析结果显示,共将OSO患者分为3类。不同类别人群四肢骨骼肌指数、握力、BF%、BMDL1~4、BMD髋部、BMD股骨颈、BMI、腰围比较,差异均有统计学意义（P<0.05）。其中第1类人群的BMDL1~4、BMD髋部、BMD股骨颈均低于其他两类人群（P<0.05）;第2类人群的BMI和腰围均低于其他两类人群（P<0.05）;第3类人群的四肢骨骼肌指数、握力和BMD均高于其他两类人群,BF%低于其他两类人群（P<0.05）。不同类别人群性别、受教育程度、个人月收入分布、总胆固醇（TC）、高密度脂蛋白胆固醇（HDL-C）、尿酸（UA）、肌酐（Cr）水平比较,差异有统计学意义（P<0.05）。第1类人群中本科以下学历者占比高于第3类人群（P<0.017）;第2类人群TC水平高于第3类人群（P<0.05）;第3类人群个人月收入≥5 000元者占比,以及UA、Cr水平均高于其他两类人群,女性占比低于其他两类人群（P<0.05或P<0.017）。 结论 可从骨质疏松、肌肉与体脂、肥胖3个方面对OSO诊断变量进行概括和解释;OSO患者具有不同的结构特征。应用多元统计学方法研究OSO患者的结构特征,有助于实现对不同类型OSO患者的个体化管理。     

空运进驻高原急性高原病症状因子分析

目的：探讨经空运进驻高原时,发生急性高原病（AMS）的主要症状之间的潜在联系。方法：采用随机抽样方法抽取307人作为高原研究组,运用症状调查表调查急性高原病（AMS）的主要症状及评分,运用WinSAS6．11统计软件对症状及评分进行因子分析。结果：提取的三个公因子分别为脑型AMS公因子、肺型AMS公因子和轻型AMS公因子,其解释脑型AMS公因子的主要症状为：恶心、呕吐、食欲减退、头痛;解释肺型AMS公因子的主要症状为：气急、胸闷、乏力、呼吸困难;解释轻型AMS公因子的主要症状为：心悸、烦燥不安、睡眠障碍、咳嗽。结论：运用因子分析加斜交旋转提取的三个公因子模型能够较好的解释空运进驻高原发生的各型AMS。     

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.     

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…     

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.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Dr.Zhang Ren's Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

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.