灯盏花素治疗早期高血压性脑出血疗效观察

目的探讨灯盏花索对脑出血血肿的吸收及神经功能恢复的影响。方法将72例脑出血患者随机分为灯盏花素治疗组和对照组各36例,观察血肿体积及神经功能缺损评分的变化。结果灯盏花素治疗组于治疗后7d血肿体积开始缩小,对照组于治疗14d才开始缩小,治疗后14、21d治疗组较对照组血肿体积缩小明显,差异有显著性（P〈0．05）;治疗组于治疗后7d神经功能缺损评分开始下降,对照组于治疗后14d才开始下降,治疗后14、21d治疗组较对照组神经功能缺损评分下降明显,差异有显著性（P〈0．05）;血肿体积的减小与神经功能缺损评分的下降呈正相关性（r=0．829,P〈0．01）。结论高血压性脑出血患者早期使用灯盏花素能促进血肿的吸收和神经功能的恢复。     

平肝熄风汤治疗急性脑出血的临床疗效及对血清NSE影响的研究

目的观察平肝熄风汤对脑出血患者血清神经元特异性烯醇化酶（NSE）浓度及症候和神经功能缺损评分的影响，探讨平肝熄风汤对脑出血神经元的保护作用和临床疗效。方法对70例脑出血患者分别采用平肝熄风汤（组）与西药（组）治疗，于治疗前和治疗10d后采集血标本，用放射免疫法测定惠者血清NSE浓度，同时进行症候评分和神经功能缺损评分；并将神经功能缺损积分与NSE浓度作相关分析。结果急性脑出血患者血清NSE浓度明显升高（P〈0．05），且与神经功能缺损积分呈正相关（r=0．752，P〈0．05）。平肝熄风汤组与西药组治疗后血清NSE均下降，但仍高于正常组；两组比较，平肝熄风汤组NSE浓度下降较西药组更明显（P〈0．05）。平肝熄风汤对脑出血患者症状和神经功能缺损的改善也优于西药对照组（P〈0．05或P〈0．01）。结论血清NSE水平能反映急性脑出血患者神经元损伤的程度，且与神经元损伤的严重程度呈正相关。平肝熄风汤能较明显的降低急性脑出血患者血清NSE浓度和改善脑出血患者症状及神经功能损害，提示平肝熄风汤对脑出血患者神经元损伤具有保护作用。     

尼莫地平对高血压脑出血的疗效观察

目的：探讨尼莫地平对高血压脑出血血肿吸收及神经功能的影响。方法：将我院100例高血压脑出血患者随机分为治疗组及对照组，对照组采用常规治疗方法，治疗组在此基础上加用尼莫地平。比较治疗后两组患者的血肿体积、CSS评分及疗效。结果：经过治疗，两组患者12h内、15d后、30d后的血肿体积、CSS评分、生活质量均显著改善，治疗组显著优于对照组，治疗组的总有效率为90．00％，显著高于对照组的60．00％，差异均有统计学意义（P〈0．05）。结论：尼莫地平能有效缓解血管痉挛，促进血肿溶解和吸收，保护神经细胞，改善患者神经功能缺损及生活质量。     

马来酸桂哌齐特治疗急性脑出血的临床研究

目的 探讨马来酸桂哌齐特对脑出血患者血肿吸收、周围水肿改善及神经功能恢复的影响。方法 将90 例患者随机分为治疗组(45例)和对照组(45例),分别于入组第1、7、21天利用CT测量血肿体积、水肿面积,并行 临床神经功能评分(chinese stroke seale,CSS)。治疗组给予5％葡萄糖500ml加马来酸桂哌齐特320 mg／d,连用14 d。结果 治疗组水肿面积、血肿体积和CSS均较对照组明显改善(P<0．01)。应用马来酸桂哌齐特治疗后第21 天水肿面积由(4．3±O．6)cm2变为(2．8±0．7)cm2,血肿体积由(19±5)ml变为(6±6)ml,CSS由(22±9)变为(9± 7)。对照组第21天水肿面积由(4．5±O．7)cm2变为(3．2±0．6)cm2,血肿体积由(20±5)ml变为(11±7)ml,CSS由 (23±8)变为(14±8)。两组比较,差异有显著意义(P相似文献   

早期微创颅内血肿清除术治疗高血压脑出血100例的疗效分析

目的探讨早期微创颅内血肿清除术治疗高血压脑出血的临床疗效及对患者血清炎症因子的变化。方法将该院收治的急性高血压脑出血的患者200例分为研究组和对照组,各100例,对照组给予常规保守治疗,研究组进行微创颅内血肿清除术治疗。并于治疗前及治疗后7、14d行头颅CT检查患者血肿及血肿周围水肿体积,患者血清白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平,治疗后14d应用美国国立卫生研究院卒中量表(NIHSS)评价两组患者神经功能缺损情况。结果治疗后14d两组患者血肿周围水肿量明显低于治疗前及治疗后7d,差异有统计学意义(P<0.05);治疗后7、14d研究组血肿量及血肿周围水肿量明显低于对照组,差异有统计学意义(P<0.01)。治疗后14d两组患者IL-6、TNF-α较治疗后7d明显降低,治疗后7、14d两组IL-6、TNF-α水平明显低于对照组,差异有统计学意义(P<0.05)。治疗后14d研究组NIHSS评分与对照组比较,差异有统计学意义(P<0.05)。结论早期微创颅内血肿清除术可以有效地清除颅内病灶,减轻脑出血急性期炎症因子水平和颅内血肿周围水肿情况,有助于减轻患者神经功能缺损。     

微创颅内血肿清除术对高血压脑出血患者的治疗作用及TCD评价

目的:探讨微创颅内血肿清除术对高血压脑出血患者的治疗作用,及动态TCD监测对患者神经功能恢复的预测价值。方法:选取我院收治的高血压脑出血患者70例,依据治疗方案不同分为微创组及保守组各35例;两组入院后均接受药物保守治疗,微创组同时行尿激酶联合YL-1型血肿穿刺针微创治疗,于治疗前及治疗后第1d、5d、10d和21d行TCD检测,计算血肿及水肿体积变化,并于各时间段行神经功能障碍评分(NIHSS)以评价神经功能恢复情况。结果:微创组治疗后各时间点TCD检测参数Vs、Vd、Vm逐渐升高,PI逐渐降低;保守组治疗后Vs、Vd、Vm先降低后升高,PI先升高后减低,且在治疗后第10d达到低点/峰值;治疗后5d、10d、21d微创组Vs、Vd、Vm高于保守组,PI低于保守组(P<0.05)。治疗后两组脑血肿及水肿体积逐渐降低(P<0.05),微创组各时间点脑血肿及水肿体积明显低于保守组(P<0.05)。治疗后微创组NIHSS评分逐渐下降,保守组NIHSS评分先升高后降低,于治疗后第10d达到峰值,且各时间点均高于微创治疗(P<0.05)。结论:早期微创手术可明显改善高血压脑出血患者血肿周围血流量,利于神经功能恢复,TCD不仅可以用于高血压脑出血患者脑血流量的动态变化监测,对患者神经功能预后具有一定评价价值。     

实验性脑出血后血S-100B动态变化规律研究

目的探讨急性脑出血后血清S-100B蛋白的含量变化、临床意义。方法选取小型猪16只,随机分为实验组（脑出血模型组）10只和对照组（假手术组）6只。ELISA法测定术后血清6h、1d、2d、3d、5d、7dS-100B浓度;结果血清S-100B浓度在6h即开始升高,在3d达高峰,其后开始下降,实验组6h到7d血清、S-100B浓度与对照组比较有显著差异（P〈0．01）。实验组内第3d与第1d的浓度比较有显著性差异（P〈0．01）。结论血清S-100B浓度检测能反映脑组织的损害情况,为判断病情及预后提供依据,为全脑保护治疗及血肿清除术包括微创血肿清除术提供了理论支持。     

脑水肿和神经损害与脑出血病人血清基质金属蛋白酶水平的关系

目的 探讨脑出血志者血清基质金属蛋白酶(MMPs)水平与脑水肿和神经功能损害的关系.方法 应用酶联免疫吸附法测定31例脑出血患者发病后1d、3d、7d和14d时血清MMP-9和MMP-2水平;发病当日及14d时头颅CT测定血肿及其周围脑水肿体积,同时进行卒中评分量表(NIHSS)评分.结果 血清MMP-9.MMP-2水平发病后各时间点明显高于正常对照组(均P<0.05);发病7d及14d时MMP-9水平与血肿周围水肿体积呈正相关(r=0.748,P<0.001;r=0.436,P<0.05),与血肿体积及NIHSS评分无相关;各时间点MMP 2水平与血肿体积、血肿周围水肿体积及NIHSS评分无相关.结论 脑出血后MMP-9过表达参与土肿周围水肿的形成.     

活血类药物在脑出血治疗中的时间窗选择

目的观察脑出血3-5d和10-14d应用丹红注射液对血肿吸收的疗效。方法急性脑出血患者58例随机分为2组,治疗组在起病3-5d应用丹红注射液,对照组起病10-14d应用丹红注射液.分别观察3周后两组血肿吸收情况及神经功能恢复情况。结果治疗组在血肿吸收、神经功能恢复情况都优于对照组（P〈0.01）。结论丹红注射液可以有效地促进脑出血急性期血肿吸收,促进神经功能恢复。     

急性脑卒中患者血清神经元特异性烯醇化酶浓度测定

目的测定急性脑卒中患者血清神经元特异性烯醇化酶(NSE)浓度并探讨其临床意义。方法应用酶联免疫反应法测定62例急性脑卒中患者发病3d内血清NSE浓度,同时按中国卒中评分标准进行神经功能缺损评分。结果(1)急性脑卒中患者血清NSE浓度23．25±8．91 μg／L与对照组6．98±2．11 μg／L相比明显增高(P<0．01),脑梗死24．31±9．41μg／L和脑出血23．13±8．03 μg／L两组之间血清NSE浓度无显著性差异(P>0．05);(2)急性脑卒中患者血清NSE浓度与脑梗死灶大小、脑出血血肿量及神经功能缺损程度明显相关(均P<0．01);(3)急性脑卒中患者血清NSE浓度与发病30 d Barthel指数评分无相关性(rS=-0．02,P=0．11)。结论急性脑卒中患者发病早期血清NSE浓度升高与脑损害和病情严重程度有密切关系。     

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.