排尿功能障碍致上尿路损害216例临床分析

目的探讨排尿功能障碍致上尿路损害的致病机制。方法对216例排尿功能障碍导致上尿路功能损害病例的尿动力学、泌尿影像学及肾脏功能学资料进行回顾,观察膀胱残余尿、膀胱压力和膀胱容量与上尿路损害之间的关系并进行分析。结果在引起上尿路损害的216例患者中,膀胱出口梗阻是最主要的病变(89.4%,185/207);部分患者(21.2%,43/216)残余尿量不多(<50cmH2O),但已引起上尿路损害;70.1%(145/216)以上患者膀胱储尿期压力大于40cmH2O,初始尿意压力(47.4±3.2)cmH2O和最大尿意压力(51.7±9.3)cmH2O均在膀胱安全压力(40cmH2O)之上,初始尿意容量(438.4±81.7)ml明显大于安全容量(357.9±73.3)ml(P<0.01)。结论40cmH2O是上尿路损害的膀胱压安全临界值;达到或超过安全压仍继续储尿是上尿路损害的最重要原因;将膀胱压降至安全压以下以及在安全容量前排空膀胱是治疗和预防上尿路损害的重要措施。     

双J管对肾盂压力的影响及临床意义

目的了解留置双J管（Double-J）对肾盂压力的影响。方法对24例经皮肾镜碎石术（PCNL）后,留置F5Double-J及F16肾造瘘管对患者肾盂压力进行测定,记录膀胱储尿期和排尿期肾盂压力、膀胱压力的变化。结果肾盂压力基础值为（33.07&#177;7.04）cmH2O;在储尿期达到膀胱最大容量时,膀胱压力为（41.61&#177;10.34）cmH2O,肾盂压力为（39.44&#177;7.33）cmH2O;在排尿期达到膀胱最大压力时,膀胱压力为（74.95&#177;12.79）cmH2O,肾盂压力为（65.68&#177;17.03）cmH2O。储尿期和排尿期肾盂压力随膀胱压力升高而升高,两者显著正相关（r分别为0.682,0.921,P〈0.05）,并且肾盂压力超过返流的阈值（40cmH2O）。结论 Double-J的留置会导致肾盂压力增高,引起肾功能损害。因此,在可能的情况下,尽量不放置Double-J或治疗结束后,尽早拔除。     

小体积前列腺增生的治疗

目的比较和评价TURP加经尿道膀胱颈切开（TUIBN）与TURP加经尿道膀胱颈电切术（TURBN）治疗小体积前列腺增生的疗效。方法总结经尿道手术治疗小体积前列腺增生27例的临床资料，12例行TURP加经尿道膀胱颈切开。15例行TURP加经尿道膀胱颈电切术，比较研究两组病例术前、术后国际前列腺症状评分（IPSS）、最大尿流率（Qmax）、残余尿量（PVR），以评估疗效。结果TURP＋TUIBN组：术前、术后IPSS评分分别为：（24．3&#177;3．8）分、（7．2&#177;3．6）分；Qmax：（8．5&#177;3．6）mL／s、（17．4&#177;4．2）mL／s；PVK：（102．0&#177;20．0）mL、（19．0&#177;4．0）mL。TURP＋T1瓜BN组：术前、术后IPSS评分分别为：（23．6&#177;5．7）分、（6．9&#177;3．0）分；Qmax：（8．2&#177;3．1）mL／s、（23．1&#177;3．1）mL／s；PvR：（96．0&#177;37．0）mL、（9．0&#177;5．0）mL。术前IPSS、Qmax、PVt（两组间差异无显著性（P〉0．05），术后两组间IPSS评分差异无显著性（P〉0．05），而Qmax、PvR两组间差异有显著性（P〈0．01）。结论TURP＋TURBN治疗小体积前列腺增生的临床疗效比TURP＋TUIBN更理想。     

经尿道前列腺电切术治疗前列腺增生53例临床分析

目的探索经尿道前列腺电切术治疗前列腺增生（BPH）的疗效。方法总结经尿道前列腺电切治疗53例前列腺增生患者的临床资料。结果所有患者手术效果满意,拔管后恢复正常排尿,夜尿症状明显缓解,平均切除前列腺组织55g,平均电切时间54min,术后I-PSS评分（26．3&#177;3．3）分。剩余尿量平均（20&#177;13．1）mL。术后3个月最大尿流率（19．8&#177;3．5）mL/s。结论经尿道前列腺电切是治疗BPH理想的电切外科技术,具有疗效显著、术中安全、并发症少等优点,值得基层推广应用。     

良性前列腺增生症汽化术后膀胱功能恢复的研究

目的 应用尿流动力学检查对经尿道前列腺汽化术（Transurethral Electrovaporization of the Prostate,TUVP,TVP)后膀胱功能的恢复情况进行评价。方法 43例良性前列腺增生（Benign Prostatic Hyperplasia,BPH）患者（平均年龄67.49岁、平均随访时间6.95个月），按术后随访时间分为A组（18人，平均随访时间3.22个月）、B组（13人，平均随访时间6个月）、C组（12人，平均随访时间13.58个月），进行手术前后的前列腺症状评分和尿动力学检查。结果 与术前相比，IPSS评分由22.60分减少到11.63分，最大尿流率由7.87ml/s上升至16.51ml/s，最大尿流率逼尿肌压由78.41cmH2O(32例）下降至40.00cmH2O(26例），提示梗阻得到解除；膀胱性由22.76ml/cmH2O升至41.11ml/cmH2O,初始尿意容积由术前的104.39ml上升至163.26ml`最大尿交流电 容积由285.93ml上升至339.63ml,提示膀胱功能得到恢复;各级病人膀胱顺性、初始尿意容积、最大尿意容积手术前后有差异，但术后各组间无明显差异。结论 TUVP可切实的解除良性前列腺增生所致的膀胱流出道梗阻，恢复膀胱运动和感觉功能，且效果稳定。     

高能聚焦超声治疗152例良性前列腺增生的临床疗效

目的探讨高能聚焦超声（HIFU）治疗前列腺增生（BPH）的临床疗效和安全性。方法应FEP—BY01型高强度聚焦超声治疗机治疗前列腺增生患者152例,治疗后定期随访观察、记录患者IPSS、QOL、残余尿量、前列腺超声影像学变化以及平均尿流率的变化。结果152例前列腺增生患者经过治疗后IPSs由术前（28．8&#177;3．6）分降至术后（9．2&#177;2．5）分,QOL由术前（5．9&#177;1．6）分降至术后（1．6&#177;0．5）分,治疗前残余尿量由大于50ml甚至尿潴留,治疗后降至小于30ml,甚至无残余尿,有效134例,无效18例,总有效率达到88．2％。患者的临床症状、IPSS评分、QOL评分、残余尿量、前列腺超声影像学变化以及平均尿流率均达到很好的的治疗效果。结论高能聚焦超声在治疗前列腺增生疾病方面的安全性和疗效是值得肯定的,可以作为一种创伤小、痛苦轻的治疗前列腺增生的首选方法之一。     

良性前列腺增生汽化电切术后尿动力学研究

目的应用尿动力学检查指标对经尿道前列腺汽化术后的尿动力学改变进行研究.方法43例良性前列腺增生患者按TUVP术后随访时间分为3组,分别进行术前、术后的国际前列腺症状评分和尿动力学检查.结果与术前相比,IPSS评分由22.60分减少到11.63分,最大尿流率由7.87 ml/s上升至16.51ml/s,而最大尿流率时膀胱逼尿肌压由78.41 cmH2O(32例)下降至40.00cmH2O(26例),膀胱顺应性由22.76 ml/cmH2O升至41.11ml/cmH2O,最大尿意膀胱容量由285.93 ml升至339.63ml,结果同时显示手术对尿道外括约肌可能有短期的、可恢复性的损伤.结论该研究以客观的指标证实经尿道前列腺汽化术可切实地解除由良性前列腺增生所致的膀胱流出道梗阻改善膀胱功能.     

良性前列腺增生合并膀胱结石的腔内治疗

目的：探讨气压道道／超声碎石术和经尿道前列腺汽化电切术治疗前列腺增生（BPH）合并膀胱结石的治疗效果。方法：采用瑞士气压弹道／超声碎石清石系统（lithoclast Rmaster）和经尿道前列腺汽化电切设备治疗前列腺增生合并膀胱结石43例。结果：41例一次手术成功,手术中碎石时间15～60min,平均32min;前列腺电切时间50～110min,平均85min。术中术后均无输血,未发生前列腺电切综合征、膀胱穿孔等并发症。术后5～6d拔除尿管,未发生排尿困难、尿失禁等。病理结果均为良性前列腺增生（BPH）。国际前列腺症状评分由术前（21．4士2．06）分下降至术后（7．4&#177;1．2）分（t=2．182,P〈0．05）,最大尿流率由术前（6．37&#177;1．96）ml／s升至（19．05&#177;1．95）ml／s（t=29．9904,P〈0．0000）,生活质量评分由术前（4．76&#177;0．94）分术降至为（2．25士0．75）分（t=13．626,P〈0．0000）。结论：气压弹道／超声碎石术和经尿道前列腺汽化电切术能有效治疗BPH合并膀胱结石。     

COPD机械通气病人撤机参数分析

目的研究闭合气道压（P0．1）、急性生理与慢性健康状况（APACHE）Ⅱ评分、血浆白蛋白（AIb）水平、浅快呼吸指数（RSBI）在慢性阻塞性肺病（COP13）机械通气病人撤机时的指导意义。方法对126例符合临床撤机条件的COPD机械通气病人测定P0．1、APAGHEⅡ评分、AIb水平、RSBI值、然后进行撤机试验、并观察上述指标与撤机结果之间的关系。结果撤机成功组76例、P0．1值为（220&#177;0．56）cmH2O、APACHEⅡ评分为225&#177;2．7、AIb值为（554&#177;4．9）g／L、RSBI值为（64．17&#177;25．64）bpm／L；撤机失败组50例，P0．1值为（4．25&#177;0．71）cmH2O、APACHEⅡ评分为298&#177;52、AIb值为（26．5&#177;8．4）g／L、RSBI值为（87．62&#177;26．52）bpm／L。撤机失败组的P0.1值、APACHEⅡ评分、R8BI明显高于成功组（“P〈0．05”）。撤机成功组的AIb值明显高于撤机失败组（“P〈0．05”）。撤机成功组中、70例P0.1≤6cmH2O，67例RSBI≤105bpm／L，6例P0.1〉6cmH2O，9例RSBI〉105bpm／L；失败组中，17例P0．1≤cmH2O、31例PSBI≤105bpm／L，33例P0．1〉6cmH2O，19例PSBI〉105bpm／L。以P0．1≤cmH2O、RSBI≤105bpm／L为标准、其预测撤机成功的灵敏度分别为92．11％、88．16％、特异度分别为66.0％、58．0％。结论P0．1、APACHEⅡ评分、AIb、RSBI对COPD机械通气病人的撤机有一定指导意义。     

腔内治疗前列腺增生伴膀胱结石26例

1临床资料 本组26例病例均为2007-02／2007—10在我科治疗的患者，年龄54～83（68．6&#177;9．8）岁，病程2～8（5．2&#177;1．2）a．均有反复尿路感染，排尿中断，排尿困难典型症状，并经直肠指检、B超、X线检查诊断为前列腺增生症（BPH）合并膀胱结石．B超检查前列腺质量26—68（46．5&#177;6．8）g．剩余尿量70～450（185&#177;58）mL．最大尿流率（MFR）（7．0&#177;2．6）mL／s，国际前列腺症状评分（IPSS评分）为（28．8&#177;4．1）分，生活质量（5．7&#177;0．6）分；     

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.