急性脑梗塞超早期脑循环动力学改变与CT对比研究

应用脑循环动力学检测仪探测脑梗塞超早期血流动力改变，与ＣＴ比较，探讨ＣＶＡ对脑梗超早期诊断价值。方法：对１２８例超早期和急性期脑梗塞患者同时进行ＣＶＡ和ＣＴ检查，比较两间及与对照组检测指标的差异和相关性。结论ＣＶＡ检测对脑梗塞超早期诊断具有敏感性，定性必至疾病超早期治疗，预后评估等具有重要性。     

脑梗塞患者CT与MRI诊断价值研究

目的研究脑梗塞患者CT及MRI诊断的临床特点。方法选取我院2013年9月至2014年8月脑梗塞患者84例为研究对象,分别采取CT及MRI诊断,比较两种检测方式对不同类型脑梗塞的检出率及不同发病时间两种检测方式符合率差异。结果84例患者MRI总检出78例,占92.9%,显著高于CT检测符合率66.7%,MRI对缺血性脑梗塞及腔隙性脑梗塞检出率分别为93.1%、97.2%显著高于CT的65.5%、61.1%,差异具有统计学意义(P0.05);MRI发病内12h检出率为84.0%,12-24h为94.6%,与CT检测率52.0%、64.7%比较显著较高(P0.05),24h后两种方式检出率比较无统计学意义(P0.05)。结论 CT与MRI均为诊断脑梗塞的有效方式,MRI对于早期诊断以及对各类型脑梗塞的检出率均优于CT,临床工作中建议两者结合以提高脑梗塞的诊断准确率。     

急性脑梗塞的脑电图及脑电地形图分析

目的观察急性脑梗塞脑电图(EEG)及脑电地形图(BEAM)的改变,探讨其对临床诊断的参考价值。方法对53例急性脑梗塞患者早期作EEG及BEAM检测,与同期头部CT或MRI表现作对照。结果急性脑梗塞早期(72h内)EEG异常88.7%,CT异常67.9%,两者相差20.8%,存在着明显差异。EEG异常以广泛性及局限性改变为主,BEAM频带定侧、定位能力最强。结论急性脑梗塞早期EEG、BEAM检测有一定优越性,特别对CT或MRI检查阴性病例可提供早期诊断。     

MRI弥散加权成像(DWI)诊断不同类型急性脑梗塞的临床价值及相关定量参数

目的:讨论不同类型急性脑梗塞患者应用MRI弥散加权成像(DWI)的结果,及相关ADC(表观弥散系数图)的诊断值。方法:选取笔者医院进行急性脑梗塞治疗的50例患者,其中急性脑梗塞患者37例,超急性脑梗塞患者13例,对50例脑梗塞患者进行MRI弥散加权成像诊检查与常规CT、MR检查,比较不同诊断手段在急性脑梗塞诊断中准确性、敏感性,并测量ADC的相关值,对病灶的范围进行测定。结果:MRI弥散加权成像(DWI)结果显示:37例急性脑梗塞患者在DWI上呈现不同程度的高信号,12例超急性脑梗塞患者;与常规CT、MR检查比较,急性脑梗塞患者只检测出30例,超急性脑梗塞患者在常规CT、MR检查中显示正常(T2WI)。ADC值与对侧相应区域相比,平均值差异具有统计学意义,并且急性脑梗塞患者在ADC值上都表现为梯度征。结论:MRI弥散加权成像(DWI)诊断对脑梗塞患者的不同类型有敏感性,同时诊断正确率远高于常规CT、MR检查;ADC值的测定,可以有效的推测脑梗塞病灶的大小及程度,为治疗提供重要的参考依据。     

60例脑梗塞的CT与磁共振(MRI)表现

目的 探讨脑梗塞的CT与磁共振(MRI)表现,评价其在诊断脑梗塞中的价值. 方法 60例临床怀疑脑梗塞行CT和MRI检查. 结果 60例可疑患者发现56例脑梗塞,其中CT明确诊断为43例,余13例进一步行MRI检查后明确诊断.常见CT表现为点状、小圆形、斑片状、扇形或楔形低密度或稍低密度影,MRI表现为与CT形态相仿的长T1、长T2信号,新发梗塞于弥散加权(DWI)呈高信号. 结论 磁共振对脑梗塞的诊断优于CT,尤其对超急性期或急性期脑梗塞的诊断有很高的价值,能早期发现和明确诊断,对临床早期及时有效治疗有重要指导意义.     

CT与MRI检查在脑梗塞患者诊断中的价值研究

目的探讨CT与MRI检查在脑梗塞患者诊断中的价值。方法选取脑梗塞患者63例,分别进行CT及MRI检查,比较两种检查方式诊断脑梗塞的价值。结果与CT诊断比较,MRI诊断腔隙性脑梗塞、缺血性脑梗塞及总检出率明显提高,差异有统计学意义(P0.05);发病时间在24h内,MRI脑梗塞检出率明显高于CT诊断,差异有统计学意义(P0.05)。结论与CT诊断相比,MRI可提高早期诊断脑梗塞的检出率以及各类型脑梗塞的检出率。     

CT、MRI诊断早期腔隙性脑梗塞的临床效果及其病灶定位准确率

目的探讨CT、MRI用于早期腔隙性脑梗塞诊断的临床效果及其病灶定位准确率。方法采用CT常规扫描及MRI扫描的常规序列、弥散加权序列(DWI)诊断早期腔隙性脑梗塞,比较其病灶定位准确率。结果对于病程<6和6~24 h的患者,CT与MRI检出率差异有显著性(P<0.05)。与CT相比,MRI诊断的早期腔隙性脑梗塞病例中,脑沟裂、脑池变浅或消失、脑回肿胀情况更明显,差异有显著性(P<0.05)。不同病程时,CT图像显示动脉致密征例数与MRI的FLAIR序列显示线样高信号的例数,差异有显著性(P<0.05)。随着患者病程的延长,CT检出率逐渐升高(P<0.05),而MRI检出率差异无显著性(P>0.05)。随发病时程的不同,两种检测方式检出病灶数差异有显著性(P<0.05)。MRI对额叶、小脑、脑干的病灶检出率均明显高于CT(P<0.05)。结论 MRI对早期腔隙性脑梗塞病例及病灶的检出率,以及对较小直径病灶的检出率均明显高于CT,且对颅底病灶的敏感性高于CT,对早期腔隙性脑梗塞的诊断价值更高。     

超急性期脑梗塞常规CT检查与CT灌注成像的比较研究

目的：探讨常规CT与CT、灌注成像对超急性期脑梗塞的诊断应用价值。方法：对96例临床诊断超急性期脑梗塞的病人行常规CT头颅平扫及CT脑灌注成像,在常规轴面扫描后一般选取基底节层面,经肘静脉灌注对比剂,同时开始持续46S的单层连续动态扫描,重建46幅动态图像使用CT脑灌注软件包进行处理,获得灌注成像。计算最大峰值时间(PT),平均通过时间(MTT)和相对血流量(RF)。结果：早期常规CT头颅平扫,显示大脑中动脉高密度征,脑实质低密度征等共35例,占36．4％,CT灌注成像发现88例与临床症状相对应的灌注异常区,表现为达峰时间延长,另外8例未发现灌注异常区。结论：常规CT对超急性期脑梗塞的诊断,具有一定价值,但作用有限,在准确性远不能满足临床应用的需要。脑CT灌注成像已成为早期诊断超急性期缺血性脑血管病和指导临床治疗(尤其是溶栓治疗)的最佳方法。     

脑梗塞前期患者的脑血流动力学的改变及多排CT灌注成像表现及分期

目的探析多排CT灌注成像在脑梗塞前期患者脑血流动力学改变及分期中的应用。方法选择2013年4月-2015年4月来我院就诊的57例门诊/住院患者作为研究对象,所有患者均行常规CT平扫、增强扫描及动态CT扫描。获取r CBV、r CBF、MTT、TTP等脑血流动力学参数脑并将病侧与健侧各参数值进行比较以凸显脑梗塞前期患者脑血流动力学变化情况。结果患者病侧与健侧的CBV值接近,比较无统计学意义(P0.05),但病侧CBF明显低于健侧、MTT与TTP则高于健侧,提示脑梗死的发生导致CBF减低、MTT与TTP延长,差异的比较有统计学意义(P0.05)。结论多排CT灌注成像可明确提示脑梗塞前期血流动力学异常,并通过脑血流动力学参数变化幅度对脑梗塞前期进行分期,掌握脑局部低灌注的病理生理学状态,对于疾病防治具有显著临床价值。     

多层CT血管造影对超早期大面积脑梗塞的诊断作用

目的 评价多层CT血管造影（MS—CTA）对超早期大面积脑梗塞的诊断作用。方法 临床怀疑超早期（出现症状6小时内）大面积脑梗塞的病人20例,均在CT平扫后进行CTA检查。结果 20例病人MS—CTA都得到了可以达到诊断目的的高质量动脉图像。在所有影像和临床随访证实为非腔隙性脑梗塞的13例中．MS—CTA均看到了潜在的血管病变。结论 对于急性早期大面积脑梗塞的病例,MS—CTA是迅速和综合评价脑血管的有力手段。     

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.