新式剖宫产腹壁切口3种缝合方式效果比较

目的 探讨剖宫产过程中腹壁横切口更好的缝合方法.方法 选择符合要求并经新式剖宫产术结束分娩的患者300例,分为不缝合皮下脂肪层直接行皮内连续缝合、常规皮内连续缝合、新式间断缝合3组,每组100例,分析其切口缝合时间、切口愈合不良反应及术后42 d切口瘢痕增生发生率等指标.结果 (1)不缝合皮下脂肪层直接行皮内连续缝合组手术时间[(4.5±1.5)min vs (6.7±1.8)min,P=0.000]、拆线时切口愈合不良(7% vs 66%,P=0.000)、术后42 d切口瘢痕增生发生率(3% vs 5%,P=0.000)均低于常规皮内连续缝合组;(2)与新式间断缝合组相比,不缝合皮下脂肪层直接行皮内连续缝合组术后42 d皮下硬结发生率低(2=11.06,P=0.001).结论 剖宫产腹壁横切口皮下脂肪层不缝合的皮内连续缝合法具有手术时间短、切口愈合不良发生率低及恢复快等优点,是一种更好的剖宫产腹壁横切口缝合方法.     

新式剖宫产腹壁切口三种缝合方式的临床效果分析

目的:探讨剖宫产过程中腹壁横切口更好的缝合方法。方法:选择符合要求并在本院经新式剖宫产术结束分娩的患者300例,分为不缝合皮下脂肪层直接行皮内连续缝合、常规皮内连续缝合、新式间断缝合三组,每组100例,分析其切口缝合时间、切口愈合不良反应及术后42d切口瘢痕增生发生率等指标。结果:⑴不缝合皮下脂肪层直接行皮内连续缝合组手术时间、拆线时切口愈合不良、术后42d切口瘢痕增生发生率均低于常规皮内连续缝合组〔（4.5±1.5）min和（6.7±1.8）min,P =0.000;7﹪,P =0.000;3﹪,P =0.000〕;⑵与新式间断缝合组相比,不缝合皮下脂肪层直接行皮内连续缝合组拆线时切口愈合不良、术后42d皮下硬结发生率均低（X2=68.92,P =0.000;X2=11.06,P=0.001）。结论:剖宫产腹壁横切口皮下脂肪层不缝合的皮内连续缝合法具有手术时间短、切口愈合不良发生率低及恢复快等优点,是一种更好的剖宫产腹壁横切口缝合方法。 [关键词] 剖宫产;缝合方式;皮内连续缝合;     

283例腹壁肥胖剖宫产纵切口不同缝合方法的临床观察

目的探讨腹壁肥胖孕妇腹壁纵切口剖宫产术,皮肤切口的缝合技巧.方法将283例经下腹部正中切口子宫下段剖宫产术的产妇,按皮肤、皮下缝合方式不同分3种,比较切口的愈合情况,其中A组65例,皮下脂肪及皮肤分别用丝线间断缝合,B组147例,用丝线间断全层缝合皮下脂肪及皮肤,C组71例,用4/0薇养线分别连续缝合皮下脂肪和真皮层.结果A组中有7例渗液,4例皮肤裂开,愈合不良占16.928%;B组有6例渗液,1例裂开,愈合不良占4.76%;C组出现1例裂开,1例渗液,愈合不良占1.41%.结论腹壁肥胖孕妇经下腹部纵切口剖宫产时,皮肤皮下缝合首选可吸收线分层连续缝合法,其次是丝线全层间断缝合法.     

剖宫产腹部切口缝合技术的改进方法

潍坊市潍城区杏埠中心卫生院于2007年1～12月份行剖宫产术289例，其中采用改进技术缝合皮肤切口102例，方法为皮下脂肪层不缝合，只用3／0华利康多股编织可吸收线皮内连续缝合。该方法可缩短手术时间，不影响血液循环，切口对合愈合良好，术后不需拆线，缩短了住院时间，减少切口硬结，遗留疤痕小，现将应用体会总结如下。     

横切口脂肪层自然对合400例临床体会

目的探讨妇产科腹部横切口,保留腹壁浅层血管、脂肪层自然对合伤口愈合情况.方法对400例妇科与产科腹部手术横切口,取pfannenstial皱纹切口,采用新式剖宫产方法进腹腔.腹膜及筋膜层用0/2可吸收线连续缝合,脂肪层不缝合,皮肤用0/2或0/4可吸收线皮内包埋缝合,两端点各留1～2cm,术后5d可将缝线完整抽出(若为0/2可吸收线缝合)或修剪两端线头.结果 400例手术病员伤口全部Ⅰ期愈合,伤口软、平整呈线状.结论腹部横切口保留腹壁浅层血管、脂肪层自然对合可减少伤口局部炎性反应,减轻瘢痕形成,值得广大临床妇产科医生采用.     

可吸收合成线在妇产科手术中的应用

目的探讨可吸收合成线应用于妇产科手术腹部切口缝合的效果。方法观察组520例采用可吸收合成线皮内连续缝合,对照组500例传统丝线间断缝合腹部皮肤,对两组效果进行比较。结果与传统法比较,可吸收线皮内连续缝合,术后疼痛较轻,伤口愈合好,瘢痕小,住院时间短(P<0.05)。结论妇产科手术腹部切口应用可吸收线皮内连续缝合术是一种较理想的缝合方法。     

手术切口皮内内缝的临床观察

目的：改进手术切口的缝合技术，提高伤口甲级愈合率。方法：将剖宫产术采用手术切口皮内内缝的产妇随机抽取60例为观察组，随机选择同期常规方法采用三针间断褥式缝合手术切口的病例60例为对照组，评估两组术后伤口愈合情况。结果：观察组手术切口甲级愈合率明显高于对照组，且平均住院时间明显短于对照组，两组对照差别有明显统计学意义（P〈0．05）。结论：薇乔可吸收线皮内连续缝合手术切口能有效避免无感染性伤口愈合不良，提高伤口甲级愈合率。     

可吸收合成线用于妇产科剖腹手术皮内美容缝合临床观察

目的探讨可吸收合成线座用于妇产科剖腹手术腹部切口皮内美容缝合的效果。方法观察组270例采用可吸收合成线皮内连续美容缝合，对照纽230例传统丝线向断缝合腹部皮肤，对两纽效果进行比较。结果与传统法比较，可吸收线皮内连续缝合，术后疼痛较轻、伤口愈合好、瘢痕小呈线形、住院时间短（P〈0．05）。结论妇产科手术腹部切口应用可吸收线皮内连续美容缝合法是一种较理想的缝合方法。     

脂肪层自然对合加腹带固定法在下腹纵切口手术中的应用

目的:改进肥胖患者腹壁纵切口的缝合方法。方法:以腹壁切口皮下脂肪层厚度>5 cm作为肥胖标准,选择行纵切口经腹手术治疗的肥胖患者150例,随机分为两组,观察组腹壁切口采用丝线间断褥式缝合皮肤,缝合深度约0.5 cm,皮下脂肪层自然对合,术后腹带固定3 d;对照组腹壁切口采用传统的丝线全层间断褥式缝合皮肤及皮下脂肪层,观察两组切口出现脂肪液化、裂开、硬结的比率及甲级愈合率。结果:观察组出现切口脂肪液化、裂开、硬结的几率明显低于对照组,而甲级愈合率明显高于对照组,两组比较差异有统计学意义(P<0.05)。结论:肥胖患者经腹纵切口手术中腹壁采用脂肪层自然对合加腹带固定法处理出现切口愈合不良事件少,甲级愈合率高,值到推广。     

腹部切口皮内连续缝合在妇产科手术中的探讨

目的 探讨行妇产科手术腹部切口皮内连续缝合的效果。方法将2011年12月—2012年12月行妇产科手术的病人200例腹部切口缝合法随机分为皮内缝合组（对照组）和间断缝合组各100例,观察组100例（剖宫产术80例,妇科手术20例）用4-0可吸收缝线行皮内连续缝合皮肤切口,其中疤痕腹18例;对照组100例（剖宫产术70例,妇科手术30例）用1号丝线间断缝合皮肤切口,其中疤痕腹15例,观察两组的疗效。结果观察组有99例甲级愈合和1例乙级愈合（没有疤痕者）;对照组有94例甲级愈合和6例乙级愈合,其中有2例疤痕者,差异有统计学意义（P〈0.05）;观察组术后开始下床活动时间均早于对照组,平均住院天数短于对照组;产后42 d,观察组术后腹壁遗留瘢痕的情况优于对照组,差异有统计学意义（P〈0.05）。结论妇产科手术用可吸收缝线行皮内缝合,切口疼痛轻,愈合好。无需拆线,瘢痕小更加美容,病人恢复快,可缩短住院时间。     

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.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

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.