早产儿脑损伤早期诊断方法评价

目的：通过比较早产儿脑损伤早期诊断方法的效果,寻求早产儿脑损伤早期诊断的最佳方法。方法：选择存在脑损伤高危因素的早产儿83例,于生后6小时内行振幅整合脑电图（Amplitude intergrated electroencephalogram, aEEG）监测,收集生后24小时内尿液标本行S100B蛋白检测,在生后7~10天内完成头颅MRI检查,并在纠正胎龄18月时行婴幼儿智能发育量表检查,比较三项指标的灵敏度和特异度,并与神经行为学随访结果行相关性分析。结果：脑损伤组51例中aEEG轻度异常14例,重度异常27例,正常10例;非脑损伤组32例中aEEG轻度异常5例,重度异常1例,正常26例,两组aEEG异常率差异具有统计学意义（χ2=70.92,P<0.01）。脑损伤组尿S100B蛋白1.93±0.79 ng/mL,异常37例,正常14例;非脑损伤组S100B蛋白0.93±0.38 ng/mL,异常7例,正常25例,两组尿S100B蛋白水平差异具有统计学意义（F=48.95,P<0.01）。脑损伤组MRI异常36例（70.59%）,正常15例（29.41%）;非脑损伤组MRI异常3例（9.38%）,正常29例（90.62%）,两组MRI异常率差异有统计学意义（χ2=68.12,P<0.01）。aEEG灵敏度最高,MRI特异度最高,aEEGROC曲线下面积最大,诊断价值为三者中最高。头颅MRI与纠正胎龄18月时神经行为学随访结局相关性高于aEEG及尿S100B 蛋白。结论：aEEG是早期诊断早产儿脑损伤的有效手段,头颅MRI有助于判断早产儿脑损伤预后。     

振幅整合脑电图在监测早产儿早期脑损伤中的应用价值研究

目的:探究振幅整合脑电图在监测早产儿早期脑损伤中的应用价值,为临床早期及时治疗提供指导,降低后遗症发生率。方法:选取30例早期脑损伤早产儿(试验组)及同期30例无脑损伤早产儿(对照组)为本次研究对象,并实施振幅整合脑电图监测,研究、对比两组早产儿的监测结果。结果:试验组30例早产儿的连续性电压评估率、睡眠周期性评估率(分别为30.00%、40.00%)显著低于对照组早产儿(分别为93.33%、90.00%),差异无统计学意义(P<0.05),脑损伤组30例早产儿a EEG背景活动异常率为83.33%,明显高于对照组早产儿(10.00%),差异有统计学意义(P<0.05)。结论:对早期脑损伤早产儿实施振幅整合脑电图监测具有较显著的临床意义,能为临床早期诊断脑损伤提供依据,可以及时进行干预治疗,降低后遗症发生率。     

MRI 在早产儿脑损伤及脑发育中的临床诊断价值

目的：探讨利用 MRI 技术对早产儿脑损伤及脑发育的诊断价值和早产儿不同部位脑损伤的发生情况,为临床上诊治早产儿脑损伤提供指导。方法选取80例早产儿。当矫正胎龄为40周时,各项功能区域稳定,便对早产儿做 MRI 影像学检查,根据影像学诊断,分为早产儿脑损伤组和早产儿无脑损伤组。采用 MRI 的大脑发育成熟度（TMS）评分判定大脑的发育成熟度,同时统计早产儿脑损伤不同部位的发生率。利用盖泽儿（GESELL)评分判定大脑发育程度。结果早产儿脑损伤组在髓鞘化程度、大脑卷曲程度和胶质细胞迁移带3项得分低于无脑损伤组,差异具有统计学意义（P＜0.05）;2组在胚胎机制残留得分上差异无统计学意义。早产儿无脑损伤组的 TMS、GESELL 评分均高于早产儿脑损伤组,差异有统计学意义（P<0.05)。早产儿脑损伤部位最容易出现在蛛网膜下腔,其次为脑白质,皮质层出血也不少见。MRI 对早产儿脑损伤诊断阳性率为93.2%（41/44）,敏感性为90.9%(40/44）。结论由于早产儿脑损伤缺乏特异性表现,而 MRI 对其有较高的诊断率,脑损伤部位最易出现在蛛网膜下腔,TMS 评分和 GESELL 评分越高则早产儿脑损伤预后、脑发育越好,MRI 能够早期诊断脑损伤,值得临床推广使用。     

磁共振成像早期诊断早产儿脑损伤的临床研究

目的探讨磁共振成像早期诊断早产儿脑损伤的价值及早产儿脑损伤类型。方法对我院住院早产儿364例,在生后3~7 d行头颅磁共振检查。结果早产儿脑损伤以缺血性病灶为多见(占76.09%),最常见是脑白质损伤。出血性损伤以生发基质和脑室内出血为主。弥散加权成像(DWI)对缺血灶的检出率高于常规扫描,比常规MRI能更早地显示早产儿脑白质损伤。结论磁共振成像对早产儿脑损伤的早期诊断提供了准确的影像学依据。     

窒息早产儿床旁颅脑超声的应用价值探讨

目的探讨窒息早产儿床旁颅脑超声检查的应用价值。方法对2007年1月至2010年8月我院新生儿科收治的有窒息史的早产儿190例,于出生后1～7d内行床旁颅脑超声检查。结果窒息早产儿脑损伤发生率86%（163/190）,窒息早产儿的脑损伤以脑室内出血和脑室周围白质软化为主,脑室内出血发生率为51.6%（98/190）;脑室周围白质软化发生率为44.7%（85/190）,重度窒息早产儿重度脑损伤发生率41.7%（25/60）,明显高于轻度窒息早产儿19%（25/130）,P〈0.05。结论对新生儿重症监护室的窒息早产儿早期行床旁颅脑超声检查,可尽早对脑损伤做出诊断,尤其可筛查出无症状的脑损伤患儿,适宜在基层医院推广应用。     

超声结合视频脑电图在早产儿脑损伤早期诊断及预后评价中的应用

【摘要】 目的 探讨超声结合视频脑电图（VEEG）在早产儿脑损伤早期诊断及预后评价中的应用价值。 方法 选取出生后由产科转入新生儿重症监护室（NICU）的53例早产儿为研究对象,收集其临床资料,根据早产儿临床表现,将出生时Apgar评分低于7分、10d后经MRI检查确认有脑损伤改变的早产儿作为脑损伤组（n=24）,其他设为无脑损伤组（n=29）,所有早产儿出生后48h~72h均进行颅脑超声检查,且在床旁进行VEEG监测。 结果 超声诊断无脑损伤30例,脑损伤23例。VEEG监测显示脑损伤组及无脑损伤组分别有19例、5例早产儿出现脑电异常情况,脑损伤组VEEG脑电图异常率显著高于无脑损伤组（P＜0.05）。超声对早产儿脑损伤早期诊断的灵敏度、特异度、准确度分别为8.33%、89.66%、86.79%;VEEG对早产儿脑损伤早期诊断的灵敏度、特异度、准确度依次为79.17%、82.76%、81.13%;超声结合VEEG对早产儿脑损伤早期诊断的灵敏度、特异度、准确度分别为95.83%、96.55%、96.23%,均高于单纯超声和单纯VEEG检测（P＜0.05）。随访结果显示,12月龄时,超声结合VEEG诊断为脑损伤的早产儿MDI、PDI评分均较超声结合VEEG诊断为无脑损伤的早产儿低（P＜0.05）,脑瘫、癫痫发生率均较其高（P＜0.05）。 结论 超声结合VEEG能提高早产儿脑损伤早期诊断效能,在其预后评价中具有重要价值,可供临床借鉴。     

新生儿轻、中度缺血缺氧性脑病终期的MRI表现

目的：探讨新生儿轻、中度缺血缺氧性脑病终期的MRI表现及其诊断价值。方法：对51例围产期有轻、中度缺血缺氧病史,临床上表现为脑瘫的早产或足月产忠儿进行MRI研究。结果：51例中的19例早产儿MRI表现为脑室周围脑白质软化症;32例足月儿中25例MRI表现为分水岭区脑损伤,7例表现为脑室周围脑白质软化症。结论：早产及足月新生儿轻、中度缺血缺氧性脑病的终期均具有典型的MRI表现,MRI可作为显示其病理改变的首选影像学检查方法。     

振幅整合脑电图在早产儿脑损伤中应用的有效性评价

目的:探讨振幅整合脑电图(a EEG)在早产儿脑损伤(HIE)中的临床应用及效果。方法:选取2013年3月-2014年3月在本院分娩的40例胎龄28~36周的脑损伤早产儿和18例胎龄28~36周的无脑损伤早产儿,前者为HIE组后者为健康组,在产后48 h内,采用脑电图仪对两组早产儿进行监测,每次连续检测≥2 h。对两组早产儿的振幅整合脑电图(a EEG)进行分析比较,观察其特点与差异。结果:HIE组的a EEG连续性、睡眠觉醒周期、下边缘振幅值比健康组早产儿的相应值低,差异均有统计学意义(P0.05);且a EEG连续性、睡眠觉醒周期、下边缘振幅值与胎龄相关。结论:振幅整合脑电图异常与早产儿脑损伤具有密切关系,据此,可以及时诊断早产儿是否有脑损伤并且对其病情进行预测。a EEG操作简单、受环境干扰因素少、容易判读在早产儿脑损伤中具有重要临床应用价值。     

振幅整合脑电图在晚期早产儿PIVH中的应用研究

目的研究振幅整合脑电图（aEEG）在晚期早产儿脑室周-脑室内出血（PIVH）中的改变及其早期诊断PIVH的临床价值。方法选取入住NICU、出生胎龄为34~36+6周的晚期早产儿82例,于生后72 h内行aEEG检查,生后10 d内行颅脑彩超检查。根据胎龄不同分为3组,分别是34周组（34~34+6周）、35周组（35~35+6周）和36周组（36~36+6周）。再根据彩超检查结果,在每个胎龄组的基础上再分为PIVH组和无PIVH组。结果3个胎龄PIVH组患儿aEEG在总分评分、睡眠觉醒周期评分、35周和36周胎龄组带宽的评分均低于无PIVH组患儿（P < 0.01）。约登指数最大时,34周组的总分最佳截断值为8.5,灵敏度73.31%,特异性81.80%;35周组的总分最佳截断值为9.5,灵敏度71.43%,特异性92.32%;36周组的总分最佳截断值为10.5,灵敏度84.62%,特异性87.51%。结论晚期早产儿PIVH组患儿aEEG在总分、睡眠觉醒周期及35周和36周胎龄组带宽的评分低于无PIVH组患儿。各胎龄在取最佳截断值时,aEEG对诊断PIVH有较高的灵敏度及特异性。     

脑电图对以精神障碍为首发症状的急性病毒性脑炎的诊断价值

目的探讨脑电图在以精神障碍为首发症状的急性病毒性脑炎诊断中的应用价值。方法选取62例以精神障碍为首发症状的急性病毒性脑炎患者,分别行脑电图和影像学检查(头颅CT及MRI),对比分析不同检查方法的诊断阳性率。结果脑电图诊断阳性率为100%(62/62),头颅CT为12.90%(8/62),头颅MRI为33.87%(21/62)。脑电图诊断阳性率明显较头颅CT及MRI高,差异均有统计学意义(P<0.05)。结论脑电图对以精神障碍为首发症状的急性病毒性脑炎诊断价值较高,值得临床推广应用。     

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.