肝硬化并发上消化道出血相关危险因素分析

目的探讨肝硬化并发上消化性出血的相关危险因素。方法选择2011年12月-2013年12月住院的肝硬化患者252例进行病例对照研究,按其是否合并出血分为2组,出血组120例,未出血组132例。统计2组性别、年龄、血常规及生化结果、凝血功能、影像学结果、胃镜结果、肝功能Child-Pugh评分和HP感染等因素,进行单因素分析和多因素非条件Logistic回归分析,以了解肝硬化并发上消化道出血的相关危险因素。结果 单因素分析结果显示,2组食管静脉曲张程度、消化性溃疡、肝功能Child-Pugh评分、腹水情况、胃左静脉内径、血红蛋白、白蛋白、凝血酶原时间(PT)>16 s等差异有统计学意义(P<0.05),而HP感染情况无明显差异(P>0.05)。多因素非条件Logistic回归分析显示:腹水(OR=4.54,95%CI 2.73⁷.54,P=0.01)、胃左静脉内径(OR=1.53,95%C11.017.54,P=0.01)、胃左静脉内径(OR=1.53,95%C11.01².30,P=O.04)、PT>16 s(OR=2.15,95%CI 1.512.30,P=O.04)、PT>16 s(OR=2.15,95%CI 1.51³.06,P=0.01)和食管静脉曲张程度(OR=9.06,95%CI4.963.06,P=0.01)和食管静脉曲张程度(OR=9.06,95%CI4.96¹6.57,P=0.01)是肝硬化并发上消化道出血的相关危险因素。结论肝硬化并发上消化道出血的危险因素包括腹水、胃左静脉内径、PT>16 s和食管胃静脉曲张。     

肝硬化上消化道出血患者并发门静脉血栓形成的危险因素分析

目的:探讨肝硬化上消化道出血患者并发门静脉血栓形成(PVT)的危险因素,为临床防治提供参考。方法:采用病例对照研究,回顾性收集2015年1月-2019年1月在九江学院附属医院住院的肝硬化上消化道出血患者228例,依据是否并发PVT分为对照组(无PVT)166例和病例组(有PVT)62例。分析两组患者的一般临床资料,实验室、影像学等资料,分析肝硬化上消化道出血患者并发PVT的独立危险因素。结果:两组WBC、RBC、Hb、ALB、TBIL、PT、APTT、FIB、食管胃底静脉曲张等方面比较,差异均无统计学意义(P0.05);两组PLT、ALT、AST、CHE、TT、门静脉内径、脾静脉内径、脾脏厚度、肝硬化家族史、肝功能Child-Pugh分级、肝性脑病、腹水、感染等方面比较,差异均有统计学意义(P0.05)。多因素logistic回归分析结果显示,PLT、门静脉内径、肝功能Child-Pugh分级C级、腹水是肝硬化上消化道出血患者并发PVT的危险因素(P0.05)。结论:PLT增高、门静脉内径增宽、肝功能Child-Pugh分级C级、腹水增多是肝硬化上消化道出血患者并发PVT的独立危险因素。     

肝硬化门静脉高压并发上消化道出血的相关危险因素分析

目的:为了更好的指导临床对肝硬化门静脉高压并发上消化道出血的干预和治疗,分析肝硬化门静脉高压并发上消化道出血的危险因素。方法:回顾性分析2017年5月至2018年5月本院收治的126例肝硬化门静脉高压患者的临床资料,根据是否发生上消化道出血将其分为观察组(发生上消化道出血)60例和对照组(未发生上消化道出血)66例,采用单因素分析诱发肝硬化门静脉高压并发上消化道出血的危险因素,采用多因素分析诱发肝硬化门静脉高压并发上消化道出血的独立危险因素。结果:观察组肝功能Child-Pugh分级为C级、中/重度腹水、重度食管静脉曲张及凝血酶原时间(PT)>16 s的患者明显多于对照组,胃左静脉内径明显大于对照组,差异均有统计学意义(P<0.05);两组性别、年龄、病因、血小板水平、胃底静脉曲张及门脉高压性胃病患者例数比较,差异均无统计学意义(P>0.05);多因素Logistic回归分析结果显示,中/重度腹水、胃左静脉内径增大、PT>16 s和重度食管静脉曲张均是导致肝硬化门静脉高压并发上消化道出血的独立危险因素,差异有统计学意义(P<0.05)。结论:诱发肝硬化门静脉高压并发上消化道出血的危险因素很多,中/重度腹水、胃左静脉内径增大、PT>16 s和重度食管静脉曲张均是诱发其发生的独立危险因素,必须引起临床的足够重视,尽早给予干预和治疗,减少各种不良事件的发生。     

乙型肝炎肝硬化患者并发上消化道出血的危险因素分析

目的探讨乙型肝炎肝硬化患者并发上消化道出血的危险因素分析。方法选取乙型肝炎肝硬化患者62例。依据是否并发上消化道出血,分为病例组(并发上消化道出血)30例,对照组(没有并发上消化道出血)52例。分析2组患者的临床资料,筛选乙型肝炎肝硬化患者并发上消化道出血的危险因素。结果 (1)2组患者在WBC、PLT、ALT、AST、PT、FIB、脾脏厚度方面比较,差异无统计学意义(P0.05);在Hb、TBIL、ALB、D-二聚体、门静脉内径、肝功能Child分级、食管胃底静脉曲张、腹水、感染、肝性脑病比较,差异有统计学意义(P0.05);(2)非条件Logistic回归分析结果提示:Hb、肝功能Child C级、重度食管胃底静脉曲张是乙型肝炎肝硬化患者并发上消化道出血的危险因素。结论更低的Hb、肝功能Child C级、重度食管胃底静脉曲张是乙型肝炎肝硬化患者并发上消化道出血的危险因素。     

肝硬化门静脉血栓患者并发上消化道出血危险因素与预后的影响因素分析

目的:探讨肝硬化门静脉血栓患者并发上消化道出血危险因素,并分析出血患者影响其预后的相关因素。方法:选取2014年1月-2018年12月肝硬化门静脉血栓患者216例病例资料进行回顾性分析,依据是否并发上消化道出血,分为病例组(并发出血,n=152)和对照组(没有并发出血,n=64)。比较两组一般临床资料与实验室检查等资料,分析并发上消化道出血危险因素。再依据其预后,将病例组分为生存组(n=124)和死亡组(n=28),分析影响预后的相关因素。结果:病例组与对照组的肝功能分级、食管胃底静脉曲张、腹水、出血病史、血红蛋白(Hb)、血小板(PLT)、白蛋白(ALB)、凝血酶原时间(PT)、胃左静脉内径比较,差异均有统计学意义(P<0.05);生存组与死亡组在失血性休克、反复出血>2次、重度食管胃底静脉曲张、合并症、肝功能Child C级方面比较,差异均有统计学意义(P<0.05);胃左静脉内径增大、重度食管胃底静脉曲张、腹水与肝功能Child C级是肝硬化门静脉血栓患者并发上消化道出血的独立危险因素(P<0.05);失血性休克与重度食管胃底静脉曲张是影响预后的独立危险因素(P<0.05)。结论:定期监测胃左静脉内径、食管胃底静脉曲张、腹水及肝功能分级情况,进行早期预防干预,可降低肝硬化门静脉血栓患者并发上消化道出血的危险,改善其预后,提高生活质量。     

肝硬化食管静脉曲张首次套扎术后再出血危险因素分析

目的探讨肝硬化食管静脉曲张首次套扎术后再出血的危险因素。方法回顾性分析2012年12月至2018年12月收住潍坊医学院附属医院的肝硬化食管静脉曲张并首次接受食管静脉曲张套扎(EVL)治疗的178例患者资料,根据是否发生术后出血分为出血组(n=13)和未出血组(n=165)。收集可能导致术后再出血的影响因素,计量资料组间比较采用t检验或方差分析,计数资料组间比较采用χ2检验,独立危险因素分析采用非条件多因素logistic回归分析。结果单因素分析显示,首次EVL术后出血的危险因素包括:血小板(t=-3.064)、凝血酶原时间(t=5.547)、白蛋白(t=-6.080)、总胆红素(t=7.703)、Child-Pugh评分(t=3.011)、Child-Pugh分级(χ2=17.427)(P0.05)。多因素logistic回归分析显示,白蛋白[比值比(OR)=1.536,95%可信区间(95%CI)=1.264-1.867]、Child-Pugh评分[OR=1.127,95%CI=1.049-1.210]为首次EVL术后再出血的独立危险因素(P0.05)。结论白蛋白、Child-Pugh评分是首次EVL术后再出血的独立危险因素,EVL术前应纠正肝功能、改善凝血功能、补充白蛋白,从而降低EVL术后再出血的发生率。     

肝硬化患者并发急性上消化道出血的危险因素分析

目的：分析研究影响肝硬化并发急性上消化道出血的危险因素,为临床预防与控制疾病提供依据。方法：对124例肝硬化住院患者的多种影响急性上消化道出血的因素进行单因素分析和Logistic多元回归分析。结果：单因素分析显示患者病程、出血史、不良生活饮食习惯、血小板计数（BPC）、凝血酶原时间（PT）、食道静脉曲张程度、胃底静脉曲张、门脉高压性胃病及门静脉内径在出血组和非出血组间有显著性差异;非条件Logistic回归分析显示,肝硬化并发急性上消化道出血的危险因素有病程、不良生活饮食习惯、食道静脉曲张程度、BPC、PT及门静脉内径等。结论：病程、不良生活饮食习惯、食道静脉曲张程度、BPC、PT及门静脉内径是肝硬化并发急性上消化道出血的危险因素,应引起高度重视。     

肝硬化患者并发急性上消化道出血的危险因素分析

目的分析影响肝硬化并发上消化道出血的危险因素.方法对本院154例肝硬化住院患者各种可能影响急性上消化道出血的因素进行单因素分析和Logistic多元回归分析.结果单因素分析显示病程、上消化道出血史、不良饮食习惯、血小板记数、凝血酶原时间、胃底静脉曲张、食道静脉曲张程度及门静脉内径在出血组和非出血组间有显著性差异;非条件Logistic回归分析显示,肝硬化并发上消化道出血的高危因素有食道静脉曲张程度、病程及不良饮食习惯.结论食道静脉曲张程度、病程及不良饮食习惯是肝硬化并发上消化道出血的高危因素.     

肝硬化患者上消化道出血危险因素分析

目的分析肝硬化患者出现上消化道出血的危险因素。方法选取2015年1月至2017年1月来我院就诊的肝硬化患者400例作为研究对象,根据上消化道有无出血分为出血组190例和非出血组210例。回顾性分析患者临床资料和相关临床指标,分析肝硬化并发上消化道出血的危险因素。结果出血组中,饮酒史、消化道出血史、PT、ALB、HB、肝功能评分、腹水、胃底静脉曲张与非出血组比较具有统计学意义(P0.05)。结论病毒性肝炎是引起肝硬化的主要原因,减少相关危险性因素的发生,做到提前预防可以减少肝硬化并发症带来的危害。     

乙型肝炎肝硬化失代偿期并自发性细菌性腹膜炎的相关危险因素研究

目的 研究乙型肝炎肝硬化失代偿期并自发性细菌性腹膜炎（SBP）的相关危险因素.方法 随机选取我院及宝安西乡人民医院收治的100例乙型肝炎肝硬化失代偿期患者进行回顾性分析,依其是否并发SBP分为两组各50例,对一般资料、实验室检查（腹水蛋白、ALB、TBIL等）、肝功能分级（Child-Pugh）等相关危险因素作单因素分析和Logistic回归分析.结果 SBP组较非SBP组的腹水蛋白、ALB显著降低,在门静脉内径、脾脏厚度、TBIL的比较上显著增高（P＜0.05）,且两组的消化道出血史、Child-Pugh分级的组间差异显著（P＜0.05）.结论 腹水蛋白、Child-Pugh分级、ALB、TBIL、门静脉内径、脾脏厚度以及既往有消化道出血史是乙型肝炎肝硬化失代偿期并发SBP的危险因素.     

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.