生长抑素与生长激素序贯应用治疗肠外瘘的临床应用体会

目的研究生长抑素与生长激素在肠外瘘序贯应用治疗中的作用。探讨肠外瘘更合理的治疗方案。方法1998年1月￣2006年3月该院收治各类肠外瘘病人71例,其中34例单纯接受生长抑素治疗,另37例序贯应用生长抑素与生长激素治疗,对其治疗结果进行回顾性分析和总结。结果单纯生长抑素治疗后血浆白蛋白可短期内显著改善(P<0.05);平均自愈时间为(37±29.4)d,死亡5例,治愈率85%。生长抑素与生长激素序贯应用后血浆白蛋白短期内可进一步显著改善(P<0.05);平均自愈时间(31±30.7)d,较对照组显著缩短(P<0.05);死亡3例,治愈率为92%,较对照组显著提高(P<0.05)。结论生长抑素和生长激素序贯应用治疗肠外瘘,可显者缩短患者住院时间,提高肠外瘘的自行愈合率,值得临床推广应用。     

生长抑素和生长激素在肠外瘘保守治疗中的临床应用

目的观察生长抑素和生长激素在肠外瘘治疗中的疗效。方法回顾性分析2004年1月~2012年12月期间收治的各类肠外瘘患者68例,其中31例患者给予了生长抑素治疗,37例患者给予了生长抑素与生长激素联合疗法。观察两组间的临床治疗效果。结果相比于单纯生长抑素治疗组,生长抑素联合生长激素治疗组患者自愈率提高(89.18%VS 67.74%,P<0.05),平均瘘口闭合时间缩短[(22.58±7.83)d vs(28.35±10.56)d;P<0.05],平均住院时间缩短[(43.89±7.43)d vs(52.61±6.54)d],两组均无严重治疗相关并发症发生。结论联合应用生长抑素与生长激素对治疗肠外瘘有良好的效果,值得临床推广应用。     

序贯应用生长抑素与生长激素治疗肠外瘘的临床研究

目的观察序贯应用生长抑素与生长激素治疗肠外瘘的效果。方法将各类手术后肠外瘘病人40例分成两组,两组病例在发现肠瘘的1周内行禁食、胃肠减压、全胃肠外营养支持、腹腔留置引流管充分引流和冲洗、准确记录每天引流量、抗生素控制腹腔感染、纠正水电解质酸碱的失衡,补充维生素和微量元素。其中A组(n=20)在发现肠瘘开始即使用生长抑素治疗至腹膜炎症状消失、炎症得以控制、窦道形成后停用,B组(n=20)在发现肠瘘时开始序贯应用生长抑素和生长激素即先使用生长抑素至腹膜炎症状消失、炎症得以控制、窦道形成后停用,改用生长激素(思真,8u/d)至瘘口闭合。将两组瘘口闭合时间、住院时间进行比较分析。结果 B组瘘口闭合时间和住院时间较A组明显缩短,差异具有显著性(P<0.05)。结论序贯应用生长抑素与生长激素在肠外瘘治疗中具有良好的效果,提高肠外瘘的愈合率,缩短瘘口愈合时间和患者住院时间。     

腹部手术后肠外瘘9例的综合治疗体会

目的探讨腹部手术后肠外瘘的综合治疗方法。方法回顾性分析我院2006~2009年收治的9例手术后肠外瘘病人,给予瘘口局部处理、通畅引流、控制全身及局部感染、营养支持治疗、生长抑素及生长激素序贯性治疗、手术治疗的方法。结果4例病人经保守治疗后,瘘口自行愈合,5例经手术后治愈。结论肠外瘘应采用综合治疗,生长抑素与生长激素序贯应用可降低病人的死亡率,增加瘘口自愈的几率。     

肠外瘘152例临床治疗分析

目的 探讨肠外瘘的综合治疗措施.方法 对我院1992年1月～2007年12 月间收治的152例肠外瘘患者的临床资料进行回顾性分析.结果 致瘘的主要原因为腹部手术后并发症(127例,83.6%),其余为腹部外伤、炎症性肠病、腹部肿瘤等;经基本治疗后瘘口自愈64例(42.1%),58例行确定性手术治愈,总治愈率80.3%,确定性手术成功率96.7%,全组死亡率7.9%.结论 肠外瘘应采取综合治疗,包括充分引流、控制感染、营养支持、生长抑素、生长激素的序贯应用和适时的确定性手术.     

生长抑素及生长激素序贯在肝叶切除术后胆漏中的临床应用

目的探讨肝叶切除术后胆漏患者早期使用生长抑素和生长激素序贯疗法减少胆漏的作用,探讨更合理的治疗方案。方法收集我科近年因胆管结石施行肝叶切除术后胆漏的17例患者,其中3例再次手术治疗;7例单纯接受生长押素治疗（生长抑素组）;另7例序贯应用生长抑素与生长激素治疗（序贯组）,对其治疗结果进行回顾性分析和总结。结果生长押素及生长激素序贯组腹腔引流量及拔管时间明显少于生长抑素组（P〈0．05）。结论术后早期使用生长抑素及生长激素序贯治疗有助于减少腹腔引流量,提高胆漏的自愈率。     

生长抑素和生长激素联合应用治疗重症急性胰腺炎临床观察

目的探讨临床联合应用八肽生长抑素善宁 生长激素思增治疗重症急性胰腺炎是否优于临床单用善宁.方法回顾性分析1997年1月～2003年12月单用八肽生长抑素-善宁组(32例)与联合应用善宁 思增组(37例)治疗重症急性胰腺炎的临床结果,比较两组病人平均住院天数(47VS33)、血浆白蛋白转归(2.9VS3.5)、严重并发症发生率(20VS12).结果联合应用八肽生长抑素善宁 生长激素思增治疗重症急性胰腺炎效果明显优于单用善宁,两组间病人平均住院天数、血浆白蛋白回复时间、严重并发症发生率显著低于对照组(P＜0.05),两组间具有显著差别(P＜0.05).结论临床联合应用八肽生长抑素善宁 生长激素思增能显著缩短患者总住院日及血浆白蛋白回复时间,减少严重并发症发生率,具有较好疗效.     

有创-无创序贯机械通气治疗急性左心衰竭的临床观察

目的 观察有创-无创序贯机械通气治疗急性左心衰的临床疗效.方法 68例急性左心衰患者,按随机数字表法分为序贯组和对照组,各34例.序贯组应用有创-无创序贯机械通气治疗,对照组单独使用有创机械通气治疗.对比两组患者机械通气时间、住院时间、呼吸机相关肺炎(VAP)发生率.结果 序贯组治疗机械通气时间、住院时间分别为(5.4±1.9)h、(11.8±3.5)d,均短于对照组的(9.1±2.4)h、(16.2±3.7)d(P＜0.05);序贯组VAP发生率为2.9%(1/34),低于对照组的23.5%(8/34)(P＜0.05);两组各有1例患者死亡,死亡原因均为多器官功能衰竭.结论 有创-无创序贯机械通气治疗急性左心衰有较好的临床疗效,值得进一步推广.     

有创-无创序贯机械通气治疗COPD急性加重

目的 评价有创-无创序贯机械通气治疗COPD急性加重(AECOPD)的临床疗效.方法 选择ICU收治的AECOPD患者13例为序贯组,同样病情患者12例为对照组.临床出现"肺部感染控制窗"后,序贯组拔除气管插管,应用口鼻面罩双水平正压通气直至脱机;对照组继续有创机械通气,以压力支持方式脱机.比较两组患者机械通气时间、住院时间、呼吸机相关性肺炎(VAP)患病率和患者转归.结果 与对照组比较,序贯组有创机械通气时间显著缩短[(4.3±1.05)d比(10.13±2.06)d,P<0.001],ICU住院时间显著缩短[(8.79±2.07)d比(11.96±2.11)d,P<0.005],VAP发生数显著减少[0比6例,P<0.01].总机械通气时间、总住院时间、再插管率和病死率均无显著性差异(P0.05).结论 对需要机械通气的AECOPD患者,采用有创-无创序贯机械通气治疗,可以缩短有创机械通气时间和ICU住院时间,降低VAP患病率.     

生长抑素在急性粘连性肠梗阻中的应用

目的 探讨生长抑素在急性粘连性肠梗阻治疗中的临床应用和疗效.方法 将急性粘连性肠梗阻患者80例机分为常规治疗组和生长抑素治疗组各40例,2组患者入院时均采用非手术治疗,生长抑素治疗组在常规治疗基础上加用生长抑素(250 μg/h持续静脉滴注2～5d).2组患者治疗过程中出现手术指征则立即手术.结果 生长抑素治疗组与常规治疗组相比,腹痛、腹胀缓解时间缩短[(2.7±0.9) dvs(3.9±1.1)d,P＜0.05],肛门排气时间提前[(3.60±0.77) dvs (5.30±0.97)d,P＜0.05],胃肠减压引流量减少[(424.75±55.52) ml/d vs (602.95±108.07) ml/d,P＜0.05],手术比率减低[12.5％ vs 45.0％,P＜0.05],平均住院日缩短[(7.3±1.3) dvs (10.3±2.0)d,P＜0.05].结论 在常规治疗基础上加用生长抑素治疗急性粘连性肠梗阻可有效缓解症状,减少患者手术的比率,缩短平均住院日.     

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.