西洛他唑联合胰激肽原酶治疗2型糖尿病下肢血管病变临床研究

目的比较西洛他唑联合胰激肽原酶与单用西洛他唑治疗2型糖尿病下肢血管病变（LEADDP）的临床疗效。方法将LEADDP患者106例随机分为西洛他唑对照组53例,联合胰激肽原酶治疗组53例;治疗前后给予降糖药物使血糖保持稳定;对照组口服西洛他唑片100mg,2次／d,治疗组在应用西洛他唑的同时口服胰激肽原酶肠溶片120单位,3次／d,空腹服用,共3个月。比较2组治疗后临床症状、踝／肱指数（ABI）、血液流变学、甲襞微循环、动脉内中膜厚度（IMT）及斑块厚度等。结果2组患者治疗后临床症状好转、ABI较治疗前增加（P〈0．05）,联合用药组增加更明显,与对照组治疗后比较有显著性差异（P〈0．05）;右足背动脉、左右胫后动脉IMT较治疗前有明显改善（P〈0．05）,斑块厚度较治疗前减少（P〈0．01）;甲襞微循环加权积分值较治疗前改善差异有统计学意义（P〈0．01）;且治疗前后差值比对照组亦有统计学意义（P〈0．05）。结论西洛他唑与胰激肽原酶联合用药效果优于单用西洛他唑治疗PDA患者。     

西洛他唑通过P38 MAPK信号途径对大鼠脑缺血再灌注损伤的保护作用

目的探讨西洛他唑对大鼠脑缺血再灌注损伤的保护作用及其作用机制。方法将75只成年雄性SD大鼠按数字表法随机分成假手术组、模型组、西洛他唑低剂量（10mg／kg）组、西洛他唑中剂量（20mg／kg）组和西洛他唑高剂量（40mg／kg）组,每组15只,通过大脑中动脉阻塞法建立起脑缺血再灌注模型。按照LongaEZ法评估动物神经功能;Tunel染色法检测大鼠脑神经细胞凋亡,采用Westernblot法检测半胱氨酸蛋白酶3（caspase-3）及丝裂原活化蛋白激酶（MAPK）信号转导通路相关蛋白的表达。结果与假手术组相比较,模型组神经功能评分和细胞凋亡率均升高,差异有统计学意义;西洛他唑组的神经功能评分和细胞凋亡率较模型组均降低（P〈0．05）;与模型组相比较,caspase-3和MAPK信号转导通路中P—P38的表达水平均随西洛他唑剂量的增加而逐渐降低（P〈0．05）,而西洛他唑对MAPK信号转导通路中其他成员P—ERK和P—JNK的表达无明显影响。结论西洛他唑对大鼠脑缺血再灌注损伤的保护作用与抑制神经细胞凋亡有关,其抗凋亡作用机制可能与抑制P38MAPK信号转导通路途径有关。     

西洛他唑与阿司匹林治疗脑梗死后血管性痴呆的临床分析

目的：讨论西洛他唑治疗脑梗死后血管性痴呆的安全性和有效性,对比阿司匹林治疗该病的疗效差异。方法：回顾性分析120例脑梗死后血管性痴呆患者在我院住院治疗临床资料,实验组60例采用洛他唑治疗,对照组60例服用阿司匹林,观察两组治疗前及治疗后MMSE及ADLBarthel指数变化、随访12个月后不良反应发生率。结果：西洛他唑治疗后患者MMSE评定平均为24．28,阿司匹林治疗后MMSE评定平均分20．11,两组效果比较,差异具有统计学意义（P〈0．05）;西洛他唑治疗后ADL Barthel指数平均为49．93,阿司匹林治疗后ADLBarthel指数平均分38．27,两组效果比较,差异具有统计学意义（P〈0．05）;经西洛他唑治疗后仅1例发生缺血性卒中,阿司匹林治疗后共见5例不良反应,两组不良反应发生率比较,差异具有统计学意义（P〈0．05）。结论：西洛他唑可降低脑梗死后血管性卒中发生率,提高患者认知功能。     

西洛他唑联合甲钴胺治疗糖尿病周围神经病变疗效观察

目的观察西洛他唑联合甲钴胺治疗糖尿病周围神经病变（DPN）的临床疗效。方法将62例DPN患者随机分为治疗组32例和对照组30例,两组的基础治疗为：胰岛素强化治疗及甲钴胺1mg、丹参注射液20ml分别加入100ml生理盐水中静滴,治疗组在此基础上每天口服西洛他唑100mg。治疗6周后,观察两组疗效。结果与治疗前相比,治疗组周围神经传导速度明显提高,治疗组总有效率高于对照组,差异有显著性（P〈0．05）。结论西洛他唑联合甲钴胺治疗糖尿病周围神经病变较传统的甲钴胺联合扩血管药物更有效。     

西洛他唑联合前列地尔治疗2型糖尿病下肢血管病变临床疗效观察

目的观察西洛他唑联合前列地尔注射液治疗糖尿病下肢血管病变疗效。方法将50例糖尿病下肢血管病变的患者随机分为治疗组25例和对照组25例。治疗组给予西洛他唑联合前列地尔注射液治疗,对照组给予西洛他唑治疗,治疗15d,比较两组治疗前后临床症状、血流动力学参数及下肢动脉血流动力学变化。结果两组患者治疗后上述指标均改善,但治疗组总有效率明显高于对照组（P〈0．01）,治疗组足背动脉血流量和血管踝臂指数（ABI）高于对照组（P〈0．05）,凝血因子工低于对照组（P〈0．05）。结论西洛他唑联合前列地尔注射液治疗糖尿病下肢血管病变较单用西洛他唑疗效更佳。     

西洛他唑与氯吡格雷对糖尿病患者抗血小板的作用及影响因素的比较

目的：探讨西洛他唑与氯吡格雷对糖尿病患者血小板聚集率的作用及其可能影响因素。方法选择糖尿病患者1153例,随机分为西洛他唑组（n=577）和氯吡格雷组（n=576）,分别在治疗前及治疗1周后测定血小板聚集率,比较2组患者治疗前后血小板聚集率的变化差异,以及比较血脂、空腹血糖、空腹胰岛素、糖化血红蛋白、胰岛素使用剂量对血小板聚集率的影响。结果（1）西洛他唑组服药前后血小板聚集率变化为（18.77±16.57）,氯吡格雷组服药前后血小板聚集率变化为（20.92±14.03）,2组血小板聚集率变化比较,差异无统计学意义,氯吡格雷与西洛他唑疗效相同。（2）甘油三酯、胰岛素使用剂量均为西洛他唑抵抗发生的独立危险因素,低密度脂蛋白、胰岛素使用剂量为氯吡格雷抵抗发生的独立危险因素。结论对于糖尿病患者使用西洛他唑预防心脑血管事件优于氯吡格雷。     

西洛他唑对2型糖尿病患者尿白蛋白排泄率的影响

目的探讨西洛他唑治疗2型糖尿病早期肾病的临床疗效。方法将60例血压正常伴微量白蛋白尿的2型糖尿病患者，随机分为两组：治疗组30例，予口服西洛他唑片（50mg，2次/d）；对照组30例，予口服安慰剂维生素B。（10mg，2次/d），两组均治疗3个月。观察患者治疗前后尿白蛋白排泄率（UAEK）的变化。结果治疗组较治前，UAEK明显下降（P〈0．01），下降幅度达51．6％，肝肾功能均正常，约3％病人仅有轻微头痛反应。对照组治疗前后UAER无明显变化（均P〉0．05）。结论西洛他唑能显著降低糖尿病患者尿白蛋白的排泄，对糖尿病早期肾病具有治疗作用，且安全性好。     

西洛他唑治疗糖尿病合并下肢动脉闭塞症的功效及安全性观察

目的：观察西洛他唑治疗糖尿病合并下肢动脉闭塞症的效果及安全性。方法：选择糖尿病合并下肢动脉闭塞症患者33例,给予西洛他唑第一周50mg,2次／日。第二周始改为100mg,2次／日,观察并检测治疗前后症状体征,双下肢血管直径及峰值血流速度,肝肾功能,血尿常规,血脂及血液流变学等指标。结果：患者主观症状改善率在80％以上,双下肢血流峰值速度治疗后有显著性增加（P＜0．01）,血尿常规,肝肾功能等各项指标治疗前后无明显差异。结论：西洛他唑对糖尿病合并下肢动脉闭塞症是一种安全有效的药物。     

乳房纤维腺瘤切除手术靶控输注舒芬太尼、咪达唑仑联合局部麻醉的效果

目的：评价乳房纤维腺瘤切除手术患者靶控输注舒芬太尼、咪达唑仑联合局部麻醉的效果。方法拟在局麻下行乳房纤维腺瘤切除手术患者120例，ASAⅠ或Ⅱ级，年龄20-45岁，体重指数〈30kg／m^2。随机分为4组（n=30），N组：持续静脉输注生理盐水0．15ml／（k·小时）；M组：靶控输注咪达唑仑辅助，效应室靶浓度（Ce）60ng／ml；S组：靶控输注舒芬太尼辅助，效应室靶浓度0．15ng／ml；MS组：靶控输注舒芬太尼0．1mg／ml，咪达唑仑40ng／ml。10分钟后用含1：20万肾上腺素的利多卡因行术野局部浸润麻醉。术中每5分钟采用Rammsay评分评价镇静程度；采用视觉模拟评分法（VAS评分）评价镇痛程度。S组VAS评分〉3分时为麻醉失败，其余3组VAS评分〉3分时，增加靶控浓度或静脉注射咪达唑仑2mg或舒芬太尼5μg；如出现Rammsay评分〉3分或呼吸抑制[RR〈8次／分和（或）SPO2〈94％]，则为麻醉失败。于手术前和切皮后加分钟时记录BP和HR。记录术中躁动、上呼吸道梗阻、呼吸抑制、低血压、肌强直等不良反应情况。结果：S组、SM组麻醉成功率（分别为92％、100％）高于N组、M组（分别为38％、62％）（P〈0．05）。与N组比较，术中20分钟时M组SP、DP和HR差异无统计学意义（P〉0．05），S组和SM组SP、DP和HR降低（P〈0．05）。M组躁动发生率较高，4组不良反应发生率比较差异无统计学意义（P〉0．05）。结论：靶控输注舒芬太尼Ce0．15mg／ml和咪达唑仑Ce40ng／ml复合舒芬太尼Ce0．1ng／ml联合利多卡因局部浸润麻醉可安全、有效地用于患者乳房纤维腺瘤切除手术。     

HPLC法测定富马酸卢帕他定的含量

目的 建立HPLC法测定富马酸卢帕他定的含量。方法采用高效液相色谱法，以Diamonsil（钻石）C18柱（4．6×250mm，5μm）为色谱柱，pH-4．0磷酸盐缓冲液-甲醇（35：65）为流动相，流速1．0ml／min，检测波长244nm。结果富马酸卢帕他定在1．0012-100．12μg/ml范围内线性关系良好（r=0．9999），平均回收率为99．91％（RSD=0．58％）。结论所建立的方法准确、简便、快速，适用于富马酸卢帕他定的质量控制。     

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.