实时三平面组织多普勒成像技术评价单纯糖尿病患者左室舒张功能

目的：应用实时三平面组织多普勒成像技术对单纯糖尿病患者左室舒张功能进行评价。方法：单纯糖尿病患者30例,对照组25例。常规超声记录二尖瓣13血流频谱舒张早期峰值速度（E）、舒张晚期峰值速度（A）;实时三平面组织多普勒成像技术测量左室侧壁、后间隔、前壁、下壁、后壁及前间隔二尖瓣环舒张早期峰值速度（Ve）、舒张晚期峰值速度（Va）。结果：二尖瓣口直流频谱E、A、E／A值在两组之间差异无统计学意义;二尖瓣环6个节段的Ve平均值在两组之间差异无统计学意义,但糖尿病组Va的平均值明显升高,各节段Ve／Va的平均值显著降低。结论：单纯糖尿病患者左室舒张功能减低,实时三平面组织多普勒成像技术较常规二尖瓣口血流频谱评价其舒张功能更加敏感。     

组织多普勒超声对冠心病患者左室舒张功能的评价

目的探讨组织多普勒超声对冠心病左心室舒张功能的诊断价值。方法对冠心病组（n=20例）及正常人组（n=20例）分别测量：（1）二尖瓣口血流频谱，测量舒张早期E峰血流速度（E）和舒张晚期A峰血流速度（A），并计算E／A比值；（2）二尖瓣环组织多普勒速度频谱，测量舒张早期峰值速度（Ea）和舒张晚期峰值速度（Aa），计算EaJAa比值。结果二尖瓣口血流频谱E、A峰值以及E／A比值，二尖瓣环运动频谱Ea峰值以及EaJAa比值两组间差异有显著性（P〈0．01）。结论组织多普勒超声测量二尖瓣环运动速度可以准确反映左心室舒张功能，是判断心脏舒张功能的可靠指标。     

定量组织速度成像用于左室舒张功能的评价

目的 应用定量组织速度成像（QTVI）测定二尖瓣环运动速度评价高血压病患者左室舒张功能。方法 应用定量组织速度成像测定30例正常人和60例高血压病患者的二尖瓣环舒张早期峰值速度（Ve）、左房收缩期峰值速度（Va），计算Ve／Va比值；并用脉冲多普勒测定二尖瓣口舒张早期峰值血流速度E峰、舒张晚期峰值血流速度A峰，计算E／A值。结果 正常组舒张早期峰值速度（E）〉左房收缩期峰值速度（A），E／A〉1；二尖瓣环舒张早期峰值速度（Ve）〉左房收缩期峰值速度（Va），Ve／Va〉1，高血压病人组二尖瓣口血流频谱及二尖瓣环运动组织速度成像测值差异有显著性，高血压组中二尖瓣环运动速度Ve／Va与二尖瓣血流频谱V／A差异无显著性。但在检出病例中QTVI明显优于血流频谱。结论 应用定量组织速度成像测定二尖瓣口运动速度能较准确估计高血压病患者左室舒张功能。     

多普勒超声心动图评价高血压病左室舒张功能

目的研究彩色多普勒超声心动图对评价高血压患者左室舒张功能的应用价值。方法应用彩色多普勒超声心动图对60例高血压患者（高血压组）及54例健康人（对照组）进行检查,测定二尖辩口左室快速充盈峰值血流速度即E峰,左室舒张晚期峰值速度即A峰,E／A值,左室等容舒张时间（IVRT）,E峰减速时间（DT）,肺静脉收缩期峰值流速（S）、舒张期流速（D）、收缩期峰值流速与舒张期末流速之比（S／D）、舒张末逆行血流峰值（PVa）,并对两组结果进行比较。结果高血压病组与正常组比较,E峰降低,A峰增高,E／A比值降低,IVRT延长,DT延长,S波升高,S／D增高,PVa增高,两组差异有显著性（P〈0．01）。结论彩色多普勒超声心动图将肺静脉血流频谱与二尖瓣前向血流频谱结合,可较全面评价左室的舒张功能,具有临床诊断价值。     

多普勒超声心动图评价高血压左室舒张功能的临床价值

目的:探讨多普勒超声心动图评价高血压左室舒张功能的临床价值。方法:应用多普勒超声心动图对116例高血压病患者和62例健康人进行检查,测量左心房内径(LAD)、左室舒张末内径(LADd)、左室后壁厚度(LVPWd)、室间隔厚度(IVSd);二尖瓣舒张早期峰值流速(E)及减速时间(EDT)、舒张晚期峰值流速(A)、舒张早期与舒张晚期峰值流速之比(E/A)、等容舒张时间(IVRT);肺静脉血流频谱的心室收缩波峰值流速(S波)、心室舒张波峰值流速(D波)、心房收缩波峰值流速(AR波)、心室收缩波峰值与舒张波峰值之比(S/D)、S波流速积分(Si)及D波流速积分(Di),将两组测量结果进行比较分析。结果:高血压病组二维及M型超声测量LAD、LADd、LVPWd、IVSd等指标均明显高于正常对照组(P0.001);两组二尖瓣血流频谱的E、A、E/A、EDT、IVRT指标和肺静脉血流频谱的S、D、AR、S/D、Si、Di等指标比较差异均有统计学意义(P0.05)。结论:应用多普勒超声心动图二尖瓣和肺静脉血流频谱检测过程简便、无创、重复性好,可较全面评价左室舒张功能,对于判断左室舒张功能的障碍程度、治疗的效果和病情的转归均具有重要的临床价值。     

定量组织速度显像评价高血压病患者左心室舒张功能的研究

目的研究高血压病患者左室整体舒张功能变化及定量组织速度显像（QTW）估测的舒张功能参数与常规二尖瓣血流参数的相关关系。方法依照左室质量指数将高血压组患者分为左室肥厚组（LVH group，n=53）与非左室肥厚组（N—LVHgroup，n=50）。应用M型超声测量舒张期室间隔厚度（IVSd）、左室后壁厚度（LVPWd）、左室内径（LVEDD），常规脉冲多普勒测量二尖瓣舒张期E波峰速度（E）、A波峰速度（A）、计算E／A比值。利用QTVI技术测量二尖瓣环六位点舒张期早期运动速度（e）、舒张期晚期运动速度（a）、计算e／a。同时计算六位点平均速度（em、am、em／am）以及E／em，比较三组舒张功能指标的差异及各参数间的相关关系。结果高血压病LVH组及N—LVH组与正常对照组比较，多项舒张功能指标（e、a、e／a、em、am、em／am以及E／em）差异具有显著性（P〈0．05），二尖瓣环舒张期运动速度与二尖瓣多普勒血流速度相关。结论高血压病无论是否存在左室肥厚均有舒张功能损害，QTVI为定量评价高血压病左室舒张功能提供了一种新方法。     

尿毒症患者左心功能损害的超声检测与分析

目的 探讨尿毒症患者左室功能不同受损程度的超声表现.方法 40例尿毒症患者,20例健康志愿者作为对照组.首先所有被检者均进行常规超声心动图检查及多普勒检查,获取相关参数:室间隔舒张末厚度(IVSd),左室后壁舒张末厚度(LVPWd),左室腔舒张末内径(LVDd),左室质量指数(LVMI);运用Simpson方法测量左室射血分数(LVEF),通过二尖瓣口血流频谱图测量并计算E峰与A峰峰值速度比值(E/A);然后将系统切换到脉冲组织多普勒模式(PW-TDI),获取二尖瓣环四个位点的心肌运动频谱图,测量并计算e峰及a峰的峰值速度比值(e/a),并结合心电图标Ⅱ导联在一个心动周期内测量等容收缩期(ICT),射血期(ET)及等容舒张期(IRT),计算Tei指数.结果 根据常规超声心动图检查结果将尿毒症患者分为左室轻度肥厚组和左室肥厚组,与正常对照组相比,两组尿毒症患者的左室舒张功能指标E/A,e/a均减低(P＜0.01);而左室收缩功能指标EF仅左室肥厚组出现减低(P＜0.05);两组尿毒症患者Tei指数均明显增大(P＜0.01).结论 ①尿毒症患者左室功能均存在不同程度受损,舒张功能减低较早出现,且普遍存在,随着左室功能受损加重,室壁增厚,在舒张功能减低的同时出现收缩功能的减低.②PW-TDI检测参数和Tei指数是评价尿毒症患者左室功能的敏感指标.     

多普勒超声心动图对高血压病左室舒张功能的检测分析

目的：探讨高血压痛患者左室舒张功能不全的发生情况。方法：应用多普勒超声心动图检测高血压痛患者79例（有左心形态改变的45例，无左心形态改变的34例）并与正常对照组40例比较，观察两组患者二尖瓣舒张早期快速充盈峰值流速（E）、舒张晚期充盈峰值流速（A）以及E／A比值和左室等容舒张时间（IVRT）。结果：高血压组与对照组比较，E值显著减低，A值显著增高，E／A比值显著减少且小于1，同时，IVRT显著延长且大于90ms；高血压组中，有左心形态改变者较之无左心形态改变者．以及无左心形态改变的亚组较之正常对照组E值显著减低，A值显著增高，E／A比值显著减少。结论：高血压病患者左室舒张功能异常普遍存在，可以很早发生于左心形态改变之前，严重的是发生于左心形态改变的基础之上。     

肺静脉血流频谱对急性心肌梗死患者左心室舒张功能的评价

目的 应用彩色多普勒超声心动固研究肺静脉血流频谱评价急性心肌梗死患者左心室舒张功能的价值。方法 急性前壁心肌梗死患者30例，同时选择30例正常人作为对照组，用彩色多普勒超声心动图检测肺静脉血流频谱指标：收缩期肺静脉前向峰值流速(S)、舒张早期肺静脉前向峰值流速(D)及其比值S／D、心房收缩期肺静脉逆向峰值流速(PA)、PA波间期(PAd)，与所检测的二尖瓣血流频谱指标：舒张早期峰值流速(E)、舒张晚期峰值流速(A)及其比值E／A、E波减速时间(DT)、A波间期(Ad)比较，将结果进行对比分析。结果 急性心肌梗死组PA、PAd—Ad较正常对照组显著增大，增大幅度与左心室舒张功能明显相关。结论 肺静脉血流频谱指标能鉴别二尖瓣血流频谱“伪正常化”，与二尖瓣血流频谱结合评价左心室舒张功能比单独用二尖瓣血流频谱更准确可靠。     

脉冲多普勒组织成像技术评价2型糖尿病患者的左室舒张功能

目的 探讨脉冲多普勒组织成像技术评价2型糖尿病患者左室舒张功能异常的实用价值。方法 2型糖尿病患者77例,对照组43例,采用脉冲多普勒组织成像技术测量其二尖瓣环6个位点的舒张早、晚期最大运动速度Em、Am及Em／Am比值;采用二尖瓣血流多普勒频谱测量二尖瓣舒张早、晚期最大血流速度E、A、E／A比值和等容舒张时间。结果 2型糖尿病组Em和Em／Am比值明显减低、A增高、E／A减低、等容舒张时间延长;Em／Am与E／A具良好相关性;PW-DTI和二尖瓣血流多普勒频谱对2型糖尿病患者组左室舒张功能异常的检出率分别为94．81％、79．22％（P〈0．005）。结论 脉冲多普勒组织成像与二尖瓣血流多普勒频谱均可检测出2型糖尿病患者的左室舒张功能受损,脉冲多普勒组织成像能够识别假性正常化模式,提高左室舒张功能异常诊断的准确性和敏感性,从而为糖尿病心肌病提供更早期的诊断依据。     

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.