急诊死亡的脑血管病296例的相关因素分析

目的探讨脑出血、蛛网膜下腔出血和脑梗死的年龄、性别、季节和危险因素等流行病学特征。方法回顾性分析2001年1月至2010年12月在本院急诊室死亡的296例脑出血、蛛网膜下腔出血和脑梗死的临床特点和危险因素。结果脑出血以冬、春季发病率较高,集中在12～3月;脑梗死以夏季发生率最高,主要集中在5～7月;存在季节性差异。蛛网膜下腔出血的季节分布无明显差异。脑出血中以高血压、吸烟为重要危险因素(P<0.01);脑梗死的危险因素以糖尿病、高血脂、肥胖为主(P<0.01);蛛网膜下腔出血以高血压为主要危险因素(P<0.01)。结论 (1)脑血管病的发病年龄、季节与其临床类型及危险因素密切相关;(2)代谢综合征(包括高血压、高脂血症、糖尿病和肥胖)是造成病情发生、发展的重要危险因素。     

内源性大麻素对海马神经元AMPA受体GluR2的作用

目的探索内源性大麻素预处理对小鼠全脑缺血再灌注损伤后海马神经元α-氨基-3羟基-5-甲基-4-异恶唑丙酸(AMPA)受体2亚基(GluR2)表达的影响及机制。方法雄性C57BL/6小鼠随机分为假手术组、模型组、2-花生酰基甘油(2-AG)处理组、大麻素1型受体(CB1R)拮抗剂(AM251)+2-AG组和溶剂组。2-AG处理组腹腔注射2-AG 5 mg/kg;AM251+2-AG组腹腔注射AM251 1 mg/kg,30 min后腹腔给予2-AG 5 mg/kg;溶剂组腹腔给予0.1 ml二甲基亚砜(DMSO)。各组小鼠在预处理后30 min采用夹闭双侧颈总动脉20 min行再灌注的方法制备全脑缺血再灌注损伤模型。再灌注2 h取材行Western blot及免疫荧光检测。结果 GluR2高表达于正常小鼠海马CA1区锥体神经元;C57小鼠全脑缺血20 min,再灌后2 h海马组织GluR2表达明显下调(P0.05);与模型组比较,2-AG处理组海马组织GluR2明显增高(P0.05);与2-AG处理组比较,AM251+2-AG组海马组织GluR2明显下降(P0.05)。结论内源性大麻素2-AG作用于神经元CB1R,逆转全脑缺血损伤导致的海马神经元GluR2表达下降。     

生物反馈治疗仪治疗功能性便秘病人的护理

功能性便秘是由非器质性原因引起的无法排便或排便困难相关的腹部病症。并通过结肠镜或钡灌肠以及甲状腺功能等相关检查,排除其他原因引起的继发性便秘。其确切原因尚不清楚,既往多认为是由于肠道动力障碍所致,它是一种临床常见病,对病人的日常生活、健康、     

Analysis of clinical features of painless aortic dissection

The clinical characteristics of painless aortic dissection were investigated in order to improve the awareness of diagnosis and treatment of atypical aortic dissection. The 482 cases of aortic dissection were divided into painless group and pain group, and the data of the two groups were retrospectively analyzed. The major clinical symptom was pain in 447 cases（92.74%）, while 35 patients（7.26%） had no typical pain. The gender, age, hypertension, hyperlipidemia, diabetes, smoking and drinking history had no statistically significant differences between the two groups（P〉0.05）. The proportion of Stanford type A in painless group was significantly higher than that in pain group（48.57% vs. 21.03%, P=0.006）. The incidence of unconsciousness in the painless group was significantly higher than that in the pain group（14.29% vs. 3.58%, P=0.011）. The incidence of hypotension in painless group was significantly higher than that in pain group for 4.26 folds（P=0.01）. Computed tomography angiography（CTA） examination revealed that the incidence of aortic arch involved in the painless group was signifi-cantly higher than that in the pain group（19.23% vs. 5.52%, P=0.019）. It was concluded that the incidence of painless aortic dissection was higher in Stanford A type patients, commonly seen in the patients complicated with hypotension and unconsciousness. CTA examination revealed higher incidence of aor-tic arch involvement.     

消化系统疾病患者食物不耐受状况及饮食护理

目的了解消化系统疾病患者食物不耐受状况,为患者进行饮食护理提供依据。方法对109例消化系统疾病患者采用酶联免疫吸附法检测血清中14种常见食物特异性IgG。结果105例(96.33%)患者食物特异性IgG为阳性,以炎症性肠病、肠易激综合征和腹型紫癜患者发生率高。14种食物中黄豆、蟹、鸡蛋、鸡肉、鱼、牛肉、西红柿测得的特异性IgG阳性率较高(40.37%～59.63%)。结论消化系统疾病患者食物不耐受状况发生率较高,针对食物特异性IgG水平和进食后症状指导患者调整饮食,以减少疾病发生和加重的因素。     

管状胃对食管癌手术后胃食管反流的影响

目的探讨管状胃对食管癌手术后胃食管反流的影响。方法将40例食管癌手术患者按手术方式不同分成管状胃组(20例)和传统手术组(20例),另选20例健康体检正常成人为对照组。分别对食管癌患者在术后2周内进行食管腔内24hpH值监测,并同对照组进行比较。结果术后24hpH监测提示:DeMeester总评分、24h酸反流次数、>5min酸返流次数、最长反流持续时间、pH值<4.00的总时间、pH值<4.00占总时间的百分比各项结果传统手术组>管状胃组>正常对照组,组间比较差异均有统计学意义(均P<0.05)。结论两组患者术后均存在不同程度的病理性胃食管反流,而管状胃组反流较传统手术组明显减轻。     

胶囊内镜检查失败原因分析及对策

目的 探讨胶囊内镜检查失败原因及对策,提高胶囊内镜检查的成功率.方法 回顾性分析同济医院2008年5月至2012年5月64例胶囊内镜检查病例.结果 64例胶囊内镜检查全小肠完成率为95％.食管扩张术后食管再狭窄胶囊内镜不能通过食管1例(1.5％),胶囊内镜小肠内嵌顿1例(1.5％),胶囊内镜胃内排出延迟10例(15.6％),电池耗竭前胶囊内镜没有通过回盲瓣1例(1.5％),肠道准备不佳致图像紊乱模糊6例(9.4％).结论 术前认真评估,合理选择患者,充分肠道准备,实时监测指导患者,可以提高胶囊内镜检查的成功率和诊断率.     

Adeno-associated viral vector mediated and cardiac-specific delivery of CD151 gene in ischemic rat hearts

Our previous studies demonstrated that CD151 gene promoted neovascularization in ischemic heart model.To improve the delivery efficacy and target specificity of CD151 gene to ischemic heart,we generated an adeno-associated virus(AAV) vector in which CD151 expression was controlled by the myosin light chain(MLC-2v) promoter to achieve the cardiac-specific expression of CD151 gene in ischemic myocardium and to limit unwanted CD151 expression in extracardiac organs.The function of this vector was examined in rat ischemic myocardium model.The protein expression of CD151 in the ischemic myocardium areas,liver and kidney was confirmed by using Western blot,while the microvessels within ischemic myocardium areas were detected by using immunohistochemistry.The results showed that MLC-2v significantly enhanced the expression of CD151 in ischemic myocardium,but attenuated its expression in other organs.The forced CD151 expression could increase the number of microvessels in the ischemic myocardium.This study demonstrates the AAV-mediated and MLC-2v regulated CD151 gene is highly expressed in the ischemic myocardium and cardiac-specific delivery that is more efficiently targets CD151 to the ischemia myocardium after myocardial infarction.     

社区冠心病危险因素及生活质量调查

为了探讨社区冠心病及其危险因素与患者生活质量的关系，随机调查了79名门诊或住院冠心病患者的临床类型及危险因素。结果表明，患者的生活质量与并发症的发生率呈负相关，而吸烟，高血压、高血脂、糖尿病等危险因素能促进冠心病的发生与发展。