补阳还五汤联合低分子肝素预防股骨转子间骨折术后深静脉血栓形成的临床研究

【目的】探讨补阳还五汤联合低分子肝素预防股骨转子间骨折术后深静脉血栓形成(DVT)的临床疗效。【方法】根据性别、年龄、手术时间、手术方式及Evens分型将96例股骨转子间骨折术后病例按照分层随机化法分为试验组和对照组各48例。2组均给予皮下注射低分子肝素,同时试验组给予补阳还五汤治疗,每日1剂,连续7 d。分别观察2组受试对象试验前、试验后凝血—纤溶系统、血液流变学指标及伤肢彩色多普勒超声检查结果的变化情况。【结果】(1)试验后,2组患者的凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)与D-二聚体(D-D)、组织型纤溶酶原激活抑制因子(PAI)等凝血—纤溶系统相关指标及血液流变学指标均显著改善,与试验前比较,差异均有统计学意义(P0.05),且试验组的改善作用优于对照组,差异均有统计学意义(P0.05)。(2)伤肢彩色多普勒超声检查结果显示,试验组的伤肢DVT发生率明显少于对照组,2组比较差异有统计学意义(P0.05)。【结论】补阳还五汤联合低分子肝素能够改善股骨转子间骨折术后患者血液高凝状态,激活纤溶系统,调节血液流变学状态,预防伤肢深静脉血栓形成。     

桃红四物汤预防股骨粗隆间骨折早期深静脉血栓形成的临床研究

【目的】从血液流变学角度观察桃红四物汤预防股骨粗隆间骨折早期深静脉血栓形成的临床疗效。【方法】采用前瞻随机对照临床试验设计方法,根据一般情况及Evens分型将60例股骨粗隆间骨折早期病例按照分层随机化的方法以1∶1比例分成试验组和对照组各30例。根据《中国骨科大手术静脉血栓栓塞症预防指南》,2组予以相同的综合预防方案,同时试验组予以桃红四物汤,每日1剂,连续7 d。分别观察2组受试对象试验前、试验后血液流变学及伤肢彩色多普勒超声检查结果变化情况。【结果】2组患者一般情况及Evens分型比较差异均无统计学意义(P>0.05)。2组患者试验前血液流变学结果比较,差异均无统计学意义(P>0.05);试验后2组均显著改善(与试验前比较,P<0.05或P<0.01),且试验组的改善作用显著优于对照组,差异均有统计学意义(P<0.05)。试验组试验后伤肢深静脉血栓(DVT)发生率显著低于对照组,差异有统计学意义(P<0.05)。【结论】根据《中国骨科大手术静脉血栓栓塞症预防指南》制定综合预防方案,同时配合桃红四物汤活血化瘀,能够改善股骨粗隆间骨折早期血液流变学状态,预防伤肢深静脉血栓形成,值得临床推广应用。     

化瘀祛湿通络法预防股骨干骨折早期DVT形成

目的观察中药化瘀祛湿通络法预防股骨干骨折早期深静脉血栓(DVT)形成的临床疗效。方法将80例股骨干骨折患者随机分成试验组和对照组各40例。试验组在基础治疗措施的基础上加服中药化瘀祛湿通络方,对照组不服用中药。检测两组患者在入院后第1,3,7,13天D-二聚体(D-D)及血液流变学指标,并在入院后第3,7,13天行患肢血管超声检查以明确DVT的发生率。结果试验组3例发生DVT(7.5%),对照组10例发生DVT(25.0%),两组DVT发生率差异有统计学意义(P0.05)。两组入院后第3、7、13天D-D含量对比,试验组少于对照组,差异有统计学意义(P0.05,P0.01)。在血液流变学指标方面,入院后第3天两组全血黏度(高切、低切)、血浆黏度、红细胞压积(HCT)对比,试验组少于对照组,差异有统计学意义(P0.05,P0.01);第7天两组全血黏度(高切、低切)、血浆黏度对比,试验组少于对照组,差异有统计学意义(P0.01);第13天两组全血黏度低切、血浆黏度、HCT对比,试验组少于对照组,差异有统计学意义(P0.05,P0.01)。结论中药化瘀祛湿通络法具有改善血液纤溶活性及高凝状态、改善静脉血流瘀滞和高黏滞状态及降低DVT形成风险的作用,对股骨干骨折早期DVT形成有良好的预防效果。     

低分子肝素预防合并糖尿病的腹腔镜手术患者围手术期静脉血栓形成的效果

目的 探讨合并糖尿病的腹腔镜手术患者应用低分子肝素(LMWH)预防围手术期深静脉血栓(DVT)的效果。 方法 将100例2型糖尿病腹腔镜手术患者随机分为2组,非LMWH组常规手术,LMWH组术后腹壁皮下注射低分子肝素。于手术前后取患者空腹静脉血,测定血小板功能(PLT、MPV、PCT、CD62p、vWF),凝血-纤溶功能(PT、APTT、Fib、AT-Ⅲ、t-PA、PAI-1)及血液流变学指标(全血粘度、血浆粘度、HCT、RBCAI);并以50例非糖尿病腹腔镜手术者为对照组行对比分析。 结果 非LMWH组下腔DVT发生率高于LMWH组和对照组(P＜0.05),LMWH组与对照组差异无统计学意义(P＞0.05)。术前,非LMWH组和LMWH组之间PLT、MPV、PCT、CD62p、vWF、全血粘度、血浆粘度、HCT、RBCAI、Fib、AT-Ⅲ、PAI-1、t-PA水平差异均无统计学意义(P＞0.05),且AT-Ⅲ与t-PA低于对照组,其他指标高于对照组(P＜0.05)。术后3组AT-Ⅲ与t-PA降低,且非LMWH组低于LMWH组,LMWH组低于对照组;其他各项指标升高,且非LMWH组高于LMWH组,LMWH组高于对照组,其组间差异均有统计学意义(P＜0.05)。 结论 糖尿病患者血小板、血液流变学及凝血-纤溶参数异于常人,腹腔镜术后DVT发生率高,低分子肝素可起到预防效果,具有较高的应用价值。      

补阳还五汤对人工全髋关节置换术患者术后DVT及血液流变学指标的影响

目的：观察补阳还五汤对人工全髋关节置换术（THA）患者术后深静脉血栓形成（DVT及血液流变学指标的影响。方法：选取南昌市洪都中医院2020年10月-2021年12月拟行THA治疗的83例患者,依据随机数字表法分为对照组（n=42）、研究组（n=41）。对照组术后接受常规治疗,研究组术后在对照组基础上接受补阳还五汤治疗。比较两组凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、纤维蛋白原（FIB）、D-二聚体（D-D）、术后DVT发生率及血液流变学指标（全血高切黏度、全血低切黏度、血浆黏度）。结果：两组治疗7 d后PT、APTT均较治疗前升高,FIB、D-D均较治疗前降低,且研究组各指标水平较对照组变化均更明显,差异均有统计学意义（P<0.05）;研究组术后DVT发生率（2.44%）较对照组低（19.05%）(P<0.05);两组治疗7 d后全血高、低切黏度与血浆黏度均较治疗前降低,且研究组全血高、低切黏度与血浆黏度均较对照组低（P<0.05）。结论：THA患者术后加用补阳还五汤治疗可改善凝血-纤溶指标,降低术后DVT发生率,下调血液流变学指标。     

空气压力波联合低分子肝素钙对COPD急性加重期患者下肢深静脉血栓的预防护理研究

目的 探讨空气压力波联合低分子肝素钙对COPD急性加重期患者下肢深静脉血栓(DVT)的预防护理效果。方法 选择我院2015年4月至2019年4月收治的COPD急性加重期患者105例,通过随机数表法分为观察组55例和对照组50例,在常规治疗基础上,对照组给予低分子肝素钙治疗,观察组联合空气压力波治疗仪治疗,均连续治疗1周。比较两组凝血、纤溶指标、血液流变学的变化、DVT发生率及不良反应。结果 治疗后1周,观察组活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、凝血酶时间(TT)均明显长于对照组(P0.05),观察组D-二聚体(DD)、纤维蛋白原(FIB)、全血高切黏度、全血低切黏度、血浆黏度均明显低于对照组(P0.05);观察组DVT总发生率明显低于对照组(P0.05);两组不良反应总发生率比较,差异无统计学意义(P0.05)。结论 空气压力波联合低分子肝素钙可有效改善COPD急性加重期患者凝血纤溶功能及血液流变学,在预防DVT的发生率中有明显作用,护理效果满意。     

低相对分子质量肝素联合活血灵防治骨科大手术后深静脉血栓形成

目的评价活血灵预防骨科大手术后深静脉血栓形成(DVT)的临床疗效。方法选择2013年4月至2014年12月来我院行骨科大手术的病人100例,根据excel表格随机数字表法随机分为两组:皮下注射低相对分子质量肝素(LMWH)组(西医组,50人)和皮下注射LMWH联合口服活血灵组(联合组,50人),分别检测患者手术后12 d血小板(PLT)凝血酶原时间(PT)活化部分凝血活酶时间(aPTT)值。在术后12 d用超声检测是否有下肢DVT的发生。根据血液流变学光学检测方式检测术前及术后12 d全血低切还原粘度、全血高切还原粘度、红细胞聚集指数,全血方程K值。结果两组术后全血低切还原粘度、全血高切还原粘度、红细胞聚集指数,全血方程K值,较术前都有所降低(P0.05),组间比较结果显示,术后联合组的血液流变学指标较西医组低(P0.05);联合组的aPTT值、PT值均高于西医组(P0.05(;西医组有7人发生下肢DVT,联合组有1人,P0.05,差异有统计学意义。结论活血灵能够有效的降低血浆粘度及延长PT和aPTT,能有效的降低骨科大手术后DVT的发病率。     

低分子肝素治疗心绞痛疗效及对血液流变学的影响

目的:探讨低分子肝素(LMWH)治疗心绞痛的临床疗效。方法:将86例患者随机分成两组,对照组42例,予抗心肌缺血基础药物治疗。治疗组44例,在上述治疗基础上给予低分子肝素钙0.4ml,每隔12h1次,连续应用10d。观察用药前后心电图、血生化、血流变、血脂,并记录不良反应。结果:治疗组治疗心绞痛总有效率90.8%,明显优于对照组(P<0.01)。治疗组全血粘度、血浆粘度、全血还原粘度均显著降低(P<0.01);血小板聚集率显著降低(P<0.01);血总胆固醇、甘油三酯降低显著(P<0.05)。治疗组疗效明显优于对照组(P<0.01)。结论:低分子肝素治疗心绞痛,安全、有效并能改善血液流变学。     

逐瘀生骨汤联合低分子肝素钙对髋关节置换患者功能恢复、血液流变学、深静脉血栓形成的影响

【目的】探讨逐瘀生骨汤联合低分子肝素钙对髋关节置换患者功能恢复、血液流变学、深静脉血栓（DVT）形成的影响。【方法】将102例具备髋关节置换指征并拟行髋关节置换的患者随机分为对照组和观察组，每组各51例。2组患者均给予行髋关节置换治疗，对照组术后给予低分子肝素钙抗凝治疗，观察组给予逐瘀生骨汤联合低分子肝素钙治疗，疗程为2周。观察2组患者术后第1天和术后2周血液流变学指标[血浆黏度、纤维蛋白原（FIB）、红细胞比容（Hct）]及炎症指标[肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)、转化生长因子β(TGF-β)]水平的变化情况，统计2组术后DVT发生率，并采用Harris髋关节功能评分（HHS）对2组患者术前及术后2周、1个月及3个月的髋关节功能进行评定。【结果】（1）血液流变学方面，术后2周，2组患者的血浆黏度、FIB、Hct水平均较术后第1天明显降低（P<0.05），且观察组的降低作用均明显优于对照组（P<0.01）。（2）炎症指标方面，术后2周，2组患者的血清TNF-α、IL-6、TGF-β水平均较术后第1天明显降低（P<0.05），且观察组的降低作用均...     

高压氧与低分子肝素对改善脑梗死患者血液流变状态的实验研究

目的比较高压氧与低分子肝素对脑梗死患者血液流变状态的影响。方法随机选取经临床确诊的脑梗死患者66例作为治疗组,并将其按接受两种不同治疗方案分成两个不同的实验组,一组31例给予高压氧治疗,另一组35例给予低分子量肝素治疗,同时随机选取体检健康人群作为试验对照组。分别测量两治疗组治疗前和治疗后血液流变学的多项指标,并与对照组进行比较。结果治疗组血液流变学中全血高切粘度、全血低切粘度、血浆粘度和红细胞沉降率（ESR）较对照组有明显升高（P〈0．05）,治疗组治疗后较治疗前血液流变学多个指标（全血高切粘度、全血低切粘度、血浆粘度和ESR）均明显下降（P〈0．05）,但治疗组内两个实验组间各指标间无显著性差异。结论高压氧与低分子肝素治疗能明显改善脑梗死患者血液流变状态,增强抗凝聚和抗血栓作用。     

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.     

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.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

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.     

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.