急性肺栓塞26例临床分析

目的 分析急性肺栓塞（Pulmonary embolism，PE），即临床上出现呼吸困难、晕厥、休克等症状的住院患者进行回顾分析，提高对该病的认识和早期诊断治疗。方法 将确诊的26例急性肺栓塞患者按入院先后顺序分为A、B组。A组12例，采用溶栓加抗凝治疗；B组14例，采用单纯抗凝治疗。观察疗效并于6个月后复查肺功能、CT、MR、心功超声、放射性核素肺扫描，判定肺栓塞对远期肺功能的影响和慢性肺栓塞、肺动脉高压形成等改变。结果 A组有效率75％，症状得到明显改善。6个月后复查，呼吸困难缓解，心率、血压维持在正常水平。B组有效率64％，呼吸困难、胸痛、心悸等症状均得到改善。结论 溶栓加抗凝疗法治疗PE优于单纯抗凝疗法，早期诊断治疗是预防猝死、改善预后的关键。     

围术期肺栓塞的预防

目的：对有高度肺栓塞（PE）危险的手术病入围术期采用低分子肝素（LMWH）抗凝和充气加压泵（IPC）对双下肢充气加压的方法进行预防,观察预防效果。方法：有高度PE危险的手术病人分为两组：Ⅰ组：术前D-二聚体（D—D）〉0．5mg／dL或B超检查发现已有下肢静脉血栓形成（DVT）者125例为实验组Ⅰ,术后1～7d,每天使用LMWH 4000U进行皮下注射;Ⅱ组：术前D—D〈0．5mg／dl且B超检查未发现有下肢DVT者178例为实验组Ⅱ,术中采用IPC对双下肢充气加压的方法,术后连续应用7d;Ⅲ组,检索既往病历中有高度PE危险的病例213例为对照组。未采取任何预防PE措施。比较3组病人PE确诊率、疑诊率、死亡率并进行统计分析。结果：Ⅰ组确诊PE 1例,疑诊3例,死亡2例;Ⅱ组确诊PE 1例,疑诊2例,死亡1例;Ⅲ组确诊PE 11例,疑诊31例,死亡14例;Ⅰ、Ⅱ组PE确诊率、疑诊率、死亡率均明显少于Ⅲ组（P〈0．05）,Ⅰ、Ⅱ组间无明显差别（P〉0．05）。结论：对围术期有高度PE危险的手术病人,采用LMWH抗凝和IPC对双下肢充气加压的方法可明显减少围术期PE确诊病例和疑诊病例的发病率、死亡率,减少围术期并发PE的可能。提高围术期安全。     

溶栓加抗凝疗法与单纯抗凝疗法对次大面积肺栓塞的疗效及远期预后的影响

目的分析次大面积肺栓塞症患者行溶栓或抗凝治疗的有效性及安全性,并随访1年,观察远期无事件生存率。方法将确诊的106例次大面积肺栓塞症患者随机分为两组,A组（n=51）予以尿激酶20000U／kg静脉滴注。溶栓结束后,开始予以皮下注射低分子量肝素治疗,并重叠口服华法林,尔后单纯应用华法林,直至INR达到2～3。B组（n=55）只用低分子量肝素和华法林抗凝,用法同A组。观察疗效并随访1年,观察主要终点事件（再发肺栓塞、严重出血及死亡）发生率。结果两组一般情况、基础临床情况均无显著差异（P〉0．05）。A组51例用尿激酶溶栓和低分子量肝素抗凝治疗者,46例有效（90．2％）,有1例（1．9％）患者发生脑出血;B组55例单用低分子量肝素抗凝治疗者,37例有效（67．3％）,无严重出血发生.随访1年时,A组有4例（13．7％）发生主要终点事件,B组有6例（14．5％）发生主要终点事件,两组之间无统计学差异（P〉0．05）。结论联合应用尿激酶溶栓和低分子量肝素抗凝治疗次大面积肺栓塞症患者安全、有效,但与单用低分子量肝素抗凝治疗相比,其并不能改善1年后的无事件生存率。     

冠心病心力衰竭患者窦性心率震荡56例分析

目的观察冠心病心力衰竭患者窦性心率震荡（HRT）现象的特征并探讨其临床意义。方法2007年1月至2010年1月根据有效24h动态心电图表现,分析比较36例冠心病心力衰竭患者和20例冠心痛心力衰竭猝死及36名健康者的HRT的初始值（TO）、HRT的斜率（TS）,并进行TO、TS与年龄、左室射血分数（LVEF）、左室舒张末期内径（LVED）组间比较。结果冠心病心力衰竭组与健康组HRT间存在明显差别：冠心病心力衰竭患者TO明显高于健康者（P〈0．05）;冠心病心力衰竭组TO明显低于冠心病心力衰竭猝死组（P〉0．05）：冠心病心力衰竭组TS明显低于健康对照组[（3．20±2．01）％与（9．62±6．64）％,P〈0．01];冠心病心力衰竭组TS明显高于猝死组（P〉0．05）;TO、TS与年龄、LVEF、LVED相关。结论冠心病心力衰竭患者窦性心律震荡现象明显减弱,由于TO、TS与LVEF、LVED相关,可应用TO、TS对冠心病心力衰竭患者进行危险分析,作为冠心痛心力衰竭猝死率的预测指标。     

急性肺栓塞47例临床分析

目的分析急性肺栓塞（acute pulmonary embolism,APE）的危险因素、临床特点、误诊情况及治疗方法,以提高确诊率,改善预后。方法选用2009年1月至2012年12月本院确诊APE病例47例,对其危险因素、临床表现、实验室检查及治疗情况进行统计分析,并根据发病年限分为2组,比较两组的确诊时间及预后。结果APE患者极易误诊,首诊误诊情况依次为心力衰竭10例（21．3％）,肺部感染8例（17．0％）,急性冠脉综合征（ACS）7例（14．9％）,脑梗死2例（4．3％）,漏诊1例（2．1％）,使用修正的Geneva评分对患者进行评估,早期确诊率得到明显提高。结论APE可并发于多种疾病,临床表现多样,极易误诊漏诊,使用修正的Geneva评分对患者进行筛选,可提高早期确诊率。     

瑞替普酶溶栓治疗急性心肌梗死68例疗效分析

目的观察瑞替普酶治疗急性心肌梗死疗效。方法68例急性心肌梗死患者作为溶栓组，用瑞替普酶按10Mu-20Mu剂量治疗；49例急性心肌梗死患者为对照组，比较两组的再灌注率、住院2周内病死率、心力衰竭、心源性休克、严重心律失常及不良反应发生率。结果溶栓治疗组冉灌注率（80．9％）显著高于对照组（20．4％），（P〈0．01），溶栓组3周病死率（7．8％）、心力衰竭（12％）、心源性休克（8％）和严重心律失常（12％）发生率均明显低于对照组（分别为19％、35％、和31％），有统计学意义（P〈0．01）。溶栓组有一例脑出血，轻度出血发生率溶栓组（10．3％）高于对照组（8．3％）P〈0．05）。结论瑞替普酶溶栓效果好，不良反应少，疗效确切，简便易行，价格较廉，适合基层医院推广应用。     

急性肺血栓栓塞27例误诊原因分析

目的探讨急性肺血栓栓塞的临床误诊常见原因及应对措施。方法回顾性分析2006年5月至2013年9月正阳县人民医院收治的首诊误诊的27例急性肺栓塞患者临床资料,总结误诊常见原因及应对方法。结果 27例患者中误诊为冠心病14例,慢性阻塞性肺疾病合并感染4例,胸膜炎并胸腔积液3例,慢性心力衰竭3例,肺部感染1例,脑梗死1例,短暂性脑缺血发作1例,经外院肺通气灌注扫描确诊3例,经螺旋CT肺动脉造影确诊24例,误诊时间<3 d者4例,4~7 d者15例,8~14 d者5例,14~18 d者3例。给予溶栓、抗凝等治疗,25例患者好转,2例死亡。结论应提高对急性肺栓塞的认识,结合辅助检查结果全面分析病情,提高早期诊断率,采取有效治疗措施,改善患者预后。     

老年慢性充血性心力衰竭合并肺栓塞的临床误诊分析

目的总结12例老年慢性充血性心力衰竭（CHF）合并肺栓塞（PE）的临床资料,分析误诊原因,以提高PE的确诊率,降低误诊率。方法回顾性分析我院2007年1月至2010年收入院的12例老年CHF合并PE的临床资料。结果 8例入院时误诊为冠心病心力衰竭症状加重;1例误诊为冠心病急性心肌梗死泵功能Ⅳ,1例误诊为肺部感染,2例误诊为肺心病右心功能衰竭。结论 CHF合并PE的误诊率高,对高度怀疑PE者要更详细的追问病史、详细的体格检查,结合血气分析、心电图、超声心动图及D-二聚体、胸部增强CT,以助尽快确诊。     

尿激酶治疗高龄急性心肌梗死30例临床观察

目的探讨高龄急性心肌梗死患者溶栓治疗的效果、安全性及预后。方法尿激酶10o万～150万单位加入生理盐水100毫升30分钟静滴完毕．同时配合低分子及口服小剂量阿司匹林，在治疗过程中对其疗效，安全性，预后进行观察。结果溶栓2小时后，19例患者梗死相关血管再通，再通率为63．33％．4周后观察，预后良好21例（70％），死亡5例（16．67％）。结论高龄急性心肌梗死患者不是溶栓的禁区，尽早溶栓治疗可减低患者的心力衰竭，心源性休克，严重心律失常等并发症的发病率，从而减少病死率。     

术后发生急性肺栓塞误诊率和死亡率高的原因与介入治疗的有效性

目的：分析术后发生急性肺栓塞（PE）死亡率高的原因及治疗对策。方法：采用肺动脉造影及临床综合手段,诊断了9例术后发生急性PE。结果：9例患初诊全部误诊,其中6例死亡（67％）;介入治疗使致死性性PE迅速摆脱临床症状。结论：术后发生的急性PE误诊率高,死亡率高,应提高医师的诊断意识和诊断水平;术后溶栓药物受限时,应考虑介入治疗。     

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.     

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.