Clinical safety evaluation of tooth extraction under electrocardiographic monitoring for patients with cardiovascular diseases

目的 探讨心电监护提高心血管疾病患者拔牙安全性的作用.方法 对290例心血管病患者(非健康组)及100例无心血管病的患者(健康组)在拔牙过程中全程心电监护,分别观察两组患者拔牙过程中心率、血压、血氧饱和度、心电图的变化.结果 无论患者是否伴有心血管疾病,在麻醉中及拔牙中,血压显著升高(P＜0.01),心率显著加快(P＜0.01),但血压组间差异无统计学意义;心率在拔牙中组间差异有统计学意义(P＜0.01);血氧饱和度和心电图变化组间差异有统计学意义(P＜0.01),即伴有心血管疾病的患者出现血氧饱和度降低和出现心律失常的比例明显高于无心血管疾病的患者.并且非健康组术中一过性ST-T改变较多,而健康组术中未出现ST-T改变.结论 心血管病患者在心电监护下接受拔牙手术能够明显提高安全性,具有一定的必要性.     

心血管病患者在心电监护下拔牙的安全性临床评价

目的探讨心电监护提高心血管疾病患者拔牙安全性的作用。方法对290例心血管病患者(非健康组)及100例无心血管病的患者(健康组)在拔牙过程中全程心电监护,分别观察两组患者拔牙过程中心率、血压、血氧饱和度、心电图的变化。结果无论患者是否伴有心血管疾病,在麻醉中及拔牙中,血压显著升高(P<0.01),心率显著加快(P<0.01),但血压组间差异无统计学意义;心率在拔牙中组间差异有统计学意义(P<0.01);血氧饱和度和心电图变化组间差异有统计学意义(P<0.01),即伴有心血管疾病的患者出现血氧饱和度降低和出现心律失常的比例明显高于无心血管疾病的患者。并且非健康组术中一过性ST-T改变较多,而健康组术中未出现ST-T改变。结论心血管病患者在心电监护下接受拔牙手术能够明显提高安全性,具有一定的必要性。     

心血管病患者拔牙的临床分析及治疗

目的 探讨提高心血管疾病患者拔牙安全性的措施.方法 回顾性分析256例心血管疾病患者拔牙的临床资料.结果 本组256例心血管病患者拔牙均顺利完成,仅26例术中出现恐惧、心率加快,6例出现暂时血压升高,对症处理后缓解,无严重并发症发生.结论 心血管疾病患者拔牙术前充分心理辅导,术中麻醉确切、手术操作快速准确和术后观察可有效防止并发症的发生.     

严重心血管疾病患者拔牙的讨论

目的：探讨严重心血管疾病患者拔牙的可行性。方法：对78例严重心血管疾病患者在心电、血压监护下拔牙并进行血压、心电图、心率的观察。结果：78例患者术中、术后血压有明显改变，心率也有影响，心电图基本无改变。全部病例未因血压、心电图、心率的改变而影响手术，术后临床表现均这。结论：严重心血管疾病患者采用心电监护拔牙是可行的。     

327例老年患者拔牙前后血压变化的临床体会

目的观查327例老年患者拔牙前后血压的变化。方法对327例老年拔牙患者做术前调查,检测拔牙前后的血压,将测量结果进行对照分析。结果老年拔牙患者术后血压平均值较术前有所增加。结论拔牙术可增加老年患者,尤其是有心血管疾病患者的风险。     

老年心血管病患者拔牙中血压及心电图动态观察

目的　观察老年心血管病患者在拔牙过程中心率、血压、心电图的变化 ,评价老年心血管病患者拔牙一般耐受性 ,为提高老年心血管病患者的拔牙安全性提供帮助。方法　对 81例患有心血管病 ,年龄 60岁以上的患者在拔牙过程中进行全程心电监护 ,观测术前、术中及术后心率、血压、心电图的变化。结果　本组患者手术前后心率、收缩压均无显著变化 (P >0 0 5 ) ,舒张压差异有显著性 (P <0 0 5 )。新出现心律失常或原有心律失常加剧 19例 ,术前出现有心肌缺血的 9例患者术中加重 7例 ,新出现 2例 ,术后 7例恢复。结论　老年心血管病患者采取全程心电监护保障措施对确保拔牙安全极为重要 ,血压指标可在 2 3/13kPa以下 ,ST -T改变与术前心肌缺血密切相关。     

心电监护下高血压病患者拔牙术的安全性评价

目的 :通过观察高血压病患者在拔牙过程中心率、血压及心电图的变化 ,对高血压病患者拔牙的安全性进行评价。方法 :对 12 4例高血压病患者及 98例非高血压病患者在拔牙过程中进行生程心电监护 ,观察并比较两组拔牙过程中血压、心率及心电图的变化。结果 :两组患者拔牙过程中 ,血压在麻醉后及术中明显升高 (P <0 0 5 ) ,其中高血压病组升高的幅度较大 ,但仅有 3例超过 180 / 10 0mmHg(1mmHg =0 133kPa) ;心率无明显变化 (P <0 0 5 ) ;两组均出现术中心律失常增多及加重 ,但危险性心律失常很少。结论 :只要术前将血压、心率控制在安全范围内 ,避免危险性心律失常及心功能不全等高危因素 ,高血压病患者拔牙是安全的。     

心血管病患者拔牙的临床观察

目的：探讨心血管疾病患拔牙的可行性及方法。方法：收集153例心血管疾病患，经术前充分准备后拔牙，观察心率、血压的变化。结果：152例患拔牙基本顺利，但有不适，经对症处理症状消失。结论：心血管疾病经术前充分准备后拔牙是安全、可行的。     

不同高血压危险分层患者拔牙术的前瞻性分析

目的通过观察门诊不同危险分层高血压病患者在心电监护下拔牙过程中心率、血压及心电图的变化,对高血压患者拔牙的安全性进行前瞻性分析评价,并决定是否继续手术。方法对29例高血压患者进行危险分层,分为低危、中危、高危、很高危四组,在拔牙过程中进行全程心电监护,观察拔牙过程中血压、心率及心电图的变化。结果拔牙过程中,血压在麻醉时及术中明显升高（P〈0．05）,无论危险分层情况,即使术中血压上升,也很少超过180／100mmHg,即手术血压的危险界限。拔牙过程中,平均动脉压略有波动,但变化不大（P〉0．05）,心率加快但不明显（P〉0．05）,未见危险性心律失常。结论只要术前将血压、心率控制在安全范围内,避免危险性心律失常及心功能不全等高危因素,高血压患者拔牙是可行的。     

复合心理干预下拔牙对心血管患者畏惧心理血压和心率影响的效果观察

目的 探讨复合护理干预下拔牙对心血管患者焦虑状态血压和心率影响的效果观察.方法 筛选需拔牙心血管患者356例,应用牙科焦虑量表(MDAS)进行焦虑程度测评,分别在术前30分钟、10分钟接受复合护理干预,术后进行焦虑程度测评;术前10分钟、心理干预后和术后10分钟分别测取血压和心率,分析其牙科焦虑程度和心血管指数的波动.结果 患者术前30分钟焦虑程度明显低于术前10分钟(P＜0.05),显示术前10分钟是患者最焦虑状态.在拔牙过程中,心血管患者接受心理干预后他们的牙科焦虑指数,血压和心率均有较大的下降(P＜0.05).结论 复合心理干预能有效地缓解心血管患者的焦虑情绪,提高拔牙术的安全性.     

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.