急性重型颅脑创伤患者亚低温治疗的临床研究

目的 探讨亚低温治疗急性重型颅脑创伤患者的疗效.方法 将129例急性重型颅脑创伤患者分为亚低温组64例和常温组65例.观察并比较两组患者入院后颅内压及GCS评分变化、并发症发生率、肌酸激酶同工酶MB（CK-MB）及C-反应蛋白（CRP）水平变化.结果 亚低温组第1、3天颅内压与常温组比较差异有显著性;第7天比较差异无显著性.亚低温组GCS评分在第3、7、14天均高于常温组.亚低温组CK-MB及CRP水平下降程度优于常温组.亚低温组并发症和预后有效率与常温组比较差异有显著性.结论 亚低温治疗可改善急性重型颅脑创伤患者的预后,疗效确切.     

重型颅脑损伤亚低温治疗46例临床观察

目的 研究亚低温治疗对重型颅脑损伤患者疗效及预后的影响.方法 回顾性分析46例重型颅脑损伤患者,随机分为亚低温治疗组（n＝23）及常温治疗组（n＝23）.亚低温组接受体温控制在32℃～35℃的亚低温治疗,常温治疗组除亚低温治疗外,其余治疗与亚低温组相同.比较两组患者的颅内压（intracranial pressure,ICP）、并发症及预后的差异.结果 亚低温治疗组伤后ICP显著低于常温治疗组（P＜0.01）.应激性溃疡、肝肾功能异常和外伤性癫痫的发生率显著低于常温治疗组（P＜0.01）;预后显著优于常温治疗组（P＜0.05）.结论 亚低温治疗能显著降低重型颅脑损伤患者的高颅压,减少并发症,改善预后和提高生活质量.     

亚低温治疗重度颅脑损伤的疗效分析

目的　为评价亚低温在重度颅脑损伤中的治疗作用。方法　对 5 6例重度颅脑损伤患者中的亚低温治疗者 2 2例与随机抽取的 2 6例常温治疗者进行对比分析。结果　经亚低温治疗的重度颅脑损伤患者在提高存活率、降低颅内压等指标方面与对照组有显著差异。结论　亚低温可有效降低重度颅脑损伤患者的死亡率、降低颅内压 ,是重度颅脑损伤治疗中的一种重要方法。     

亚低温在治疗重型颅脑损伤的应用

目的:探讨亚低温治疗重度颅脑损伤的临床疗效。方法:将本科2004年1月至2005年6月收治的100例重型颅脑损伤患者随机分为亚低温治疗组和常温对照组各50例。前者在常规治疗的基础上加亚低温治疗;后者仅进行常规治疗,与之对照比较。结果:两组在预后、血糖、电解质等指标方面差异均有显著性。结论:亚低温能降低重型颅脑损伤患者的死亡率,改善预后。     

64例重型颅脑损伤亚低温治疗疗效观察

目的分析研究亚低温治疗重型颅脑损伤患者的临床疗效。方法将64例重型颅脑损伤患者(GCS≤8分)随机分为亚低温治疗组和常温组,每组32例。常温组给予常规治疗,亚低温组在常规治疗的基础上于伤后24h内给予亚低温治疗,直肠温度控制在32.5℃-34.5℃,持续2-3d后复温。结果亚低温治疗组病死率、重残率均低于常温组,总有效28例(87.5%),死亡4例(12.5%),与常规治疗组进行对比,差异有显著的统计学意义(P0.05)。结论对重型颅脑损伤患者实施亚低温治疗,研究结果证明此方法是一种有效、副作用少且便于实施的治疗方法,具有改善脑损伤患者的预后,提高患者生存质量的作用。     

亚低温治疗对重型颅脑创伤后递质类氨基酸释放的影响

目的从临床角度研究亚低温疗法对颅脑创伤患者脑脊液EAA含量的影响并探讨亚低温脑保护的机理。方法急性重型颅脑创伤患者分为常规治疗组和亚低温治疗组各30例,两组均于伤后第1d、第列、第7d采集脑脊液样本,对代表EAA的天冬氨酸（Asp）、谷氨酸（Olu）进行定量分析．数据经统计学处理。结果亚低温组与常规组比较,脑脊液中Asp、Olu浓度在治疗第一天无显著差异,但在后面的第三天和第七天两组显示出显著差异。结论经过亚低温治疗,重型颅脑创伤患者神经系统中EAA的释放得到明显抑制。     

亚低温治疗对重型颅脑创伤后递质类氨基酸释放的影响

目的 从临床角度研究亚低温疗法对颅脑创伤患者脑脊液中EAA含量的影响并探讨亚低温脑保护的机理.方法 急性重型颅脑创伤患者分为常规治疗组和亚低温治疗组各30例,两组均于伤后第1d,第3d、第7d采集脑脊液样本,对代表EAA的天冬氨酸(Asp)、谷氨酸(Glu)进行定量分析,数据经统计学处理.结果 亚低温组与常规组比较,脑脊液中Asp、Glu浓度在治疗第一天无显著差异.但在后面的第三天和第七天两组显示出显著差异.结论 经过亚低温治疗,重型颅脑创伤患者神经系统中EAA的释放得到明显抑制.     

亚低温治疗重型颅脑损伤的护理体会

目的探讨亚低温治疗重型颅脑损伤患者的临床疗效及护理措施。方法将86例重度颅脑外伤患者随机分为观察组和对照组各43例。观察组给予亚低温治疗和相应护理措施,对照组给予常温治疗。结果亚低温治疗组的死亡率显著低于对照组,而生存质量良好者明显多于对照组（P〈0.05）。结论亚低温是重型颅脑损伤患者的重要治疗方法,疗效显著,治疗期间的观察与护理非常重要,可显著改善患者的预后。     

亚低温及高压氧在重度颅脑创伤中的治疗作用研究

目的:探究亚低温及高压氧在重度颅脑创伤中的治疗作用。方法:选取2016年2月-2017年6月我院收治的124例重度颅脑创伤患者作为研究对象,随机分为观察组与对照组,对照组患者采用亚低温治疗,观察组患者采用亚低温联合高压氧治疗,对比2组患者预后及自理情况。结果:观察组患者良好率显著高于对照组(P0.05),死亡率明显低于对照组(P0.05);2组患者治疗后ADL均较治疗前显著升高(P0.05),且观察组高于对照组(P0.05)。结论:亚低温及高压氧联合治疗重度颅脑创伤可有效改善预后,提高患者自理能力。     

用诱发电位检测亚低温对高温高湿环境下特重型颅脑伤的疗效

目的通过诱发电位(EP)监测,探讨亚低温对高温高湿环境下特重型颅脑伤的疗效。方法选择受伤后在高温高湿环境下(≥32℃,RH≥80%)8h内入院的特重型颅脑伤患者(GCS≤5)60例,患者随机分为亚低温组(n=30)和常温组(n=30)。亚低温组体温降至33~35℃,于降温前、降温过程中及复温后监测正中神经短潜伏期体感诱发电位(SLSEP)和脑干听觉诱发电位(BAEP):常温组在同样的时间段监测上述指标。统计分析亚低温组与常温组诱发电位的变化情况。结果亚低温组在治疗后SLSEP的N20波同变化值为(0.87±0.52)μV,常温组为(0.61±0.49)μV,两者有显著性差异(P<0.05):BAEP的V/I波幅比值,差异显著性(P<0.05)。结论从神经电生里角度来看,亚低温对GCS为3~5分的高温高湿环境下特重型颅脑伤有较好疗效。     

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.     

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.