90例精神分裂症患者睡眠呼吸暂停的初步研究

目的探讨精神分裂症患者睡眠呼吸暂停事件的发生率及严重程度.方法应用英国Oxford工厂生产的Medilog多导睡眠图记录仪,对90例精神分裂症住院病人和正常人对照进行整晚的多导睡眠图记录.结果精神分裂症患者与正常人对照中睡眠呼吸暂停的发生率均较高,两组间无显著差异(P>0.05);女性精神分裂症患者的发生率略高(男:女为1:1.13),与正常对照中男性的发生率(1.16:1)较高的趋势有所不同;女性患者中睡眠呼吸暂停的严重程度明显增加.结论精神科临床中应注意睡眠呼吸暂停的存在与危害性;不同性别中睡眠呼吸暂停的发生率和严重程度有所差异,具体机制和意义有待进一步研究.     

睡眠呼吸暂停综合征与脑血管病的临床观察

目的：分析睡眠呼吸暂停综合征在脑血管病患者中的发生率。方法：选择2011年10月～2014年1月我科住院及门诊105例脑血管病患者,采用多导睡眠图进行睡眠呼吸检查方法。结果：105例患者中有82例患者患有睡眠呼吸暂停综合征,发生率为78．10％。存在睡眠呼吸暂停综合征患者AHI为26．31±18．51次/h,平均SaO2（9．056±4．31）％,最低SaO2（76．52±4．31）％,低氧时间27．11±23．55小时;不存在睡眠呼吸暂停综合征AHI为4．56±4．32次/h,平均SaO2（95．62±4．38）％,最低SaO2（86．95±4．31）％,低氧时间7．04±13．11小时,各指标差异均有统计学意义（ P＜0．05）。结论：睡眠呼吸暂停综合征在脑血管病患者中发病机率高,此病对人的身体有严重影响。     

老年慢性充血性心力衰竭与睡眠呼吸障碍的关系

目的 了解老年慢性充血性心力衰竭（心衰）患者睡眠呼吸障碍的发生情况,并探讨不同程度睡眠呼吸障碍与左心功能的关系。方法 入选56例老年慢性心衰患者,行多导睡眠图（PSG）检测,根据PSG检测结果,将老年慢性心衰患者分为正常、轻度、中度、重度睡眠呼吸障碍4组,用平衡法放射核素心室造影测定左心室射血分数（LVEF）。结果 老年慢性心衰患者睡眠呼吸暂停综合征（SAS）的发生率为67．9％,其中心衰合并轻度、中度、重度SAS的发生率分别为21．4％、25．0％和21．4％,SAS发生的类型以阻塞性睡眠呼吸暂停多见,发生率为53．6％,中枢性睡眠呼吸暂停占7．1％．混和性睡眠呼吸暂停占39.3％。心衰合并中度、重度睡眠呼吸障碍组与单纯心衰组相比。LVEF较低,夜间平均血氧饱和度较低。睡眠呼吸暂停／低通气指数与LVEF呈负相关（γ=-0．74,P〈0．01）。结论 老年慢性充血性心衰患者睡眠呼吸障碍的发生率高,严重睡眠呼吸障碍可能影响左心功能,应重视老年慢性心衰患者睡眠呼吸障碍的诊治。     

悬雍垂腭咽成形术治疗阻塞性睡眠呼吸暂停低通气综合征130例分析

目的探讨阻塞性睡眠呼吸暂停低通气综合征（Obstructive Sleep Apea-Hypopnea Syndrome．OSAHS．）患者行悬雍垂腭咽成形术（Uvu-lopalalophanyngoplasty,UPPP）后的疗效分析和总结。方法选取经多导睡眠图（Polysonmgraphy。PsG）检查并确诊的OSAHS的患者120例行UPPP手术,根据其术前及术后整夜多导睡眠图aPSG）检查结果作自身对照分析。结果术后随访六个月。120例OSAHS患者中。术后较术前PSG监测指标（呼吸暂停总时间（A1）、呼吸暂停及低通气指数（AHI）、最低血氧饱和度（SaO2）有显著性差异。结论UPPP手术治疗OSAHS是目前最有效的方法之一。     

睡眠呼吸暂停事件的睡眠时相调查

目的 探讨睡眠呼吸暂停事件与睡眠时相的关系。方法 分析68例健康志愿者的多导睡眠图资料,确定睡眠呼吸暂停事件发生的睡眠时相。结果 睡眠呼吸暂停事件在睡眠各期均可出现,但多见于浅睡眠期,以2期最明显。呼吸暂停发生的睡眠时相分布在个体发生次数的多少、不同呼吸暂停程度及男、女性别之间无明显差异（P＞0．05）。结论 睡眠呼吸暂停事件明显多见于浅睡眠期,具体原因有待进一步探讨。     

230例打鼾患者多导睡眠图分析

目的 探讨多导睡眠图（PSG）对睡眠呼吸暂停综合征（SAS）的诊断价值及睡眠呼吸暂停综合征（SAS）对睡眠结构，血氧，心血管系统的影响。方法 对230例打鼾患者进行多导睡眠图监测。结果 230例诊断SAS108例（46.9%),单纯鼾症（SS）122例，SAS与SS组两组相比在睡眠结构，呼吸紊乱，血氧，心血管系统变化等差异有显著性。结论 PSG是诊断SAS，判定病情程度，指导治疗的一种良好方法。     

OSAHS患者的临床和多导睡眠图的性别差异分析

目的:探讨阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者的临床症状及多导睡眠图等方面的性别差异。方法:回顾性分析1 371例经整夜的多导睡眠监测(PSG)确诊为OSAHS的连续病例。比较 男性和女性OSAHS患者在人口统计学、临床症状和多导睡眠图参数的差异。结果:与男性OSAHS患者相比,女性年龄较大（P＜0.05）,颈围较小（P＜0.001）。女性患者多见晨起头痛（P＜0.05）、失眠 （P＜0.001）及记忆力减退（P＜0.001）症状。不同严重程度的OSAHS患者中,女性的颈围均小于男性（P＜0.001）。不同肥胖程度的OSAHS患者中,女性的AHI小于男性（P＜0.01）。结论:与男性OSAHS 患者相比,女性患者诊断时年龄较大,颈围较大,疾病严重程度较低,缺氧程度较低,睡眠结构较好,多表现出夜尿多、失眠及记忆力减退症状。     

脑梗死与睡眠呼吸暂停综合征的关系

目的：对我院神经内科收治的脑梗死住院患者进行睡眠呼吸暂停综合征（SAS）的初步调查，并探讨不同部位缺血性脑卒中与不同类型SAS的关系。方法：入选确诊的脑梗死患者55例，根据神经影像学检查结果分为前循环脑梗死组26例，男18例，女8例，年龄42．80岁；前循环合并后循环脑梗死组22例，男16例，女6例，年龄53-80岁；后循环脑梗死共7例，男5例，女2例，年龄62-73岁。对所有入选患者进行多导睡眠仪监测，并对严重的低氧血症患者进行夜间血氧监测。结果：前循环脑梗死组和前循环合并后循环脑梗死组的呼吸暂停低通气指数（AHI）之间无显著性差异P〉0．05（P=0733）。结论：脑梗死的部位与睡眠呼吸暂停综合征的严重程度可能无关。     

鼾症病人中SAS与高血压病关系初探

目的探讨如何在高血压门诊时尽早发现中重度睡眠呼吸暂停综合征（SAS）患者。方法将73例打鼾患者分为高血压组和无高血压组，进行多导睡眠仪（PSG）监测，观察睡眠呼吸暂停低通气指数（AHI）结果，判定SAS的轻重程度，并进行比较。结果鼾症患者中高血压组SAS频率分布与无高血压组相比有显著性差异（P〈0．05），鼾症患者中高血压组SAS轻重程度频率分布与无高血压组相比其构成有显著性差异（P〈0．05），且高血压组中、重度SAS频率显著高于无高血压组的频率。结论鼾症病人在合并高血压时，易发生睡眠呼吸暂停，睡眠呼吸暂停的程度较重，由此可以认为高血压患者存在夜间打鼾，就应警惕SAS的存在，需进行PSG监测检查，尽早诊断、及早治疗睡眠呼吸暂停综合征，从而更好地控制血压。     

阻塞性睡眠呼吸暂停患者临床表现与上气道阻塞部位关系的探讨

目的 观察一组AHI接近的阻塞性睡眠呼吸暂停综合征（OSAS）患者中上气道阻塞部位对多导睡眠监测（PSG）图及临床表现的影响。方法选取36例AHI为30—40的成年男性OSAS患者行再次整夜PSG，加同步上气道及食道压力监测确定上气道最低阻塞部位。比较上气道最低阻塞部位在软腭水平、舌根水平和下咽水平的不同患者中PSG相关参数：平均SaO2、最低SaO2、最长阻塞性呼吸暂停事件时间、呼吸暂停事件中SaO2下降率（dSaO2／dt）、微觉醒指数；以及部分临床表现参数：白日嗜睡程度、入睡前收缩压／清晨收缩压、入睡前舒张压／清晨舒张压以及高血压发生率。结果平均SaO2、最长阻塞性呼吸暂停事件时间和入睡前收缩压／清晨收缩压比值在3种不同上气道最低阻塞部位患者中差异无显著性（P〉0．05），但与软腭水平相比，舌根水平和下咽水平的最低Sa02降低（P〉0．05），dSaO2／dt（％／s）比值增高（P〈0．05），微觉醒指数及白日嗜睡评分增高（P〈0．01），入睡前舒张压／清晨舒张压比值降低（P〈0．05），最低SaO2〈80％的发生率增高（P〈0．01）以及高血压的发生率增高（P〈0．01）。结论AHI接近的OSAS患者上气道阻塞部位在舌根水平以下者与软腭以上水平者相比，阻塞性呼吸暂停事件的致缺氧效率和程度提高，OSAS的临床表现加重。     

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.