乙状结肠代人工阴道手术前后护理

阴道发育异常的病理类型较多，常见的有阴道发育不良、双阴道、阴道闭锁和先天性无阴道等[1]。我院妇科自1992年4月至1997年10月，以乙状结肠代人工阴道成形术治疗先天性无阴道13例，取得满意效果，现将护理体会总结如下。一、病例资料本组13例，年龄22～28岁，平均25岁。13中先天性无阴道无子宫10例，先天性无阴道幼稚型子宫3例，均具有女性第二性征。13例均采用乙状结肠代人工阴道成形术，全部成功，性生活较为满意，未发生直肠、膀眈损伤，无肠瘘形成。出院时阴道深7～10cm，能容纳2指。二、术前护理1心理护理：此类患者因婚后性生活障碍…     

乙状结肠代阴道成形术围手术期的护理

目的:探讨乙状结肠代阴道成形术围手术期护理方法。方法:对4例先天性无阴道、行乙状结肠代阴道成形术的患者从手术前准备,手术后病情观察、饮食护理、会阴部护理、尿管护理、阴道模具的放置与护理等方面进行观察和护理。结果:4例患者中2例已结婚,婚后夫妻性生活满意。结论:乙状结肠代阴道成形术可解决先天无阴道患者生理需要和心理痛苦,高质量精心的护理是手术后恢复及保证手术效果的重要环节。     

乙状结肠移植人工阴道成形术9例

目的：对9例先天性无阴道患者行乙状结肠移植人工阴道成形术。方法：采用肠段切除，阴道造穴等手术方法。结果：术后无并发症，随访人工阴道在外观及功能上极似自然阴道、夫妇性生活满意。结论：采用乙状结肠进行人工阴道成形术成功率高，具有广泛前景。     

乙状结肠人工阴道成形术患者的护理

乙状结肠阴道成形术是利用一段带有肠系膜的乙状结肠旷置肠段覆盖于人造阴道穴腔,治疗先天性无阴道患者.乙状结肠长、宽度适当,粘膜皱壁良好,柔软湿润,常有少许粘性分泌物,取之用于阴道成形术,术后患者不必带阴道模型,性生活较满意.我院于2003年11月首次为1例先天性无阴道患者进行乙状结肠人工阴道成形术,术后效果满意,现将护理方法介绍如下.     

两种阴道成形术临床效果比较和护理方式探讨

目的比较两种阴道成形术临床效果,探讨科学的护理方式。方法回顾我院20例先天性无阴道患者的临床资料,进行手术时间、出血量、术后住院天数比较和护理方式探讨。结果两组20例患者经过手术及科学的护理方式,人工阴道成型均成功,性生活大部分满意。结论腹腔镜下腹膜代阴道成形术临床相对效果优于乙状结肠代阴道术,是值得推荐的手术方法。     

腹腔镜下腹膜代阴道与乙状结肠代阴道成形术的疗效分析

目的 探讨腹腔镜下腹膜代阴道成形术与乙状结肠代阴道成形术对无阴道患者的疗效差异.方法 对38例2010年1月至2014年12月西南医院妇产科收治的无阴道患者术前随机化完全区组设计进行腹腔镜下腹膜代阴道成形术(17例)和乙状结肠代阴道成形术(21例),对比分析2组患者的围手术期情况及术后随访疗效.结果 腹膜代阴道成形术组手术时间、术中出血量、术后肛门排气及进食时间优于乙状结肠代阴道成形术组(P＜0.01),但乙状结肠代阴道成形术组阴道长度优于腹膜代阴道成形术组(P＜0.01),腹膜代阴道成形术组需术后长时间放置阴道模具.2组患者均未发生手术并发症,阴道通畅、红润,有6例乙状结肠代阴道患者阴道分泌物较多,但对性生活满意程度和阴道成形效果差异无统计学意义(P＞0.05).结论 腹腔镜下腹膜代阴道成形术与乙状结肠代阴道成形术均可取得良好的预期疗效,腹腔镜腹膜代阴道成形术后放置模具扩张阴道更严格,但手术创伤小于乙状结肠代阴道成形术,手术各自的优势可实现先天性无阴道患者的个体化治疗.     

乙状结肠人工阴道成形术治疗先天性无阴道临床分析

目的探讨乙状结肠人工阴道成形术治疗先天性无阴道的治疗效果.先天性无阴道患者手术术式有多种,如游离皮瓣移植、羊膜移植、腹膜移植等,以上术式共同缺点是术后人工阴道不同程度狭窄及干涩.我院近年采用乙状结肠人工阴道成形术,该术式具有术后无需佩戴模具、1月后可性生活、人工阴道宽度合适、有分泌功能等优越性,治疗效果好.方法总结我院近5年来收治的先天性无阴道患者共6例,采用的治疗术式均为乙状结肠人工阴道成形术.6例患者均选择在即将结婚时机治疗.结果6例先天性无阴道患者,经过手术方式再造人工阴道,解决了患者性角色及性生活问题.6例患者手术全部成功,出院检查外阴伤口愈合好,阴道可容纳2横指,1月后随访阴道及外阴口无萎缩,阴道有分泌物,随访6-12月性生活较满意.结论乙状结肠人工阴道成形术用于治疗先天性无阴道患者,其手术方式具有明显的优越性,治疗效果好,定期的阴道扩张是预防阴道萎缩的关键.     

乙状结肠代阴道成形术的护理

乙状结肠代阴道成形术的护理王晨美我科１９９５年收治的２例先天性无阴道患者均采取了乙状结肠代阴道成形术，并收到了良好效果。１临床资料例１：患者，女，２３岁。青春期后无月经，无周期性腹痛。妇科检查：尿道口下方有一处女膜环，无阴道，无子宫。例２：患者，女，...     

3种阴道成形术的比较及远期效果评价

目的比较3种阴道成形术的优缺点，并评估其远期效果，为合理选择术式提供参考。方法回顾21例先天性无阴道患者的临床资料及手术情况，根据患者的复诊及信访，了解接受阴道成形手术患者对术后阴道分泌物性状、性生活满意度并进行效果评估。结果乙状结肠代阴道法手术时间长，术中出血多，术后个别有肠黏膜脱垂及时有腹痛发生，但分泌物较多，5例患者性生活满意的有3例。羊膜代阴道法手术方法简单，手术时间短，出血少，但术后易发生阴道孪缩，5倒患者中有1例性生活满意。阴股沟皮瓣法手术时间适中，出血量少，术后恢复较快。7例患者性生活均满意。结论阴股沟皮瓣阴道成形术是3种术式中较理想的术式。     

乙状结肠代阴道成形术16例体会

目的探讨乙状结肠代阴道成形术的手术和术后处理方法。方法对16例先天性无阴道患者行乙状结肠代阴道成形术的手术情况和术后处理进行分析。结果16例手术成功率100%,人工阴道在外观及功能上似自然阴道,随访6个月～3年,夫妻生活满意。结论乙状结肠代阴道成形术是治疗先天性无阴道畸形的理想手术方法。     

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.