Arista AH对肝肿瘤切除残肝断面止血效果及安全性探讨

目的:评估Arista AH对在肝肿瘤切除残肝断面渗血的止血效果及安全性.方法:收集因肝右叶肝癌在我院行肝肿瘤切除术并应用Arista AH止血33例(Arista AH组)及不用Arista AH止血28例(常规组);对比两组术后5 min内止血成功率、肝门累计阻断时间、术后3 d内每天腹腔引流量;胆漏、膈下感染、胸腔积液发生率,术后体温恢复正常时间.结果:常规组5 min止血成功率低于Arista AH组(P<0.05)、肝门阻断时间长于Arista AH组(P<0.05)、胸腔积液发生率高于Arista AH组(P<0.05);术后3 d内每天腹腔引流量、胆漏、膈下感染、术后体温恢复正常时间无明显差异(P>0.05).结论:Arista AH控制肝肿瘤切除断面渗血安全有效,缩短肝门阻断时间,不增加并发症及不良反应的发生.     

多微孔多聚糖止血球控制门静脉高压手术创面活动性出血的疗效

目的:观察多微孔多聚糖止血球(microporous polysaccharide hemospheres,MPH)控制门静脉高压手术创面活动性出血的效果和安全性.方法:因门静脉高压行断流手术治疗的45例患者,随机分为标准组、试验组和对照组,各15例,标准组于手术中采用常规外科手术方法止血;试验组、对照组分别使用MPH、明胶海绵作为术中止血剂,无法控制出血者加用外科方法止血,术后24 h继续观察患者的恢复情况.结果:标准组、试验组5 min止血成功率分别为86.7%、73.3%,两组间无显著性差异;对照组(40.0%)与标准组、试验组相比有显著差异(P<0.05).3组均无不良反应发生.结论:MPH具有快速、可靠、安全的止血效果,在外科手术中可以作为辅助止血装置使用.     

优质的体位护理在脊柱后路手术中的应用价值

目的评价优质的体位护理在脊柱后路手术中的应用价值。方法将采用脊柱后路手术的138例患者分成观察组和对照组,每组69例,在手术中分别采用优质的体位护理和常规护理方法,比较术中术后并发症发生率及医师满意率。结果观察组并发症发生率为2.9%,对照组并发症发生率15.9%,观察组并发症发生率低于对照组(P<0.05)。观察组医师满意率为98.6%,对照组医师满意率为79.7%,观察组医师满意率明显高于对照组(P<0.05)。结论优质的体位护理既能减少脊柱后路手术相关并发症的发生,也利于术者操作,提高手术的流畅性及安全性。     

临床护理路径对脊柱外科患者治疗中的效果观察

目的探讨临床护理路径对脊柱外科患者治疗中的效果。方法胸腰段脊柱不稳定患者120例根据护理方法的不同分为治疗组与对照组,每组60例,两组都采用经后路手术治疗,对照组按照常规护理模式,治疗组按制定好的临床路径实施每日的护理计划。结果:两组治疗后脊柱后凸角矫正角度都有明显降低(P<0.05),同时两组之间对比差异无统计学意义(P>0.05)。治疗组的时间、术中出血量与住院费用明显少于对照组(P<0.05)。结论脊柱不稳定经后路手术治疗有比较好的效果,临床护理路径的配合能有效降低创伤,减少住院费用,值得推广应用。     

B-Lynch缝合术在剖宫产术中产后出血的临床应用

目的 评价B-Lynch缝合术治疗剖宫产术中宫缩乏力性产后出血的止血效果.方法 回顾性分析剖宫产术中宫缩乏力性产后出血31例,观察组16例应用B-Lynch缝合术治疗,对照组15例行宫腔纱布填塞,比较两组手术时间、产后出血量、治疗效果及产褥病率.结果 两组疗效均显著,但观察组手术时间短,产后出血少,产褥病率低,与对照组比较差异显著.结论 B-Lynch缝合术止血迅速有效,操作简单,并发症少,是治疗剖宫产术中产后出血的较好方法.     

自制可控性吸引管在腹腔镜手术烟雾吸除中的应用

目的探讨自制可控性吸引管在腹腔镜手术电外科烟雾吸除中的应用效果。方法将60例普外科腹腔镜手术患者随机分为对照组和观察组各30例,对照组采用传统的方法,将一次性吸引连接管经trocar侧孔吸引去除腹腔镜手术中电外科烟雾;观察组采用自制可控性吸引管经trocar侧孔吸引去除腹腔镜手术中电外科烟雾。比较两种不同的吸雾方法在腹腔镜手术中对手术医生止血操作的干扰率、手术创面止血时间及手术耗材成本。结果观察组腹腔镜手术中电外科烟雾吸除操作对手术医生止血操作的干扰率、手术创面止血时间及手术耗材成本均低于对照组,两组比较,差异有统计学意义(P0.05)。结论自制可控性吸引管能快速去除腹腔镜手术中电外科烟雾,保持手术野清晰,避免手术医生因吸除电外科烟雾而对术中止血操作的干扰,提高手术安全性,减少了手术耗材费用。     

术中体位规范化护理在脊柱后路手术患者中的应用效果

目的:观察术中体位规范化护理在脊柱后路手术患者中的应用效果。方法:选取124例行脊柱后路手术患者作为研究对象,采取随机数字表法将其分为对照组与观察组各62例。对照组术中予以常规护理,观察组在对照组基础上给予体位规范化护理。比较两组护理满意度和并发症发生情况。结果:观察组并发症发生率明显低于对照组,护理满意度明显高于对照组,差异均有统计学意义(P<0.05)。结论:在常规护理基础上,术中体位规范化护理可有效减少并发症和提高护理满意度的效果优于单纯常规护理效果。     

面部涂抹粘多糖应用于俯卧位下脊柱手术中对压疮防治的研究

目的:探究涂抹和不涂抹粘多糖在俯卧位下脊柱手术中的临床效果观察.方法:2015年11月-2017年8月收治的80例脊柱后路俯卧位手术患者,随机分为对照组和试验组,对照组不涂抹粘多糖,试验组涂抹粘多糖.然后术后观察术后压疮的发生率及恢复能力,并对比两组患者的满意度.结果:对照组压疮发生率为46%,高于试验组的6%,比较差异有统计学意义(P<0.05).结论:面部涂抹粘多糖应用于俯卧位下脊柱手术中对压疮的防治疗效显著,并具有较好的临床应用价值.     

脊柱骨折后路手术内固定治疗的效果初评

目的：研究脊柱骨折后路手术内固定治疗的效果。方法研究资料方便选自2013年6月—2015年2月该院收治的脊柱骨折患者100例,根据随机数字表法,分为两组,后路术组和常规术组。常规术组施以传统手术;后路术组施以脊柱骨折后路手术内固定手术。就两组患者实施前后疼痛评分﹑Cobb角和手术优良率进行比较。结果后路术组手术优良率高于常规术组,χ2检验显示差异有统计学意义,P<0.05。术前两组疼痛评分﹑Cobb角差异不大,P>0.05;术后后路术组患者疼痛评分﹑Cobb角优于常规术组,t检验显示差异有统计学意义,P<0.05。结论脊柱骨折后路手术内固定治疗的效果确切,可有效减轻患者痛苦,提高患者骨折后康复优良率,值得推广。     

难治性产后出血止血手术26例

目的:探究难治性产后出血止血手术的临床效果。方法:回顾性分析46例难治性产后出血患者,按治疗方法分为两组,对照组采用常规子宫压迫缝合术进行止血,观察组采用血管介入治疗的方法进行止血,比较两组患者的治疗效果和术后并发症的发生情况。结果:观察组患者的治疗效果明显优于对照组,观察组患者术后并发症的发生率低于对照组。结论:血管介入治疗术相比常规子宫缝合术治疗难治性产后出血疗效更显著,手术安全性较高。     

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.     

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.     

Notes for contributors to Journal of Nanjing Medical University

Journal of Nanjing Medical University (English Edition) JNMU, sponsored by Nanjing Medical University, was established in 1987. It is a bimonthly comprehensive English medical journal published locally and abroad.Since 2007, Journal of Nanjing Medical University (English Edition )was granted Elsevier the full publishing and distribution rights worldwide for the Electronic Edition, excluding the People's Republic of China.