中医药对微创保胆取石后预防胆囊结石复发的研究

目的：采用中医药方法，降低微创保胆内镜取石术后患者胆囊结石的复发。方法：将135例行微创保胆取石术后患者，随机分成对照组与防石胶囊组及防石胶囊加推按运经仪组，每组45例，分别予不同治疗，观察胆囊壁的厚度及胆囊收缩功能的变化；结果：防石胶囊加推按运经仪组胆囊壁厚度明显变薄，胆囊收缩功能明显增强，其次为防石组，最后为对照组（P〈0．001），对照组有2例结石复发；结论：该治疗方法能减轻或消除胆囊壁的炎症，增强胆囊的收缩功能，有助于防止胆囊结石的复发。     

胆胃舒颗粒联合脐针治疗肝胆气滞型慢性胆囊炎的临床观察

【目的】观察胆胃舒颗粒联合脐针治疗肝胆气滞型慢性胆囊炎的临床疗效,并探讨其对胆囊功能、血清肿瘤坏死因子α(TNF-α)和瘦素(LEP)水平的影响。【方法】将100例肝胆气滞型慢性胆囊炎患者随机分为观察组和对照组,每组各50例。对照组给予口服胆胃舒颗粒治疗,观察组给予胆胃舒颗粒联合脐针治疗,疗程为1个月。观察2组患者治疗前后中医证候评分、胆囊收缩功能、胆囊壁厚度、血清TNF-α和LEP水平的变化情况,评价2组患者的临床疗效。【结果】(1)治疗期间,观察组与对照组均脱落2例,实际完成试验各48例,占入组病例的96%。(2)治疗1个月后,观察组的总有效率为93.75%(45/48),对照组为79.17%(38/48),组间比较,观察组的疗效优于对照组,差异有统计学意义(P 0.05)。(3)治疗后,2组患者的胆囊壁厚度均较治疗前缩小,胆囊收缩功能均较治疗前增强(P 0.05),且观察组对胆囊壁厚度的缩小作用及对胆囊收缩功能的增强作用均明显优于对照组,差异均有统计学意义(P 0.05)。(4)治疗后,2组患者血清TNF-α和LEP水平均较治疗前明显降低(P 0.05),且观察组对血清TNF-α和LEP水平的降低作用均明显优于对照组,差异均有统计学意义(P 0.05)。【结论】胆胃舒颗粒联合脐针治疗肝胆气滞型慢性胆囊炎患者疗效确切,能有效缓解临床症状、改善胆囊收缩功能、减小胆囊壁厚度、下调TNF-α和LEP水平,其疗效优于单独应用胆胃舒颗粒治疗。     

胆胃舒颗粒治疗胆囊息肉临床观察

目的:观察胆胃舒颗粒治疗胆囊息肉的临床疗效。方法:本研究60例患者均经彩超检查确诊为胆囊息肉,所有患者均予胆胃舒颗粒口服治疗。疗程为3个月。结果:治愈24例,有效28例,无效6例,中途改手术治疗2例,总有效率达89.7%。结论:胆胃舒颗粒治疗胆囊息肉疗效显著,值得推广。     

内镜微创保胆取息肉术治疗胆囊息肉的研究

目的:探讨内镜微创保胆取息肉术治疗胆囊息肉的效果。方法:选取我院2014年8月至2016年4月收治的胆囊息肉患者114例作为研究对象,随机分为观察组和对照组,各组57例。对照组采用腹腔镜胆囊切除术,观察组采用内镜微创保胆取息肉术。观察两组患者术中出血量、手术时间、胃肠功能恢复时间、住院时间、胆囊壁厚度、胆囊收缩功能改善情况以及发生不良反应情况。结果:观察组患者术中出血量明显比对照组少(P0.05);观察组患者手术时间、胃肠功能恢复时间、住院时间均显著比对照组短(P0.05);观察组患者胆囊壁厚度及胆囊收缩功能改善情况比对照组好(P0.05);观察组患者不良反应发生率明显比对照组低(P0.05)。结论:内镜微创保胆取息肉术治疗胆囊息肉的效果明显,明显降低不良反应发生率,值得应用及推广。     

保胆取石术后口服舒胆浓缩液促进胆囊功能恢复的临床观察

目的 观察保胆取石术后口服中药制剂舒胆浓缩液促进胆囊功能恢复的临床疗效.方法 选择60例保胆取石术后的患者,运用随机数字表法,将观察对象按就诊顺序编号,随机分为治疗组和对照组两组,每组30例.治疗组术后服用舒胆浓缩液每次50 mL,每日2次,连续服用30 d;对照组术后服用熊去氧胶囊每次500mg,每日2次,连续服用30 d.两组服药并观察1个月,1个月后行超声检查患者胆囊壁厚度及胆囊收缩功能,并进行中医证候的主要症状评分,比较评判两组患者的疗效.结果 经过一个月服用药物后,治疗组患者胆囊超声示胆囊壁厚度、胆囊收缩功能,以及中医证候的主要症状评分均较对照组恢复明显,两组间比较差异有显著性(P＜0.05).治疗组中医证候的主要症状疗效以及胆囊B超的疗效比较均高于对照组的总有效率,两组间比较差异有显著性(P＜0.05).结论 保胆取石术后口服舒胆浓缩液对于促进胆囊功能的恢复疗效确切,值得临床推广.     

电针远近取穴干预胆石症保胆取石术后恢复研究

目的：探讨电针远、近部取穴对胆石症保胆取石术后恢复情况及其差异性。方法将80例胆石症保胆取石术后患者采用随机数字表法随机分为对照组、远部组、近部组以及联合组各20例。对照组予西医常规术后治疗,远部组（胆囊穴、阳陵泉）、近部组（肝俞、胆俞）以及联合组（前两组穴位相加）在对照组基础上对相应腧穴施予电针法,共治疗10 d。各组于治疗前后分别检查胆囊壁厚度、胆囊收缩功能以及术后2年复发率和并发症发生情况,评价临床疗效。结果与治疗前比较,各组胆囊壁厚度及胆囊收缩功能均有好转,治疗后远部组、近部组以及联合组均优于对照组,联合组最优（P ＜0.05）,远部组、近部组比较差异无统计学意义（P ＞0.05）;复发率联合组优于对照组（P ＜0.05）,其他组间对照以及并发症发生率的组间对照差异无统计学意义（P ＞0.05）。结论与对照组相比,电针法可有效促进胆石症保胆取石术后恢复,远近联合取穴较单独取穴疗效更佳。     

腹腔镜联合胆道镜保胆取石术对患者胆囊收缩功能及胆囊壁厚度的影响

目的研究腹腔镜联合胆道镜保胆取石术对患者胆囊收缩功能及胆囊壁厚度的影响。方法选取2015年6月至2016年6月于郑州市金水区总医院治疗的胆囊结石患者74例,根据治疗方案将患者分为对照组和观察组,每组37例。对照组接受腹腔镜下胆囊切除术,观察组接受腹腔镜联合胆道镜保胆取石术。比较两组患者相关手术指标、并发症发生情况;对观察组患者随访1 a,观察胆囊收缩功能及厚度变化情况。结果两组患者手术相关指标比较,差异无统计学意义(P>0.05);对照组并发症发生率比观察组高,差异有统计学意义(P<0.05);术后1 a,观察组胆囊收缩功能较术前提高,且胆囊厚度降低,差异均有统计学意义(P<0.05)。结论腹腔镜联合胆道镜进行保胆手术治疗,可有效降低患者并发症发生率,安全性高,能够有效恢复患者胆道收缩功能,降低胆囊壁厚度。     

腹腔镜联合胆道镜行微创保胆取石术治疗胆囊结石的临床应用

目的：探究腹腔镜联合胆道镜行微创保胆取石术对胆囊结石的治疗效果。方法：选取2009年12月至2011年12月我院收治的胆囊结石患者120例,将其随机分为观察组和对照组,每组60例。其中对照组患者采取纤维胆道镜取石术,观察组采取腹腔镜联合胆道镜行微创保胆取石术。术后对患者跟踪随访1年,观察并比较两组患者的结石清除情况、术后并发症、生活质量评分和胆囊壁厚度及胆囊收缩情况。结果：观察组术中出血量明显少于对照组,术后3个月、1年后患者的FACT—G评分较术前明显提高,且观察组术后1年的FAcT—G评分较对照组高;术后1年两组患者的胆囊壁厚度较术前均明显变薄、胆囊收缩功能均明显加强,且观察组患者的胆囊壁厚度较对照组薄,收缩功能较对照组强;观察组术后结石清除率为98．33％,较对照组的76．67％高,并发症发生率、1年后结石复发率分别为1．67％、3．33％,明显低于对照组,P〈0．05,具有统计学意义。结论：腹腔镜联合胆道镜行微创保胆取石术治疗胆囊结石的疗效较好,不仅保留了胆囊的完整性,且术后引起的并发症较少。     

胃胆功能性疾病患者的胃和胆囊运动研究——胃胆功能性疾病研究之一

对45例胃胆功能性疾病(functional gastric—cholecystic disorders,FGCD)患者的胃胆运动进行了前瞻性研究,包括检测餐后胃窦部收缩运动;Tc 放射性闪烁法序列显像测定空腹胆囊、餐后胆囊和胃排空功能;与15例正常对照组相比较;口服多潘立酮后复查上述指标。结果显示 FGCD 患者均有胃窦部收缩运动的异常,其收缩波的振幅和频率都影响胃排空运动,其中频率为主要因素。空腹和餐后胆囊排空与胃排空运动的速度成正比,FGCD 患者患有同等程度的胃和胆囊运动障碍,多潘立酮能促使 FGCD 患者的胃胆运动恢复正常而达到治疗目的。结论是胃胆运动互相联系,相互影响,是一个功能整体。据此提出了胃胆功能性疾病的新概念。     

柴芍六君子汤配合耳穴压豆预防微创保胆取石后结石复发

目的:观察中药柴芍六君子汤配合耳穴压豆预防微创保胆内镜取石术后患者胆囊结石复发的疗效。方法:80例行微创保胆取石术后患者随机分成观察组和对照组各40例,两组术后均给予饮食和生活习惯改变的指导,观察组加用中药柴芍六君子汤配合耳穴压豆,对照组加用牛磺熊去氧胆酸(TUDCA,商品名:滔罗特)。结果:观察组患者治疗前后胆囊壁厚度、胆囊收缩功能相比均有显著性差异(P<0.05);对照组患者治疗前后胆囊壁厚度、胆囊收缩功能相比均有显著性差异(P<0.05);两组患者治疗后胆囊壁厚度比较及胆囊收缩功能组间比较,无明显差异(P>0.05)。两组患者均有1例胆囊结石复发,复发率2.5%。结论:中药柴芍六君子汤配合耳穴压豆有利于减轻胆囊壁的炎症,增强胆囊的收缩功能,有助于防止胆囊结石的复发。     

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.