急性高容量血液稀释结合尼卡地平控制性降压对全髋翻修围术期血液动力学的影响

目的:观察急性高容量血液稀释（AHH）结合尼卡地平控制性降压对全髋翻修手术中患者血液动力学的影响。方法:全髋翻修手术患者40例分成两组，按手术先后顺序单数为A组，双数为B组：A组 AHH结合尼卡地平控制降压组（20例）和B组为对照组（20例）。两组患者在诱导后切皮前实施AHH，A组快速输注6%羟乙基淀粉15 mL•kg^-1、30 mL•min^-1，同时用微量泵输注尼卡地平0.3~0.5 mg•kg^-1•h^-1.MAP控制在60~65 mmHg(1mmHg=0.133kPa)；B组输注等量生理盐水，观察记录术前、AHH后1 h和术后24 h时的心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、血红蛋白(Hb)、红细胞比容(Hct)、血小板(Plt)变化。结 果：A组联合降压AHH后MAP显著低于术前（P<0.01）和B组（P<0.01）,停止降压后略高于B组；HR两组无明显变化。AHH后两组CVP均明显升高（P<0.01），A组低于B组(P<0.05)。AHH后两组患者Hb、Hct、Plt均显著下降（P<0.05或P<0.01），术后24 h上升，B组低于术前，但无统计学意义，但A组Hb低于术前(P<0.05)。结论：在全髋翻修术中应用急性高容量血液稀释结合尼卡地平控制性降压能够维持围手术期血液动力学稳定。     

急性高容量血液稀释联合硝普钠或尼卡地平在鼻内窥镜手术中的应用

目的：观察急性高容量血液稀释（AHH）联合硝普钠或尼卡地平控制性降压（con-trolled hypotension,CH）在鼻内窥镜手术中应用的临床效果和安全性。方法：30例择期行全组鼻窦开放手术的患者,ASAl-2级,随机化分为硝普钠组（A组）和尼卡地平组（B组）。全麻诱导后30min内输6%羟乙基淀粉13%.415ml/kg,手术开始前维持MAP55～65mmHg,观察手术中From-me评分,尿量,出血量,反射性心率增快的发生和停止降压后的血压恢复正常的时间。结果：A组失血量（349.2±162.2）均显著高于B组（208.0±92.8ml）（P〈0.05）,停止降压后血压恢复至正常的时间B组（15±4.0min）明显长于A组（7.3±1.1min）（P〈0.05）。结论：急性高容量血液稀释联合尼卡地平可以安全的用于鼻内窥镜手术,并明显的减少术中的出血量。     

硝酸甘油复合美托洛尔控制性降压用于鼻内窥镜手术

目的探讨硝酸甘油复合美托洛尔控制性降压技术在鼻内窥镜手术中应用的效果。方法选择60例拟行鼻内窥镜手术患者,ASAI~Ⅱ级。随机分为三组,每组20例,在单纯静脉麻醉下,A组不加用降压药,B组予硝酸甘油控制性降压,C组予硝酸甘油复合美托洛尔控制性降压,比较各组术中出血量,手术时间,平均动脉压、心率及手术医生对手术视野的满意度。结果C组术中出血量显著少于A、B组(P均<0.01),B、C组手术时间显著短于A组(P均<0.01),B组术中心率显著快于A、C组(P均<0.01),B、C组平均动脉压显著低于A组(P<0.01),C组的手术视野满意率显著高于A、B组(P<0.05或<0.01)。结论硝酸甘油复合美托洛尔控制性降压技术是鼻内窥镜手术的理想降压技术。     

血液稀释联合控制性降压用于颅脑肿瘤的临床观察

目的探讨血液稀释联合应用控制性降压对颅脑肿瘤手术患者的血流动力学及血红蛋白、红细胞比积的影响。方法颅脑肿瘤患者30例,随机分为联合组(A组,n=15)和对照组(B组,n=15),持续监测MAP、HR、CVP、Hb、Hct,术中失血量、输血量、输液量和尿量变化。结果A组MAP明显低于术前和B组(P<0.01),Hb、Hct较术前水平明显降低,但均在正常代偿范围,A组术中出血量明显少于B组。结论AHH联合CH可明显减少手术失血量及异体血用量,对血流动力学影响小及对组织器官血流灌注无明显影响。     

急性高容量血液稀释复合控制性降压用于颅脑肿瘤手术

目的　观察急性高容量血液稀释 (AHH)联合应用控制性降压 (CH )对颅脑肿瘤手术病人血流动力学的影响及对节约用血的评估。　方法　 ASA ～ 级的颅脑手术病人 2 4例随机分为 AHH +CH组 (A组 ,n=1 2 )和单纯 AHH组 (B组 ,n=1 2 )。两组病人术前血红蛋白 (Hb)和红细胞压积 (Hct)均 >1 1 0 g/ L和 35 %。两组用 6 %羟已基淀粉 (1 5 m L / kg)在麻醉后至硬脑膜打开之前进行血液稀释 ,A组在硬脑膜打开后复合应用硝酸甘油 (0 .5μg· kg- 1 · min- 1 )降压 ,B组未用控制性降压。观察两组 AHH前后平均动脉压 (MAP)、心率 (HR)、中心静脉压(CVP)、尿量变化、失血量和输血量。　结果　两组在 AHH后 MAP、HR均无明显变化 (P>0 .0 5 ) ,CVP均比 AHH前升高 (P<0 .0 5 ) ,但仍在正常范围。 A组在应用硝酸甘油后 CVP下降 (P<0 .0 5 ) ,A组失血量明显小于 B组 (P<0 .0 5 )。　结论　在颅脑肿瘤手术病人 ,实施 AHH(6 %羟已基淀粉 1 5 m L / kg)进行高容量血液稀释能保持血流动力学稳定 ,复合应用控制性降压效果更好     

艾司洛尔联合硝普钠控制性降压在鼻内镜手术的应用

目的探讨艾司洛尔联合硝普钠控制性降压技术在鼻内镜手术中应用的效果。方法 ASAⅠ~Ⅱ级择期鼻内镜手术58例,随机分为两组,Ⅰ组(n=30),硝普钠控制性降压;Ⅱ组(n=28),艾司洛尔联合硝普钠控制性降压。两组术中平均动脉压(MAP)控制于基础血压的2/3,记录术前、降压平稳后及停降压20min时的心率(HR),记录手术时间、术中出血量及硝普钠用量。结果Ⅱ组手术时间、术中出血量及硝普钠用量明显低于Ⅰ组(P<0.05或P<0.01);与术前相比,Ⅰ组降压后HR明显升高(P<0.01),组间比较,降压后Ⅰ组HR明显高于Ⅱ组(P<0.01)。结论艾司洛尔联合硝普钠控制血压于本实验水平,可明显减少鼻内镜术中渗血,有利于手术操作,用于鼻内窥镜手术是安全有效的。     

控制性降压复合急性高容血液稀释在全髋关节置换术中应用的观察

目的 探讨控制性降压复合急性高容血液稀释(AHH)用于减少全髋关节置换术中出血的有效性以及安全性.方法 选择全髋关节置换术病人30例随机分为两组:控制性降压复合AHH组(A组)麻醉成功后将硝酸甘油5 mg溶于5%葡萄糖溶液50 ml中,微泵输入速度为3～6 μg/(kg·min) ,在15 min内使动脉血压缓慢降至原水平的(65±5)%,最低不低于60 mmHg,同时于手术前快速输入6%羟乙基淀粉15 ml/kg及复方乳酸钠8 ml/kg使血容量增加约25%,术中维持动脉压在65～70 mmHg,内固定结束后停用硝酸甘油.对照组(B组)麻醉成功后输复方乳酸钠10ml/kg后行手术.分别记录AHH前(T0)、AHH 完毕(T1)、术毕(T2)各时间点的心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、血氧饱和度(SpO2)及术中出血量和输血量.结果 两组病人T2时的HR均极显著高于同组T0(P＜0.01),B组T2时的HR极显著高于同时段的A组;A组MAP在T1 极明显低于同组T0(P＜0.01),与B组同时段比较有极显著性差异(P＜0.01);B组MAP在T2极明显低于同组T0(P＜0.01),与A组同时段比较有极显著性差异(P＜0.01);A组CVP在T1极显著高于同组T0(P＜0.01),与B组同时段比较有极显著性差异(P＜0.01);A组的出血量、输血量均极显著低于B组(P＜0.01).结论 控制性降压复合急性高容血液稀释能安全有效地减少全髋关节置换术中的出血量和输血量,值得临床推广.     

急性高容量血液稀释联合控制性降压用于鼻内窥镜手术血液保护效果观察

目的评价急性高容量血液稀释（AHH）联合控制性降压（CH）用于鼻内窥镜手术中的血液保护效果。方法选择需行鼻内镜手术患者70例,性别不限,年龄20~55岁,ASAⅠ或Ⅱ级。随机分为2组,即AHH＋CH组（n=35）和CH组（n=35）。两组患者均在手术开始后静脉输注硝酸甘油,速率为0.3~1μg/（kg·min）进行控制性降压,在10~15min将MAP降至60~65mmHg。心率〉100次/min时单次静脉给艾司洛尔20mg。AHH＋CH组：麻醉气管插管后即刻至切皮前即刻,静脉输注6%羟乙基淀粉130/0.4溶液15ml/kg,速率50ml/min。记录两组患者术中心率（HR）,平均动脉压（MAP）,中心静脉压（CVP）,血氧饱和度（SpO2）,出血量,尿量,手术时间及异体输血情况。结果与CH组比较,AHH＋CH组手术时间缩短,术中出血量减少,尿量增多（P〈0.01）,2组患者均无异体输血。术中生命体征均平稳,无心、肺、脑、肾相关并发症发生。结论 AHH联合控性降压对鼻内镜手术血液保护效果好,安全性高。     

连续硬膜外麻醉下急性高容性血液稀释复合控制性降压在髋关节手术中的应用

目的:评价连续硬膜外麻醉(CEA)与急性高容性血液稀释(AHH)和控制性降压(CH)相结合的血液保护效果及安全性。方法:择期髋关节手术40例,随机分为两组,1组为对照组,2组为CEA+AHH+CH。两组均采用气管插管全身麻醉。2组行CEA下以6%贺斯行AHH,硝酸甘油与艾司洛尔行CH,观察术中出血量、输血输液量、围术期的Hb、HCT。结果:(1)2组术中出血量、输血量和输血例数较1组有显著减少(P<0.01)。(2)两组患者AHH后、术毕、术后1d、术后7d的Hb、HCT明显低于AHH前,但均在允许范围内。结论:采用CEA下AHH和CH技术,可安全的用于髋关节手术,并明显减少此类患者的术中失血量和异体输血量,是一种围手术期有效的血液保护方法。     

急性高容量血液稀释联合硝酸甘油控制性降压的临床观察

目的 观察术中急性高容量血液稀释(AHH)联合硝酸甘油控制性降压时血液动力学、氧代谢的变化,评价其可行性.方法 择期全麻手术病人40例,随机分为两组,每组20例.组Ⅰ为单纯AHH组,组Ⅱ为AHH联合应用硝酸甘油控制性降压(CH)组.组Ⅰ手术开始后在30 min内输入菲克雪浓15 mL/kg,CVP控制在16 cmH2O以内.组Ⅱ手术开始30 min内输注菲克雪浓15 mL/kg,同时以MAP基础值的70%为目标行CH.分别于麻醉诱导后(基础值,T0),AHH或AHH联合CH后30 min(T1),60 min(T2)记录血液动力学指标,同时采集中心静脉血,股动脉血测定血气及动脉血乳酸浓度(LAC),计算氧供(DO2),氧耗(VO2)和氧摄取率(ERO2).结果 AHH后,两组Hb、Hct在均明显下降(P＜0.01).组ⅠMAP、CVP明显升高(P＜0.01),组ⅡMAP、CVP无明显变化(P＞0.05).与T0比较,两组在T1、T2的DO2、VO2、LAC均无明显变化(P＞0.05).结论 AHH联合硝酸甘油CH,循环负荷增加少,CVP升高不明显,不易出现心力衰竭及肺水肿,能较好维持机体血液动力学和氧代谢的相对稳定,相对单纯AHH,临床应用更安全.     

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.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

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.