闭合性腹部损伤的诊治体会

目的探讨腹部闭合伤的诊断,治疗及如何降低病死率。方法通过对我院2005年1月-2008年9月闭合性腹部外伤168例进行回顾性分析。结果单一脏器损伤127例,多脏器或合并其他重要系统损伤41例,共损伤脏器214个,非手术治疗11例,手术治疗157例,结果痊愈158例,死亡10例。结论B超、X线检查、腹腔穿刺、CT检查对诊断腹部闭合伤的准确率高,简单易行;及时确诊,早期抗休克,合理处理多发伤,合理应用抗生素是腹部闭合伤治疗的关键。     

腹部脏器闭合性损伤的超声诊断

目的：探讨超声对腹部脏器闭合性损伤的诊断价值，以利临床医师及时作出正确的诊断，争取抢救时间。方法：使用B型超声诊断仪检查88例腹部闭合性损伤患，并与手术结果对照。结果：88例患中多数为单一脏器损伤约占61％，受损脏器以脾脏最常见，约占39％。实质性脏器损伤超声符合率约94％，而胃肠及血管等空腔脏器损伤的超声符合率仅56％。腹腔积液超声符合率100％。检出腹腔内血凝块超声符合率约为77％。结论：超声应为腹部脏器闭合伤、内出血尤其是实质性脏器损伤的首选检查方法。     

腹部闭合性损伤156例诊治体会

目的总结腹部闭合性损伤的诊治体会。方法回顾性分析本院自2002年10月-2007年10月期间收治的156例腹部闭合伤。其中，单一脏器损伤92例，腹部多脏器损伤56例，合并其它重要系统损伤54例。结果非手术治疗14例（其中包括介入脾动脉栓塞4例），手术治疗142例。治愈143例，死亡13例。结论腹部闭合伤常病情复杂，发展快，迅速准确诊断，及时有效、合理的治疗是关键。详细了解病史，结合腹腔穿刺、X线、B超、CT检查可提高诊断率。     

腹部闭合伤45例诊治体会

目的　总结腹部闭合伤的诊治体会。方法　 45例伤者中 ,单一脏器损伤 15例 ,多脏器或合并其他重要脏器损伤 3 0例 ,其中合并 2个脏器损伤 18例 ,3个及 3个以上脏器损伤 12例 ;非手术治疗 3例 ,其中脾脏血肿 2例 ,腹膜后血肿 1例 ,手术治疗 42例。结果　治愈 40例 ,死亡 5例 ,其中死于失血性休克 2例 ,急性肾功能衰竭 1例 ,脑外伤致脑疝 2例。结论　腹腔穿刺、X线、CT检查对腹部闭合伤确诊率高。     

腹部闭合性损伤的诊治体会

目的:探讨腹部闭合性损伤的早期诊断和手术治疗方法。方法:回顾性分析经手术治疗的72例腹部闭合性器官损伤的部位、程度、早期诊断方法及手术措施。结果:72例均进行手术治疗,分别施行脏器修补,全部或部分切除。治愈69例,死亡3例。结论:腹部闭合伤常引起实质性或空腔性脏器的损伤,伤势险恶,死亡率高。全面仔细检查、及早腹腔穿刺、B超、X线、CT等检查对早期诊断、及时手术治疗是抢救腹部闭合性损伤的治疗原则。     

胸外伤415例临床分析

目的：探讨胸外伤的临床特点，以提高诊治水平。方法：回顾性分析415例胸外伤患者的临床资料。结果：胸部伤主要是肺挫伤、血气胸、多发肋骨骨折，合并伤主要是颅脑损伤、腹部闭合伤、四肢骨折。采用胸腔闭式引流267例(64.3％)，开胸手术46例(11．1％)。结论：合并ARDS、颅脑损伤、腹部脏器损伤是其主要死亡原因。CT检查比X线平片更具有优越性。     

腹部闭合伤51例临床分析

为探讨腹部闭合伤的诊断处理，分析５１例腹部闭合伤的临床资料，发现脾破裂最常见，而多脏器损伤的处理较复杂。Ｂ超和腹腔穿刺是诊断腹部闭合伤的重要方法，正确的急症处理和手术十分关键。     

肝损伤合并腹腔其它脏器损伤58例诊疗分析

目的：探讨肝损伤合并腹腔其它脏器损伤的诊疗方法。方法：回顾性分析2000年至2007年收治的58例肝损伤合并腹腔其它脏器损伤的临床资料，均行手术治疗。结果：治愈45例，死亡13例，病死率22．4％，死亡原因主要为严重的失血性休克、腹部合并伤、多器官功能衰竭。结论：腹部创伤诊断仍以腹部症状、休征为主要依据，腹腔穿刺、腹部CT检查对诊断腹部脏器损伤的准确率高，根据伤情正确选择治疗方法，积极处理合并伤，可降低病死率。     

严重腹部闭合伤早期诊治41例

目的；探讨严重腹部闭合伤的早期诊断，提高治疗水平。方法：对我院1999年1月至2000年12月急诊收治的腹部闭合伤41例的临床资料进行分析，全组伤均合并有腹内脏器损伤，早期主要表现为腹痛，呕吐，休克，主要诊断手段为诊断性腹穿，腹部X线检查，CT，B超。结果：手术32例，术后死亡5例。9例保守治疗，均治愈出院。死亡原因：失血性休克，多器官功能不全，反复仔细体检，结合适当的辅助检查有助提高中创伤诊断水平。结论：剖腹探查术是有效的治疗手段，及早纠正休克是提高救治成功的关键。创伤后的多器官功能不全，细菌移位等问题应引起足够的重视。     

腹部闭合伤51例临床分析

为探讨腹部闭合伤的诊断处理,分析51例腹部闭合伤的临床资料,发现脾破裂最常见,而多脏器损伤的处理较复杂。B超和腹腔穿刺是诊断腹部闭合伤的重要方法,正确的急症处理和手术十分关键     

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.