一氧化氮吸入治疗新生儿持续肺动脉高压的临床研究

目的探讨吸入一氧化氮(NO)对新生儿持续肺动脉高压(PPHN)的治疗效果。方法对20例临床诊断PPHN的患儿进行NO吸入治疗,入院后经高频振荡机械通气呼吸支持,应用NO前呼吸机吸入氧浓度(FiO2)为(0.91±0.12),气道压力(MAP)为(1.31±0.21)kPa,入院4~24h在呼吸机支持同时加NO吸入治疗。NO吸入前、后0.5h、6h、12h、24h、48h动态观察经皮血氧饱和度(SpO2)、血气动脉血氧分压(PaO2)、MAP、氧合指数(OI)、心率(HR)、血压(BP)的测定。结果患儿吸入NO治疗48h内经皮SpO2明显上升,OI、MAP明显下降(P<0.05),PaO2明显上升(P<0.05),而HR、BP无明显变化(P>0.05)。24~48h后经皮SpO2持续稳定。治愈18例,2例死于严重并发症,吸入NO时二氧化氮(NO2)浓度监测均<2ppm。结论 NO吸入能选择性扩张肺血管,改善氧合,对心血管无明显不良反应,在保证有效通气及良好灌注时为有效的治疗PPHN的手段。     

一氧化氮联合高频振荡通气治疗新生儿持续肺动脉高压的疗效观察

目的探讨一氧化氮（NO）联合高频振荡通气治疗新生儿持续肺动脉高压（PPHN）的疗效及安全性。方法对35例PPHN患儿在高频振荡通气下联合NO吸入,浓度从20×10-6mg/L（20ppm）开始,有效后可逐渐调低NO的浓度,降至5×10-6mg/L后维持3672 h。治疗时监测NO吸入前、吸入1 h、24 h和48 h后的pH值、肺动脉压力（PAP）、平均气道压（MAP）、氧分压（PaO2）、氧合指数（OI）、动脉导管前及动脉导管后的经皮血氧饱和度（SpO2）、血压、心率、吸入前后监测二氧化氮（NO2）的浓度。结果与吸入前比较,吸入1 h、24 h、48 h时MAP、PAP、OI均下降（P〈0.05）,动脉导管前、后SpO2、PaO2、pH值升高（P〈0.05）,心率、血压无明显改变（P〉0.05）。治疗期间,监测NO2均在安全范围内。结论 NO联合高频振荡通气治疗新生儿PPHN有显著疗效,而且无明显的毒副作用。     

不同剂量西地那非治疗新生儿肺动脉高压的疗效

目的探讨口服不同剂量的西地那非(SIL)治疗新生儿持续性肺动脉高压(PPHN)的疗效、有效剂量和不良反应。方法 48例PPHN患儿在呼吸机机械通气下口服SIL,根据用药剂量分为3组,每6h给药1次,每次剂量分别是0.3、0.5和1.0mg/kg。治疗前和治疗后3d检测动脉氧合和肺动脉压(PAP)的变化,记录心率、血压、呕吐次数等。结果口服SIL 3d后3组患儿动脉血氧分压(PaO2)和动脉血氧饱和度(SaO2)均明显提高(均P<0.01),PAP显著下降(P<0.05或P<0.01);3组患儿在提高动脉氧合指标(PaO2、SaO2)上无显著差异,而0.3mg/kg组PAP下降程度及PPHN治疗有效率小于0.5、1.0mg/kg组(均P<0.05);治疗期间所有患儿均未出现明显不良反应。结论口服SIL在新生儿持续性肺动脉高压的治疗上有显著疗效,安全性好,有效剂量为每次0.3～1.0mg/kg,6h给药1次。     

高频振荡通气联合西地那非治疗新生儿持续性肺动脉高压

目的探讨高频振荡通气(HFOV)联合西地那非治疗新生儿持续性肺动脉高压(PPHN)的疗效。方法 50例PPHN患儿分为HFOV组(A组,n=16)、HFOV联合低剂量西地那非组(B组,n=16)和HFOV联合高剂量西地那非组(C组,n=18),观察并比较3组治疗前及治疗3 d后肺动脉压(PAP)、动脉血氧分压(PaO2)、动脉血氧饱和度(SaO2)和动脉血CO2分压(PaCO2)。结果治疗前各组PAP、PaO2、SaO2及PaCO2比较差异均无统计学意义(P>0.05)。治疗后各组PAP较治疗前均显著下降,差异有统计学意义(P<0.05);各组PAP降幅比较差异均有统计学意义(P<0.05)。C组治疗有效率高于A组,差异有统计学意义(P<0.05)。治疗后各组PaO2、SaO2较治疗前升高,PaCO2下降,差异均有统计学意义(P<0.05)。B、C 2组PaO2和SaO2升高的幅度及PaCO2下降的幅度大于A组,差异有统计学意义(P<0.05)。C组SaO2升高的幅度和PaCO2下降的幅度大于B组,差异有统计学意义(P<0.05)。结论 HFOV联合西地那非治疗PPHN疗效较好。     

前列地尔联合雾化吸入硝普钠治疗新生儿持续肺动脉高压的疗效观察

目的探讨前列地尔联合雾化吸入硝普钠治疗新生儿持续肺动脉高压的疗效。方法将58例诊断为新生儿肺动脉高压的患儿随机分为治疗组（28例）和对照组（30例）。对照组给予头罩加压吸氧、抗凝、强心、利尿等基础治疗及钙通道阻滞剂;治疗组在对照组治疗基础上联合前列地尔和雾化吸入硝普钠。在用药前、后分别测量肺动脉收缩压（PAP）、动脉血氧饱和度（SaO2）、血氧分压（PaO2）、血压（BP）和心律（HR）的数值。结果两组患儿治疗后在肺动脉压力、动脉血氧分压、血氧分压指标均有明显改善（P〈0.05）,治疗组较对照组改善更显著（P〈0.05）。结论前列地尔联合雾化吸入硝普钠是治疗新生儿肺动脉高压的有效方法。     

肺泡表面活性物质对持续肺动脉高压新生儿血气指标及肺动脉压的影响

目的观察肺泡表面活性物质(PS)对新生儿持续肺动脉高压(PPHN)血气指标及肺动脉压(PAP)的影响。方法将该院2016年11月-2017年10月治疗的92例PPHN患者作为研究对象,将入选患儿依据随机数表法分为两组,各46例。对照组实施持续正压通气(CPAP)治疗,观察组则于对照组基础上加以PS治疗。观察两组临床疗效、临床相关指标与治疗前后血气指标、PAP变化情况。结果两组治疗总有效率相比,对照组低于观察组,差异有统计学意义(P0.05);两组氧疗时间、CPAP治疗时间以及住院时间等对比,对照组高于观察组,差异有统计学意义(P0.05);治疗前两组吸入氧浓度(FiO_2)、动脉血氧分压(PaO_2)、酸碱度(pH)、PAP水平对比差异无统计学意义(P0.05);治疗后观察组FiO_2、PAP低于对照组,PaO_2、pH高于对照组,差异有统计学意义(P0.05)。结论在CPAP治疗基础上,将PS应用于PPHN治疗中效果确切,可调节患儿血气指标、降低PAP,缩短治疗时间,促进患儿早日恢复。     

硫酸镁治疗新生儿持续肺动脉高压临床观察

目的:观察硫酸镁治疗新生儿持续肺动脉高压(PPHN)的临床效果。方法:对收治并确诊的31例PPHN患儿,呼吸支持的基础上采用硫酸镁治疗,硫酸镁首剂200 mg/kg,30 min内微量泵静脉注入,继之维持量40～50 mg/(kg.h)持续微量泵静脉注入,待病情好转后再逐渐减量至20 mg/(kg.h)后停用,监测血压、经皮血氧饱和度、血气分析、血钙、血镁、肺动脉压。结果:硫酸镁治疗后血氧饱和度、血氧分压、pH值与用药前比较明显改善,肺动脉压下降,差异显著。硫酸镁平均治疗(72.3±12.17)h。结论:硫酸镁治疗新生儿持续肺动脉高压疗效确切,适合基层医院使用。     

雾化吸入伊洛前列素以及硫酸镁对治疗新生儿持续性肺动脉高压的临床研究

目的:探讨雾化吸入伊洛前列素、硫酸镁对新生儿持续性肺动脉高压(persistent pulmonary hypertension of newborn,PPHN)的临床治疗效果。方法:选取本院于2010年9月-2016年9月收治的60例PPHN患儿,采用随机数字表法将患儿分为三组,每组20例。其中对照组给予常规支持疗法;试验组A在常规支持疗法下加用雾化吸入伊洛前列素2μg/kg,10 min/次,1次/d,连用3 d;试验组B在常规治疗下加用硫酸镁负荷量200 mg/kg,在30 min内静脉注射,负荷量后给予30~50 mg/(kg·h)连续静脉滴注3 d。比较三组患儿治疗前后的平均肺动脉压(pulmonary arterial mean pressure,PAMP)、动脉血氧分压(Pa O2)、血氧饱和度(Sp O2)及每搏输出量(SV)。结果:试验组A与试验组B治疗后平均肺动脉压(pulmonary arterial mean pressure,PAMP)、动脉血氧分压(Pa O2)、血氧饱和度(Sp O2)、每搏输出量(SV)及治疗有效率均优于对照组,差异均有统计学意义(P0.05);但试验组A与试验组B的PAMP、Pa O2、Sp O2、SV和治疗有效率比较,差异均无统计学意义(P0.05)。结论:雾化吸入伊洛前列素和硫酸镁能降低肺动脉压力,提高血氧含量,有利于治疗PPHN。     

伊洛前列素联合一氧化氮吸入治疗新生儿持续性肺动脉高压的效果

目的：观察伊洛前列素联合一氧化氮(NO)吸入治疗新生儿持续性肺动脉高压(PPHN)的效果。方法：选取64例PPHN患儿为研究对象,采用随机数字表法分为对照组和研究组各32例。对照组采用NO吸入治疗,研究组采用伊洛前列素联合NO吸入治疗。比较两组临床疗效、治疗前后血流动力学指标[肺动脉收缩压、肺循环阻力(PVR)和体循环阻力(SVR)]水平、血气指标[血氧饱和度(SaO₂)、动脉血氧分压(PaO2)和氧合指数(OI)]水平和不良反应发生率。结果：研究组治疗总有效率为93.75%(30/32),高于对照组的65.63%(21/32),差异有统计学意义(P<0.05);治疗后,研究组肺动脉收缩压、PVR和SVP等血流动力学指标水平均低于对照组,差异有统计学意义(P<0.05);治疗后,研究组SaO₂、PaO₂和OI等血气指标水平均高于对照组,差异有统计学意义(P<0.05);研究组不良反应发生率为9.38%(3/32),低于对照组的34.38%(11/32),差异有统计学意义(P<0.05)。结论：伊洛...     

NO吸入治疗新生儿肺动脉高压临床观察

目的:探讨NO吸入治疗新生儿肺动脉高压的方法及临床效果。方法:选取我院自2011年4月~2013年4月收治的52例肺动脉高压新生儿随机分为观察组与参考组,各为26例,观察组患儿采用一氧化氮吸入治疗,参考组患儿采用硫酸镁静脉滴注治疗,比较2组患儿治疗前、后动脉血氧分压(PaO2)、肺动脉压力(SPAP)、体循环收缩压(SBP)变化。结果:2组患儿治疗1~2小时、24~48小时及治疗后的PaO2、SPAP相较治疗前均有明显变化,P0.05;观察组患儿SBP与治疗前相比无显著差异,P0.05;参考组患儿SBP出现明显下降,P0.05。结论:NO吸入治疗新生儿肺动脉高压安全有效,药效发挥快,有着显著的临床价值。     

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.