坏疽穿孔性阑尾炎术后放置引流589例临床分析

目的：比较分析坏疽穿孔性阑尾炎术中放置引流的利弊,以明确放置引流的指征。方法：将589例坏疽穿孔性阑尾炎患者随机分为引流和非引流组。比较两组术后切口感染、腹腔脓肿、肠粘连、术后发热天数、住院天数,并观察引流组的术后引流量。结果：引流和非引流组切口感染率分别为11.57％,9.65％;腹腔脓肿为2.31％,4.02％;肠...     

急性阑尾炎并腹膜炎术后不置腹腔引流对临床疗效的影响

目的探讨急性阑尾炎并腹膜炎术后不放置腹腔引流对临床疗效的影响.方法将810例急性阑尾炎并腹膜炎患者随机分为引流组和非引流组,比较术后两组切口感染、肠粘连等并发症的发生率.结果引流组与非引流组切口感染率分别为20.5%和5.7%(P＜0.01);肠粘连发生率引流组与非引流组分别为15.18%和3.16%(P＜0.01),引流组还存在拔管恐惧,大网膜随管带出体外等并发症.结论急性阑尾炎并腹膜炎术后不置腹腔引流较置腹腔引流更明显地降低术后并发症,值得临床推广应用.     

预防急性阑尾炎并腹膜炎手术切口感染的疗效分析

目的探讨降低急性化脓性阑尾炎并腹膜炎病人手术切口感染几率的方法。方法将217例化脓性阑尾炎并腹膜炎病例分为穿孔性阑尾炎并腹膜炎（A组）114例,非穿孔性阑尾炎并腹膜炎（B组）103例,其中A组放置腹腔引流79例,未放置引流35例;B组放置腹腔引流42例,未放置引流61例,分析统计两组切口感染率。结果本组病例切口感染率为（10／217）4．61％,其中A组切口感染率（9／114）7．89％,B组切口感染率（1／103）0．79％（P〈0．05）。A组放置引流切口感染率为（8／79）10．13％,未放置引流切口感染率为（1／35）2．86％（P〈0．05）。放置引流切口感染率A组（10．13％）与B组（3．23％）相比较,差异有统计学意义（P〈0．05）。结论急性化脓性阑尾炎并腹膜炎手术切口感染与腹膜炎严重程度有关,早诊断、早手术、避免误诊,术中严格无菌操作,掌握抗生素使用指征可减少切口感染几率,放置引流与否应视病人个体而定。     

消化道恶性肿瘤患者术后早期肠内营养支持的应用评价

目的探讨消化道恶性肿瘤术后早期肠内营养与肠外营养在术后并发症以及医学经济学方面的差异。方法对2003年9月至2005年12月我院普通外科住院的164名消化道恶性肿瘤患者术后进行营养支持干预，其中84例（EN组）采用术后早期肠内营养（24—48h内），80例（TPN组）采用肠外营养治疗，分别比较两组患者术后7—10d的营养指标变化、肛门排气、胃排空恢复时问、术后住院日和总住院费、并发症发生率。结果EN组术后第7天血清前白蛋白（309±49）mg／L，高于TPN组的（277±46）mg／L（P〈0．05）。EN组肛门排气时间、胃排空恢复时间、平均术后住院时间分别为（54±17）h、（7．1±2．8）h和（18±6）d，均显著低于TPN组的（75±15）h（P〈0．05）、（13．1±6．7）h（P〈0．01）和（21±4）d（P〈0．05）。EN组的营养支持并发症发生率和总住院费分别是19．0％和16376．60元，显著低于TPN组37．5％和23748．50元（P〈0．01）。结论消化道恶性肿瘤患者术后给予早期肠内营养比单纯肠外营养安全可靠、简便，更符合正常生理状态，对胃肠功能恢复有利，且相关并发症少，费用更低廉。     

腹腔镜阑尾切除术与开腹阑尾切除术疗效比较

目的比较腹腔镜阑尾切除术与开腹阑尾切除术的手术效果。方法将我院2009年1月。2010年1月住院治疗的64例阑尾炎患者按照随机分组的原则分为A组（腹腔镜阑尾切除术）与B组（开腹阑尾切除术）各32例,比较两组的术中出血量、住院时间、放置引流管、术后近期发生切口感染、肠粘连并发症情况。结果腹腔镜阑尾切除术（A组）的手术效果与开腹阑尾切除术手术（B组）比较：A组的术中出血量明显少于对照组（P〈0．05）,且A组的住院时间短于B组（P〈0．05）,A组术后放置引流管的例数明显少于B组（P〈0．05）,且术后近期发生切口感染、肠粘连并发症的发生率明显低于B组（P〈0．05）。A组的手术用时多于B组,但差异并无统计学意义（P〉0．05）。结论腹腔镜阑尾切除术手术疗效明显优于开腹阑尾切除术,具有出血量少、并发症少、住院时间短的优点,值得广泛推广和应用。     

无张力腹股沟疝修补手术35例临床分析

目的探讨无张力腹股沟疝手术的优点。方法选择我院2006年4月～2008年10月住院的腹股沟疝病例65例，行无张力腹股沟疝修补手术35例为实验组和传统开刀腹股沟疝修补手术30例为对照组，比较手术时间、术中出血量、术后镇痛药的应用、术后下地时间、术后疼痛、术后复发情况、术后切口感染、术后住院天数等。结果无张力腹股沟疝手术和传统开刀腹股沟疝修补手术相比，手术时间分别为（10±10）min、（30±15）min（P〈0．05）；术中出血量分别为5mL、50mL（P〈0．01）；术后镇痛药的应用分别为0、75．2％（P〈0．01）；术后进食时间分别为8h、48h（P〈0．01）；术后复发分别为0、6．7％（P〈0．01）；术后切口感染率分别为0、8．2％（P〈0．01）；术后住院天数分别为4、8d（P〈0．01）。结论无张力腹股沟疝手术和传统开刀腹股沟疝修补手术相比，无张力腹股沟疝手术具有较明显优势，为当今疝修补手术首选。     

小切口胆囊切除术与传统胆囊切除术疗效比较

目的探讨小切口胆囊切除术（MC）在基层医院的临床应用价值。方法回顾性分析我院应用小切口胆囊切除术治疗的25例患者的临床资料,并与应用传统开腹胆囊切除术（OC）的25例比较,对两组手术时间、术中出血、术后肛门排气时间、术后下床活动时间、术后并发症、住院天数等指标进行对比分析。结果MC组手术时间为（40．2±16．6）min,对照组为（52．4±18．0）min,两组比较差异有统计学意义（P〈0．05）;MC组术中出血（50．3±11．2）mL,OC组（150.3±22．5）mL,两组比较差异有统计学意义（P〈0．05）;术后肛门排气时间、术后下床时间、住院天数和并发症指标比较,MC组均显著优于OC组（P〈0．05）。结论小切口胆囊切除术创伤小,术后恢复快,值得在基层医院推广应用。     

快速康复外科在老年腹股沟疝术中的应用

目的对比快速康复外科（FTS）和传统方法治疗老年腹股沟疝患者的临床效果。方法将92例老年腹股沟疝患者按就诊时间分为两组：FTS组采用吣治疗,对照组采用传统方法。对比两组患者术后首次通气时间、腹胀发生率、住院费用及术后住院时间等指标。结果FTS组患者住院费用为（2230±389）元,对照组为（2948±520）元;FTS组患者术后住院时间为（5．05±1．28）d,对照组为（7．10±2．70）d,差异均有统计学意义（P〈0．05）。两组患者首次通气时间、术后进食时间、下床活动时间间差异均有统计学意义（P〈0．05）,但两组患者术后腹胀发生率间差异无统计学意义（P〉0．05）。结论应用FTS理念治疗,老年腹股沟疝患者术后康复加快,术后住院时间缩短,住院费用减少。     

阿奇霉素与红霉素治疗小儿支原体肺炎的疗效对照观察

目的 对比观察在治疗小儿支原体肺炎过程中阿奇霉索与红霉素的临床疗效与不良反应，评价阿奇霉素治疗肺炎支原体肺炎的临床疗效及安全性。方法 选择临床诊断为支原体肺炎的患儿72例。随机分为两组，治疗组36例应用阿奇霉素10mg·kg^-1·d^-1。静滴，对照组36例给予红霉素15～30mg·kg^-1·d^-1。静滴，观察疗效及其不良反应，并对比分析。结果治疗组有效率100％，对照组有效率92．86％，两组差异有显著性（P〈0．05）。治疗组平均住院天数（5．8±1．6）d，对照组平均住院天数（7．5±2．0）d，两组差异有显著性（P〈0．01）。治疗组体温恢复正常时间（2．2±0．8）d短于对照组（2．6±1．3）d（P〈0．05）。治疗组胃肠道不良反应发生率813％，对照组的发生率22．2％，两组差异有显著性（P〈0．01）。结论 阿奇霉素治疗肺炎支原体肺炎具有疗效好、安全性高、不良反应少、住院时间短等优点．同时通过对比发现应用阿奇霉素治疗组平均住院费用无明显增加。故值得推广应用。     

奥曲肽联合奥美拉唑治疗肝硬化并发非静脉曲张上消化道出血疗效观察

目的观察奥曲肽联合奥美拉唑治疗肝硬化并发非静脉曲张上消化道出血的疗效。方法将76例肝硬化并非静脉曲张上消化道出血患者，随机分为治疗组（A组）39例和对照组（B组）37例，治疗组采用奥曲肽和奥美拉唑联合治疗，对照组单用奥美拉唑治疗，并观察相关指标。结果A组48h再出血率（7．70％）明显低于B组（27．00％），P〈0．05；A组住院天数（5．20±2．10天）明显少于B组（7．80±2．90天），P〈0．05；A组输血量（3．60±2．20u）与B组输血量（3．40±2．30u）比较差异无显著性（P〉0．05）；A、B两组死亡率无明显差异（P〉0．05）。结论奥曲肽联合奥美拉唑治疗肝硬化并发非静脉曲张上消化道出血，能有效预防早期再出血发生和缩短住院天数。     

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.     

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.     

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.