不同血浆代用品体外循环预充对3岁以下婴幼儿肝功能及凝血功能的影响

目的 探讨6%羟乙基淀粉130/0.4(万汶)和琥珀酰明胶(血定安)预充对于3岁以下先天性心脏病(先心病)手术患儿肝功能及凝血功能的影响. 方法 45例年龄≤3岁的非紫绀型先心病患者,按照随机数字法分为3组:羟乙基淀粉组(H组)、琥珀酰明胶组(G组)和血浆对照组(C组),每组15例.分别于术前(T0)、术后2 h(T1...     

不同液体急性高容量血液稀释对剖宫产产妇围术期血液流变学状态及凝血功能的影响

目的 评价不同液体急性高容量血液稀释（AHHD）对剖宫产产妇围术期血液流变学状态及凝血功能的影响。方法 选择在腰硬联合麻醉下行择期剖宫产足月单胎健康产妇120例,ASA分级Ⅰ或Ⅱ级,按不同液体AHHD分为4组,每组30例:对照组（C组）、聚明胶肽组（P组）、琥珀酰明胶组（G组）和6%羟乙基淀粉130/0.4组（H组）。C组、P组、G组和H组分别于麻醉前30min静脉输注乳酸钠林格液、聚明胶肽、4%琥珀酰明胶和6%羟乙基淀粉130/0.4进行AHHD,输液速度为20mL·kg-1·h-1。分别于AHHD前（T0）,AHHD后30min（T1）、1h（T2）和手术结束后2h（T3）时采集静脉血样,测定血红蛋白（Hb）含量、血红细胞比容（Hct）、血液流变学指标（全血高切黏度、全血低切黏度、血浆黏度值、红细胞聚集指数、血小板聚集指数和血沉）及凝血功能指标[血小板计数（PLT）、凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）和纤维蛋白（Fib）]。结果 与C组比较,P组、G组和H组T1—T3时Hb含量及Hct降低（P<0.05）,T1—T2时全血高切黏度、全血低切黏度、红细胞聚集指数、血小板聚集指数、PLT和Fib降低,APTT延长（P<0.05）,血浆黏度值、血沉及PT差异无统计学意义（P>0.05）;与H组比较,P组和G组T1—T2时红细胞聚集指数、血小板聚集指数及血沉升高（P<0.05）,余指标差异无统计学意义（P>0.05）。结论 术前应用聚明胶肽、4%琥珀酰明胶或6%羟乙基淀粉130/0.4行AHHD对剖宫产产妇凝血功能影响轻微,但可改善产妇围术期血液流变学状态,增加组织血液灌注,且6%羟乙基淀粉130/0.4相较其他液体对降低血液黏度时效更长。     

人工胶体对ICU患者毛细血管通透性的影响

目的:观察羟乙基淀粉130/0.4、琥珀明胶、乳酸钠林格液对ICU术后患者MAU水平与炎性因子浓度的影响。方法:100例收入ICU患者随机分成五组(每组20例),术中分别给予羟乙基淀粉130/0.4 500 ml或1 000 ml、琥珀明胶500 ml或1 000 ml及乳酸钠林格液。分别测定患者术前及入ICU 6 h MAU水平和血浆IL-6浓度。结果:人工胶体组的MACR变化水平均较晶体组低(P<0.05);而相同剂量羟乙基淀粉组和琥珀明胶组MACR虽差异无统计学意义(P=0.630;P=0.701),但前者的MACR均值较低。各组入ICU 6 h时血浆IL-6的浓度较术前基础值都明显增高(P<0.05),且三种液体组间血浆IL-6的浓度变化差异有统计学意义(P<0.05),其中羟乙基淀粉组最低。结论:人工胶体MACR变化水平较晶体组低,且能有效降低血浆IL-6水平,提示其具有毛细血管堵漏作用及抗炎作用,其中羟乙基淀粉130/0.4的作用优于琥珀明胶。     

中分子量羟乙基淀粉130/0.4电解质注射液作为体外循环预充液对凝血功能影响的临床研究

目的观察羟乙基淀粉130/0.4电解质注射液用于成人体外循环(ECC)管路预充对术后凝血功能的影响。方法采用双盲、随机对照研究方法,272例18岁以上于2019年5月至2019年11月于本院ECC下行心脏手术患者,分为羟乙基淀粉130/0.4电解质注射液组(20 ml/kg,A组)、羟乙基淀粉130/0.4电解质注射液组(40 ml/kg,B组)、琥珀酰明胶组(20 ml/kg,C组)、琥珀酰明胶组(40 ml/kg,D组),每组各68例。应用血栓弹力图测定检测转前(T1)、鱼精蛋白中和后15 min(T2)、转后4 h(T3)及术后24 h(T4)的凝血功能。结果四组患者年龄、身高、体重、性别、手术种类及术前心功能差异均无统计学意义(P0.05),ECC时间、主动脉阻断时间、术后呼吸机辅助通气时间、ICU监护时间、术中红细胞用量、术后24 h红细胞用量、24 h胸液引流量差异均无统计学意义(P0.05)。组间比较,B组血小板数量在T2时点组与A组、C组、D组有显著性差异(P=0.005);血栓弹力图最大幅度值在T2时点,B组与A组、C组和D组有显著性差异(P=0.009)。结论中分子量羟乙基淀粉130/0.4电解质注射液作为ECC预充液,当剂量小于40 ml/kg时对机体凝血功能不会造成明显影响。     

不同人工胶体对成人患者体外循环中血糖的影响

目的评价心脏手术围术期使用不同的人工胶体进行预充及容量管理是否对体外循环期间血糖有不同的影响。方法入选70名择期体外循环下行心脏手术的成人患者,随机分入两组,分别采用6%羟乙基淀粉130/0.4（组Ⅰ）和4%琥珀酰明胶（组Ⅱ）预充。记录患者一般情况、术前资料及手术信息,并于术中5个时点监测血糖。比较两组患者最高血糖、高血糖发生率、血糖标准差及不同时点血糖的整体水平。结果两组患者术前一般情况、术前检查及手术情况无显著性差异。两组患者最高血糖[（8.3±1.7）mmol/L vs（7.9±1.5）mmol/L,P=0.236]和血糖标准差[（1.4±0.7）mmol/L vs（1.3±0.6）mmol/L,P=0.202]无明显差异。组Ⅰ患者有较多发生高血糖的趋势（62.8%vs 42.9%,P=0.094）。重复测量方差分析未检出两种不同胶体对血糖有不同的影响（P=0.349）,但不同时间点的血糖明显不同（P〈0.001）。结论现有证据尚不足以证实6%羟乙基淀粉130/0.4和4%琥珀酰明胶对成人患者体外循环中血糖有不同的影响。     

6%羟乙基淀粉130/0.4对老年患者经尿道前列腺电切手术血浆渗透压及电解质K+、Na+、Cl-的影响

目的观察6%羟乙基淀粉130/0.4对老年经尿道前列腺电切术患者的血浆渗透压和电解质K 、Na 、C l-的影响。方法40例ASAⅠ~Ⅲ级行经尿道前列腺电切术老年患者随机分为羟乙基淀粉组(Ⅰ)和乳酸钠林格注射液组(Ⅱ);麻醉诱导开始45 m in内按10 m l/kg分别输注6%羟乙基淀粉130/0.4(Ⅰ)和乳酸钠林格注射液(Ⅱ),随后均用乳酸钠林格注射液维持容量;于输液前、手术30 m in和术毕取静脉血检测血浆渗透压和电解质K 、Na 、C l-,分别记录各组血流动力学指标、B超前列腺大小、术中冲洗液用量、手术时间、静脉输液总量。结果血浆渗透压变化Ⅰ组较Ⅱ组小,差异有显著性(P<0.01);K 变化两组比较差异无显著性,Na 、C l-变化Ⅰ组较Ⅱ组小,差异有显著性(P<0.05);术毕收缩压两组比较差异有显著性(P<0.05)。结论老年患者经尿道前列腺电切术术中应用6%羟乙基淀粉130/0.4,有利于维持机体内环境及血流动力学的平稳。     

两种血浆代用品对婴幼儿体外循环术后转归的影响

目的观察4%琥珀酰明胶和6%羟乙基淀粉130/0.4用于婴幼儿体外循环（extracorporeal circulation,ECC）预充对术中血乳酸和术后转归的影响。方法30例择期行心内畸形矫治术的婴幼儿患者,随机分为2组,每组15例。分别应用4%琥珀酰明胶（佳乐施）和6%羟乙基淀粉130/0.4（万汶）进行ECC预充。记录两组患儿代血浆用量和库血使用量,检测ECC中15 min、终止ECC 5 min和2 h的血乳酸浓度,检测ECC中15 min和终止ECC 2 h的血红蛋白。记录两组患儿术后24 h引流液量及尿量、苏醒时间、呼吸机使用时间、ICU停留时间、术后并发症发生率、多巴胺/多巴酚丁胺用量以及术毕肌酐、尿素氮含量等。结果两组患儿均痊愈出院,两组间各项指标均无显著性差异。结论佳乐施和万汶用于婴幼儿ECC预充对术中血乳酸和术后转归无影响,不会增加并发症,两种血浆代用品均可安全用于婴幼儿ECC。     

不同血浆代用品对红细胞聚集性的影响

目的比较不同血浆代用品对红细胞聚集性的影响。方法分别从20个单位的红细胞悬液中各取血40m l,平均分为四份,每份10 m l,分别加入等容积的乳酸钠林格注射液(L组)、4%人血白蛋白(A组)、4%琥珀酰明胶注射液(G组)和6%羟乙基淀粉200/0.5注射液(H组)中。混匀后测各组红细胞压积,血红蛋白浓度和血气,于室温下用魏氏法测10 m in、20 m in、30 m in、60 m in血沉值,余血离心后取上清测血浆粘度和血浆胶体渗透压。结果G组和H组各时点血沉值均高于L组和A组,差异有显著性(P<0.01);G组和H组比较,G组各时点血沉比H组快,差异有显著性(P<0.01)。形态学变化可见G组和H组红细胞聚集明显。结论4%琥珀酰明胶注射液和6%羟乙基淀粉200/0.5注射液均促进红细胞聚集,又以4%琥珀酰明胶更为显著。     

羟乙基淀粉对体外循环后急性炎性反应的影响

目的观察羟乙基淀粉130/0.4(万汶)用于体外循环(extracorporeal circulation,ECC)冠脉搭桥手术的安全性,及其对ECC后急性炎性反应的影响。方法24例患者随机分为两组,组Ⅰ的ECC预充液及围术期48h容量治疗选用万汶;组Ⅱ使用琥珀酰明胶(佳乐施)。观察两组患者的容量治疗策略和急性炎性反应的发生情况、肝肾和凝血功能指标的变化,并采取动脉血检测C反应蛋白(CRP)、白介素-6(IL-6)、P选择素(P-selection)和细胞间黏附因子(ICAM-1)的含量。结果组Ⅰ患者的天冬氨酸转氨酶(AST)和丙氨酸转氨酶(ALT)较组Ⅱ患者显著升高(P<0.05)。两组患者的急性炎性反应的发生情况相似;与组Ⅱ相比,组Ⅰ患者术后48 h的CRP升高更为显著(P<0.05);术后48 h,组Ⅱ患者的ICAM-1升高更为显著(P<0.05)。结论羟乙基淀粉130/0.4可用于冠状动脉旁路移植术(CABG)患者围术期容量治疗,但应警惕其对患者肝功能的潜在影响,另外,羟乙基淀粉130/0.4有利于激活急性期反应蛋白,维持内皮稳定,从而减轻CABG后急性炎性反应。     

不同液体对全麻患者血容量影响的比较

目的:比较在全麻状态下高渗氯化钠羟乙基淀粉40、6%羟乙基淀粉130/0.4、琥珀酰明胶、乳酸钠林格氏液及复方电解质溶液对成年患者的扩容效果.方法:40名接受全麻手术的ASA Ⅰ级成年男性患者,随机分为5组(n=8),通过身高体重公式计算基础血容量并抽取动脉血2ml测定基础血宝红蛋白浓度及记录平均动脉压(MAP).经静脉快诱导气管插管,术中以静吸复合麻醉维持.开始全麻后各组分别在1小时内静脉恒速输注5ml/kg岛渗氯化钠羟乙基淀粉40(A组)、8ml/kg 6%羟乙基淀粉130/0.4(B组)和琥珀酰明胶(C组)、24ml/kg乳酸钠林格氏液(D组)及复方电解质溶液(E组).输液结束及输液结束后60min抽取动脉血2ml测定血红蛋白浓度并记录MAP,根据基础血容量及血红蛋白浓度变化计算输液后血容量,从而得到血容量增加值和液体潴留率(FR%)并比较各组全麻前后的MAP.结果:输液结束时,A组平均FR为207.0%,B组平均FR为99.8%,C组平均FR为85.5%,D组平均FR为32.0%,E组平均FR为32.6%;输液结束后60min时,A组平均FR为89.4%,B组平均FR为59.4%,C组平均FR为47.3%,D组平均FR为10.3%,E组甲均FR为11.8%:全麻后各组MAP较麻醉前下降(P<0.05),输液结束后0min与60minMAP差异无统计学意义(P>0.05).结论:全麻状态下6%羟乙基淀粉130/0.4和琥珀酰明胶可获得良好的扩容效果及维持时间,而高渗羟乙基淀粉在血管内的潴留率更大于这两种胶体液.即使输入大量晶体液得到的扩容及维持效果仍欠佳.     

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.