自体输血对心脏瓣膜置换手术病人血液学、血液动力学及氧合状况的影响

目的 :观察自体输血对心瓣膜置换术病人血液学、血液动力学及氧合状况的影响。方法 :2 0例心瓣膜置换术病人 ,心功能Ⅱ～Ⅲ级 ,年龄 2 5～ 5 7岁 ,用芬太尼、咪唑安定、维库溴铵麻醉诱导 ,并以芬太尼、维库溴铵、吸入异氟醚维持麻醉。体外循环用乳酸林格氏液及血定安或血浆作预充液 ,使血液达中等稀释程度 ,并用血液回收机回收术野及体外循环机器管道内剩余血 ,术毕经处理后回输给病人。观测自体输血前后血液学、血液动力学及氧合的变化。结果 :心脏复跳后RBC ,HB ,HCT ,PLT明显降低 ,凝血酶原时间 (PT)和活化部分凝血酶原时间 (APTT)明显延长 ,PvO2 、SvO2 值明显升高 ,氧摄取率 (O2 ER)增高。术毕回输自体血后HB ,HCT明显回升 ,虽仍低于术前水平 ,但MAP ,CVP ,PCWP和CI维持稳定 ,混合静脉血氧分压 (PvO2 )和混合静脉血氧饱和度 (SvO2 )明显回升并在正常范围 ,O2 ER明显回降。结论 :中度血液稀释和回收式自体输血 ,术中应用于非重度瓣膜置换术病人 ,对组织氧合状况及凝血功能影响不明显     

回收式自体输血联合血液稀释应用于骨科手术的研究

目的观察血液回收机行自体输血及急性等容性血液稀释在骨科手术的效果及氧代谢的变化。方法30例骨科手术患者,无明显心肺功能及凝血功能障碍,ASA分级Ⅰ～Ⅱ。年龄49.1±15.6岁,体重52.7±8.3公斤,随机分为术中自体输血组及输库血组,每组各15例。经桡动脉置管采血及右颈内静脉置漂浮导管监测血液动力学及氧代谢变化。结果自体输血组与库血输注组相比,术中出血量分别为850±443ml与775±434ml(P>0.05),术中库血输入量分别为88±202ml与380±304ml(P<0.05);两组输血前HCT分别为自体输血组23.3%±6.2%,库血组24.4%±5.9%(P>0.05)。术毕HCT分别为自体输血组28.1%±6.1%,库血组33.4%±7.2%(P>0.05)。术中自体输血及血液稀释期间外周循环阻力明显降低,心输出量明显增加,组织氧供、氧耗、氧摄取率及血乳酸无明显变化。结论骨科手术行血液回收机自体输血及血液稀释明显减少库血输注,血液稀释至23%左右对心肺功能良好的病人氧代谢状况无明显影响。     

术前血液稀释性自体输血在口腔颌面外科中的应用

【目的】探讨血液稀释自体输血在口腔颌面外科手术中的应用。【方法】 17例口腔颌面部手术患者术中采用了血液稀释自体输血 ,术后检测观察血红蛋白 (HB)、红细胞压积 (HCT)、血小板 (PLT)的恢复情况及抗生素应用时间和用量 ,15例术中同种异体输血病例为对照组。【结果】血液稀释自体输血组术前HB 134g/L ,HCT 0 42 8% ,PLT 14 6× 10 9。术后 3dHB 119g/L ,HCT 0 36 8% ,PLT 12 2× 10 9。术后 1周HB 12 1g/L ,HCT 0 40 2 % ,PLT 12 5× 10 9,恢复速度明显快于对照组 ,抗生素应用时间及用量明显少于对照组。【结论】血液稀释自体输血是口腔颌面外科手术中一种安全有效的输血方式 ,有利于病人术后的恢复 ,减少输血的并发症。     

急性等容性血液稀释在22例骨科手术中的应用体会

目的 探讨骨科手术行急性等容性血液稀释自体血回输对手术患者术中及术后循环功能及凝血功能的影响.方法 22例骨科手术病人术前行挠动脉穿刺采自体血,同时于外周静脉输入2～3倍的长源雪安和平衡液,术中连续监测HR、MAP、CVP、SpO2及尿量变化,分别于采血前、后30 min,回输血前、后30 min及术后1 d和7 d监测HCT、Hb、PLT、RBC的变化.结果 手术全过程的HR、MAP、CVP、SpO2无明显变化（P＞0.05）,ECG未见心肌缺血表现,稀释后HCT、Hb明显降低（P＜0.01）,但未低于最低值（0.25）.PCT、RBC有所下降（P＜0.05）;术后7 d HLT、Hb、RBC恢复较快,PLT明显升高.结论 在骨科手术中应用急性等容性血液稀释自体血回输,能保证术中及术后循环功能及凝血功能的稳定,术后凝血功能明显恢复,并能减少输异体血所至的并发症,是一种安全的有效的自体输血方法.     

稀释性自体血回输在脊柱手术中的应用

目的探讨稀释性自体血回输在脊柱手术中的应用。方法选择骨科择期脊柱手术患者60例随机分为观察组和实验组,各30例。观察组术中行常规方法,实验组按稀释式自体血回输方法进行自体血采集并行血液稀释。通过采集围术期患者血液样本,检测术前(T0)、输血前(T1)、术毕即刻(T2)、术后24 h(T3)红细胞(RBC)、血红蛋白(Hb)、红细胞压积(HCT)、凝血酶原时间(PT)、活化部分凝血酶时间(APTT)。同时,观察对机体的不良反应和并发症。结果观察组术中出血(873.5±310.4)m L,实验组术中出血(834.1±295.3)m L,2组出血量差异无统计学意义(P>0.05);异体输血量实验组明显少于观察组(P<0.05),2组输血前RBC、Hb、HCT、均较术前明显下降,并在术毕和术后明显回升(P<0.05)。2组PT及APTT在术毕较术前明显延长,术后24 h明显恢复,与术前差异无统计学意义(P>0.05)。所有患者均未发生不良反应。结论稀释性自体血回输是自体血液储备与血液稀释相结合的一种血液保护措施,它不仅明显减少异体血的使用并避免传染性疾病传播,而且对血液系统影响小,值得临床推广使用。     

急性等容血液稀释用于颅脑外科围术期血液保护

目的　观察急性等容血液稀释在颅脑外科围手术期的血液保护效应。方法　将 4 0例颅脑外科手术患者随机等分为空白对照组 (A组 )、急性等容血液稀释组 (B组 ) ,观察两组患者诱导前、诱导插管后 5min(B组相当于采血前 )、插管后 2 5min(B组相当于采血后 )、输血前、术毕各时点平均动脉压 (MAP)、中心静脉压 (CVP)、脉搏 (P)变化 ;上述各时点动脉血氧饱和度 (SaO2 )分压 (PvO2 )、血乳酸 (ABL)、锁骨下静脉血氧饱和度 (SaO2 )、氧分压 (PvO2 )、血乳酸 (VBL)水平 ;诱导前、插管后 2 5min、输血前、术毕、术后第 2天、第 7天血红蛋白 (Hb)、红细胞压积 (HCT)、白细胞 (WBC)、血小板 (PLT)变化 ;手术失血量、术后 2 4h切口引流量、术中、术后异体红细胞、异体全血输注量 ;未输异体血病例数。结果　两组患者各时点MAP、CVP、P比较无明显差别 ;诱导插管后时点SaO2 、PaO2 明显高于诱导前 (P <0 .0 1) ,输血前SvO2 、PvO2 明显低于诱导前 (P <0 .0 1) ,ABL、VBL无明显差别 ;B组患者自体采血后Hb、HCT明显低于诱导前 (P <0 .0 1)及同时点的A组水平 (P <0 .0 1) ,两组患者输血前、术毕、第 2天、第 7天Hb、HCT均明显低于诱导前 (P <0 .0 1) ,但组间比较无明显差别 ,两组患者从输血前开始WBC明显升高 (P <0 .0 1) ,     

稀释式自体输血在心脏手术中的应用

目的 稀释式自身输血应用于心脏手术中观察不用或少用异体库血进行心脏手术效果.方法 对40例进行心脏手术患者(试验组)术中采用稀释式自身输血节血措施,同期使用异体输血法的40例心脏手术患者作为对照组,比较两组见血小板(plt) 血红蛋白(HB) 红细胞压积(HCT) 异体输血等差异.结果 稀释式能避免和减少输用异体血液,术后血小板血红蛋白和红细胞压积均无统计学行状差异(p>0.05).结论 心脏手术中采用稀释式自体输血能明显减少手术出血少输和不输异体血,降低对库血的需要量.     

食管贲门癌肺癌外科治疗采用等容血液稀释自身输血临床研究

目的自身输血安全可靠,前者可扩大病人的血容量[1],后者可减少病人的血液丢失,防止供血途径感染(HIV HAV HBV HCV).方法临床手术中21例患者采用了等容血液稀释自身输血.术前采患者外周静脉血密闭,室温下贮存,同样输入血浆代用品,患者血液被稀释,手术结束后,将贮存的患者血回输.结果男性15例,女性6例,患者年龄34～74岁,21例中食管贲门癌肺癌20例,回盲部肉瘤1例.每例患者均采用血200ml,稀释液用血浆代用品706代血浆400ml,手术结束后回输无不良反应,手术中患者平稳.患者血液稀释前后及术后二周血流动力学、血生化学、凝血功能、肝肾功能等正常,患者HCT平均值降至28.28%,HB平均值降至92g/L,达到中度血液稀释,血液稀释前相比,患者HB、HCT、RBC显著降低,仍在正常范围内,术后两周HB、HCT、RBC与稀释前比无显著变化.结论急性等容血液稀释自身输血的方法操作简单,安全方便,用于肿瘤患者具有理想、实用、可靠、经济及预后良好的优点,该方法不抑制免疫功能,可以提高生存率,降低复发率,减少患者的用血量.是节约用血,防止输血传播各种病毒的一种好方法,可用于基层边远山区医院病人抢救和治疗及适合家庭贫困患者更理想.     

急性等容血液稀释在双髋关节置换手术中的应用

目的 :观察在双髋关节置换手术中 ,应用急性等容血液稀释和自身输血的临床效果。方法 :33例双髋关节置换手术均采用静吸复合全麻 ,补充禁食所失液量和采血量等量的血浆代用品— 6 %贺斯 ,于桡静脉处采血 6 0 0～ 80 0 ml,待手术需输血时 ,回输自体血。于血液稀释前后及自身血回输后取血样测定 Hb、HCT、PL T,观察其变化。结果 :血稀后 Hb、HCT比血稀前明显降低 (P<0 .0 1) ,但 HCT仍在 2 5 %以上 ,PL T较前稍降低 (P<0 .0 5 ) ,自身血回输后 ,Hb、HCT、PL T明显上升 (P<0 .0 5 )。结论 :在双髋关节置换手术中应用急性等容血液稀释技术和自身输血 ,可减少血液浪费及术后输血并发症 ,做到了血液保护 ,安全可靠     

高原地区自体输血及血液稀释的临床研究

目的研究高原地区自体输血、血液稀释在围手术期应用的可行性及意义。方法选择ASAⅠ-Ⅱ级,年龄23-68岁,术前Hb≥130g/L,HCT≥0.4L/L,术中出血约在800ml以上的择期外科手术病例80例,分为两组。实验纽40例,于术前或(和)麻醉后采集自体血400-800ml,用以自体血回输,术中给予扩容行血液稀释,通过监测HCT和Hb控制输血。对照组按常规方法输血和输液。结果实验组术中输血量为(462±220)ml,比对照组(1297±640)ml减少60%,术中输血费用:实验组为46636.2元,比对照组(93379.08元)减少49.9%。术中实验组动脉血气正常,血流动力学稳定,凝血功能变化不大。结论在高海拔地区可以采用自体输血与术中扩容血液稀释相结合的方法达到节约用血的目的。     

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.     

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.     

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.