联机血液透析滤过治疗尿毒症的效果观察

目的：观察联机血液透析滤过治疗尿毒症的临床疗效和不良反应。方法：回顾性分析我院21例常规血液透析（HD）1－7年，伴有HD并发症及不适症状患行后稀释法联机血液透析滤过（HDF）252例次，并与23例常规HD患874例次进行比较，观察血尿素氮（BUN），肌酐（Scr)，血钙（Ca)，血磷（Sp)，β2-微球蛋白（β2－M）下降及治疗中常见稼析并发症和不良反应发生率。结果：联机HDF疗效优于HD，并发症和不良反应低于HD(P＜0．01），HDF治疗后BNU，Scr,Sp,β2-M水平显降低，Ca有所提高。结论：后稀释法联机ＨＤＦ能有效地清除尿毒症患血中的大，中，小分子物质，透析效果显，患对该疗法对耐受性显提高，是伴有HD并发症及不适症状尿毒症患的良好选择。     

血液透析滤过的临床应用

目的:探讨血液透析滤过(HDF)的临床疗效及患者对治疗的耐受性.方法:选择29例经维持性血透(HD)伴严重尿毒症症状的终末期肾衰患者进行402次HDF,记录HDF中急性并发症,检测HDF治疗6个月前后血浆Scr、Bun、β2-MG水平.比较初用血滤器、透析器分别进行HDF、HD前后血Scr、Bun、β2-MG、CO2CP变化.结果:HDF对高血压、心衰、心包及胸腔积液、中枢神经病变的改善优于HD,低血压发生率明显低于HD(P＜0.001),HDF对Scr、Bun的清除与HD无显著差异(P＞0.05),但对β2-MG的清除及纠正酸中毒的能力均优于HD(P＜0.01,P＜0.05).结论:HDF能有效清除中小分子尿毒素,是一种高效透析模式,显著提高透析充分性及对治疗的耐受性.     

不同血液净化方法治疗尿毒症患者皮肤瘙痒

目的 探讨血液透析,血液透析滤过,血液灌流加血液透析治疗尿毒症皮肤瘙痒的疗效.方法 将38例尿毒症行维持性血透的患者,根据不同的个体情况分为血液透析(HD)组,血液透析滤过(HDF)组和血液灌流加血液透析(HP+HD)治疗组.HD组,每周患者行HD 2～3次,每次透析时间4.5 h ;HP+HD组,患者每周HD 2次和1次HP+HD,每次透析时间4.5 h;HDF组,患者每周行2次HDF,每次透析时间为4 h,其他治疗措施均相同.比较三组患者治疗前后血肌酐(SCr),尿素氮(BUN),甲状旁腺激素(PTH)和β2-微球蛋白(β2 -MG)变化.结果 三组透析前与透析后血SCr,BUN都有明显下降(P<0.05),HDF组和HP+HD组治疗前后PTH和β2 -MG比较,差异有显著统计学意义(P<0.01),该两组与HD组比较差异均有显著统计学意义(P<0.01).结论 尿毒症患者在维持性HD治疗同时定 期接受HDF或HP+HD治疗,可改善和缓冲长期规律血透患者的皮肤瘙痒,提高患者的生存质量.     

血液透析滤过的临床应用

目的：探讨血液透析滤过(HDF)的临床疗效及患者对治疗的耐受性。方法：选择29例经维持性血透(HD)伴严重尿毒症症状的终末期肾衰患者进行402次HDF，记录HDF中急性并发症，检测HDF治疗6个月前后血浆Scr、Bun、β2-MG水平。比较初用血滤器、透析器分别进行HDF、HD前后血Scr、Bun、β2-MG、C02CP变化。结果：HDF对高血压、心衰、心包及胸腔积液、中枢神经病变的改善优于HD，低血压发生率明显低于HD(P＜O．001)，HDF对Scr、Bun的清除与HD无显著差异(P＞O．05)，但对β2-MG的清除及纠正酸中毒的能力均优于HD(P＜O．01，P＜O．05)。结论：HDF能有效清除中小分子尿毒素，是一种高效透析模式，显著提高透析充分性及对治疗的耐受性。     

血液透析滤过在维持性血透患者中的应用

目的 探讨联机血液透析滤过(HDF)治疗尿毒症患者不同分子量毒素清除效果及长期并发症、不适应证的临床疗效.方法 选择100例常规透析2年以上的尿毒症患者,根据经济状况分血液透析滤过组(HDF)和常规血液透析组(HD),每组50例.HDF 组每周做HDF1次,每次4h,用后稀释法,血流量230～280mL/min透析液流量700mL/min,置换液量(12±1)L,流量50mL/min,做HD每周1～2次,方法与常规透析相同;HD组每周透析2～3次,每次4h,血流量200～250mL/min,透析液流量500mL/min,两组均治疗8周.观察两组治疗前后BUN、Cr、P3-浓度、β 2-MG生化指标的变化,比较两组治疗后平均下降率及长期透析患者并发症及不适应证治疗的有效率.结果 HDF组在治疗前后4项生化指标均有显著差异(P<0.05),HD组中BUN、Cr治疗前后差异显著( P<0.05)、P3-浓度、β2-MG、无显著差异( P＞0.05)比较两组治疗后BUN、Cr平均下降率无统计学意义( P＞0.05),P3-浓度、β2-MG有显著差异(P<0.01);长期并发症及不适应证治疗的有效率,HDF组明显低于HD组,两组对照( P<0.01)有统计学意义.结论 后稀释法联机HDF能有效清除尿毒症患者血中大、中、小分子物质,透析效果明显提高,长期透析并发症症状得到改善,不适应证的发生率下降.     

不同透析方法对尿毒症的疗效观察

目的观察评价单纯血液透析(HD)、血液透析联合血液灌流(HD+HP)、血液透析联合透析滤过(HDF)三种不同血液净化方式对尿毒症患者的临床疗效。方法选取2011年1月~2014年5月我院收治的90例尿毒症患者为研究对象。将90例患者随机分为单纯血液透析(HD)组、血液透析联合血液灌流(HD+HP)组及血液透析联合透析滤过(HDF)组,每组30例,分别采取对应的血液净化疗法。两个月后对治疗前后各组血中毒素水平及皮肤瘙痒症状改善情况进行比较。结果治疗前三组的Pi、Scr及BUN水平均无显著性差异(P>0.05),治疗后各组Pi、Scr及BUN水平较治疗前均有显著下降(P<0.05),三组间各指标相比无显著性差异(P>0.05)。治疗前三组PTH、β2-MG及Cys C水平均无显著性差异(P>0.05),治疗后HD组各指标水平较治疗前无显著变化(P>0.05),(HD+HP)组、HDF组各指标水平较治疗前明显降低(P<0.05);组间多重比较结果显示治疗后(HD+HP)组、HDF组的各项指标水平均低于HD组(P<0.05),但两组间并未见显著差异(P>0.05)。治疗(HD+HP)组、HDF组皮肤瘙痒症状的改善率均高于HD组(P<0.05),但(HD+HP)组、HDF组组间比较改善率无显著差异(P>0.05)。结论 HD、(HD+HP)与HDF对小分子物质的清除作用大致相同,(HD+HP)与HDF对大、中分子物质的清除效果均优于HD,其中以(HD+HP)效果最佳。     

血液透析滤过的临床评价

对25例尿毒症患者进行血液透析滤过(HDF)治疗,观察HDF与常规血液透析(HD)和血液滤过(HF)治疗的实验室指标变化和临床疗效。结果表明,HDF对小分子物质和β_2-微球蛋白的清除效率在单位时间内均大于HD和HF,内毒素反滤量显著低于高通量膜HD,HDF治疗后患者的低血浆纤维连接蛋白状态改善或纠正,透析并发症和不适症状发生率显著低于HD;HDF治疗顽固性尿毒性高血压和皮肤瘙痒症有效,是高效短时血液净化的一种理想模式。     

用HD/HDF交替透析模式治疗尿毒症的效果观察

目的：观察用HD/HDF交替透析模式治疗尿毒症的临床疗效。方法：将2011年7月至2013年8月我院收治的42例尿毒症患者分为观察组和对照组,每组各21例患者。为观察组患者采用HD/HDF交替透析的模式进行治疗,为对照组患者进行常规HD治疗,对比分析其临床疗效。结果：观察组患者在进行治疗后Scr、BUN、β2-MG三项指标的下降率均优于对照组患者,差异显著（P<0.05）,有统计学意义,其发生不良反应及并发症的几率明显低于对照组患者。结论：采取HD/HDF交替透析疗法不仅可有效清除尿毒症患者血液中的BUN、Scr 和β2-MG等中、小分子毒性物质,有效纠正其水、电解质和酸碱紊乱的状况,增强其心血管功能和血流动力学的稳定性,还可减少其发生并发症的几率,提高其生存质量,其临床疗效明显优于常规的单纯HD疗法。     

不同透析方式治疗老年尿毒症的临床对比分析

目的探讨老年尿毒症患者较为理想的透析方法。方法对40例血液透析（HD）,36例腹膜透析（PD）,和24例血液透析滤过（HDF）的老年尿毒症患者进行比较。观察三组患者透析前后生化指标变化,以及主要并发症、生存率和死亡原因。结果PD组透析后白蛋白显著下降,三酰甘油和总胆固醇都有小幅上升。HDF对尿素氮、血肌酐和β2-微球蛋白的清除效果显著。三种透析方式的KT／V值均大于1．2,达到充分透析的要求。结论这三种方法都是老年尿毒症患者理想的透析方式,但是它们有各自的优点和缺点。HD组心血管并发症较高。PD组心血管稳定性好,但容易发生营养不良和感染。对于那些有心血管疾病的患者,可考虑选择PD进行透析。HDF组患者对治疗的耐受性高,改善了生存质量,病死率低。适用于易出现血透并发症及不适症的尿毒症患者。     

血液透析滤过对尿毒症患者疗效的临床观察

目的探讨血液透析滤过对尿毒症患者的临床疗效。方法对65例尿毒症患者随机分为血液透析滤过组（HDF）和常规血液透析组（HD）,所有患者均给予相应的基础治疗,分别观察其在治疗过程中发生的并发症及血红蛋白、尿素氮（BUN）、尿酸（UA）及β2-微球蛋白（β2-MG）清除情况。结果血红蛋白两组治疗前后比较差异无统计学意义（P〉0.05）;BUN、UA两组比较治疗前后差异有统计学意义（P〈0.05）;HD治疗后不能有效清除β2-MG,治疗前后比较差异无统计学意义（P〉0.05）,HDF能有效清除β2-MG,两组比较治疗前后差异有统计学意义（P〈0.05）。结论 HDF能够加强中大分子物质的清除,提高透析的充分性,减少并发症,而且具有稳定的血液动力学,提高患者的耐受性,减少不良反应的发生,值得推广应用。     

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.