肝硬变腹水病人的低钠血症

本文分析８２例肝硬变腹水并低钠血症病人，血钠１３１～１３５ｍｍｏｌ／Ｌ者３５例，１２６～１３０ｍｍｏｌ／Ｌ者２７例，≤１２５ｍｍｏｌ／Ｌ者２０例。低钠血症与Ｃｈｉｌｄ分级和肾功能及预后相关（Ｐ＜０．００１～Ｐ＜０．０２），并发症也影响预后（Ｐ＜０．００１）。低钠血症的发生常与治疗不当有关，急性低钠综合征多与利尿基础上大量放腹水有关，３％氯化钠输注可用于急性低钠综合征及严重低钠血症患者。     

肝硬化腹水低钠血症的临床探讨

对８３例肝硬化腹水合并低钠血症患者进行分析，血钠１３１～１３５ｍｍｏｌ／Ｌ２２例、１２６～１３０ｍｍｏｌ／Ｌ４８例、≤１２５ｍｍｏｌ／Ｌ　１３例，死亡２９例，血钠降低与Ｃｈｉｌｄ分级、肾功能以及预后相关（Ｐ＜０．０５，＜０．００５）。６例在原有低钠状态下，利尿与放腹水后发生急性低钠综合征，２例死亡，４例经用３％或１０％氯化钠后恢复。本组临床分析表明，在原有低血钠状态下，特别是对血钠≤１２５ｍｍｏｌ／Ｌ及全身和肝肾功能差者，在同时放腹水与用强利尿剂时应慎重，并应预防急性低钠血症的发生。自身腹水回输为此类患者的治疗开辟了一条新的途径。     

肝硬化腹水并发低钠血症82例临床分析

目的：探讨肝硬化腹水病人低钠血症的临床特点。方法：对82例肝硬化腹水并发低钠血症患者的临床资料进行总结分析。结果：低血钠与肝性脑病、肝肾综合征有关(P＜0．05）,与病情严重程度及预后显著相关（P＜0．01）。结论：低钠血症是肝硬化腹水病人常见的并发症,应予高度重视,临床上主要采取综合措施治疗。     

肝硬变腹水并发低钠血症78例临床分析

肝硬变腹水在发展及治疗过程中并发低钠血症临床上很常见,而不同程度的低钠血症与预后有关[1],故应做到早发现、早预防、早治疗.本文对收集的78例肝硬变腹水并低钠血症作一回顾性分析。1临床资料1.1一般资料本文收集共计78例肝硬变腹水并低钠血症,其中男64例,女14例,年龄8岁至76岁,平均年龄47岁;其中肝炎后肝硬变61例,酒精性6例,血吸虫性4例,肝糖源累积综合症1例,隐源性6例。1.2诊断依据①测定血清钠值在（120—125mmol／L之间为轻度,血清钠在（110—120）mmol／L为中度低血钠,血清钠＜110mmol／L为重度。②有电解质丢失的明…     

日间连续性肾替代治疗重症急性低钠血症

目的探讨日间连续性肾替代治疗（CRRT）重症急性低钠血症的有效性、安全性。方法对我院2005年1月～2010年12月的17例重症急性低钠血症住院患者使用金宝Prisma行连续性肾替代治疗（CVVH），每天治疗8h，连续3d，置换液使用前稀释，置换液流量4L／h，治疗前患者血清钠水平（112．5±4．0）mmol／L，第1天设定置换液钠浓度比血清钠水平高（10-14）mmol／L，第2、3天设定置换液治疗结束时钠浓度比实际血清钠水平高（9～12）mmol／L、（6～9）mmol／L。结果所有患者治疗时间3d，每天8h，均顺利完成，血清钠由治疗前（112．5±4．0）mmol／L上升到（140．2±2．8）mmol／L，血清渗透压逐渐恢复正常，神经精神症状明显好转，G1asgow评分由治疗前的（8．3±1．7）上升到（14．5±0．6）。结论CBP治疗急性严重低钠血症避免了传统方法使血清钠升得过快或过慢等缺点，能够按目标调整纠正血钠速度，本组研究表明CBP治疗急性严重低钠血症疗效确切，成功率高、安全，不失为急性重症低钠血症重要治疗手段。     

垂体后叶素治疗咯血致低钠血症115例临床分析

目的了解垂体后叶素治疗咯血时低钠血症及相关的神经系统症状的发生情况。方法回顾性分析115例经垂体后叶素治疗的咯血患者的临床资料。结果使用垂体后叶素后平均血钠水平下降5．9mmol／L（P=6．298×10^-21），47例（40．8％）发生低钠血症。垂体后叶素使用较多者发生低钠血症的几率较高（e=-0．050）。低钠血症常见的神经系统症状为头昏、头痛、感觉迟钝和淡漠，严重的昏迷少见，发生于极低的低钠血症患者及血钠纠正过快者。出现抽搐的患者伴有低钙血症。结论垂体后叶素治疗咯血可能引起血钠水平减少，且与剂量呈正相关。低钠血症合并的神经系统症状多数轻微，个别极低血钠者可能出现严重的症状。不能确定抽搐是否与低钠血症有关。     

肝硬化腹水并发低钠血症107例临床分析

目的：分析低钠血症与肝硬化腹水并发症及临床转归的关系，提高对该病认识水平，以利于指导诊治。方法：对107例肝硬化腹水并低钠血症患者的临床资料进行总结分析。结果：重度低钠血症的肝肾综合征、肝性脑病的发生率及死亡率，明显高于轻、中度低钠血症者，差异有统计学意义（P〈0．01，P〈0．05）。结论：血钠越低，肝性脑病、肝肾综合征等肝硬化并发症发生及死亡率越高。     

小儿重症肺炎并电解质紊乱的临床分析

目的 探讨小儿重症肺炎并电解质紊乱的治疗和转归。方法 我院2000-2004年采用7020-A型全自动生化分析仪检测67例小儿重症肺炎患儿的电解质，并对患儿的临床表现及转归等进行统计分析。结果 67例中低钠血症50例（74％），低钾血症20例（29．8％）。血钠〈120mmol／L，予3％氯化钠溶液治疗，血钾〈3．5mmol／L每天补氯化钾。50例重症肺炎伴低钠血症者，治愈和好转27例（54％），17倒未伴低钠者，治愈及好转13例（76％）。50例低钠患儿成功纠正低钠40例，其中治愈和好转25例（62．5％），而10例未能纠正低钠者治愈及好转2例（20％）。结论 小儿重症肺炎常合并电解质紊乱，以低钠血症最为常见，并明显影响预后；临床常规监测电解质，并及时纠正电解质紊乱能明显提高小儿重症肺炎的抢救成功率。     

低钠血症对老年重症肺炎预后的影响

目的探讨老年重症肺炎并低钠血症的原因、治疗及转归.方法对85例老年重症肺炎患者进行血钠检测,血钠在120～134.9 mmol/L适当补充生理盐水;血钠低于120 mmol/L,予3%高渗氯化钠溶液治疗.结果85例中低钠血症50例(58.80%).50例重症肺炎伴低钠血症患者,治愈及好转24例(48.00%);预后35例未伴低钠者,治愈及好转26例(74.29%),P＜0.05;50例低钠患者32例成功纠正低钠,其中治愈和好转21例(65.63%),而18例血钠无法纠正者,治愈和好转3例(16.67%),两组比较差异具有统计学意义(P＜0.01).结论老年重症肺炎伴低钠血症且不能纠正者预后差,常规监测电解质,及时纠正低钠能明显提高重症肺炎的抢救成功率.     

54例肝硬化并发低钠血症临床分析

目的 探讨肝硬化并发低钠血症的原因及低钠血症与并发症的关系和对预后的影响.方法 测定2001年8月至2008年12月之间收治的54例肝硬化合并低钠血症的患者血钠的数值.结果 轻度低血钠(125～135 mmol/L)14例,中度(110～125 mmol/L)29例,重度(＜110 mmol/L)11例.结论 随着血钠的降低患者肝性脑病和肝肾综合征的发生率越高,并且死亡率越高.应引起临床医生的高度重视,积极治疗低钠血症,减少并发症的发生,降低死亡率.     

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.