腹痛急诊方法研究

目的:探讨提高腹痛急诊质量水平的方法。方法:通过腹痛急诊患者378例的病情判断、查体、诊断及辅检以及止痛药应用情况,收入住院情况进行分析。结果:在急诊科最终诊断明确359例(94.97%);不明诊断19例(5.03%);病危30例(7.94%);做一项及一项以上辅检病例346例(91.51%);应用各类止痛药292例(58.47%),收入住院317例(83.86%)。结论:腹痛急诊病例首先应明确患者有无生命危险,且生命体征和主诉仍是确定威胁患者生命的最主要点。重点查体是正确诊断腹痛病因的重要手段,正确评价辅助检查,切忌过份依赖辅检。忌用止痛药,以免掩盖病情延误诊断,造成严重后果,病情危重者及时抢救,病情稳定后立即收入专科治疗,从而提高腹痛患者急诊质量水平。     

急性腹痛诊断方法的分析

目的：探讨、分析以急性腹痛原因待查入院者的诊断方法。方法：选择1994～2004年我院急诊科以急性腹痛原因待查收治的512例患者的临床资料。分析其常见病因及延迟确诊的原因。结果：512例急性腹痛者中，有482例在发病24小时内明确诊断。内科系统疾病343例（71．2％）；普通外科92例（18．0％）；妇产科38例（7．9％）；泌尿外科5例（0．9％）；胸外科4例（0．8％）。30例未能及时做出诊断，主要是因为询问病史不详细和查体不全面；缺乏跨学科知识。思维范围局限等造成。结论：对腹痛患者应详细询问病史，全面查体。正确认识局部与整体的关系，必要时可剖腹探查。     

急诊病人病死率的统计学分析

找院急诊科于1988年～1995年的8年间共诊治重症急诊病人10359例，占同期急诊总数的4．94o，门诊病人的0．640．收入院3941例（38．04％）；转院806例（7．78％）（因专科床位紧张、夜间没有CT、腹部B超等特殊检查等原因）；自动离院404例（3．09％）（家属因病情危重无治疗信心、诊断明确后要求就近医院或家庭病床治疗等）；住急诊科抢救治疗痊愈或明显好转4444例（42.90％）；在急诊科抢救无效死亡772例，病死率7.45％．病种构成：内科疾患占绝大多数．8809例（85.04％），并以脑血管疾病最多，3376例（32．59％）．占前10位的疾病依次为…     

住院精神病患者夜间急诊30例临床分析

目的：分析精神病患者夜间急诊的原因及处理方法。方法：回顾性分析本院的30例精神病患者的夜间急诊，通过对医生的入院病历记录和护士交接班记录的资料分析，观察精神病患者夜间发生急诊的原因、疾病类型及处理方法。结果：30例住院精神病患者夜间急诊中，躯体疾病并发症占首位（46．7％），精神病症状所致居第2位（33．3％），再次为抗精神病药物副作用（20％）。结论：医护人员在收入精神病患者时，要详细询问病史，全面体格检查，在住院期间密切观察病情变化；精神科医务人员要努力提高急症的诊治水平。     

94例儿童发热待查的临床分析

目的：探讨儿童发热待查（FUO）病因构成及诊断方法。方法：回顾性总结分析符合FUO诊断标准的患儿94例，结果：94例中明确诊断85例，确诊率为90．4％，未明确诊断9例（9．6％）。确诊病例中，感染性疾病58例（68．2％），肿瘤及瘤样病变12例（14．1％），结缔组织病7例（8．2％），其他疾病8例（9．4％）。9例病因不明。结论：根据临床经过和必要的辅助检查可以明确FUO中的大多数病例的病因诊断，感染性疾病，肿瘤性疾病及结缔组织病是本组FUO的主要病因。     

45例胎盘早剥临床分析

胎盘早剥是妊娠晚期的一种严重并发症，往往起病急，进展快，若处理不及时，可危及母儿生命。本文回顾分析本院45例胎盘早剥病例，探讨诊断及防治措施。1资料与方法1．1一般资料：本院1994年1月-1997年12月4年间住院分娩10873例，其中胎盘早剥45例，全部病例均在产后检查胎盘发现血块和血迹而确诊，发生率为0．41％；平均年龄26．6岁（21－38）；初产妇四例，经产妇11例，平均孕36+6周（28-41+6），其中＜37周者30例，占66．7％。1．2临床症状及体征：胎盘早剥常见症状、体征有：阴道出血（53．33％）、腹痛（53．33％）、胎心异常（4O．00…     

110例60岁以上老年人纤维支气管镜检查分析

目的：分析110例60岁以上老年人纤维支气管镜检查的意义；方法：采用日本产OlympusIT-10型纤维支气管镜进行常规检查；结果：支气管炎症病变49例（44．5％）、肺癌34例（31．85）、肺结核9例（8．2％）、17例患者未能明确诊断（15．5％），全部病例均在纤维支气管镜检查室完成，未出现严重的并发症；结论：老年人进行纤维支气管镜检查是安全的，对明确肺部肿瘤及结核的诊断是有益的。     

基层医院急性腹痛患者救治策略

目的探索基层医院急诊急性腹痛患者的救治策略。方法分析129例于2015年4月至2017年4月在某基层医院急诊科就诊急性腹痛患者病例资料。结果 127例患者痊愈,2例死亡。结论在基层医院急诊,对急性腹痛患者处置,要在问病、查体、辅助检查方面多下功夫;诊断不明确者,要动态观察病情;急诊医师必须熟悉各种急性腹痛的特点;要及时请专科会诊;必要时尽快转上级医院。     

克罗恩病急诊的临床分析(附23例报告)

目的：分析探讨克罗恩病（CD）急诊的临床特点，诊断和治疗；方法：调查了1988年－2002年30例CD患者，其中23例（76．6％）发生急诊，对本病临床情况，诊断和治疗方法及疗效进行了回顾，结果：本组CD急诊误诊率为10例（43％），手术治疗17例，内科治疗6例，22例患者症状改善，病情缓解，一例死于并发的恶性肿瘤；结论：CD临床特点是急诊发生率高，误诊与其临床表现多样，缺乏对CD认识有关；诊断需用结肠镜，X线，腹部B超，DSA，CT等检查综合评价，及时手术和积极内科治疗对本病的预后有重要的意义。     

52例创伤性休克患者的急诊护理探讨

目的探讨创伤性休克患者的急诊护理方法与价值。方法抽取该院自2011年1月-2013年1月收治的52例创伤性休克患者作为研究对象，给予患者常规护理、优质护理，观察患者抢救成功率、平均住院时间及患者对护理满意率。结果患者成功抢救后痊愈49例，抢救成功率为94．2％；患者平均住院时间为（11．05±2．13）d，患者对护理非常满意30例，满意19例，满意率为94．2％。结论创伤性休克患者病情凶险，死亡率较高，治疗期间给予患者优质综合性护理有助于提高临床抢救率，临床意义显著。     

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.