血浆置换治疗重症疾病临床应用

目的探讨血浆置换(PE)治疗重症疾病患者的方法与疗效。方法对29例格林巴利综合症(GBS)和重症肌无力(MG)等重症患者采用血浆单采仪采集患者血浆,以右旋糖酐40葡萄糖注射液和经病毒灭活的去白细胞冰冻血浆为置换液,进行血浆置换。结果经血浆置换后效果良好,置换过程顺利,未发生严重不良反应。结论血浆置换对自身免疫性疾病和重症急性中毒等疾病疗效明显。     

血浆置换治疗血栓性血小板减少性紫癜的疗效观察

目的 进一步了解血浆置换治疗血栓性血小板减少性紫癜(TTP)的疗效. 方法 对4例确诊为TTP的患者给予糖皮质激素治疗联合血浆置换,深静脉置管建立体外循环,用贝朗Diapact CRRT机及费森尤斯P2S血浆分离器进行血浆置换,新鲜冰冻血浆为置换液,血浆置换量35～ 40 mL/kg,置换速度15 ～20 mL/min,血流速度120～150 mL/min,小剂量低分子肝素抗凝.血浆置换每日或隔日治疗1次.观察血液检验指标和临床症状改善情况. 结果 4例TTP患者每例完成3～5次血浆置换,治疗后血小板计数(PLT)、血红蛋白(Hb)上升,尿素(BUN)、总胆红素(IBIL)、乳酸脱氢酶(LDH)降低,治疗前后的结果经统计学处理,P＜0.01,随访6个月全部治愈.结论 血浆置换治疗TTP效果明显,TTP病人应争取早期血浆置换治疗,提高疗效,降低病死率.     

血浆置换成功治疗血栓性血小板减少性紫癜12例报道

目的观察血浆置换治疗血栓性血小板减少性紫癜(TTP)的疗效。方法12例TTP患者,以新鲜冰冻血浆为置换液,进行血浆置换,每日1次,血浆置换次数中位数为7次(1~9次)。结果血浆置换治疗12例患者中10例存活。血浆置换治疗后12~72h,10例存活患者清醒;血浆置换4次后发热消退,皮下无新鲜出血点和淤斑,黄疸消失,红细胞压积和血小板数逐渐升高。结论血浆置换治疗TTP疗效好,值得推广。     

血浆置换治疗血栓性血小板减少性紫癜的临床分析

目的 观察新鲜冰冻血浆作为置换液治疗TTP的临床疗效.方法 血浆置换后症状缓解配合大剂量糖皮质激素和营养支持等药物治疗.结果 5例患者中4例分别做血浆置换1～6次,1例复发后又做血浆置换3次,4例治愈,1例死亡.结论 血浆置换辅以大剂量糖皮质激素和营养支持是治疗TTP的首选有效方法 .     

血浆置换治疗难治性系统性红斑狼疮10例疗效观察

目的探讨血浆置换疗法配合常规药物治疗重型难治性系统性红斑狼疮(SLE)的疗效。方法置换液选晶体液、胶体液、新鲜冰冻血浆,按1∶1∶1比例,顺序依次为晶体液、胶体液、新鲜冰冻血浆。10例患者中血浆置换1次3例,2次2例,3次4例,5次1例。结果10例SLE患者血浆置换后症状好转者9例,其中8例面部红斑浮肿消失,6例关节痛好转,1例心包积液消失,2例神经症状改善,5例肾功能均有改善,1例皮肤溃疡创面愈合,8例尿蛋白由置换前平均(6.02±4.43)g/24h,置换后(1.11±1.80)g/24h(P<0.05),ESR置换前(80±40)mm/h,置换后(33±18)mm/h(P<0.05);抗核抗体阳性10例6例转阴,抗DsDNA抗体5例转阴,抗核糖体阳性转阴1例。仅有1例高敏体质出现严重过敏,中途停止置换。结论对常规治疗难以奏效的重型难治性系统性红斑狼疮患者应用血浆置换治疗以去除体内循环的自身免疫抗体和免疫复合物。大部分患者可获得较好的治疗效果。     

血浆置换在胸腺切除治疗重症肌无力术前的应用(附53例报告)

目的分析血浆置换(PE)在胸腺切除治疗重症肌无力(MG)中的应用价值.方法血浆置换使用美国CS-3000PLUS全自动血细胞分离机,置换液使用生理盐水、"706"代血浆和新鲜冰冻血浆,采出血浆量为2000ml,时间间隔为48h.结果全部患者治疗后症状明显缓解,达到可施行胸腺切除手术临床要求的指征.结论血浆置换配合胸腺切除术治疗重症肌无力是一种有效的治疗手段,是治疗重症肌无力危象、提高疗效的有力措施.     

血浆置换治疗血栓性血小板减少性紫癜

目的观察新鲜冰冻血浆作为置换液治疗血栓性血小板减少性紫癜(TTP)的临床疗效。方法血浆置换加大剂量糖皮质激素治疗。结果 3例患者中分别做血浆置换1～5次,全部治愈。结论血浆置换辅以大剂量糖皮质激素是治疗TTP的首选有效方法 。     

血浆置换治疗17例重症农药中毒疗效观察

目的探讨应用血浆置换治疗急性重症有机磷农药中毒的疗效。方法在常规治疗基础上，对我院收治的17例急性重症有机磷农药中毒患者进行血浆置换治疗。置换液为新鲜冰冻血浆，平均置换量为2200ml。结果17例患者中，16例治疗有效，1例死亡。中毒早期进行血浆置换治疗效果明显。结论血浆置换是治疗急性重症有机磷农药中毒的一种有效手段，早期治疗效果较好。     

血浆置换在难治性自身免疫溶血性贫血临床应用

目的探讨血浆置换治疗严重难治性自身免疫性溶血性贫血患者疗效。方法采用德国费森尤斯血细胞分离机程序性血浆单采患者血浆,回输正常人新鲜灭活冰冻血浆和血浆代用品,治疗12例患者,男5例,女7例,每次置换血浆量1375±256ml,置换2-3次,间隔3-4d。结果 10例患者置换治疗后1周、2周、3周血红蛋白逐渐上升,溶血现象逐渐减少,置换过程有轻微不良反应,都能耐受,顺利完成。结论血浆置换对难治性自身免疫性溶血性贫血患者疗效较好。     

简易血浆置换疗法治疗重症肌无力症

血浆置换多采用进口或国产HF血液成分分离机进行置换,我们采用单采血浆回输器,少量多次进行血浆置换,以新鲜冰冻血浆作置换液,治疗重症肌无力危象1例,取得较理想疗效。     

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.