肝素钠脉冲式正压封管液在乳糜性胸腹水患者中心导管置管后预防静脉血栓的应用研究

目的探讨肝素钠脉冲式正压封管液预防乳糜性胸腹水患者中心导管(PICC)置管后静脉血栓的效果。方法选择2015年1月至2017年1月于我院就诊的120例行PICC置管的乳糜性胸腹水患者作为研究对象。120例患者随机分为对照组(60例)和试验组(60例)。两组均采用脉冲式正压封管方式,对照组采用生理盐水作为封管液,试验组采用肝素钠作为封管液。探讨肝素钠脉冲式正压封管液预防乳糜性胸腹水患者PICC置管后静脉血栓,血栓标志物D-D和v WF水平,以及其他并发症情况。结果试验组静脉血栓发生率低于对照组(13.33%vs 31.67%)(P0.05)。试验组D-D水平(2.02±0.33)低于对照组(5.52±0.33)(P0.05)。试验组v WF水平(63.13±6.33)低于对照组(85.52±8.33)(P0.05)。试验组患者导管堵管、静脉炎发生率降低(P0.05)。结论乳糜性胸腹水患者PICC置管时,采用肝素钠脉冲式正压封管,可以降低静脉血栓发生率,还可改善血栓标志物水平,     

肝素钠和地塞米松混合液浸泡PICC管预防机械性静脉炎的研究

目的 观察肝素钠液和地塞米松浸泡经外周静脉置入中心静脉导管（PICC）,置管后联合红外线照射预防机械性静脉炎的效果.方法 将行PICC的乳腺癌患者分为观察组和对照组,各62例.对照组置管前常规用0.9％氯化钠注射液冲洗导管,观察组置管前采用稀肝素钠液＋地塞米松浸泡PICC导管,置管后采取红外线灯照射穿刺侧上肢,穿刺点周围涂擦多磺酸粘多糖乳膏.结果 观察组机械性静脉炎发生率3.2％,对照组发生率19.4％,两组差异有统计学意义（P＜0.01）.结论 肝素钠液和地塞米松浸泡PICC导管,置管后联合红外线照射,多磺酸粘多糖乳膏涂抹预防机械性静脉炎的效果显著.     

周林频谱仪照射预防PICC致机械性静脉炎临床护理研究

目的:探讨周林频谱仪照射预防PICC致机械性静脉炎发生的疗效,以期降低留置PICC管患者机械性静脉炎的发生率,为患者提供安全有效的PICC置管临床护理方案,延长PICC管使用期及增加患者舒适度。方法:将164例PICC置管患者随机分成对照组82例,试验组82例。对照组:PICC置管后常规护理,置管后给予外帖IV3000透明护肤膜,24 h更换敷料后每周更换或敷料随松随脏随时更换,输液期间、输液完后用0.9%NaCl 20 ml脉冲式冲管,用含50 u/ml肝素钠盐水封管,非输液期间每周冲管、封管及更换肝素帽接头一次。试验组:PICC置管后常规护理同对照组,不同的是在置管后30 min裸露照射部位,即术肢穿刺点至肩峰的管道走向部位,给予周林频谱仪照射,高度大约20~40 cm,温度以患者感觉皮肤温热、舒适为宜,每次照射20~30 min,2次/d,连照三天。结果:82例置管患者发生Ⅰ级机械性静脉炎4例。对照组:82例置管患者发生Ⅰ级机械性静脉炎11例、Ⅱ级机械性静脉炎3例、Ⅲ级机械性静脉炎2例。结论:PICC置管后在常规护理基础上增加周林频谱仪照射穿刺点至肩峰的管道走向部位,可有效预防PICC致机械性静脉炎,显著降低了PICC置管患者机械性静脉炎的发生率。     

3种不同封管方法应用于植入式静脉输液港的效果研究

目的 探讨3种不同封管方法对植入式静脉输液港的影响,选择最佳封管方法.方法 将植入静脉输液港的乳腺癌患者60例随机分为A、B、C组各20例.A组每天输液完毕用20mL生理盐水脉冲式冲管,再用5mL生理盐水正压封管,1个输液周期结束,拔除蝶翼针时用20mL生理盐水脉冲式冲管,再用5mL生理盐水正压封管;B组每天输液完毕用20mL生理盐水脉冲式冲管,再用5mL肝素盐水(0.05U/L)正压封管,拔除蝶翼针用20mL生理盐水脉冲式冲管,再用5mL肝素盐水(0.05U/L)正压封管;C组每天输液完毕用20mL生理盐水脉冲式冲管,再用5mL生理盐水正压封管,1个输液周期结束,拔除蝶翼针时先用20mL生理盐水脉冲式冲管,再用5mL肝素钠盐水(0.05U/L)正压封管.比较3组患者输液港堵管发生率.结果 A组与B组比较,A组与C组比较,输液港堵管发生率差异均有统计学意义(P＜0.01);B组与C组比较,输液港堵管发生率差异无统计学意义(P＞0.05).结论 每天输液完毕用20mL生理盐水脉冲式冲管,再用5mL生理盐水正压封管,1个输液周期结束,拔除蝶翼针时先用20mL生理盐水脉冲式冲管,再用5mL肝素钠盐水(0.05U/L)正压封管,方法最佳,经济实惠,没有安全隐患,堵管发生率低.     

地塞米松预防早产儿PICC静脉炎的效果观察

目的探讨地塞米松溶液浸泡PICC导管对预防早产儿PICC置管后静脉炎的效果。方法将2009年10月-2010年10月PICU住院的低出生体重儿46例,分为对照组23例,干预组23例。对照组按传统的方法进行置管;干预组在置管前将NS 10 ml＋地塞米松5 mg配制成的液体预冲在PICC导管的保护套膜内,浸泡PICC导管5 min左右后进行置管,观察两组静脉炎的发生率。结果对照组发生静脉炎10例,发生率43.5%;干预组发生静脉炎3例,发生率13.0%,两组比较差异有统计学意义（P〈0.05）。结论早产儿PICC置管前用地塞米松溶液浸泡PICC导管,再进行PICC穿刺,可有效地预防PICC置管后静脉炎的发生。     

导管准备方法对PICC引发静脉炎的影响

目的研究置管前用肝素盐水浸泡PICC导管对PICC引发静脉炎的影响。方法将PICC置管的病人随机分成两组,实验组置管前采用肝素盐水浸泡导管,对照组置管前不用肝素盐水浸泡导管,观察两组病人静脉炎的发生率。结果两种导管准备方法对PICC引发静脉炎的发生率差异有显著性(P<0.05)。结论经肝素盐水浸泡过的PICC导管置入后静脉炎发生率明显下降。     

脉冲式封管与普通式封管对于深静脉置管的应用比较

目的 比较脉冲式封管与普通式封管对于有效防止深静脉置管封管后再次应用时输液不畅的效果.方法 观察组用10 ml稀释肝素液(125 U/ml)脉冲式封管(推一下停一下),每推注0.2 ml,暂停1 s,再推注0.2 ml,如此反复进行至完成封管.对照组用10 ml稀释肝素液缓慢推注封管.两组在封管时均采用边推注封管液边退针的正压封管.将活塞夹闭在深静脉置管的近端.比较两组封管的效果.结果 两组封管结果,观察组深静脉置管针的堵管发生率远远小于对照组,而输液速度快于对照组.结论 脉冲式封管对保护深静脉置管在输液中的应用效果明显好于普通式封管.     

肝素钠加地塞米松在预防肿瘤病人PICC血栓中的护理应用

目的:探讨肝素钠加地塞米松预防肿瘤病人PICC置管后血栓的作用。方法:115例留置PICC的肿瘤病人分为2组,均使用超声引导穿刺。观察组采用50单位/ml肝素钠稀释液40ml加5毫克地塞米松预浸泡导管,再置入导管;对照组采用生理盐水40ml浸泡导管后置管。2组病人置管后均采用超声监测PICC血管,观察是否有血栓形成,比较血栓发生率的差异。结果:观察组的血栓发生率低于对照组(P<0.05)。结论:使用肝素钠稀释液地塞米松浸泡导管可降低肿瘤病人PICC置管后血栓的发生率。     

金黄散与低分子肝素钠合用防治PICC置管致机械性静脉炎

目的 观察应用金黄散与低分子肝素钠合用预防及治疗PICC置管致机械性静脉炎的疗效.方法 经患者知情同意后,根据医生开医嘱先后顺序,将80例患者间隔分为实验组40例和对照组40例;实验组PICC置管后按常规方法进行导管护理,并选择6 cm×7 cm的金黄散与低分子肝素钠的敷料沿穿刺静脉走向平行覆盖于透明贴膜上方,下缘距穿刺点2～3 cm,覆盖3～7 d;对照组给予常规PICC置管后导管护理,如发生机械性静脉炎,再覆盖金黄散与低分子肝素钠的敷料,比较两组患者机械性静脉炎的发生率,并比较应用硫酸镁湿敷和应用金黄散与低分子肝素钠合用的敷料治疗静脉炎的效果.结果 实验组1例患者发生机械性静脉炎,发生率为2.50%;对照组共有8例发生机械性静脉炎,发生率为20.00%,两组差异有统计学意义( P <0.05),应用金黄散与低分子肝素钠合用的敷料治疗PICC置管致机械性静脉炎,8例(88.89%)治愈,1例(11.11%)显效;应用50%硫酸镁湿敷治疗静脉炎,14例(87150%)治愈,1例(6.25%)显效.结论 金黄散与低分子肝素钠合用的敷料能有效预防及治疗PICC置管后机械性静脉炎,有较好的临床应用价值.     

硫酸镁联合芦荟预防肺癌患者PICC置管后静脉炎的临床研究

目的 探讨硫酸镁联合芦荟对肺癌患者留置中心静脉导管(peripherally inserted central catheter,PICC)后静脉炎的预防作用.方法 选取2011年1月至2013年7月内江市第二人民医院肿瘤科住院治疗的肺癌患者119例,留置PICC导管,并按置管先后顺序随机分为两组.实验组在置管后立即予新鲜芦荟汁涂擦置管静脉,24 h后予50％硫酸镁湿热敷置管静脉;对照组置管24 h后予50％硫酸镁湿热敷置管静脉,比较两组静脉炎的发生率.结果 实验组及对照组静脉炎的发生率分别是3.3％和15.3％(x2 =5.039,P=0.025).结论 硫酸镁联合芦荟对PICC所致静脉炎具有良好的预防作用.     

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.