近4年基层医院异位妊娠诊断及治疗的进展（附349例分析）

目的 探讨近4年异位妊娠发生率及诊断、治疗方法的变化。方法 逐年回顾分析我院1998年1月至2002年12月间349例异位妊娠的诊治情况。结果 (1)异位妊娠与同期分娩数之比由1998年的1．0：12．6上升为1．0：8．6。(2)诊断技术有改进，剖腹的比例下降，而经超声检查结合血绒毛膜促性腺激素(β—hCG)检测，电视腹腔镜确诊增多，确诊时间稍缩短。(3)经腹输卵管切除术比例下降，腹腔镜手术、保守治疗比例上升。(4)保守性手术成功率87．7％。药物保守治疗方式多样，其期待治疗成功率均约为85％左右。结论 异位妊娠发生率增高。超声结合敏感的β—hCG测定，腹腔镜技术的应用缩短了确诊时间，剖腹手术减少，腹腔镜手术及保守治疗是目前异位妊娠治疗的发展方向。     

异位妊娠1121例分析

目的 :对我院妇科 1 0年异位妊娠的发病率及诊治方法的变化进行回顾性分析。方法 :把我院妇科 1 993年1月至 2 0 0 2年 1 2月间 1 1 2 1例异位妊娠病例 ,分成数个时间段或前后两组 ,对发病率、诊断及治疗方法进行分析。结果 :(1 )异位妊娠与同期分娩数之比由 1 993～ 1 994年的 1∶85 .8上升为 2 0 0 1～ 2 0 0 2年的 1∶1 7.1。 (2 )诊断技术的改进 ,经超声结合血、尿绒毛膜促性腺激素 (β—HCG)检测和电视腹腔镜应用增多 ,剖腹探查术的比率下降。确诊时间缩短 ,1 993～ 1 997年平均确诊时间为 6 .7± 0 .5d ,1 998～ 2 0 0 2年平均为 3.6± 0 .3d ,(P <0 .0 5 )。(3)经腹输卵管切除术比例下降 ,腹腔镜手术、保守治疗比例上升 ,并且药物保守治疗方式多样化。结论 :异位妊娠发生率呈上升趋势 ,腹腔镜技术的应用 ,超声结合敏感的 β—hCG检查缩短了确诊时间 ,剖腹探查术减少 ,而腹腔镜手术及保守治疗是目前异位妊娠治疗的主要方法     

腹腔镜技术对异位妊娠诊治的探讨

目的探讨腹腔镜对异位妊娠的早期诊断价值和腹腔镜下治疗的优势。方法：腹腔镜下确诊异位妊娠后,采用镜下局部注射氨甲喋呤（ｍｅｔｈｏｒｔｅｘａｔｅ,ＭＴＸ）或手术治疗。结果约一半的异位妊娠在腹腔内积血〈５０ｍｌ时即可明确诊断,镜下注射ＭＴＸ治疗早期异位妊娠的成功率为８２．３５％,镜下手术成功率为９２．７７％,无严重并发症。结论腹腔镜技术在异妊娠的早期即可作出明确的诊断;腹腔镜下手术治疗异位妊娠具有出血少     

孕妇异位妊娠的临床诊断与治疗分析

目的：探讨孕妇异位妊娠（EP）的变化情况及临床诊断与疗效。方法：对2006年6月-2008年5月收治的146例异位妊娠患者的治疗情况进行回顾性分析,并对人工流产史、盆腔炎发病史、生育史及避孕等进行了比较。结果：异位妊娠在妇科急腹症中的发病率有上升趋势,保守治疗成功率增加,少见部位异位妊娠发生率变化不明显。结论：异位妊娠的误诊率明显下降,对于生命体征平稳、无腹腔内活动性出血的异位妊娠患者,尽量采用保守治疗。     

超声诊断异位妊娠52例分析

目的探讨异位妊娠的超声图像特征及其诊断。方法回顾性分析2008年1月～2008年12月52例异位妊娠超声现象特征与诊断,并与手术及病理结果对照。结果52例异位妊娠中输卵管妊娠47例（90．3％）,子宫角妊娠2例（3．8％）,腹腔妊娠1例（1．9％）,卵巢伞端妊娠1例（1．9％）,子宫残角妊娠1例（1．9％）;超声确诊49例,占94．2％。结论超声检查是诊断异位妊娠的首选方法,对异位妊娠诊断有较高的准确性,为临床选择治疗方案和确定手术时机提供了重要依据。     

彩色多普勒超声诊断异位妊娠的临床意义

目的：探讨彩色多普勒超声诊断异位妊娠的临床意义。方法：对176例临床可疑异位妊娠的患者,采用经阴道二维超声、彩色多普勒（CDFI）进行检查,将超声结果与临床病理以及随访资料进行对比。结果：超声诊断异位妊娠148例,经临床手术及保守治疗后确诊143例,假阳性率0．2％,假阴性率0．14％,诊断准确率为96．6％。结论：彩色多普勒超声检查对异位妊娠诊断准确性高,对异位妊娠诊断直观、安全、方便、重复性好,能为临床提供可靠诊断依据,具有重要的临床应用价值,是诊断异位妊娠的首选检查方法。     

异位妊娠早期诊断及中西医结合保守治疗观察

目的探讨异位妊娠早期诊断的有效方法及中西医结合保守治疗的临床效果。方法我院2009年3月至2011年3月早期异位妊娠患者102例,根据检查方法分为观察组1及对照组1,观察组1(n=58)行血β-HCG、孕酮、阴道彩色超声波检查,对照组1(n=44)只行血β-HCG、阴道彩色超声波检查,比较两组确诊正确率、确诊时间;根据治疗方案随机分成观察组2及对照组2,观察组2(n=62)采用中西医结合保守治疗,对照组2(n=40)采用单纯西医保守治疗40例,比较两组治疗疗效。结果观察组1和对照组1的确诊正确率差异无统计学意义(P>0.05),但确诊时间观察组1比对照组1明显缩短,差异具有统计学意义(P<0.05)。观察组2和对照组2保守成功率分别为91.94%、85.00%,差异具有统计学意义(P<0.05)。结论以血β-HCG、B超检查是早期异位妊娠诊断的有效方法,联合孕酮水平监测使早期异位妊娠诊断更早。中西医结合保守治疗早期异位妊娠比单纯西医保守治疗效果好,减少手术率,对迫切要求保留生育能力的妇女意义重大。     

联合用药保守治疗异位妊娠的护理

宫外孕是引起妇科急腹症的常见病因,在全球呈逐年上升趋势,手术治疗后遗症发生较多,严重影响妇女生育能力。随着诊断技术的提高如快速敏感的β－ＨＣＧ测定的开展、高分辨Ｂ超的使用、异位妊娠的早期诊断有很大的进步,为保留生育能力,治疗方法逐渐转向保守治疗。我院１９９４年６月～１９９８年８月共收治异位妊娠患者１０６例,采用联合用药保守治疗５６例,成功率为７６％。兹报告如下：１　临床资料５６例患者中均为入院后经系统的临床及辅助检查如Ｂ超、血清β－ＨＣＧ放免测定、诊刮等确诊为异位妊娠,且病情平缓,心、肾、肝、血…     

异位妊娠药物保守治疗与手术保留功能性治疗后再次妊娠情况比较

目的：探索药物保守治疗异位妊娠与手术保留功能性治疗异位妊娠3年内再次妊娠的情况。方法：回顾分析102例（A组）有指征药物保守治疗异位妊娠、212例（B组）保留输卵管功能性手术治疗异位妊娠临床资料及随访情况,分析治疗方案的最佳选择。结果：A组治疗后随访3年：6个月～1年内再次异位妊娠2例、宫内妊娠3例,1—2年内再次异位妊娠2例、宫内妊娠15例,2—3年内再次异位妊娠1例、宫内妊娠19例;B组治疗后随访3年：6个月～1年内再次异位妊娠3例、宫内妊娠13例,1—2年内再次异位妊娠10例、宫内妊娠35例,2～3年内再次异位妊娠5例、宫内妊娠36例。结论：药物保守治疗和手术保留输卵管功能性治疗异位妊娠均有良好疗效而且最常用;药物保守治疗异位妊娠较手术保留功能性治疗异位妊娠时间长,患侧再次异位妊娠的概率与手术保留输卵管功能性无显著性差异,宫内受孕成功率无著性差异,但创伤小、费用低。     

异位妊娠保守治疗的疗效观察

异位妊娠是妇产科的常见病 ,其发生率呈逐年上升的趋势 ,随着诊断和治疗技术的进步 ,其早期确诊率不断提高 ,从而使许多未破裂的异位妊娠得以保守治疗。本文对比了米非司酮 (Ｒｎ4 86 )、氨甲喋呤 (ＭＴＸ)治疗异位妊娠的疗效及副反应 ,现报道如下。1 　资料与方法1 1　研究对象　 1999年 1月 1日至 2 0 0 1年 1月 1日对我院收治的异位妊娠患者 97例 ,随机分为 4 8例与 4 9例。异位妊娠的诊断依据为病史、妇科检查、血 β-ｈＣＧ检查 ,结合Ｂ超检查确诊。 97例患者生命体征平稳 ,无明显急性内出血体征 ,Ｂ超证实宫腔内无妊娠囊 ,一侧附件包…     

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.