不同透析方法治疗重症胰腺炎临床观察

目的 探讨不同透析方法治疗重症胰腺炎（SAP）的疗效。方法 40例SAP患者分为两组,腹膜透析（PD）组26例,连续性静脉-静脉血液滤过（CVVH）组14例。结果 CVVH组血、尿淀粉酶及白细胞计数恢复正常范围时间短于PD组（P〈0．01）,平均住院天数亦短于PD组（P〈0．01）,病死率、并发症发生率均低于PD组（P〈0．05）。结论 CVVH治疗SAP优于PD,可作为治疗SAP首选。     

活性碳血液灌流联合持续性血液透析治疗重型肝炎的临床疗效分析

目的探讨持续性血液透析联合活性碳血液灌流治疗重型肝炎的疗效。方法将梅州市大埔县人民医院88例慢性重型肝炎患者随机分为两组,对照组（n=43）给予内科综合治疗及活性碳血液灌流治疗,观察组（n=45）在对照组基础上联用持续性血液透析治疗。观察两组治疗前、治疗结束时和治疗48h后的临床疗效及生化指标的变化。结果观察组的临床症状改善率达97．78％,显著高于对照组的81．39％,差异有统计学意义（P〈0．05）;低钾血症和低钠血症的复常率分别为100％和84．44％,与对照组比较差异有统计学意义（P〈0．05）。观察组肾功能明显改善．血BUN和Scr明显减低（P〈0．05）：且治疗后血总胆红素明显低于对照组,但两组下降幅度差异无统计学意义（P〉0．05）,而治疗48h后观察组总胆红素反弹幅度低于对照组（P〈0．05）。结论活性碳血液灌流联合持续性血液透析可显著改善慢性重型肝炎患者临床症状和肝肾功能,延缓胆红素治疗后反弹,值得推广应用。     

益生菌治疗急性胰腺炎疗效观察

目的 探讨益生菌在治疗急性胰腺炎（AP）中的作用。方法 80例AP中，给予益生菌治疗40例[轻型急性胰腺炎（MAP）30例，重症急性胰腺炎（SAP）10例]，未给予益生菌治疗的40例作为对照组（MAP32例，SAP8例）。比较两组的临床疗效。结果对于MAP，益生菌治疗组的住院时间、全身炎症反应综合征发生率明显低于对照组，差异有统计学意义（P〈0．05）。对于SAP,益生菌治疗组的症状和体征缓解时间、血淀粉酶恢复时间、住院时间均明显低于对照组，差异有统计学意义（P〈0．05）。全身炎症反应综合征、霉菌感染及多器官功能障碍综合征的发生率也明显低于对照组（P〈0．05）。结论 益生菌能有效缓解AP尤其是SAP病情，降低并发症的发生率，缩短住院时间。     

鼻罩与面罩连接NIPPV对辅助治疗COPD急性加重期合并Ⅱ型呼吸衰竭的护理研究

目的：分析无创正压通气（NIPPV）失败的因素,探讨NIPPV治疗慢性阻塞性肺疾病（COPD）急性加重期（AECO-PD）合并Ⅱ型呼吸衰竭的临床疗效及护理。方法：将120例AECOPD合并Ⅱ型呼吸衰竭的患者随机分为观察组NIPPV鼻罩连接及对照组NIPPV面罩连接,两组均给予解痉、祛痰、平喘、抗炎、呼吸兴奋剂等治疗基础上行NIPPV,观察两组患者的血气、血氧饱和度、患者舒适度及依从性、成功率、插管率。结果：观察组4、24h,PaO2明显上升（P〈0．05）,PaCO2明显下降（P〈0．05）,神志开始清醒,24～48h后有5例感不舒适不能耐受放弃治疗（8．3％）,3例行气管插管（5％）,平均通气时间9d,成功率86．7％;对照组4、24h后动脉血气PaO2明显上升（P〈0．05）,PaCO2下降不明显（P〉0．05）,17例行气管插管（28．3％）,26例（43．3％）由于不能耐受最后改为鼻罩组,成功率为28．3％,失败率明显高于观察组（P〈0．05）。结论：AECOPD合并Ⅱ型呼吸衰竭应用NIPPV鼻罩连接可更快的缓解患者的临床症状,提高PaO2,降低PaCO2,增加患者舒适度及耐受性,提高成功率。     

环磷酰胺冲击治疗紫癜性肾炎疗效观察

目的探讨环磷酰胺冲击疗法治疗重症紫癜性肾炎的疗效及不良反应。方法选择40例重症紫癜性肾炎患儿分为对照组和观察组，观察组给予CTX 8～12mg／（kg·次），加入生理盐水100mL中静滴，累计剂量150mg／kg。对照组常规采用泼尼松1．5～2．0mg／（kg·d），双嘧达莫3～5mg／（kg·d）治疗。结果（1）40例HSPN中，单纯蛋白尿型2例（5．0％），单纯血尿加蛋白尿型12例（30．0％），肾炎综合征型8例（20．0％），急进性肾炎型3例（7．5％），肾病综合征型15例（33．0％）；有胃肠道症状21例（52．5％），关节症状19例（47．5％）。（2）两组治疗后血浆总蛋白和清蛋白均高于治疗前（P〈0．05～0．01）；24h尿蛋白定量低于治疗前（P〈0．05～0．01）。观察组治疗后血浆总蛋白、白蛋白较对照组明显上升（P〈0．05），而24h尿蛋白定量下降明显（P〈0．01）；（3）观察组总有效率（80．0％）高于对照组（65．0％），不良反应低于对照组。结论采用CTX冲击方法治疗重症HSPN疗效好，且不良反应少。     

急性胰腺炎患者血清抗坏血酸水平及维生素C辅助治疗的临床研究

目的探讨血清抗坏血酸（AA）水平变化与急性胰腺炎（AP）及其严重程度的关系及维生素C对重症急性胰腺炎（SAP）的辅助治疗作用。方法患者40例，其中轻型急性胰腺炎（MAP）24例，SAP16例，将患者分为治疗组及对照组．治疗组加用维生素C2g稀释于5％葡萄糖液500ml中静滴．每日1次，连用7d，对照组不用维生素C。另取10名健康体检者为正常对照组。分别检测正常对照组和患者入院时血清AA及C．反应蛋白（CRP）．SAP对照组及治疗组另外分别在入院第2、3、7天检测血清AA，并观察两组SAP患者腹痛、发热症状消失时间。血淀粉酶恢复正常时间及住院天数。结果AP患者与正常对照组相比，血清AA明显降低（P〈0．01），CRP明显升高（P〈0．01）；SAP患者与MAP患者相比，血清AA显著降低（P〈0．01）．CRP显著升高（P〈0．01）；SAP治疗组入院第2、3、7天血清AA均较对照组显著升高（P〈0．05），SAP治疗组患者体温、血淀粉酶恢复正常时间及住院时间均较对照组明显缩短（P〈0．05）。结论AP患者血清AA明显降低，且其降低程度与AP的严重程度相关，给予维生素C治疗能明显提高SAP患者血清AA水平，对SAP可能具有辅助治疗作用。     

急性胰腺炎患者血清抗坏血酸水平及维生素C辅助治疗的临床研究

目的探讨血清抗坏血酸（AA）水平变化与急性胰腺炎（AP）及其严重程度的关系以及维生素C（Vitc）对重症急性胰腺炎（SAP）的辅助治疗作用。方法AP患者40例，其中轻型急性胰腺炎（MAP）24例，SAP16例。将16例SAP分为治疗组及对照组，治疗组加用VitC2g稀释于5％葡萄糖500ml中静滴，每日1次，连用7d；对照组不用VitC。另选10例健康体检者为正常对照组。分别检测正常对照组和AP患者入院时血清AA及C-反应蛋白（CRP），另外，对SAP两组分别在入院第2、3、7天检测血清从，并观察两组SAP患者腹痛、发热症状消失时间、血淀粉酶恢复正常时间及住院天数。结果AP患者与正常对照组相比，血清从明显降低（P〈0．01），CRP明显升高（P〈0．01），SAP患者与MAP患者相比，血清从显著降低（P〈0．01），CRP显著升高（P〈0．01），SAP治疗组入院第2、3、7天血清从均较对照组显著升高（P〈0．05）。SAP治疗组患者体温、血淀粉酶恢复正常时间及住院时间均较对照组明显缩短（P〈0．05）。结论AP患者血清从明显降低，且其降低程度与AP的严重程度相关，给予VitC治疗能明显提高SAP患者血清从水平，对SAP可能具有辅助治疗作用。     

床边插管腹膜透析在慢性肾脏病发生急性肾衰中的应用

目的探讨床边插管腹膜透析（PD）治疗慢性肾脏病发生急性肾衰（A／C）的疗效及安全性方法回顾性分析我院在综合治疗基础上联合床边插管PD治疗26例A／C患者的疗效与转归，观察患者PD治疗前后血肌酐（Scr）、尿素氮（BUN）、钾（K^＋）、二氧化碳结合力（CO2CP）水平的变化以及床边插管PD的并发症、结果大多数A／C患者经PD治疗后短期内血BUN、Scr、K^＋、CO2CP下降非常明显（P〈0．01），18例患者肾功能恢复到基础水平，脱离透析；8例患者肾功能无明显改变，其中1例进入维持性透析、无1例因插管出现严重的并发症、结论床边插管PD治疗A／C是一种安全、简单、经济、有效的治疗方法，早期、持续地行PD治疗有利于改善A／C的预后。     

血浆胰蛋白酶原激活肽和尿胰蛋白酶原-2在急性胰腺炎预后监测中的价值

目的探讨血浆胰蛋白酶原激活肽（TAP）和尿胰蛋白酶原-2在急性胰腺炎（AP）预后监测中的价值。方法86例AP患者[25例重症患者（SAP）和61例轻症患者（MAP）]在入院后1、12、24h、3、5、7d取血样测试TAP浓度；25例SAP于入院后1、24h、3、5、7d取尿样检测尿胰蛋白酶原-2浓度，并测同时点血清C-反应蛋白（CRP）含量，入院后1、24h进行APACHEⅡ评分，并对结果对照分析。结果SAP组在入院24h内血TAP浓度明显高于MAP组（P〈0．05），而24h后血TAP浓度两组间差异无统计学意义（P〉0．05）。尿胰蛋白酶原-2在入院后1h对SAP检测的敏感性为88．0％、特异性为85．7％，明显高于同时点CRP的敏感性56．0％、特异性74．3％（P〈0．05）及同时点APACHEⅡ评分的敏感性72．0％、特异性71．4％（P〈0．05）；而在入院24h，SAP组APACHEⅡ评分、尿胰蛋白酶原-2、CRP检测的敏感性、特异性比较差异无统计学意义（P〉0．05）。结论血浆TAP对SAP的早期诊治有帮助，而尿胰蛋白酶原-2对AP预后具有良好的预测作用。     

双水平气道正压通气治疗慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭

目的探讨双水平气道正压通气（BiPAP）治疗慢性阻塞性肺疾病（COPD）合并Ⅱ型呼吸衰竭的疗效。方法加例COPD合并Ⅱ型呼吸衰竭患者随机分为BiPAP通气加常规治疗组（治疗组）和单用常规治疗组（对照组）各20例，定期记录生命体征、血气分析变化，观察2组的治疗效果。结果通气4h后2组比较，治疗组较对照组PaO2、pH明显增加，PaCO2、心率和呼吸频率降低（P〈0．05）；24h后改善情况更为明显。对照组需气管插管者12例（60．0％），而治疗组仅3例（15．0％），2组比较差异有显著意义（P〈0．05）。治疗组中1例（5．0％）死亡，对照组中3例（15％）死亡，2组比较差异有显著意义（P〈0．05）。结论BiPAP通气可作为COPD合并呼吸衰竭的一线治疗手段。     

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.