人工肝支持系统在重症肝炎救治中的应用

应用人工肝支持系统 (血浆置换 +胆红素吸附 +血液透析 ) ,对 7例慢性重症肝炎患者进行治疗。经人工肝支持系统治疗后 ,患者症状好转 ,肝功能有所好转 [丙氨酸转移酶由 (15 9.49± 96 .6 9) U/ L 降至 (82 .42± 10 8.71) U/L,P<0 .0 5 ;血白蛋白由 (33.2 6± 2 .14) g/ L 升至 (37.0 6± 4.0 6 ) g/ L,P<0 .0 1;总胆红素由 (5 2 6 .0 4± 2 5 7.46 ) μm ol/L 降至 (389.19± 185 .2 6 ) μmol/ L,P<0 .0 0 1],尿素氮及血肌酐水平分别由 (2 4.41± 6 .5 1) mmol/ L 和 (334 .75±113.11) μm ol/ L 降至 (14.40± 5 .5 2 ) m mol/ L 和 (2 11.5 6± 6 4.0 8) μmol/ L,P<0 .0 0 1和 P<0 .0 1。 3例患者分别在治疗 1、 3、 6次后行肝移植存活 ,其中 1例在肝移植前停止人工肝支持系统治疗而肝功能稳定达 12 d。另 4例死亡。结果提示 ,人工肝支持系统是重症肝炎有益的治疗方法之一 ,并可作为肝移植前的准备     

100例慢性肾功能衰竭维持性血透临床分析

目的 分析对慢性肾功能衰竭患者使用维持性血液透析治疗对的临床疗效.方法 随机性收集慢性肾功能衰竭患者100例作为研究对象,对所有患者均实施维持性血液透析,对所有患者在治疗前后的血尿素氮、肌酐、尿酸和并发症发生率情况等进行收集和分析,观察对慢性肾功能衰竭患者实施维持性血透的治疗效果.结果 实施维持性血液透析治疗前,患者肌酐为(405.63±89.81)μmol/L,治疗后肌酐为(267.91±52.32)μmol/L.治疗前患者血尿素氮(18.36±4.23)mmol/L,治疗后血尿素氮为(12.64±2.84)mmol/L.治疗前患者尿酸(327.82±42.57)μmol/L,治疗后尿酸(229.31±15.47)μmol/L.治疗后的血尿素氮、肌酐、尿酸均明显下降(P<0.05).3例患者出现透析中凝血,5例患者出现肌肉痉挛,7例患者发生恶心呕吐,并发症发生率15%.结论 对慢性肾功能衰竭患者实施维持性血液透析的治疗能够取得较好的治疗效果,可明显降低其血尿素氮、肌酐、尿酸.但会导致患者出现一定的并发症,需关注到治疗的安全性.     

腹膜透析患者残余肾功能保护的观察

目的 :探讨腹膜透析患者残余肾功能的保护措施。方法 :观察 6例腹膜透析患者的残余肾功能和尿量变化 ,为期 1年。男 2例 ,女 4例 ,年龄 2 5～ 6 2岁。原发病为慢性肾小球肾炎、糖尿病和高血压病。均采用 Baxter双联透析液CAPD治疗 ,每天 4次。同时配合注射 EPO、降血压和营养治疗等。透析前血尿素氮 (BUN)(38.2± 1 1 .7) mmol/ L,肌酐 (Scr) (830± 2 5 4)μmol/ L,2 4h尿量 (6 40± 1 80 ) ml。透析 1个月后 BUN(1 7.6± 8.5 ) mmol/ L ,Scr(4 91± 1 2 0 )μmol/ L,2 4h尿量 (4 6 0± 1 1 0 ) ml。透析 1 2月后 BUN(1 9.7± 9.…     

长期低蛋白饮食治疗重度慢性肾衰患者的临床研究

目的　研究低蛋白饮食综合治疗慢性肾衰患者的疗效及安全性。方法　 16例患者均为因各种原因所致的肾小球疾病的慢性肾衰患者 ,入选时根据患者意愿 8例进入低蛋白饮食组 (LPD)和 8例进入常规蛋白饮食组 (NPD)。结果　低蛋白饮食组蛋白摄入量为 (0 5 5± 0 17)g/(kg·d) ,盐的摄入量为 (6 3± 0 45 )g/d ,常规蛋白饮食组蛋白质和食盐摄入量分别为 (1 5 6± 0 2 3)g/(kg·d)和 (12 8± 2 5 6)g/d ;为达到降压目标值 ,低蛋白饮食组所用降压药物种类为 2 33种 ,而常规蛋白饮食组所用降压药物种类为 3 4种 ,为维持血磷正常LPD和NPD组所服用碳酸钙总量分别为 12 0 0mg/d和 2 40 0mg/d ,为保持血碳酸氢根浓度 2 3mmol/L以上 ,两组所消耗的碳酸氢钠分别为LPD组 2～ 3g/d和NPD 4 5～ 8g/d。经过最长 2 5年 ,最短 1 5年跟踪观察 ,其中除NPD组有 2例患者因血肌酐显著升高 ,水肿及心衰进入透析治疗外 ,两组中其余患者营养状态良好 ,体重稳定 ,仍然继续接受保守治疗。血肌酐值LPD和NPD组分别为 (687± 12 3 3)μmol/L和 (712± 34 4) μmol/L ,内生肌酐清除率分别为 (8± 2 34 )和 (6 5± 1 2 9)ml/min ,肾功能不全进展速度 (0 12 5±0 0 72 )和 (0 2 14± 0 0 17)ml/(min·月 ) ,两组比较差异无显著性     

异丙酚与依托咪酯诱导对血浆皮质醇浓度的影响

目的　观察异丙酚与依托咪酯诱导对肾上腺皮质功能的影响。方法　在 2 0例择期手术麻醉的患者中分别对 2 m g/kg异丙酚与 0 .3 m g/kg依托咪酯诱导时血浆皮质醇浓度的变化进行观察。结果　异丙酚组给药后 2 h血浆皮质醇浓度由 (30 8.7± 2 7.4) nm ol/L降至 (2 6 7.7± 31.2 ) nm ol/L ,5 h后升高至 (4 0 0 .2± 2 6 .9) nm ol/L ,2 4h后恢复至给药前水平为 (30 6 .4± 35 .4) nm ol/L ;依托咪酯组给药后 2 h血浆皮质醇浓度由 (30 9.1± 36 .6 ) nm ol/L降至 (115 .9± 2 9.7) nm ol/L ,5 h时维持在 (171.1± 34.7) nm ol/L ,2 4h后恢复至给药前水平为 (311.8± 46 .2 ) nm ol/L。结论　异丙酚诱导对肾上腺皮质功能影响小 ,依托咪酯诱导则造成短暂的肾上腺皮质功能抑制。     

营养疗法对婴儿腹泻及营养不良的阻断作用

目的 :观察营养疗法对婴儿腹泻及营养不良的治疗和阻断作用。方法 :用以炒米粉为主的营养配方(营养止泻奶 ;专利号 :94 10 2 15 6 4 )喂养婴儿腹泻 372例。结果 :治疗后在临床症状恢复时间上观察组优于对照组 ,P <0 0 1。在营养指标中观察组治疗后 ,体重从 (9 6 0± 2 0 5 )kg增至 (10 2 1± 2 12 )kg ,P <0 0 1;血总蛋白从(6 0 2 3± 8 30 ) g/L增至 (6 5 94± 4 86 )g/L ;尿素氮从 (2 4 0± 1 30 )mmol/L增至 (3 35± 0 85 )mmol/L ;周围血淋巴细胞从 (0 6 3± 0 34)× 10 9增至 (0 79± 0 32 )× 10 9,P <0 0 5～ 0 0 1。结论 :婴儿腹泻期的合理喂养 (选用营养止泻奶 )能促进腹泻病恢复 ,并能预防和阻断腹泻病营养不良的发生     

连续性肾脏替代治疗肾功能衰竭的疗效分析

目的 :回顾分析 2 0 0 3年 1月至 1 2月间 2 1例行CRRT病例的诊治方法及疗效。方法 :2 1例中急性肾衰 9例 ,慢性肾衰 8例 ,败血症 2例 ,肝肾综合症 1例 ,顽固性心衰 1例 ,均有不同程度的其他器官功能损害。应用DiapactCRRT治疗仪及配套管路 ,滤器为NIPS - 1 2 (Braun)或FB - 1 5 0A(NI POR) ,置换液为碳酸氢盐液 ,透析液为乳酸盐液 ,前稀释法输入 ,分组抗凝。结果 :CRRT治疗中 2例死亡 ,其余全部存活 ,存活组中治疗前血钾 ,肌酐 ,尿素氮分别为 (6 .1± 0 .5 )mmol/L ,(86 0 .5± 5 0 .2 )umol/L ,(2 6 .5± 4 .7)mmol/L ,治疗后血钾 ,肌酐 ,尿素氮分别为 (4 .0± 0 .4 )mmol/L ,(99.0± 2 1 .7)umol/L ,(7.2± 2 .5 )mmol/L。伴感染的 8例中 ,WBC治疗前为 (1 4 .8± 2 .5 )× 1 0 9,治疗后为 (8.3± 1 .8)× 1 0 9,1例顽固性心衰肺动脉高压 ,肺淤血明显改善。结论 :CRRT血流动力学稳定 ,能有效清除炎症介质 ,改善机体状态 ,作为危重疾病的重要治疗手段 ,具有广泛的应用前景     

吲哒帕胺对老年原发生高血压患者血钾的影响

目的 :了解吲哒帕胺对老年原发性高血压患者血钾的影响。方法 :分别测定服药前后患者的血钾并做统计学分析。结果 :(1)服药前后血钾 :观察组为 (4 .46± 0 .5 6 ) m mol/ L 和 (4 .0 8± 0 .70 ) m mol/ L,P <0 .0 5 ,对照组为 (4 .5 6± 0 .5 0 ) m mol/ L和 (4 .43± 0 .6 2 ) m mol/ L,P >0 .0 5 。 (2 )服药前血钾 :观察组为 (4 .46± 0 .5 6 ) mm ol/ L,对照组为 (4 .5 6± 0 .5 0 ) m mol/ L,P >0 .0 5 。 (3)服药后血钾 :观察组为 (4 .0 8± 0 .70 ) mmol/ L,对照组为 (4 .43± 0 .6 2 ) m mol/ L,P <0 .0 5 。 (4 )服药后低血钾发生率 :观察组为 10 % (5例 ) ,对照组为 2 % (1例 ) ,P <0 .0 5。结论 :老年原发性高血压患者服用吲哒帕胺后血钾水平较服药前显著下降 ,且低血钾发生率显著高于对照组。老年高血压患者服用该药时应监测血钾 ,及时补钾     

科素亚降低糖尿病肾病尿蛋白排泄的临床研究

探讨科素亚降低糖尿病肾病尿蛋白排泄率的作用。方法 :40例 2型糖尿病肾病患者随机分为两组 ,2 0例常规接受口服降糖药或胰岛素治疗作为对照组 ,2 0例在常规治疗基础上给予科素亚 5 0 m g,每天一次 ,共 8周作为治疗组。结果 :科素亚能显著降低糖尿病肾病 2 4h尿白蛋白排泄率 (mg/2 4h) (12 5 .6± 43.2降至 87.5± 30 .4,t=3.2 2 5 6 ,P <0 .0 1) ,尿微球蛋白 (mg/L) (0 .134± 0 .0 34降至 0 .10 6± 0 .0 2 5 ,t=2 .96 72 ,P <0 .0 1) ,动脉收缩压 (k Pa) (18.71± 2 .6 2降至 17.45± 2 .0 6 ,t=0 .30 46 ,P <0 .0 5 )及平均动脉压 (k Pa) (14.2 0± 2 .33降至 12 .5 6± 2 .0 3,t=2 .385 6 ,P <0 .0 5 )。而内生肌酐清除率(Ccr)、血尿素氮 (BU N)及肌酐 (Cr)无显著变化。科素亚降低 2 4h尿蛋白排泄率及其对动脉收缩压及平均动脉压的降压作用无显著相关 (r=0 .311,P>0 .0 5及 r=0 .2 2 7,P>0 .0 5 )。结论 :科素亚能显著降低糖尿病肾病的尿白蛋白及 β2 -微球蛋白排泄率 ,对延缓糖尿病肾病发展 ,可能具有重要价值。     

积极胰岛素治疗对2型糖尿病患者胰岛功能恢复和一氧化氮水平的影响

目的　观察短期积极胰岛素治疗控制高血糖前后 2型糖尿病病人内源性胰岛素 (Ins)水平和血清一氧化氮 (NO)水平的动态变化。方法　 2型糖尿病无并发症者 2 0例 ,均为口服降糖药治疗 ,空腹血糖 >10 m mol/ L者。短期积极给与三餐前皮下注射胰岛素治疗 ,高血糖控制前后均作 OGTT及 Ins释放试验并测血清 NO水平。结果　 1治疗后空腹血糖水平和 OGTT血糖曲线下面积均较治疗前显著降低 ,分别为 (7.4 2± 1.71) m mol/ L vs(13.10± 2 .5 0 ) mm ol/ L,P=0 .0 0 0和 (4 5 .5 9± 2 1.34) mm ol/ (L· h) vs(6 1.10± 9.2 2 ) mm ol/ (L· h) ,P=0 .0 0 3;2治疗后空腹 Ins水平和 Ins曲线下面积较治疗前显著升高 ,分别为 (16 .0 3± 3.33) m U/ L vs(11.73±1.89) m U/ L,P=0 .0 0 0 ,和 (98.82± 33.2 2 ) m U/ (L· h) vs(5 7.83± 11.6 2 ) m U/ (L· h) ,P=0 .0 0 0 ;3治疗后血清 NO水平较治疗前显著升高 ,为 (12 6 .6 1± 75 .0 5 ) μmol/ L vs. (6 2 .0 7± 34.4 1) μmol/ L,P=0 .0 0 0。结论　葡萄糖毒性是抑制 2型糖尿病病人胰岛分泌功能和抑制 NO生成的环节之一 ,短期积极有效胰岛素控制高血糖有利于2型糖尿病病人胰岛分泌功能和 NO水平的恢复     

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.     

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.     

Electro-Acupuncture Combined with the Trigger Point Needle-Embedding for Treatment of Primary Trigeminal Neuralgia in 31 Cases

In recent years, the author of this essay has applied electro-acupuncture combined with the trigger point needle-embedding for treatment of primary trigeminal neuralgia in 31 cases, yielding satis- factory results as reported in the following.     

Investigation of Matrix Metalloproteinase -1, 2 and tissue inhibitor of matrix metalloproteinases-1 in Endometriosis

Objective： To explore the role of matrix metalloproteinase-1,2 （MMP-1, MMP-2） and tissue inhibitor of matrix metalloproteinases-1 （TIMP-1） in endometriosis. Methods： The eutopic and ectopic endometria from 40 subjects suffering from endometriosis and regular.endometria from 40 subjects （excluding endometriosis） were collected and examined by in situ hybridization technology and western blot assay. Results： Both expressions of MMP-1 and -2 were stronger in ectopic endometrium and eutopic endometrium than in normal endometrium. On the contrary, the expression of TIMP-1 in ectopic endometrium and eutopic endometrium was lower. The differences were significant （P 〈 0.01 ）. Moreover, there was no relationship among the expressions of MMP-1, 2 and TIMP-1 in ectopic endometrium. Conclusion： The expressions of MMP-1, 2 and TIMP-1 lose balance and lack of periodic changes in ectopic endometrium , which explains the biological invasive behavior of endometriosis. It was suggested-that regulating the balance between the MMPs and TIMP-1 should be an ideal therapeutic target to endometriosis.     

Shi Da-zhuo (史大卓) —An outstanding cardiologist of integrative medicine

Prof. SHI Da-zhuo, Ph.D., male, was born on March 20, 1960. Prof. SHI entered the Ph.D. program in 1990 at the China Academy of Chinese Medical Sciences under the supervision of Prof. CHEN Ke-ji, majoring in the treatment of cardiovascular diseases. After receiving his Ph.D. degree in 1993, Prof. SHI started working at the Cardiovascular Center in Xiyuan Hospital affiliated to China Academy of Chinese Medical sciences.     

Persist in and Carry Forward the Integrative Medical Research——Speech at the 6th National General Congress of Chinese Association of Integrative Medicine by Academician CHEN Zhu,Minister of Ministry of Health

The 6th National General Congress of Chinese Association of Integrative Medicine （CALM） was convened at 19-20, April 2008 in Beijing. Academician CHEN Zhu, the minister of Ministry of Health indicated at the congress that the integration of Chinese and Western medicine is very well in keeping with the situation of our country and the general rule of development in medical science; and as a good integration of Chinese medicine and Western medicine, it is mutually beneficial and advantageous to both of them. Seeing the creativity shown in integrative medical investigation in theoretic and methodological sides, we should and must persist in and develop it.