早期肠内营养对重症急性胰腺炎患者肠黏膜屏障功能的影响

目的:研究早期肠内营养(EN)对重症急性胰腺炎(SAP)患者血清内毒素、炎症细胞因子和肠黏膜通透性等的影响.方法:符合条件的43例患者入院24～48 h后随机分为早期肠内营养组(EN组,22例)和肠外营养组(PN组,21例),行营养支持.检测两组患者治疗前,治疗后3 d和14 d的血清内毒素,炎症细胞因子,淀粉酶等生化指标,治疗前和治疗后14 d尿液乳果糖与甘露醇排泄率比值(L/M);观察其APACHE-Ⅱ评分、MODS和胰腺及胰周感染发生率.结果:EN组患者均能良好耐受早期EN治疗.两组营养支持治疗前血清内毒素、炎症细胞因子水平和APACHE-Ⅱ评分差异均无显著性(P＞0.05).与PN组相比,EN组3 d、14 d后血清内毒素水平均显著降低(P＜0.05).营养支持治疗后3 d两组血清各细胞因子水平均差异无显著性(P＞0.05),14 d后EN组显著低于PN组(P＜0.05).治疗前两组尿中(L/M)比值差异无显著性,14 d后EN组L/M比值较PN组显著降低(P＜0.05).与PN组相比,EN组14 d后APACHE-Ⅱ评分显著降低(P＜0.05),MODS和胰腺及胰周感染发生率明显降低(P＜0.05).结论:早期EN可促进SAP患者肠黏膜屏障功能恢复,减轻肠源性内毒素血症,缓和急性期炎症反应,降低MODS和胰腺及胰周感染发生率.     

营养方式对重症急性胰腺炎预后的影响

目的探讨营养方式的选择对重症急性胰腺炎（SAP）预后的影响。方法选择接受营养治疗的SAP患者154例,其中78例接受全肠外营养（TPN）;76例同时接受肠外营养（PN）和肠内营养（EN）。比较两组患者感染率、并发症发生率、住院时间和死亡率的差异。结果与TPN组相比,PN＋EN组患者的胰腺感染率PN＋EN7．8％,TPN12．8％,P〈0．05,其他部位感染率PN＋EN17．1％,TPN24．3％,P〈0．05,并发症发生率（PN＋EN31．5％,TPN38．4％,P〈0．05）明显降低,住院时间[PN＋EN（36．87±8．93）d,TPN（48．17±14．5）d]明显缩短,死亡率（11．8％,TPN10．2％,P〉0．05）两组无差异。结论PN和EN联合应用是SAP首选的营养方式。     

食道癌病人术后营养支持方式探讨

目的：观察不同营养支持方式对食道癌病人术后营养状态的影响，探讨食道癌病人术后合理的营养支持方案。方法：选择食道癌病人115例，术前随机分为肠外营养组（PN组，n＝38）、肠内营养组（EN组，n＝38）及肠外、肠内营养联合应用组（EN＋PN组，n＝39），同时将只进行常规补液的食道癌病人42例作为常规补液组。均于术后第1天开始给予营养支持或补液，分别于术后第1天、第8天测定营养相关指标并进行比较，再比较各组术后并发症发生率、营养支持平均费用、住院费用、肠道功能恢复时间以及术后住院天数等临床相关指标。结果：术后第8天4组病人体重均较术前下降，其中常规补液组和EN组下降幅度较大（P〈0．05），而PN＋EN组和PN组下降幅度较小（P〉0．05），与常规补液组比较差异有统计学意义（P〈0．05）。术后第8天PN＋EN组和PN组病人血浆总蛋白、白蛋白、前白蛋白及血红蛋白水平均较术后第1天明显升高（P〈0．05），且与常规补液组相比差异有统计学意义（P〈0．05）；术后第8天EN组病人的前白蛋白及血红蛋白水平较术后第1天明显升高（P〈0．05），但低于PN＋EN组和PN组（P〈0．05），血浆总蛋白和白蛋白的水平高于常规补液组（P〈0．05），但与术后第1天相比无明显升高（P〉0．05）；术后第8天常规补液组上述指标在术后第8天较术后第1天均无明显升高，血浆总蛋白和白蛋白的水平甚至低于营养支持前（P〈0．05）。常规补液组切口感染发生率也高于其它3组（P〈0．05）。PN组的日均营养支持费用、住院费用高于EN组和PN＋EN组（P〈0．05）。EN组和PN＋EN组的肠道功能恢复时间短于PN组和常规补液组（P〈0．05）。PN组、EN组和PN＋EN组术后住院天数少于常规补液组（P〈0．05）。结论：食道癌病人术后肠内、肠外营养联合应用可避免单用肠内或肠外营养支持的不足，并可降低手术和营养支持相关并发症，达到最佳的费用效益比。     

添加低聚半乳糖肠内营养对重症急性胰腺炎大鼠炎性细胞因子的作用

目的研究给予添加低聚半乳糖（GOS）肠内营养对重症急性胰腺炎（SAP）大鼠血清炎性细胞因子的作用。方法将SAP造模成功的32只SD大鼠随机分为普通肠内营养（EN）组（n=16）和GOS—EN组（N=16）,同时设立假手术对照组（n=16）,然后按照动物处死时间每组又分为4d和7d两个时间点亚组,每个亚组各8只动物。采用胰被膜下均匀注射38g／L牛磺胆酸钠法建立SAP大鼠模型,检测各时间点血清淀粉酶、血清促炎细胞因子TNF—α和抗炎细胞因子IL-2、IL-10水平。结果各SAP组的血清淀粉酶水平显著高于假手术对照组（P〈0．01）,GOS—EN组显著低于EN组（P〈0．01）;各SAP组的TNF-α和IL-10水平均显著高于假手术对照组（P〈0．01）,而IL-2显著低于假手术对照组（P〈0．01）。GOS—EN组的TNF-α水平显著低于EN组（P〈0．05）,而IL-2、IL-10水平以及IL-10／TNF—α比值显著高于EN组（P〈0．05）。结论早期给予GOS—EN能够调节SAP大鼠促、抗炎细胞因子平衡。     

肺癌患者术后肠内营养支持的探讨

目的研究肺癌手术后早期应用肠内营养（EN）支持对患者营养状况的影响。方法60例肺癌术后患者随机分为EN组和肠外营养（PN）组,观察营养支持前后营养状况变化。结果经过10天营养支持,PNA患者的上臂肌围（MAMC）和血清总蛋白（TP）显著低于术前（P〈0．05）;EN组患者的前白蛋白（PA）显著高于术前（P〈0．05）,TP、PA、白蛋白（Alb）显著高于同期DN组（P〈0.05）。结论早期EN可改善患者蛋白质代谢和患者营养状况,疗效优于PN。     

早期肠内营养在重症急性胰腺炎治疗中的疗效评价

目的：探讨早期空肠内营养支持疗法在重症急性胰腺炎（SAP）治疗中应用的安全性和有效性。方法：采用回顾性方法分析我院2007年1月～2010年12月收治的52例SAP患者的临床资料,按营养支持不同分为肠内营养（EN）组和全胃肠外营养（TPN）组,每组各26例,观察两组治疗前后各生化指标、APACHE-Ⅱ评分、住院天数、平均住院费用、并发症发生率和死亡率的差异。结果：EN组治疗2周后C反应蛋白和APACHE-Ⅱ评分明显低于TPN组,而血清白蛋白和前白蛋白水平明显高于TPN组,差异均有统计学意义（P〈0．05）;EN组患者的住院天数和平均住院费用均明显低于TPN组（P〈0．05）,而两组患者的并发症发生率和死亡率差异无统计学意义（P〉0．05）。结论：早期肠内营养对SAP的治疗是安全、有效的,有助于改善SAP患者的营养状况,值得临床进一步推广。     

重症急性胰腺炎完全胃肠外营养与肠外联合肠内营养治疗对比研究

目的 观察重症急性胰腺炎（SAP）完全胃肠外营养（TPN）与肠外营养（PN）联合肠内营养（EN）治疗中各项指标的变化,分析二者疗效.方法 29例SAP随机分为TPN组（14例）和PN＋EN组（15例）,并均行非手术治疗14 d,观察疗效及化验指标的变化.结果 营养支持治疗14 d后,各组血清白蛋白（ALB）、总蛋白（TSP）、血钙（Ca2＋）、谷丙转氨酶（ALT）、谷草转氨酶（AST） 较营养支持前均显著升高（P〈0.05）;各组血糖、血清淀粉酶、血WBC均较营养支持前显著下降（P〈0.05）;各组血总胆红素（TB）治疗前后差异无统计学意义（P〉0.05）;PN＋EN组血WBC显著低于TPN组（P〈0.05）,其余化验指标组间比较差异无统计学意义（P〉0.05）;各组APACHEⅡ评分较治疗前显著降低（P〈0.05）,PN＋EN组评分显著低于TPN组（P〈0.05）.PN＋EN组住院天数、住院总费用、感染发生率及死亡率均显著低于TPN组（P〈0.05）.结论 PN联合EN治疗SAP优于TPN.     

早期肠内营养对老年胃癌根治术后预后及炎症反应的影响

目的：探讨早期肠内营养（EN）对老年胃癌患者术后营养状况、丙二醛（MDA）、超氧化物歧化酶（SOD）及机体炎症反应性的影响。方法：将80例胃癌根治术患者随机分为EN组及肠外营养（PN）组,各40例,EN组于术后第1天给予早期肠内营养支持治疗,PN组于术后第1天给予胃肠外营养支持治疗,对比分析两组患者术前、术后第1天、术后第7天营养指标[IgG、氮平衡（NB）、总蛋白（TP）、血清蛋白（ALB）]、MDA、SOD及炎症因子白介素-2、6、8（IL-2、6、8）和肿瘤坏死因子-α（TNF-α）变化情况。结果：与术后1d相比,两组治疗术后7dIgG、NB、TP、ALB水平均显著改善（P〈0．05）,而EN组术后7d各营养指标改善效果优于PN组,差异有统计学意义（P〈0．05）。两组患者术后第1天血清SOD水平显著下降,术后第7天恢复至术前水平,而EN组术后第7天MDA值恢复至术前水平,PN组MDA值高于EN组,差异有统计学意义（P〈0．05）。两组患者术后第1天IL-2、6、8和TNF-α水平显著升高,术后第7天两组IL-2、6、8和TNF-α水平低于术后第1天,且EN组低于PN组,差异有统计学意义（P〈0．05）。结论：早期肠内营养支持可有效改善机体营养,调节血清sOD、MDA变化,降低机体炎症应激性反应,促进机体康复。     

食管癌患者术后早期肠内营养支持治疗50例

目的观察肠内营养（enteralnutrition,EN）对食管癌术后早期患者的临床疗效。方法将100例食管癌术后患者随机分成EN组和肠外营养（parenteralnutrition,PN）组。EN组从术后1d开始经营养管予EN治疗,疗程7d;PN组从术后1d开始给予全外周静脉营养,疗程同EN组。观察两组患者术后胃肠道功能恢复时间及营养支持治疗并发症;术后1d及术后8d检测两组患者清蛋白（albumin,ALB）、转铁蛋白（transferrin,TEN）、前清蛋白（prealbumin,PreALB）和免疫球蛋白G（immunoglubinG,IgG）、免疫球蛋白A（immunoglubinA,IgA）、免疫球蛋白M（immunoglubinM,IgM）以及淋巴细胞（1ymphocyte,LC）计数。结果EN组胃肠道功能恢复时间显著少于PN组（P〈0．01）;EN组术后消化道症状不明显。与术后1d比较,术后8d两组PreALB和TEN水平显著升高（P〈0．01）;术后8d,EN组PreALB和TEN水平显著高于PN组（P〈0．05）。术后8d,EN组IgA、IgG和IgM水平显著高于PN组（P〈0．05,或P〈0．01）。结论食管癌术后早期EN治疗能够促进肠道功能早日恢复,有效改善机体营养状况和提高免疫功能。     

肠内外营养对机械通气患者脏器功能的影响

目的探讨肠内外营养支持治疗对机械通气患者内脏功能的保护作用。方法将63例机械通气患者随机分为肠内营养（EN）组，肠外营养（PN）组和对照组，每组21例。给予相应治疗7d后观察患者血清丙氨酸氨基转移酶（ALT）、动脉血氧分压（PaO2）、动脉血二氧化碳分压（PaCO2）、血尿素氮（BUN）、白细胞计数（WBC）的变化及消化道出血发生率。结果对照组ALT、WBC均明显高于EN组和PN组（P均〈0．05）；EN组间ALT、WBC及PaO2差异无统计学意义。对照组和PN组消化道出血发生率均为28．3％，明显高于EN组的14．3％（P〈0．05）。三组患者血BUN及PaCO2则无明显变化（P均〉0．05）。结论机械通气患者及早给予EN、PN比单纯葡萄糖供能要优越得多，有助于保护胃肠道和其他重要器官功能，防止肠道细菌及毒素移位，减少全身炎症反应，防止多脏器功能不全发生。     

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.