外伤性肝破裂临床诊治体会

外伤性肝破裂临床诊治体会（３１４３００）浙江省海盐县人民医院朱忠良吴建飞李福新本组自１９８６年１２月～１９９６年１２月共收治肝损伤３６例，其中采用手术治疗３１例，非手术治疗５例。现总结报告如下，１临床资料１．１一般资料：男２９例，女７例，年龄３～６１...     

腹部钝性损伤出血非手术治疗的病例选择

为了探索腹部钝性损伤出血的非手术治疗指征，总结９７例已诊断为腹腔出血的病例。分为甲乙两组；甲组５２例在Ｂ超及ＣＴ的监测下，密切观察血液动力学变化，１７例非手术治疗成功，３５例手术治疗。乙组４５例，除１例非手术治疗外４４例急诊手术。比较两组非手术治疗率分别为３２７％（１７／５２）和２２％（１／４５）。术前肝脾损伤诊断符合率分别为９５５％（２１／２２）和６２５％（２０／３２）手术单纯探查率分别为５７％（２／３５）和２７３％（１２／４４），以上均有显著差异，认为对于血液动力学稳定，出血量不超过５００ｍｌ，即便是肝脾损伤均可行非手术治疗     

喉外伤的急救处理

目的：探讨喉外伤的合理救治;方法：回顾性分析了１９８２年１１月～１９９８年１２月收治的１６例急诊喉外伤患者的临床资料,其中１４例为开放性喉外伤,２例为闭合性外伤。对其１２例行喉腔探查。结果：１２例中拔管９例,喉狭窄２例,１例死于颅脑损伤。结论：在对喉外伤行急救处理时要一期重建喉的结构,对严重的闭合性喉外伤要尽早行手术探查。     

脾破裂非手术治疗的临床观察

１９８７个１月～１９９７年１２月,本科收治外伤性脾破裂２１３例,选择６７例进行非手术治疗,效果满意。现报告如下。１资料与方法１．１资料本组６７例,男６３例,女４例。年龄１７～７０岁,平均３７．６岁。受伤原因有车祸、坠落、跌倒、打击等。受伤至入院时间１...     

贲门癌引起急性大出血的诊断与治疗5例报告

我院于１９９０年１月～１９９６年１２月共收治贲门癌１８２例，其中５例以急性消化道出血导致休克症状入院，占同期贲门癌患者手术的２７％。现就诊断、手术时机和手术方式的选择，结合文献复习讨论如下。１　临床资料１１　一般资料　男４例，女１例，年龄４５～６１岁。４例表现为突然大量呕血，血量１０００～２５００ｍｌ／２４ｈ，１例表现为大量黑便。５例均伴有晕厥、出冷汗、血压下降（１０～４／６～０ｋＰａ）、脉细速等休克征象，４例行胃镜检查，其中２例确诊，２例提示为贲门胃底部出血。仅１例术前行上腹部ＣＴ检查，未…     

乡镇医院诊治闭合性腹部损伤59例体会

目的探讨目前乡镇医院特殊条件下诊治腹部闭合性损伤的有效方法,术中应注意的事项及非手术治疗的指征。方法对我院2002年10月～2010年1月收治的腹部闭合性损伤的所有病例均行腹部超声探查,并将病人的临床表现、治疗及手术方法进行分析。结果腹部超声探查阳性结果55例,59例中急诊手术36例,非手术治疗10例,非手术治疗无效中转手术8例,在本院治愈54例,转送上级医院5例,在上级医院治愈4例,死亡1例。结论腹部闭合性损伤要首先诊断是否有实质和（或）空腔脏器的损伤。腹部超声探查为乡镇医院特殊条件下诊断腹部闭合性损伤的有效方法。有实质和（或）空腔脏器的损伤者应在积极抢救的同时争取尽早手术以降低死亡率。对那些生命体征稳定的病人可在密切监测下行非手术治疗,但应作好充分的术前准备,一旦病情变化应及时手术,以提高治愈率。     

创伤后迟发性肠破裂12例报告

创伤后迟发性肠破裂１２例报告吴平浙江医科大学湖州第二教学医院（３１３０００）１９８６年１月～１９９７年１０月，我科收治并经手术处理小儿外伤性肠破裂１４１例，其中迟发性肠破裂１２例，现报告如下。１临床资料男１０例，女２例。年龄３～１４岁。均为腹部闭合性...     

周围神经断离伤急诊手术23例体会

我院外科１９９０年１月至１９９７年１２月收治周围神经开放性多神经断离伤２３例,共３２条神经,均行急诊手术修复,疗效满意,现总结如下。１临床资料１．１一般资料：本组２３例,男１７例,女６例,年龄１５～２３岁,平均２５．７岁。均为开放性损伤,其中上肢２２...     

小肠扭转22例临床分析

小肠扭转２２例临床分析罗扬明（广西贺县信都卫生院）关键词小肠扭转；腹痛；手术治疗我院自１９９０年１月～１９９４年１２月共收治经手术证实的２２例小肠扭转病人，现总结分析如下：１临床资料本组２２例，其中男１８例，女４例，男女比４．５：１，年龄１７～４６岁...     

胆漏包裹致幽门梗阻2例报告

胆漏包裹致幽门梗阻２例报告陈晓鹏刘中金我院近年收治２例由胆漏包裹所致的幽门梗阻患者，均经Ｂ超、胃镜检查确诊，１例并经手术探查证实。２例分别经手术和非手术引流胆漏而治愈，现报道如下。１病历报道例１女，２８岁。１９９３年１２月因胆囊炎、胆石症住我科行胆囊...     

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.