全麻斜视矫正术致应激性溃疡并上消化道出血1例

1病历报告患儿,女,7岁。因双眼共转性斜视于2005年6月21日入院。入院后查血常规WBC8.7×109/L,RBC4.7×1012/L,Hb139g/L、PLT260×109/L,凝血四项:APTT30s、PT12.5s、TT13s、INR1.2,其他辅助检查均正常;并于1周后在全麻下行双眼内斜矫正术,术后约40min,患儿突然口腔及鼻腔涌出血性物,咖啡色,有凝血块,量约150ml,同时出现呼吸困难、唇面发紫,查体:双眼切口无明显出血,瞳孔直径约6mm,对光反射迟钝,心律不齐,脉搏140次/min,呼吸16次/min,血压75/52mmHg。经消化内科、小儿科会诊,一致认为麻醉刺激及手术应激所致应激性溃疡并上消化道…     

术前血常规及凝血指标对甲状腺术后出血的预测价值分析

目的：分析甲状腺手术患者术前血小板(platelet, PLT)、血红蛋白(hemoglobin, Hb)、凝血酶原时间(prothrombin time, PT)、凝血酶时间(thrombin time, TT)、活化部分凝血活酶时间(activated partial thromboplastin time, APTT)、纤维蛋白原(fibrinogen, Fbg)以及D-二聚体(D-Dimer, D-Di)和术后出血的相关性。方法：收集2014年1月—2017年11月于我院进行甲状腺手术的775例患者为病例组,根据是否发生术后出血分为病例对照组和出血组,另选择正常对照组100例,回顾性分析各组的出、凝血相关指标,并进行统计学分析,作出对术后出血的预测判断。结果：病例对照组PLT为(196.75±41.65)×109/L,Hb为(137.37±5.39) g/L,Fbg为(2.63±0.53) g/L,PT为(12.87±1.00) s,APTT为(28.80±4.46) s,D-Di为(0.27±0.16) g/L;出血组PLT为(164.17±14.61)×109/L,Hb为(139.72±7.92) g/L,PT为(17.43±1.06) s,APTT为(29.38±4.15) s,Fbg为(1.83±0.608) g/L,D-Di为(0.46±0.16) g/L。两组PLT、PT、Fbg及D-Di比较差异均有统计学意义(均P＜0.05),而Hb、APTT、TT比较差异均无统计学意义(均P＞0.05)。Logistic回归分析显示,PT是术后发生出血的独立危险因素。结论：甲状腺患者术前的PLT、PT、Fbg及D-Di的水平可作为术后出血的预测指标,具有一定的临床应用价值,PT是术后发生出血的独立危险因素。     

侵袭性NK细胞白血病并发多器官功能障碍综合征2例

例1 患者,男,16岁,因反复发热17 d,加重伴气促1 d于2015年11月7日入院.体格检查:全身皮肤黏膜黄染,全身多处散在皮下出血点,淋巴结、肝脾阴性.胸腹部CT:双肺炎症,双侧胸腔积液,脾增大.入院后查血常规:WBC 16.88×109·L-1、Hb 100 g/L、PLT 211.00×109·L-1.生化:ALT 666 U/L、AST 4 020 U/L、TBIL 196.7 μmol/L、Cr 212 μmol/L.凝血常规:APTT 167.8 s、PT 34.2 s、TT 48.8 s.EB病毒NA1IgA阴性.甲丙丁戊肝阴性,乙肝两对半阴性.骨髓穿刺:ANKL.入院后出现呼衰、无尿,肝功能持续恶化,凝血功能随之恶化,血小板低,全身出血点增多、消化道出血, 11月25日自动出院,出院诊断:(1)侵袭性NK细胞白血病(ANKL);(2)多器官功能障碍综合征(MODS)[急性呼吸窘迫综合征(ARDS)、肝功能衰竭、肾功能不全、心功能不全、弥漫性血管内凝血(DIC)];(3)感染性休克;(4)肺部感染.     

胎盘植入并中央性前置胎盘剖宫产大出血抢救成功1例

1临床资料孕妇33岁,孕2产1,孕37周,疤痕子宫,因阴道出血2h入院.患者曾于3年前行剖宫产术,入院查体:体重72 kg,血压109/60 mmHg,心率102次/min,血常规示:Hb 109 g/L,PLT 162×109/L,凝血功能基本正常,B超前置胎盘中央性,急诊行剖宫产术,入手术室血压112/65 mmHg,心率110次/     

以关节肿痛为主要表现的急性淋巴细胞白血病1例

<正> 1 一般资料 患儿女,3岁,因关节肿痛1个月入院。入院前1个月出现双手示指、双踝关节肿痛,行走困难。血常规:Hb98g/L,RBC3.32×1012/L,WBC57.7×109/L,N0.116,L0.808,PLT185×109/L,尿常规正常。按“急性关节炎”治疗,取安吉儿乐、强的     

急性有机磷中毒引起凝血因子X缺乏1例

患者 ,女性 ,17岁。口服氧化乐果 (约 70mL) ,2 0天后出现间断性鼻出血 (约 10 0mL)及血尿。查体 :全身皮肤黏膜未见出血点、皮疹 ,浅表淋巴结不大 ,心肺未见异常 ,肝脾未触及。实验室检查 :WBC 6 .3× 10 9/L ,RBC 2 .79× 10 12 /L ,Hb 90g/L ,PLT 2 35× 10 9/L ,血涂片未见异常。凝血试验检查 :凝血酶原时间 (prothrombintime,PT) 30 .6s,对照 13s ;部分凝血活酶时间 (activatedpartialthrombplastintime,APTT) 71s,对照 33s ;纤维蛋白原 (fibrinogen ,Fg) 4 .34g/L ,对照 3.3g/L ;血清丙氨酸氨基转移酶 (ALT ) 86U/L。凝血…     

以纤维蛋白溶解综合征为主要表现的主动脉夹层1例

1临床资料患者,男性,81岁,因发现全身瘀斑、血细胞减少5d,发热1d于2010年8月25日入院.入院前5d因“突发头晕、呕吐、右上肢乏力”就诊当地医院,查头颅MRI示:多发腔隙性梗死;予丹参酮Ⅱa改善循环处理,头晕、呕吐等症状缓解,但出现皮肤粘膜多处瘀斑,查血常规:WBC 8.6×109/L,HGB 112 g/L,PLT 76×109/L;凝血全套:Fib 0.67 g/L,PT和APTT等指标正常;继续丹参酮Ⅱa治疗,皮肤瘀斑范围扩大,并出现发热,体温最高37.5℃,无畏冷,复查血常规:WBC 9.3×109/L,Hb 77 g/L,PLT 87×109/L;遂转诊我院.     

阿司匹林致食管下段粘膜溃疡出血1例

<正> 1 病历简介 患者,女性,42岁。因反复头晕5年,伴右肢体麻木2d入院。既往无胃病史。查体:BP16/10kPa,神清,体型肥胖,心肺检查未见异常,腹部稍膨隆,全腹无压痛,肠鸣音正常。入院查血常规:HGB127g/L,RBC4.03×1012/L,WBC5.9×109/L,PLT253×1012/L。血脂:CHO6.02mmol/L,TG1.85 mmol/L,HDL-ch 0.82 mmol/L,LDL-ch 3.88 mmol/L。血液流变学指标呈中度异常。凝血4项正常。诊断为高脂高粘血症。除常规调脂、疏通循环治疗外,予肠溶阿司匹林75mg,每天1次,治疗14d病情好转出院。出院当天晚上突然呕血,量约为2500ml。再次入院,血常规HGB 67g/L,RBC 2.75×1012/L,凝血4项正常,大便潜血(+),胃镜:距门齿20cm食管中下段粘     

胎盘早期剥离并发弥漫性血管内凝血46例分析

目的:探讨胎盘早剥伴弥漫性血管内凝血(DIC)的诊断及治疗方法。方法:对1997年1月至2007年7月我院收治的46例胎盘剥伴DIC的患者,回顾性分析其临床资料、治疗经过、疗效及结局。结果:46例中阴道分娩5例,剖宫产41例。剖宫产时全宫切除3例,次全切除4例。产妇死亡1例,新生儿死亡35例。结论:胎盘早剥合并DIC应早预防早治疗及时终止妊娠,剖宫产时合并DIC重型出血>3000ml,血小板<20×109/L、纤维蛋白<0.1g/L、3P(+)、凝血酶原时间>120s则果断行子宫切除术。     

一例产后DIC全麻术后的护理

患者,女,30岁.G3 P2产后5h阴道持续流不凝血.于2001年2月9日上午2时30min,以"产后大出血,DIC失血性贫血"收入院.入院后急查血常规:Hb 3g/L,WBC 14.4×109/L,Ts:3min30s,Tc:1min30s,心电图显示窦性心动过速,疑血酶原时间24s.配血1200ml,血型"O"型,积极给予术前准备并通知手术室,于上午3点在全麻下行子宫次全切除术.     

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.