压力支持通气和同步间歇指令通气的临床应用比较

目的 比较压力支持通气（ＰＳＶ）和同步间歇指令通气（ＳＩＭＶ）的临床应用。方法 对２２例需要辅助通气的危重患者予ＰＳＶ和ＳＩＭＶ、观察分钟通气量（ＭＶ）、潮气量（ＶＴ）、呼吸频率（ｆ）、气道峰值压力（ＰＩＰ）、动脉血氧分压（ＰａＯ２）、二氧化碳分压（ＰａＣＯ２）及动脉血氧饱和度（ＳａＯ２）、心率（ＨＲ）、平均动脉压（ＭＡＰ）、人机对抗情况．结果 ＭＶ、ＶＴ、ｆ、ＰａＣＯ２、ＰａＯ２、ＨＲ、ＳａＯ２     

压力支持通气和同步间歇指令通气的临床应用比较

目的比较压力支持通气（ＰＳＶ）和同步间歇指令通气（ＳＩＭＶ）的临床应用。方法对２２例需要辅助通气的危重患者予ＰＳＶ和ＳＩＭＶ、观察分钟通气量（ＭＶ）、潮气量（ＶＴ）、呼吸频率（ｆ）、气道峰值压力（ＰＩＰ）、动脉血氧分压（ＰａＯ２）、二氧化碳分压（ＰａＣＯ２）及动脉血氧饱和度（ＳａＯ２）、心率（ＨＲ）、平均动脉压（ＭＡＰ）、人机对抗情况。结果ＭＶ、ＶＴ、ｆ、Ｐａ－ＣＯ２、ＰａＯ２、ＨＲ、ＳａＯ２，ＭＡＰ在两者无明显差异（Ｐ＞０．０５），但ＰＳＶ时ＰＩＰ明显降低，人机对抗少（Ｐ＜０．０１）。结论ＰＳＶ优于ＳＩＭＶ。     

慢性阻呼吸衰竭的机械通气治疗

评价双水平气道正压（ＢｉＰＡＰ）通气对慢性阻塞性病（ＣＯＰＤ）急性加重期Ⅱ型呼衰患者的疗效。方法：在相同的常规治疗下,ＢｉＰＡＰ治疗组２５例应用ＢｉＰＡＰ通气经鼻（面）罩给气,对照组２１例经鼻导 氧,用血气分析仪及脉搏血氧 度仪分别监测两组病人治疗前后的ＰａＯ２、ＳａＯ２、ＰａＣＯ２呼吸率及心率的变化。结果：治疗后ＢｉＰＡＰ组ＰａＯ２、ＳａＯ２较对照组显著提高,而ＰａＣＯ２、呼吸率及心率的变化。结     

早期机械通气对特重型颅脑损伤的临床应用研究

目的：探讨早期机械通气支持对待重型颅脑损治疗作用临床意义。方法：将４９例患者（ＧＣＳ≤５）随机分成Ａ组：即刻使用机械通气支持２０例;Ｂ组：治疗过程中如出现呼吸衰竭时才使用机械通气支持２９例,进行通气前后呼吸监测指标（ＰａＯ２、ＲＲ、ＰａＣＯ２、ＳａＯ２）及两组间预后的对比分析。结果：Ｂ组２９例有２４例出现呼吸（以Ⅱ型为主）使用了呼吸机。Ａ、Ｂ两组机械通气前后ＰａＯ２、ＲＲ、ＰａＣＯ２、ＳａＯ２等指     

BIPAP30呼吸机治疗COPD呼吸衰竭的临床观察

为探讨ＢＩＰＡＰ通气在ＣＯＰＤ呼吸衰竭中的应用价值,对施行ＢＩＰＡＰ通气的３１例ＣＯＰＤ呼吸衰竭患者进行多指标观察。ＢＩＰＡＰ通气７天后ＰａＯ２明显上升（Ｐ〈０．０５）,ＳａＯ２明显上升（Ｐ〈０．０１）,ＰａＣＯ２明显下降（Ｐ〈０．０５）,表明可提高ＣＯＰＤ呼吸衰竭患者的血氧分压、血氧饱和度,降低血二氧化碳分压。操作简便,早期应用可减少建立人工气道。     

自主呼吸条件下双相气道正压通气与持续性气管内吹气联合运用的 …

目的 探讨在自主呼吸间隙存在时应用持续性气管内吹气（ＣＴＧＩ）的可能性。方法 油酸所致急性肺伤犬模型８号,随机予双相气道正压通气（ＢＩＰＡＰ）及ＢＩＰＡＰ加用ＣＴＧＩ（流速分别为３、６、９Ｌ／ｍｉｎ,简称Ｔ３、Ｔ６、Ｔ９组）,调节ＢＩＰＡＰ压力水平使ＰａＣＯ２在各组间相等,达到稳态后测定各通气方式下的气体交换、呼吸力学、血流动力学和氧动力学指标。结果 在保证ＰａＣＯ２相同,即通气效果相同的前提下,     

允许性高碳酸血症联用低呼气末正压通气在危重哮喘中的应用

目的 探讨允许性高碳酸的血症（ＰＨＶ）联用低呼气末正压（ＰＥＥＰ）通气治疗危重哮喘的效果。方法 １２例危重哮喘患者采用容量控制或辅助／控制模式并采用ＰＨＶ通气策略（ＰａＣＯ２〈１０．６ｋＰａ,ｐＨ〉７．１５）。２例患者采用ＳＩＭＶ和ＰＥＥＰ,潮气量设定６～８ｍｌ／ｋｇ,ＰＥＥＰ设在５～１０ｃｍＨ２Ｏ压力左右。呼吸频率为１４～１６次／ｍｉｎ。同时记录吸入氧浓度（ＦｉＯ２）、气道峰压（ＰＩＰ）、动脉血     

常频喷射通气和高频喷射通气对蒸气吸入伤犬通气效率的比较

采用蒸气吸入性损伤犬模型，比较常频喷射通气（ＮＦＪＶ）和高原喷射通气（ＨＦＪＶ）的通气效率。结果表明：（１）与ＨＦＪＶ比较，ＮＦＪＶ时的气道压峰值显著升高（Ｐ＜０．０１）；（２）与ＨＦＪＶ比较，ＮＦＪＶ时的Ｐ＿ＡＯ＿２显著下降（Ｐ＜０．０５），ＰａＣＯ＿２显著升高（Ｐ＜０．０１）；（３）与ＨＦＪＶ比较，ＮＦＪＶ时的心输出量（ＣＯ）、氧供量（ＤＯ＿２）和氧耗量（ＶＯ＿２）均显著减少（分别减少１４％、２０％和２４％，Ｐ＜０．０５或Ｐ＜０．０１），而ＰａＯ＿２、ＳａＯ＿２、Ｐ＿（Ａ－ａ）Ｏ＿２、ＰａＯ＿２／Ｆ＿１Ｏ＿２、ＰｖＯ＿２、ＳｖＯ＿２和氧摄取率（ＥＲＯ＿２）均无明显变化。提示，ＮＦＪＶ与ＨＦＪＶ比较，前者导致肺泡通气不足和ＣＯ＿２潴留，且对循环和组织氧合有不良影响。     

面（鼻）罩双水平气道正压通气对慢阻肺合并急性早,中期呼衰的…

对１１例慢性阻塞性疾病（ＣＯＰＤ）经鼻导管吸氧（ＦｉＯ２〈３５％）仍处于早、中期呼衰者，施行面（鼻）罩双水平气道正压（Ｂｉ－ｌｅｖｅｌ Ｐｏｓｉｔｉｖｅ Ｑｉｒｗａｙ Ｐｒｅｓｓｕｒｅ，ＢｉＰＡＰ）辅助通气，吸气相正压（ＩＰＡＰ）为１￣１．５ｋＰａ，呼气相正压（ＥＰＡＰ）为０．２￣０．５ｋＰａ，观察治疗前后ＰａＯ２，ＰａＣＯ２，ＳａＯ２，潮气量估计值等临床指标的变化，经配对ｔ检验，结果均有显著性差     

机械通气在脑弥温性轴索损伤治疗中的应用

本文对１６例脑外伤后ＤＡＩ机械通气等综合治疗的临床资料进行了回顾性分析，结果表明：机械通气前后ＰａＯ２、ＳａＯ２、ＨＲ、ＲＲ等监测指标均有差异（Ｐ〈０．０５￣０．０１）。通气模式以ＳＩＭＶ＋ＰＥＥＲ最好，ＳＩＭＶ＋ＰＳＶ次之，ＳＯＩＭＶ较差，ＣＭＶ最差，本组死亡率为５０，机械通气的并发症发生率为４３．７５％。本文还探讨了 ＡＩ诊断与治疗中的一些问题。机械通气是ＤＡＩ综合中的重要措施。     

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.