广西玉林市临床常见急性中毒病例中毒原因的分析研究

目的分析临床常见急性中毒病例中毒原因及影响因素。方法对玉林市6家县级以上综合医院收治的2 328例急性中毒病例的临床资料进行回顾性分析。结果 2 328例急性中毒病例主要分布在农村(86.13%),以农民、儿童、学生为主(68.23%),中毒人群主要集中在60岁以下年龄组(88.75%),中毒原因以意外(35.74%)、自杀(27.96%)和误食(27.79%)为主,这3类中毒原因占病例总数的91.49%,意外性中毒多见于男性(39.17%)、36~岁组(37.86%)与60~岁组(42.37%)及化学类(62.40%)、动物类(91.30%)和其他类(75.19%)引起的中毒,自杀性中毒多见于女生(37.79%)、20~岁组(44.27%)及农药类(57.29%)和药物类(24.14%)引起的中毒,误食性中毒多见于男性(32.71%)、20岁组(57.33%)及植物娄(69.14%)和药物类(40.64%)引起的中毒。结论意外性、自杀性和误食性中毒原因与农药类和化学类毒物为玉林市临床常见急性中毒的中毒原因和毒物。应加强采取重点监控措施,针对主要中毒种类和原因采取多方式宣教措施,增强人群防毒意识,提高人群防毒技能。     

570例儿童急性中毒特点和构成分析

目的:分析近9年豫北地区儿童急性中毒特点及毒物变迁。方法:对2000年8月31日至2009年8月31日豫北地区570例急性中毒儿童的中毒年龄、中毒原因、中毒途径、中毒地域、毒物种类分析、毒物变迁进行分析。结果:中毒年龄集中在1~6岁(56.14%),中毒原因以误服最多见(61.40%)、自杀其次(35.09%),中毒途径以消化道为主(96.49%)、吸入中毒次之(3.51%),中毒地域以农村为主(96.49%),毒物种类以灭鼠药中毒为主(40.35%)、其次为农药(38.60%),毒物变迁提示2000-2006年毒物以灭鼠药为主(67.72%),2006-2009年毒物以农药为主(77.72%)。结论:儿童急性中毒年龄集中在1~6岁,以误服最多见,毒物变迁提示禁售灭鼠药的重要性。     

梅州地区急性中毒患者原因调查分析及应对策略

目的:调查和分析梅州地区急性中毒原因与流行病学特点,提出应对策略。方法:采用回顾性研究方法,对2012-2014年本院收治的急性中毒患者的性别、年龄、职业、发生时间、发生地点、中毒原因、患者来源、毒物种类、中毒物质名称、毒物侵入途径、急诊诊断、去向及转归等项目进行调查统计分析。结果:2012-2014年本院急诊科室收治559例急性中毒患者,男230例,女329例,女性多于男性。平均年龄(38.7±5.9)岁,主要集中于21~40岁。中毒患者直接来本院就诊448例(80.1%),由外院转诊111例(19.9%),农村患者多于城镇患者。急性中毒患者职业以农民、民工和待业人员居多。中毒时间集中于1~2月、5~6月和11~12月。中毒途径中口服中毒比较常见,占67.5%。自杀是中毒的主要原因,因家庭纠纷、恋爱婚姻等问题自杀的患者较集中。主要毒物为有机磷农药、一氧化碳和酒精。有机磷农药与镇静催眠药中毒患者,女性病例数明显多于男性。酒精中毒患者,男性病例数显著多于女性。559例急诊中毒患者,痊愈出院462例(82.6%),病情好转出院78例(14.0%),死亡19例(3.4%)。结论:根据本地区急性中毒的流行病学特点,制定应对策略,从而降低中毒发生率及致残率,减轻患者的经济负担,创造良好的社会效益。     

广西地区急性中毒程度的影响因素研究

目的 探讨广西地区急性中毒程度的相关影响因素.方法 采用回顾性调查分析方法 对2005-2009年6 011例中毒患者的临床资料进行查阅、分类统计及分析.结果 在6 011例中,轻、中、重度中毒分别为2 577例（42.87%）、2 038例（33.90%）和1 396例（23.22%）,死亡157例（2.61%）.各类影响因素与病例分布分析表明,发病地区以农村病例数（61.84%）最多,重度中毒率与死亡率（分别为25.88%和3.38%）最高.发病形式以散发性病例数（89.34%）最多,其重度中毒与死亡人数分别占总构成数的96.85%和95.54%.年龄以20～60岁组病例数（68.84%）最多,其重度中毒与死亡人数分别占71.78%和72.61%.中毒原因以意外性、自杀性、误食性中毒的病例数（91.89%）最多,其重度中毒与死亡人数分别占93.76%和92.99%.毒物类别以农药类与化学类的病例数（61.23%）最多,其中农药类的重度中毒与死亡人数分别占60.24%、73.25%.结论 以农村、散发性、20～60岁年龄段和意外性、自杀性、误食性原因与农药类、化学类毒物对发病人数和中毒程度有着突出影响,应为广西地区急性中毒关注的重点.     

大庆地区成人非生产性急性中毒流行病学分析

目的:调查急性中毒患者的流行病学特点,为制定急性中毒的防治策略提供科学依据。方法:收集2007年1月~2009年12月期间于大庆油田总医院急诊科住院治疗的急性中毒患者,对其性别、年龄、中毒种类等10项内容进行统计分析。结果:705例研究病例中,男女比为0.77:1。中毒高发年龄段为21~50岁(66.67%)。中毒药物种类中居首位的是农药(43.69%)。职业居首位的是农民289例(40.99%)。第4季度发生急性中毒事件最多(39.43%)。消化道吸收为主要侵入途径(92.34%)。最常见的中毒原因是自杀(91.86%)。结论:本研究提供了该院急性中毒流行病学的基本资料,为制定本地区急性中毒防治策略提供有用信息。     

急诊中毒自杀95例分析

目的：探讨急诊中毒自杀的流行病学规律以及救治情况，为制定相应的预防和控制策略提供科学依据。方法：采用横断面流行病学调查方法，对一年内在我院急诊科就诊的所有急性中毒自杀病例进行分析。结果：在调查期间内共收治中毒患者304例，其中自杀病例95例(占31.25％)。男性16例(16.84％)，女性79例(83.16％)，男女性别比为1：4．93；95．79％为本院初诊病例；20％病例使用了救护车；61．05％为本地自杀病例。自杀病例的平均年龄为26，29岁，自杀年龄主要集中在15～34岁之间。大多数病例能在1小时内送往医院接受抢救(51.58％)；前三位职业排序为服务业(21．05％)、待业(21.05％)和家务(15．79％)，平均自杀平均为20．53岁；药物(78.95％)和农药(12.63％)是自杀的主要毒物；经急诊处理后继续留观和住院的患者占52．63％；死亡1例。结论：青年人是急性中毒自杀的高危人群；经消化道摄入毒物是最常见的中毒自杀方式；为急诊科医生提供了有关综合性医院急诊中毒自杀特点的基本资料。     

自杀性急性中毒患者的临床分析

目的通过对自杀患者急性中毒资料进行分析,为今后自杀患者发生急性中毒提供防治参考依据。方法对2005年1月至2009年6月我院收治的932例自杀急性中毒患者的中毒情况、月份分布、患者性别与年龄进行分析研究。结果自杀性急性中毒病例中,女性551例,男性381例。自杀性中毒年龄发生在19-38岁者占60．08％。自杀性急性中毒的人数与国民经济发展呈负相关（r=-0．985,P〈0．05）。自杀急性中毒时间以每年1,2,5,6月多见。结论自杀性急性中毒患者以中青年为主,且女性多见;冬季和夏季自杀性急性中毒病例居多;经济发展速度快,则自杀性中毒人数相对较低。     

辽宁两所医院963例急性中毒分析

调查分析中国医科大学附属第一医院和辽宁省凤城市中心医院急诊科急性中毒患者963例的流行病学资料,所有来诊患者均填写急性中毒表格,包括年龄、性别、职业、发生时间、地点、患者来源、意图、中毒类型、中毒物质名称、剂量、毒物种类、侵入途径、急诊处理方式、诊断及转归等。结果表明,急性中毒患者以20~39岁多见,女性发病率高。常见毒物为镇静催眠类药物、一氧化碳、农药等。自杀是常见的中毒原因,口服为主要中毒途径。农民、待业人员、家务劳动者和学生是主要的中毒职业分布。     

宁夏地区2006-2010年急性职业中毒事故分析

目的掌握宁夏地区急性职业中毒发生规律和特点,为制定有效的防范措施提供依据。方法收集宁夏地区2006-2010年急性职业中毒报表进行汇总分析。结果此间宁夏共发生急性职业中毒事件8起,中毒患者43人,累计死亡6人;引起急性职业中毒主要以硫化氢、一氧化碳为主,其中一氧化碳中毒事件起数最多(4起),而硫化氢中毒例数(33例)和死亡例数(4例)最多;发生在冶金和化工行业系统的事故分别为4起和2起,中毒患者分别为32例(占74.5%)和6例(占13.9%);大部分中毒人员接触工龄都在5年以内,占到总中毒人数的79.1%。结论宁夏地区近几年急性职业中毒事故频发,应着重抓好冶金、化工、煤炭行业重点毒物,尤其是硫化氢和一氧化碳的职业卫生监督,加强企业职工的职业卫生防护。     

综合性医院急诊科急性中毒患者流行病学研究

目的研究综合性医院急诊科收治的急性中毒患者的流行病学特点。方法采用前瞻性研究方法,对2003年我院急诊科收治的急性中毒患者的性别、年龄、职业、发生时间、发生地点、中毒原因、患者来源、毒物种类、中毒物质名称、毒物侵入途径、急诊诊断、去向及转归等项目进行调查统计分析。结果2003年我院急诊科共收治急性中毒患者1 954例,男女比为1∶1.23,女性多于男性。中毒的年龄主要集中于20~29岁年龄组(占37.21%),此年龄组中女性明显多于男性(女63.41%、男36.59%),其次为30~39岁年龄组(占26.31%)。就诊时间分布特点呈无规律性波动,12月、1月、2月高发,占全年的39.92%。中毒患者的职业排在前4位的是个体开业、农民工、家务及待业人员、儿童和学生。50.92%的中毒发生在家里。就诊时间>1 h者占66.25%,自杀者占急性中毒的31.2%。毒物进入人体最常见的途径是经消化道摄入(77.89%)。首位的中毒种类是其他化学品中毒(不包括药物和农药),占中毒总数的52.58%,居中毒类型第2位的为药物中毒,占14.28%。前6位的中毒病谱依次是酒精中毒、一氧化碳中毒、食物中毒、苯二氮卓艹类镇静催眠药中毒、有机磷农药中毒、鼠剂中毒。97.68%的患者治愈出院,1.02%死亡。结论本研究为急诊科医生提供了有关综合性医院急诊中毒特点的基本资料,为急性中毒防治提供最新的科学资料和依据。     

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.