低分子肝素对重度妊高征患者血浆D-D二聚体及血小板聚集功能的影响

[目的 ]应用低分子肝素 (LMWH)结合硫酸镁治疗重度妊高征 ,探讨LMWH在重度妊高征治疗中的价值及可行性。 [方法 ]选取重度妊高征患者 5 2例 ,硫酸镁治疗 2 6例 (Ⅰ组 ) ,硫酸镁 LMWH治疗 2 6例 (Ⅱ组 ) ;检测各组产妇血浆D -D二聚体水平及血小板聚集率变化 ;测量产后或术后 2h内出血量。 [结果 ]Ⅱ组治疗前后D -D二聚体及血小板聚集率明显降低 (P <0 .0 5 ) ;Ⅰ组治疗前后血浆D -D二聚体水平及血小板聚集率变化不明显 (P >0 .0 5 ) ;Ⅰ、Ⅱ组产后出血量无显著性差异 (P >0 .0 5 )。 [结论 ]传统的硫酸镁治疗对重度妊高征患者血浆D -D二聚体水平和血小板聚集率的影响不大 ,LMWH结合硫酸镁可显著降低D -D二聚体水平及血小板聚集率且并不增加产后及术后出血量。     

酚妥拉明联合硝酸甘油治疗临产后中、重度妊高征的临床观察

目的 比较酚妥拉明联合硝酸甘油与硫酸镁治疗临产后中、重度妊高征的作用。方法 通过观察两组患者用药前后的血压、产程及母儿情况等综合评价两者的治疗效果。结果 酚妥拉明联合硝酸甘油(治疗组)降压效果比硫酸镁组(对照组)迅速、确切，且产程缩短；治疗组胎儿宫内窘迫发生率、新生儿窒息率及产后出血发生率低于对照组，差异有显著性(P＜0．05)。结论 酚妥拉明联合硝酸甘油在治疗临产后中、重度妊高征既能迅速降压又不抑制子宫收缩，对胎儿无不良影响，亦不增加产后出血发生率，且能减少产科并发症的发生。     

卡孕栓用于减少妊高征患者产后出血的临床研究

目的　观察卡前列甲酯栓 (卡孕栓 )用于预防妊娠高血压综合怔 (妊高征 )患者产后出血的效果。方法　对10 6例妊高征患者在胎儿娩出后立即阴道粘膜贴附卡孕栓 1mg(卡孕栓组 ) ,10 4例同期妊高征患者在胎儿娩出后立即臀部肌肉注射缩宫素 10IU(缩宫素组 )。观察两组患者的第三产程时间 ,产后出血量 ,产后出血发生率以及卡孕栓使用前后的血压变化、副作用。结果　①两组年龄、孕周、产次、轻、中、重度妊高征所占比例、产前和产时的处理及新生儿体重相比 ,差异无显著性 (P >0 .0 5 )。②卡孕栓组 :第三产程时间 (6 .81± 3.5 2 )min ,产后出血量为(173.6± 81.2 )ml。缩宫素组 :第三产程时间 (10 .91± 5 .4 8)min ,产后出血量为 (2 80 .5± 10 3.4 )ml,产后出血发生率为 2 2 .2 % (2 2 / 10 4 )。两组相比 ,卡孕栓组第三产程时间及产后出血量产后出血发生率均明显小于缩宫素组 (P<0 .0 1)。③ 10 6例用卡孕栓的妊高征患者 ,其用药前血压为 (19.3± 1.86 ) / (12 .7± 1.5 3)kPa ,用药后血压为 (19.5± 1.83) / (12 .6± 1.5 9)kPa,差异无显著性 (P >0 .0 5 )。④卡孕栓组有 8例出现一过性大便次数增多 ,无需处理 ,阴道粘附未见有任何不良刺激反应。结论　对妊高征患者产后予以卡孕栓阴道给药能产生强有力的     

妊娠高血压综合征患者硫酸镁治疗前后血浆内皮素含量的变化

目的 :测定妊娠高血压综合征 (妊高征 )患者血浆内皮素含量的变化 ,探讨硫酸镁治疗妊高征的机制。方法 :采用放射免疫测定法观察 36例妊高征患者 (妊高征组 )血浆内皮素水平和硫酸镁治疗 4h时内皮素的变化 ,并以 14例同期正常妊娠妇女作对照。结果 :中、重度妊高征组患者血浆内皮素水平比同期正常妊娠妇女高 (P <0 .0 5 ) ,硫酸镁治疗 4h后血浆内皮素含量较治疗前显著降低 (P <0 .0 5 ) ,而轻度妊高征患者硫酸镁治疗后血浆内皮素较治疗前差异无显著性(P >0 .0 5 )。结论 :硫酸镁可以通过调节妊高征患者血浆内皮素含量而起到治疗妊高征的作用。     

酚妥拉明治疗妊高征82例临床分析

目的:分析酚妥拉明治疗妊高征的临床疗效.方法:治疗组82例给予5%葡萄糖注射液500ml,加酚妥拉明20mg,静滴,每15分钟测量血压1次,根据血压调整滴速,使血压控制在130/90mmHg左右;对照组94例给予5%葡萄糖注射液500ml,加25%硫酸镁30ml,静脉滴注,以1g/小时的速度滴入.两组患者均使用安定10mg缓慢静脉推注,5分钟推完.结果:①血压变化:酚妥拉明静滴5分钟后,即出现血压下降,使血压控制在130/90mmHg左右,而硫酸镁组血压下降不明显,用药前后平均动脉压仅下降4.5mmHg.②产程进展:酚妥拉明不抑制子宫收缩,产程进展在各个阶段均快于硫酸镁组.③分娩方式:治疗组阴道分娩率明显高于对照组(P＜0.01)剖宫产率明显低于对照组(P＜0.05).④产科并发症:治疗组宫缩乏力、产后出血率、胎儿宫内窘迫、新生儿窒息率均明显低于对照组(P＜0.01及P＜0.05).结论:硫酸镁松弛骨骼肌,能较好地预防和控制子痫发作,但其解除小动脉痉挛及降压作用不明显,尤其在妊高征临产后有宫缩的情况下,不能在短期内起到降压作用.因此,硫酸镁不宜在妊高征临产后使用,而此时宜选用酚妥拉明,其降压效果迅速,又无明显不良反应,不影响子宫收缩,减少了产科并发症的发生.     

妊娠高血压综合征对妊娠结局的影响

目的　探讨妊娠高血压综合征对妊娠结局的影响。方法　对 51例住院分娩妊高征患者的妊娠结局进行分析 ,并与 80例正常妊娠分娩产妇比较。结果　妊高征组的分娩孕周及新生儿出生体重分别为 38.0 2± 2 .72周和 2 80 9.0 0±71 7.86g ,明显低于正常妊娠组的 38.94± 1 .81周和 30 56 .88± 439.0 5g(P <0 .0 5) ;其新生儿窒息率、围生儿病死率及手术产率、产妇并发症等均显著高于正常妊娠组 (P <0 .0 5或 0 .0 1 )。重度妊高征的新生儿出生体重明显低于轻、中度组 ,新生儿窒息率及产妇并发症高于轻、中度 (P均 <0 .0 5)。结论　妊娠高血压综合征对母婴均造成严重的不良影响 ,而且病情越重 ,母婴预后越差 ,严密的监护和合理的治疗措施对减少母婴并发症及病死率具有重要意义     

东莨菪碱配伍心痛定治疗临产后中重度妊高征45例分析

我院1996年1月至1998年12月使用东莨菪碱配伍心痛定治疗临产后中、重度妊高征45例,与同期使用硫酸镁治疗临产后中、重度妊高征48例对照,效果满意,现报告如下。1　资料与方法1.1　一般资料　本组临产的中、重度妊高征患者93例,孕37～41 周,为初产妇、单胎、血压≥20/13.3kPa,不包括入院时子痫的患者,随机分为东莨菪碱配伍心痛定组(治疗组)和硫酸镁组(对照组)。1.2　用药方法　治疗组:5%葡萄糖液250ml 东莨菪碱0.3mg静滴,心痛定片10mg舌下含化,4～6h1次。对照组;5%葡萄糖液500ml 25%硫酸镁10g静滴,以每h1.5g的速度滴入。两组均在宫口扩张3cm…     

血管内皮细胞生长因子在妊高征患者及胎儿脐血中的表达

目的　探讨血管内皮生长因子 (VEGF)在妊娠高血压综合征 (妊高征 )患者血清及其分娩的新生儿脐血中的表达。方法　用酶联免疫吸附法检测 46例妊高征患者 (妊高征组 )外周血及其分娩的新生儿脐血VEGF水平 ,并与 40例健康孕妇 (非妊高征组 )及其分娩的新生儿 (对照组 )对比分析。结果　妊高征组外周血VEGF水平为 ( 9.3± 2 .8)ng·L-1,明显低于对照组的 ( 16 .8± 9.6 )ng·L-1(P <0 .0 1)。妊高征组的新生儿脐血VEGF水平为 ( 4 2 .4± 13.7)ng·L-1,低于对照组新生儿的 ( 75 .3± 15 .7)ng·L-1(P <0 .0 5 )。结论　妊高征患者血清及其分娩的新生儿脐血中VEGF减少可能是妊高征血管病变的原因之一。     

妊高征患者血清IL-1β及瘦素水平变化的研究

目的 :研究中、重度妊娠高血压综合征 (妊高征 )患者孕晚期血清内瘦素及白介素 1- β(IL- 1β)水平的变化。方法 :应用免疫放射及放射免疫法检测 35例妊高征患者 (中度组 15例 ,重度组 2 0例 )和 35例年龄、孕前体质指数 (BMI)及孕周与其相匹配的血压正常的孕妇 (对照组 )血清瘦素及 IL- 1β水平。结果 :妊高征患者血清内瘦素水平 :中度为 (34.79± 2 .0 8) ng/ml,重度为 (4 2 .19± 2 .2 0 ) ng/m l,较对照组 (2 5 .2 8± 1.98) ng/m l明显升高 (P<0 .0 1) ,IL - 1β水平 3组无差异 (P>0 .0 5 ) ,分别为 (0 .11± 0 .0 4 ) ng/ml(正常 )、(0 .19± 0 .0 3) ng/ml(中度妊高征 )、(0 .13± 0 .0 4 ) ng/ml(重度妊高征 ) ,瘦素及 IL - 1β的水平不具有相关性。结论 :妊高征患者血清瘦素水平较对照组明显升高 ,且重度妊高征组血清瘦素浓度显著高于中度妊高征组 ,而 IL- 1β水平 3组无差异且与瘦素无相关。     

凝血-纤溶系统变化在妊高征凝血障碍机制中的作用

目的　探讨凝血 -纤溶系统变化在妊高征凝血障碍机制中的作用 ,为妊高征诱发DIC的预测提供有效诊断方法。方法　选择非孕组 40例 ,妊娠组 12 0例 ,妊高征组 5 0例 ,妊高征产后组 2 6例。采用双抗夹心酶联免疫吸附法 (ELISA)检测血浆凝血酶 -抗凝血酶复合物 (TAT)、D -二聚体 (D_dimer)含量　结果　 (1)正常早、中、晚孕TAT水平 ,与非孕组比较 ,差异有显著性 (P <0 0 5 ) ;中、重度妊高征组分别为 (15 4± 2 8) μg/L、 (2 0 5± 6 2 ) μg/L ,与晚孕组比较 ,差异有非常显著性 (P <0 0 1)。 (2 )正常早、中、晚孕D_dimer水平与非孕组比较 ,差异有非常显著性(P <0 0 1) ;中、重度妊高征组分别为 (1616 5± 14 8 1) μg/L、 (3 863 7± 3 42 4) μg/L ,与晚孕组比较 ,差异有非常显著性 (P <0 0 1) ;妊高征产后中、重度组较晚孕组明显增高 (P <0 0 5 )。结论　妊娠中晚期动态监测血浆TAT、D_dimer含量可做为DIC前状态敏感有效的辅助诊断。     

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.