＞40岁关节镜术后下肢深静脉血栓的危险因素及干预

目的：对40岁以上关节镜术后发生下肢深静脉血栓（deep venous thrombosin,DVT）并发症患者的危险因素进行分析,比较两种气压泵使用时间策略对DVT形成的影响。方法：回顾性研究2010年1月—2016年6月本院收治的311例40岁以上关节镜手术患者的临床资料,患者均行下肢深静脉血管超声检查以明确有无DVT形成,采用多因素Logistic回归模型对DVT发生的影响因素进行分析。结果：单因素分析显示术后DVT并发症在吸烟史、纤维蛋白原、D?二聚体、手术时间以及术后气压泵使用时间指标差异均有统计学意义（P＜0.05）;多因素Logistic回归模型分析显示手术时间的延长是术后DVT并发症的危险因素（OR=1.014,95%CI：1.005~1.023,P＜0.05）;术后长时间使用气压泵是术后DVT并发症的保护因素（OR=0.107,95%CI：0.038~0.298,P＜0.05）;术前D?二聚体指标升高是DVT并发症的危险因素（OR=2.182,95%CI：1.299~3.665,P＜0.05）。结论：40岁以上患者D?二聚体升高加大DVT的发生率,缩短手术时间和术后延长使用气压泵的时间,可减少关节镜患者术后DVT的发生率。     

综合ICU与NSICU重症患者DVT发生率及影响因素比较

目的:比较综合ICU与神经外科ICU(NSICU)患者深静脉血栓(DVT)发生率及危险因素,为DVT的针对性预防提供参考。方法:回顾性分析2016年1月～2022年1月在弋矶山医院综合ICU及NSICU住院且行下肢静脉血管超声检查的1 891例患者DVT发生情况,分析比较DVT的发生率及危险因素。结果:综合ICU患者DVT发生率为11.0%,下肢瘫痪(OR=2.696,95%CI:1.289～5.638)、肿瘤(OR=2.283,95%CI:1.368～3.809)、手术史(OR=1.811,95%CI:1.157～2.836)、升压药(OR=1.694,95%CI:1.150～2.497)是DVT危险因素,抗凝药(OR=0.582,95%CI:0.390～0.868)是DVT保护因素。NSICU患者DVT发生率为25.6%,手术史是其独立危险因素(OR=73.646,95%CI:36.00～150.68)。结论:NSICU患者DVT发生率较综合ICU高,同时DVT的危险因素也存在差异,临床可根据危险因素采取针对性的预防方法。     

脊椎骨折术后深静脉血栓形成的危险因素及护理预防对策

目的探讨脊椎骨折术后深静脉血栓形成(DVT)的危险因素及护理预防对策。方法选取2015年1月至2016年6月我院收治的150例脊椎骨折术后患者为研究对象,采用多层螺旋CT静脉造影术对纳入患者术后下肢DVT进行筛查,依据筛查结果将其分为DVT组和非DVT组,统计两组临床一般资料,采用单因素和多因素Logistic回归分析脊柱骨折术后患者DVT的危险因素,并探讨脊椎骨折术后深静脉血栓的护理预防措施。结果 150例脊椎骨折术后患者有80例形成DVT,发生率为53.33%;经单因素和多因素Logistic回归分析结果显示糖尿病史(OR=2.031,P=0.023,95%CI 1.015-3.258)、术后BPC低(OR=1.891,P=0.012,95%CI 1.003-3.123)、术后D-D高(OR=1.941,P=0.009,95%CI 1.011-3.192)是脊椎骨折术后DVT形成的独立危险因素,术后抗凝药物使用(OR=1.985,P=0.015,95%CI 1.019-3.210)是椎骨折术后DVT形成的保护因素(P0.05);干预组术后DVT发生率23.33%明显低于未干预组60.83%,差异显著(P0.05)。结论糖尿病史、术后PLT和D-D水平可有效预测脊椎骨折术后DVT形成,而为高危DVT患者有效使用抗凝药物并实施合理护理预防措施是有效降低术后DVT发生率的关键。     

创伤患者下肢深静脉血栓危险因素分析

目的回顾性分析创伤患者下肢深静脉血栓形成的危险因素。方法应用超声二维及彩色多普勒血流成像检查632例创伤患者血栓发生情况,运用x²检验和多因素Logistic回归分析下肢深静脉血栓形成可能的危险因素。结果超声检查发现DVT阳性患者153例(24.2%),DVT阴性患者479例(75.8%)。经)x2检验和多因素Logistic回归分析下肢深静脉血栓形成可能的危险因素。结果超声检查发现DVT阳性患者153例(24.2%),DVT阴性患者479例(75.8%)。经)x²检验和多因素Logistic回归分析发现,创伤后血栓形成的高危因素为高龄(OR=4.099,95%CI 1.5762检验和多因素Logistic回归分析发现,创伤后血栓形成的高危因素为高龄(OR=4.099,95%CI 1.576¹0.663,P<0.05)、体内恶性肿瘤(OR=2.475,95%CI 1.07710.663,P<0.05)、体内恶性肿瘤(OR=2.475,95%CI 1.077⁵.689,P<0.05)、静脉血栓史(OR=2.087,95%CI 1.0085.689,P<0.05)、静脉血栓史(OR=2.087,95%CI 1.008⁴.320,P<0.05)、吸烟(OR=2.041,95%CI 1.0114.320,P<0.05)、吸烟(OR=2.041,95%CI 1.011⁸.963,P<0.05)、发热(OR=1.351,95%CI 1.0128.963,P<0.05)、发热(OR=1.351,95%CI 1.012⁴.642,P<0.05),而少量饮酒(OR=0.471,95%CI 0.2424.642,P<0.05),而少量饮酒(OR=0.471,95%CI 0.242⁰.941,P<0.05)不会增加DVT的发病风险。结论高龄、体内恶性肿瘤、静脉血栓史、发热均是深静脉血栓的危险因素,针对不同危险因素,应加强对创伤患者的临床监护,以减少深静脉血栓的形成。     

脊柱手术术后并发下肢深静脉血栓的因素分析

目的 探讨脊柱手术术后并发下肢深静脉血栓(DVT)的因素。方法 以200例脊柱手术患者为对象,依据患者术后DVT发生情况分为DVT组(n=39)和非DVT组(n=161)。收集患者一般资料及手术相关资料,分析影响患者术后并发DVT的因素。结果 DVT组与非DVT组在在年龄、体重指数、糖尿病、凝血四项、术中输血史、手术时间、术中失血量及术后卧床时间方面比较差异显著(P<0.05)。Logostic回归分析结果显示年龄(OR=5.182)、凝血四项(OR=7.477)、输血史(OR=4.010)、失血量(OR=5.708)、术后卧床时间(OR=5.445)为脊柱术后发生DVT的危险因素。结论 脊柱术后并发下肢DVT的风险较高,高龄、凝血功能异常、术中失血量增加、围术期输血及术后卧床时间延长均与术后DVT关系密切。     

开胸术后发生肺栓塞的危险因素分析

目的:分析开胸患者术后发生肺栓塞的危险因素。方法:选取19例开胸手术后发生肺栓塞患者作为观察组,同期38例开胸手术后未发生肺栓塞患者作为对照组,对两组临床资料进行单因素和多因素分析。结果:单因素分析得出患者年龄50岁、合并心肺疾病、术中出血量200 m L、合并深静脉血栓(DVT)形成、肺癌、术后卧床时间3 d与开胸术后发生肺栓塞有关,差异均有统计学意义(P0.05)。多因素Logistics回归分析得出患者年龄50岁[OR=69.115,95%CI(2.687,1777.577)]、术中出血量200 m L[OR=27.943,95%CI(1.505,518.905)]、合并DVT形成[OR=75.908,95%CI(2.374,2426.920)]、肺癌[OR=32.282,95%CI(1.420,733.931)]、术后卧床时间3 d[OR=17.709,95%CI(1.095,286.389)]是开胸术后发生肺栓塞的危险因素。结论:患者年龄50岁、术中出血量200 m L、合并DVT形成、肺癌、术后卧床时间3 d是开胸术后发生肺栓塞的危险因素。     

肝胆外科手术患者并发下肢深静脉血栓形成危险因素分析

目的 分析肝胆外科手术患者并发下肢深静脉血栓形成(DVT)危险因素.方法 回顾分析我院2007-2009年肝胆外科手术患者456例,根据患者是否并发DVT分为两组,分析相关危险因素和DVT的相关性.结果 年龄、冠心病、高血压、代谢综合征、术后卧床时间、合并感染、休克在有无DVT两组间差异具有统计学意义(P＜0.05),Logistic回归模型筛选出的最终危险因素为卧床时间(OR=1.001,95%CI:1.000～1.001)、休克(OR=4.314,95%CI:1.239～11.993)、合并感染(OR=3.710,95%CI:1.451～8.573)、年龄(OR=0.479,95%CI:0.261～0.880).结论 肝胆外科手术患者是DVT的高发人群,外科医生应对具有高危因素患者高度关注.     

妇科手术后下肢深静脉血栓形成的危险因素及临床护理对策

目的探究妇科手术后下肢深静脉血栓(DVT)形成的危险因素及临床护理对策。方法回顾性分析2014年5月至2017年5月在我院接受妇科手术的372例患者的临床资料。依据术后患者是否发生下肢DVT,将患者分为下肢DVT组(35例)和对照组(337例)。记录影响妇科手术后下肢DVT形成的相关因素,并对其进行Logistic多元回归分析。结果 Logistic多元回归分析结果显示,年龄50岁(OR=2.098)、术前合并症(OR=2.617)、恶性肿瘤(OR=2.450)、气腹压15mmHg(OR=2.347)、D二聚体≧0.5mg/L(OR=2.776)、手术时间≧1h(OR=2.672)、术后卧床时间5d(OR=1.988)是妇科手术后下肢DVT形成的独立危险因素(P0.05)。结论妇科手术后下肢DVT形成与患者年龄、术前合并症、恶性肿瘤、术中气腹压、血浆D二聚体、手术时间、术后卧床时间等因素密切相关,临床上应予以重视并采取相对应的护理措施加以预防。     

下肢深静脉血栓并发肺栓塞的临床特点及相关危险因素分析

目的 探讨下肢深静脉血栓(DVT)并发肺栓塞(PE)的临床特点及相关危险因素。方法 收集并分析下肢DVT合并PE病例资料(包括一般资料与血液生物化学指标),同期单纯下肢DVT病例资料作为对照组。总结下肢DVT合并PE的临床特点,进行单因素及多因素危险因素分析,最后进行相关因素的诊断价值分析。结果 合并心脏病史(x²=5.886,P=0.015)；近2月内有手术史(x²=4.227,P=0.040)；CRP异常增高(x²=4.126,P=0.042)；DD异常增高(t=2.914,P=0.004)；年龄较小(t=-2.060,P=0.042)与下肢DVT并发PE密切相关。年龄(OR=1.050,95%CI=1.015-1.085)、DD(OR=0.934,95%CI=0.875-0.997)及合并心脏病史(OR=0.061,95%CI=0.007-0.545)是下肢DVT并发PE的独立危险因素。DD及年龄对其诊断的ROC曲线下面积分别为0.639、0.601。 结论 下肢DVT常常伴有多个PE的危险因素,合并心脏病史、年龄小及DD较高增加PE的风险,对此类患者应高度重视,积极诊治。     

肝胆外科手术患者并发下肢深静脉血栓形成的危险因素分析

目的探讨肝胆外科手术患者并发下肢深静脉血栓形成(DVT)的危险因素。方法选取我院2016年11月至2018年11月收治的430例行肝胆外科手术患者,按照术后DVT发生分为两组,分析术后并发下肢DVT的危险因素。结果通过比较分析可知,两组患者在年龄、合并高血压、合并冠心病、术后感染以及术后卧床时间、休克等因素存在显著差异,P 0. 05,具有统计学意义;使用多因素回归分析对上述危险因素实施统计学分析,结果显示,患者年龄(95%CI:1. 223-6. 535; OR值:3. 45)、卧床时间(95%CI:2. 234-12. 184; OR值:9. 12)、合并感染(95%CI:1. 449-8. 562; OR值:3. 698)以及休克(95%CI:1. 228-10. 982; OR值:4. 297)等为下肢静脉形成危险因素。结论在肝胆外科手术中极易并发下肢DVT,所以术后应当注重存在高危因素的患者,以此降低下肢DVT发生率。     

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.