重度颅脑外伤并发急性呼吸窘迫综合征的治疗

目的提高对重度颅脑外伤并发急性呼吸窘迫综合征(ARDS)的认识。方法回顾性分析36例重度颅脑外伤并发ARDS患者的临床资料。结果36例患者中,27例应用人工呼吸机呼气末正压通气(PEEP)治疗7～16d及相关积极治疗后,呼吸平稳,血气及胸片正常,ARDS完全纠正,好转出院;4例继发肺部感染,经加强抗炎治疗后治愈;3例ARDS有好转,但因原发病严重而死亡;2例ARDS未能纠正,最终并发多脏器功能衰竭而死亡。结论早期诊断,保持呼吸道通畅,及时开放气道,早期呼吸支持治疗,维持恰当的输液量等,是提高重度颅脑外伤并发ARDS预后的关键。     

早期适时呼吸支持在救治22例急性中毒危重患儿中的应用

目的探讨早期适时呼吸支持策略在救治急性中毒危重患儿中的临床应用价值。方法对该院22例急性中毒危重患儿采用早期适时呼吸支持策略,观察危重病例评分、生命体征及其血气指标在呼吸支持前后的动态变化并进行统计学分析。结果所有患儿初试呼吸支持模式分别为辅助控制通气(A/C)15例,同步间歇指令通气(SIMV)7例,上机时间1～5 d,平均(2.80±1.08)d,治愈20例,死亡2例,治愈者均一次成功撤机。全部患儿危重病例评分、生命体征及其血气指标在呼吸支持前后均有明显改善,差异有统计学意义(P0.05)。结论实施早期适时呼吸支持策略有助于提高急性中毒危重患儿抢救成功率,改善患儿预后。     

不同胎龄新生儿呼吸窘迫综合征治疗及预后的比较分析

目的:比较早期早产儿与晚期早产儿、足月儿新生儿呼吸窘迫综合征的治疗方案及预后的不同,为新生儿呼吸窘迫综合征的治疗及并发症的防治提供依据。方法:回顾性分析122例新生儿呼吸窘迫综合征(RDS)患儿的临床资料,按胎龄分为两组:早期早产儿组(<34周)、晚期早产儿、足月儿组(≥34周),比较两组患儿的治疗方案和预后情况。结果:RDS患儿中早期早产儿所占比例较高(57.38%),发病早,肺泡表面活性物质(PS)使用率高,PS再次使用率高,n CPAP使用率高,使用n CPAP时间长,差异均有统计学意义(P<0.05)。早期早产儿合并支气管肺发育不良、消化道出血、败血症、喂养不耐受的发生率更高,而晚期早产儿、足月儿合并新生儿持续肺动脉高压的发生率更高,差异有统计学意义(P<0.05)。两组新生儿中,早期早产儿治愈率更低,死亡率更高,住院时间更长,差异有统计学意义(P<0.05)。结论:不同胎龄新生儿RDS的治疗方案和预后存在差异,在治疗时应考虑胎龄因素,做到早诊断、早治疗、减少并发症、降低死亡率。     

肾移植术后卡氏肺孢子虫肺炎诊治分析

目的:探讨肾移植术后卡氏肺孢子虫肺炎(PCP)的诊断、治疗和预防措施.方法:回顾性分析本院首例术后2年继发PCP的肾移植患者病例,通过作肺灌洗术(BAL)取肺泡灌洗液作细菌培养、PCR、革兰氏染色等辅助检查,确诊为本院首例肾移植术后继发PCP.结果:在全身支持疗法基础上,选用复方磺胺甲基异恶唑(SMZco)治疗,15天后患者肺部感染消失、肾功能恢复正常.结论:提高肾移植患者术后并发卡氏肺孢子虫肺部感染的治愈率的关键在于早预防、早诊断、早治疗.     

瑞氏综合征的早期诊断与治疗措施探讨

目的：提高临床对瑞氏综合征的认识，早期诊断，积极治疗，改善预后。方法：对21例确诊为瑞氏综合征患儿的临床资料进行回顾性分析。结果：瑞氏综合征患儿发病前有感染史；好发于5岁以下儿童，尤其是2岁以下儿童多见；临床表现为起病急骤，频繁呕吐，迅速出现惊厥，昏迷，呼吸节律异常，肌张力增高、肝脏轻中度肿大；实验室检查高血氨、肝功异常、脑水肿为本病的主要临床特点。结论：提高临床对瑞氏综合征的认识，早期诊断、积极采取恰当措施治疗，可以改善瑞氏综合征患儿预后。     

34例儿童金黄色葡萄球菌性烫伤样皮肤综合征临床分析

目的:分析儿童金黄色葡萄球菌(金葡萄)烫伤样皮肤综合征的诱发因素、临床表现、治疗和预后。方法:回顾性分析34例金葡菌烫伤样皮肤综合征患儿临床资料。结果:34例金葡菌烫伤样皮肤综合征患儿一般见于1～4岁婴幼儿,占总病例的70.6%;34例儿童金葡菌烫伤样皮肤综合征患儿中有26例发病前有感染因素;儿童金葡菌烫伤样皮肤综合征急性起病并且皮肤损害严重,部分患儿临床表现凶险,对头孢类抗生素敏感。所有患儿在治疗7～20 d之后均痊愈出院。结论:金葡菌烫伤样皮肤综合征发病前诱因多为感染,与患儿的免疫力有关。在临床工作中提高对此病的认识,早期、足量、有效的使用抗生素是治疗的关键,做到早诊断、早治疗。     

小儿肺炎支原体感染并发心血管系统损害115例临床分析

目的 :探讨肺炎支原体 ( MP)感染心血管系统损害及早期干预治疗的意义。方法 :对临床确诊为 MP感染并发心血管系统损害 1 1 5例患儿通过临床观察 ,心电图、血清心肌酶学、血清肌钙蛋白、心肌抗体检查分析。结果 :临床头昏乏力、心前区不适、胸闷、心律失常、心音低钝等症状、血清心肌酶谱增高 ,发病 1周内与发病 2周后心功能异常有显著性差异 ,心电图部分改变 ,但无明显心律失常。结论 :MP感染可引起患儿心血管系统损害 ,存在心肌酶谱和心电图的异常 ,临床上早发现、早诊断及干预治疗 ,预后良好。     

重症手足口病患儿早期病情观察和机械通气的护理

目的 探讨重症手足口病患儿的早期观察要点及机械通气患儿的护理要点,为重症手足口病的早发现、早诊断、早治疗提供临床参考依据.方法 对48例重症手足口病患儿进行早期密切观察,及时识别肺水肿前兆,为尽早给予呼吸机支持治疗提供准确有效的依据.重视机械通气患儿的护理,强调呼吸末正压呼吸(PEEP)的应用与护理,加强吸痰护理及基础护理.结果 48例重症手足口病患儿1例突然发生心肺衰竭,病情变化极其迅速,于入院16h后死亡;3例发生神经源性肺水肿、大量肺出血导致呼吸循环衰竭不治身亡;44例住院时间为6～14d,平均7d,均好转或痊愈出院.结论 早期密切观察重症手足口病患儿的病情变化,有助于及时识别肺水肿前兆,为尽早给予呼吸机支持治疗提供准确有效的依据.辅以科学合理全面的护理,对提高重症手足口病患儿的抢救成功率,降低病死率有重要意义.     

180例肺炎支原体感染患儿临床资料分析

目的探讨肺炎支原体感染患儿的流行病学特点、临床表现、实验室诊断、治疗及预后。方法对180例确诊为肺炎支原体感染患儿的临床病例资料进行统计、分类、回顾性分析。结果肺炎支原体感染以年长儿感染居多,占总感染病例78.33%,婴幼儿感染仅占总感染病例21.67%;肺炎支原体感染全年均有发病,但冬、春寒冷季节发病率更高一些;临床表现以呼吸系统表现为主,也存在多样化肺外表现;大环内酯类治疗效果显著;患儿预后好。结论临床儿科医生应高度警惕和重视肺炎支原体感染,尽最大努力做到早诊断、早治疗。     

小儿肺炎支原体肺炎120例临床分析

目的探讨小儿肺炎支原体肺炎的特点及临床分析.方法对120例小儿肺炎支原体肺炎住院患儿病例资料进行分析.结果小儿肺炎支原体肺炎轻症治疗时采用阿奇霉素及头孢抗生素联合治疗,重症增加激素或丙种球蛋白治疗,临床效果显著.结果血清学Mp-IgM检测是早期诊断小儿肺炎支原体肺炎的必要方法,对小儿肺炎支原体感染的早期诊断,依据症状对患儿早诊断、早治疗对预后具有重要临床意义.     

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.