全关节置换术后自体引流血的回输应用

目的：评价全关节置换术后自体引流血回输的临床意义和使用的安全性。方法：对２组条件相似的初期关节置换的５０例患者进行了前瞻性研究。实验组（２５例）术后使用自体引流自回输装置,对照组（２５例）使用负压吸引球。记录引流／回输血量及与输血有关的反应。结果：实验组平均回输引流血４９２ｍｌ,未输库血,也未发现输血反应及菌血症。对照组平均术后输库血４００ｍｌ。二组患者手术前后的血红蛋白无显著差异。结论：自体引流     

自体引流血回输在双侧人工全膝关节同期置换术中的应用

目的探讨双侧人工全膝关节同期置换术后自体引流血回输的作用。方法44例双侧人工全膝关节同期置换手术患者,31例术后使用CBCⅡConstaVacTM型回输血器予自体引流血回输作为观察组,13例术后仅异体输血作为对照组。记录回输血总量并观察两组术前、术后第2天、术后第7天红细胞、血红蛋白及红细胞压积的变化。结果观察组共回输自体引流血24980ml,占总输血量52.5%,人均输血量628ml,对照组共输异体血12000ml,人均输血量923ml,两组人均输血量有显著性差异(P<0.05)。两组术前与术后第2天血红蛋白及红细胞压积有显著性差异(P<0.05),术后第7天恢复接近正常。结论自体引流血回输是双侧人工全膝关节同期置换手术中安全有效、简便可靠的输血方式,可减少异体输血量,避免其并发症。     

多功能自身输血器临床应用可行性研究

应用自行研制的多功能自身输血器回收心脏直视手术后纵隔引流血，连续同步观察静脉血，纵隔引流血及输血器内血的ＲＢＣ，ＷＢＣ，ＰＬＴ，Ｈｂ、ＨＣＴ、ＦＨｂ、ＦＤＰ、Ｆｉｂｒｉｎｏｇｅｎ及Ⅶ的因子的变化，并作细菌培养，结果显示：纵隔引流血无菌，经自身输血器滤过的血液符合血液回输的条件。     

F—800血液分析仪对血瘀证的诊断价值

用Ｆ－８００血液分析仪，对临床确诊为血瘀证的５６例患者进行了白细胞计数（ＷＢＣ）、红细胞计数（ＲＢＣ）、血红蛋白浓度（ＨＧＢ）、血细胞压积（ＨＣＴ）、平均红细胞体积（ＭＣＶ）、平均红细胞血红蛋白量（ＭＣＨ）、平均红细胞血红蛋白浓度（ＭＣＨＣ）、血小板计数（ＰＬＴ）、红细胞体积分配宽度（ＲＤＷ－ｃｖ）、血小板体积分配宽度（ＰＤＷ）及平均血小板体积（ＭＰＶ）的测定，并与６０例健康者进行了对比分析，结果     

F一800血液分析仪对血瘀证的诊断价值

月下一８００血液分析仪，对临床确诊为血瘀证的５６例患者进行了白细胞计数（ＷＢＣ）、红细胞计数（ＲＢＣ）、血红蛋白浓度（ＨＧＢ）、血细胞压积（ＨＣＴ）、平均红细胞体积（ＭＣＶ）、平均红细胞血红蛋白量（ＭＣＨ）、平均红细胞血红蛋白进度（ＭＣＨＣ）、血小板计数（ＰＬＴ）、红细胞体积分配宽度（ＲＤＷ一ｃｖ）、血小板体积分配宽度（ＰＤＷ）及平均血小板体积（ＭＰＶ）的测定，并与６０例健康者进行了对比分析，结果表明：除ＭＣＶ、ＲＤＷ一ｃｖ、ＭＰＶ及ＰＤＷ四项指标血瘀证组与健康人组相比差异非常显著（Ｐ＜０．０１）外，其余七项指标则差异不显著（Ｐ＞０．０５）。实验表明：ＭＣＶ对血瘀证具有一定的诊断价值，其敏感性高达８５；７％，而特异性为７３．３％。四项指标的联合检测，其阳性率高达９２．７％，有助于血瘀证的筛选与诊断。     

缺血性中风血浆β血小板球蛋白及血小板因子4的动态观察

应用ＥＬＩＳＡ法对３２例缺血性中风病人的β血小板球蛋白（β－ＴＧ）和血小板因子４（ＰＦ４）的血浆浓度进行了动态观察，并与２０例健康对照组比较。结果表明，ＴＩＡ组病人的ＰＦ４血浆浓度较对照组明显升高，差异有显著性（Ｐ＜０．０５），β－ＴＧ无明显变化。脑血栓组在其发病后７６以内、７～２０ｄ及３０ｄ以上３个不同时期内，其β－ＴＧ及ＰＦ４血浆浓度均高于对照组，差异有显著性（Ｐ＜０．０５）。提示血小板活性增加参与了缺血性脑血管病的发生和发展。     

机血回输对体外循环心内手术患者凝血功能的影响

目的探讨机血直接回输对体外循环（CPB）心内手术患者凝血功能的影响。方法 60例体外循环心内手术患者随机分成两组,A组30例,机血全部直接回输;B组30例,机血全部丢弃。对比两组患者切皮前即刻（T1）、给鱼精蛋白10 min后（T2）、关胸即刻（T3）、术后4 h（T4）采血测定血小板计数（PLT）、血浆游离Ca2＋、血浆凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、凝血酶时间（TT）、纤维蛋白原（FIB）、D-二聚体（D-D）含量、活化凝血酶原时间（ACT）、血红蛋白（Hb）等指标的变化,并记录术中、术后24 h库血的用量和术后24 h胸腔引流量等临床情况。结果 PLT计数、血浆游离Ca2＋、PT、APTT、TT、FIB、D-D、ACT、Hb在各时间点测定值两组间比较差异均无统计学意义（P〉0.05）。A组库血用量少于B组（P〈0.05）。术后24 h胸腔引流量两组间比较差异无统计学意义（P〉0.05）。结论体外循环后直接回输机血不加重凝血功能紊乱,体外循环后采用机血直接回输的方法,能明显减少异体输血量。     

72例旅途精神病患者的生理指标分析

对７２例旅途精神病患者和９５例正常旅客进行机体生理指标的对照研究，以期探索旅途精神病的生理指标特征。结果表明，患者血红蛋白、血钾浓度低于对照组（Ｐ＜０．０１），白细胞计数、血糖浓度高于对照组（Ｐ＜０．０１）。按超载与非超载分组，发现超载组病人血红蛋白、血钾、血尿素氮低于正常人（Ｐ＜０．０１），白细胞计数、血糖、红细胞计数、红细胞压积高于正常人（Ｐ＜０．０１）；而非超载组病人血红蛋白、血钾低于正常人（Ｐ＜０．０１），白细胞计数、血糖、红细胞压积则显著高于正常人（Ｐ＜０．０１）。     

自体血回输技术在肝脾破裂手术中的临床观察

目的观察自体血和异体血回输前后静脉血的红细胞数量和血液凝血功能的变化。方法54例肝脾破裂出血等突发性腹腔内出血患者,分为A,B两组,每组27例,A组输入自体血,B组输入异体血,分别检测血液回输前后血红蛋白（Hb）、红细胞计数（RBC）、红细胞压积（Hct）、血小板（PLT）、凝血酶原时间（PT）、部分凝血酶原时间（AFFF）、纤维蛋白原（FIB）、凝血酶时间（｜rr）。结果①未输自体血或异体血前,两组患者的Hb、RBC、Hct、PLT、FIB明显降低（P〈0．05）,PT、APTT、TT明显延长（P〈0．05）;②回输自体血或异体血后,A,B两组患者的RBC、Hct有一定增高（P〈0．05）,PT、APTT、TT进一步延长,PLT和FIB进一步降低。两组患者各项凝血功能指标无明显差异。结论自体血和异体血回输的效果相似,两者均能提高RBC和Hct,回输后患者的凝血功能均有不同程度的改变。     

自体输血等综合节血措施在体外循环心脏手术中的应用

目的 通过将自体输血等多种节血措施综合应用于体外循环心脏直视手术,观察不用或少用异体库血进行心脏手术的效果.方法 对30例进行体外循环心脏手术患者(实验组)术中采用综合节血措施,包括术前及体外循环转机前采集自体血贮存以术后回输;回输剩余机血;术前、术中应用药物保护血液提高凝血功能等.同期选择30例异体输血的心脏手术患者作为对照组,比较两组间血小板计数(PLT)、血红蛋白(Hb)、红细胞比积(HCT)、异体输血量及术后纵隔引流量等差异.结果 实验组与对照组相比,术后PLT、Hb、HCT差异均无统计学显著性(P＞0.05),而术后引流量、异体输血量实验组明显少于对照组(P＜0.05).结论 心脏直视手术采用自体输血等多种综合节血措施,能明显减少手术出血,少输或不输异体血,很大程度上避免了异体输血可能引起的传播疾病及并发症,减轻患者的精神和经济负担.     

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.