彩色多普勒超声检测高血压及糖尿病患者眼球后动脉血流动力学特点研究

目的 用彩色多普勒超声研究高血压、糖尿病患者的眼球后动脉血流动力学特点.方法 选择80例高血压患者(高血压组)、80例糖尿病患者(糖尿病组)及80例健康者(对照组),用彩色多普勒超声检测3组受检者的眼球后动脉[包括眼动脉(OA)、视网膜中央动脉(CRA)、视网膜中央静脉(CRV)及睫状动脉(SPCA)]频谱形态,比较3组受检者4支动脉的血流动力学参数.结果 高血压组患者眼球后动脉(OA、CRA、SPCA)血流速度[包括收缩期峰值流速(Vmax)、舒张末期流速(Vmin)]均显著减慢,而阻力指数(RI)均显著增高,呈低流速高阻力状态,与对照组比较,差异有统计学意义(P＜0.05).糖尿病组患者OA、CRA、SPCA血流速度均显著减慢,RI均显著增高,与对照组比较差异亦有统计学意义(P＜0.01).两组受检者CRV血流速度稍加快.结论 彩色多普勒超声检查对评价高血压、糖尿病患者眼球后动脉血流动力学改变有较重要的价值.     

颅内动脉瘤术中多普勒超声应用研究(附32例报告)

目的应用经颅多普勒(TCD)超声在颅内动脉瘤术中监测载瘤动脉血流速度变化.方法对32例颅内动脉瘤患者使用微血管多普勒(MVD)超声进行术中检测,记录载瘤动脉血流速度的变化,观察术后脑缺血性并发症.结果发现有缺血性并发症组血流速度较无并发症组明显加快(P<0.05),而两组在术前血流速度并无显著性差异(P>0.05).结论将MVD及TCD应用于术中监测载瘤动脉血流动力学变化有一定临床意义.     

杨刺风池法对椎动脉型颈椎病血流动力学的影响

[目的]观察杨刺风池法对椎动脉型颈椎病患者椎—基底动脉血流动力学的影响.[方法]将50例椎动脉型颈椎病患者随机分为治疗组和对照组各25例.对照组采用单纯针刺风池法治疗,治疗组采用杨刺风池法治疗,观察2组治疗前后彩色经颅多普勒超声(TCD)检测推动脉(VA)和基底动脉(BA)的平均血流速度的变化情况.[结果]治疗后2组的VA、BA的平均血流速度均显著增快,与治疗前比较差异均有统计学意义(P＜0.05).治疗后组间比较差异有统计学意义(P＜0.05),表明治疗组对VA、BA的平均血流速度的改善作用优于对照组.[结论]杨刺风池法是治疗椎动脉型颈椎病较有效的方法之一,对椎动脉型颈椎病患者椎—基底动脉的血流速度有明显提高作用.     

偏头痛患者颅内动脉血流动力学与血浆内皮素-1的研究

目的:观察偏头痛患者颅内动脉血流动力学和血浆内皮素-1(ET-1)含量的变化,探讨二者在偏头痛发病中的作用。方法:选择偏头痛患者(病例组)95例,其中66例行经颅多普勒超声(TCD)检查及CO2试验,82例测血浆ET-1,53例同时行TCD及血浆ET-1检查。选择60例健康人作对照(对照组),均行TCD检查及CO2试验,并测血浆ET-1。对血浆ET-1和颅内动脉血流动力学参数进行相关性分析。结果:病例组颅内动脉血流速度包括平均血流速度(Vm)、收缩期血流速度(Vs)、舒张期血流速度(Vd)均高于对照组(P均<0.05)。过度换气降低体内CO2浓度后,病例组患者颅内动脉血流速度下降,其下降量高于对照组(P均<0.01)。病例组血浆ET-1为(80.89±28.70)pg/ml,高于对照组的(66.55±14.97)pg/ml(P<0.05)。病例组血浆ET-1与颅内动脉Vs呈正相关(r=0.4282,P<0.01)。结论:偏头痛患者颅内动脉血流速度﹑CO2反应性及血浆ET-1含量增高。颅内动脉血流动力学变化及血浆ET-1含量增高均与偏头痛的发病有关。     

依达拉奉联合氯吡格雷对急性缺血性脑卒中患者炎性因子和颅内血流速度的影响

目的:探讨依达拉奉联合氯吡格雷对急性缺血性脑卒中患者炎性因子和颅内血流速度的影响。方法:选取2015年6月-2017年6月本院收治的急性缺血性脑卒中患者80例,按照随机数字表法将患者均分为对照组和试验组,各40例。对照组应用氯吡格雷进行治疗,研究组应用依达拉奉联合氯吡格雷进行治疗。比较两组治疗前后神经功能缺损评分(NIHSS)、超敏C反应蛋白(hs-CRP)、白介素-6(IL-6)、肿瘤坏死因子(TNF-α);应用多普勒超声测定两组基底动脉、大脑前动脉、中动脉、后动脉和椎动脉的血流速度。结果:研究组治疗总有效率优于对照组,差异有统计学意义(P0.05);治疗前两组NIHSS评分比较,差异无统计学意义(P0.05),治疗后研究组NIHSS评分低于对照组,差异有统计学意义(P0.05);治疗前两组炎性因子比较,差异均无统计学意义(P0.05),治疗后研究组hs-CRP、IL-6、TNF-α均低于对照组,差异均有统计学意义(P0.05);治疗前两组颅内血流速度比较,差异无统计学意义(P0.05),治疗后研究组颅内血流速度均高于对照组,差异有统计学意义(P0.05)。结论:急性缺血性脑卒中患者应用依达拉奉联合氯吡格雷进行治疗,其治疗效果比较满意,能有效控制炎性因子,提高颅内血流速度,在临床上可以进一步应用。     

彩色多普勒超声检测子宫动脉血液动力学在复发性流产患者中的应用

目的 探讨彩色多普勒超声检测子宫动脉血液动力学在复发性流产(RSA)患者中的应用价值。方法45例不明原因RSA孕产妇作为观察组,另选取同时间就诊的正常妊娠孕妇50例作为对照组。比较两组孕产妇子宫内膜厚度及子宫动脉血流动力学等参数指标,包括搏动指数(PI)、收缩期最大血流速度(S)与舒张期末期血流速度(D)的比值(S/D)及阻力指数(RI)。结果 观察组子宫内膜厚度显著小于对照组,PI、S/D及RI等指数均明显高于对照组,差异均有统计学意义(均P<0.05)。结论 孕早期采用彩色多普勒超声检测子宫动脉血流动力学参数,能了解孕妇子宫血流状况和宫内循环功能,对RSA的判断具有重要意义。     

功能性再发性腹痛儿童微生态制剂治疗前后肠系膜上动脉血流动力学的变化

目的观察微生态制剂治疗功能性再发性腹痛儿童对儿童肠系膜上动脉血流动力学的影响。方法将2014年9月~2015年7月期间收治的43例功能性再发性腹痛儿童和同一时间段来我院接受体检的43例健康儿童分别设为研究组和对照组,研究组患儿给予微生态制剂治疗,使用彩色多普勒超声检测研究组患儿治疗前、治疗后以及对照组肠系膜上动脉血流动力学。结果研究组患儿治疗前的肠系膜上动脉血流量、内径、PSV(血流收缩期峰值速度)、EDV(血流舒张末期速度)均较对照组儿童低(P0.05),血流搏动指数、阻力指数与对照组儿童比较差异无统计学意义(P0.05)。治疗前研究组患儿中影像学检查有肠系膜淋巴结肿大患儿的动脉血流量、内径、PSV、EDV、PI、VI均较影像学检查无异常的患儿低,治疗后两组血流搏动指数、阻力指数比较差异无统计学意义(P0.05),治疗后,研究组患儿肠系膜血流量、内径、PSV、EDV均提高,但与对照组儿童比较差异无统计学意义(P0.05),血流搏动指数、阻力指数与对照组儿童比较差异也无统计学意义(P0.05)。结论微生态制剂用于治疗功能性再发性腹痛患儿,能够有效改善患儿肠系膜上动脉血流动力学,促进患儿疾病早日康复。     

依达拉奉联合丁苯酞治疗对急性脑梗死患者颅内动脉血流动力学的影响研究

目的:研究依达拉奉联合丁苯酞在改善急性脑梗死患者颅内动脉血流动力学中的应用价值。方法:抽取我院收治的急性脑梗死患者68例,随机均分为两组,对照组取丁苯酞治疗,观察组在对照组的基础上取依达拉奉治疗,观察两组患者临床疗效以及颅内动脉血流动力学变化情况。结果:观察组治疗有效率为94.12%,对照组治疗有效率为73.53%,差异具有统计学意义(P0.05)。观察组患者的纤维蛋白原、全血高切黏度、全血低切黏度、血细胞比容、血浆黏度均低于对照组,差异具有统计学意义(P0.05)。观察组患者NIHSS评分、水肿面积及血肿体积均显著少于对照组,差异有统计学意义(P0.05)。结论:依达拉奉联合丁苯酞治疗急性脑梗死能够改善病情与颅内动脉血流动力学,值得推广使用。     

肝癌患者肝动脉血流动力学的彩色多普勒研究

目的探讨肝动脉血流动力学变化在预测肝癌发生中的价值。方法120例患者依据病情分为肝硬化组62例,肝癌组58例。同时选取健康体检肝脏正常者50例为对照组。所有检查者空腹8 h以上,应用彩色超声仪检测3组患者的肝动脉血流动力学,包括肝动脉内径、流速、流量,并进行比较。结果对照组血流动力学与肝硬化组比较差异无统计学意义(P>0.05);小肝癌患者与肝硬化组肝动脉血流动力学比较有显著性差异(P<0.05);小肝癌与结节型肝癌肝动脉的血流动力学差异有统计学意义(P<0.05);结节型与块状型肝癌之间肝动脉的血流动力学差异有统计学意义(P<0.05);小肝癌与块状型肝癌之间肝动脉的血流动力学差异有统计学意义(P<0.05),并且肝动脉血流动力学与肿块的直径呈正相关。结论肝动脉过度供血支撑肝癌生长,在肝癌发生早期就有血流动力学的变化,可作为肝癌发生的危险信号之一预测肝癌的发生。     

锁骨下动脉与椎动脉病变所致椎动脉反流超声鉴别诊断分析

目的 探讨不同病变部位引起推动脉(VA)反流时的血流动力学差异.方法 选取经彩色多普勒超声检查发现VA血流频谱出现反向血流,并准确诊断病变部位的125例患者.据病变部位不同分成锁骨下动脉(SA)病变组和VA病变组对比观察.结果 SA病变组81例,VA病变组44例,两组阃VA频谱类似者对比,SA组VA流速较VA组高(P＜0.05).SA组较VA组病变侧上肢动脉频谱改变发生率高;病变侧流速较健侧低,AT延长(P＜0.05).VA组双侧上肢动脉流速及AT差异无统计学意义(P＞0.05).束臂试验阳性率SA组较VA组高(P＜0.05).结论 VA反流可由锁骨下动脉或无名动脉或推动脉狭窄或闭塞引起,结合病变侧椎动脉流速、上肢动脉血流动力学变化及束臂试验,可提高鉴别诊断.     

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.     

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.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.