高钾血症应用心电图检查的诊断作用研究

目的:研究高钾血症应用心电图检查的诊断作用.方法:择于2014年6月至2015年8月在该院进行治疗的60例高钾血症患者作为研究资料进行分析,为患者分别进行血清钾、心电图的检查,并分析检查结果.结果:60例患者在进行血清钾检查后均被确诊为高钾血症;其中45例患者经过心电图检查后被确诊为高钾血症,诊断结合的符合率高达75％;有15例患者心电图检查之后未被确诊为高钾血症,并诊断病原来自于急性肠胃炎、术后肿瘤等.参与研究的60例患者患有高钾血症的原因来自于肾功能不全,再者是肝功能及糖尿病等问题.血钾清浓度大于7.0 mmol/L的患者,与浓度处于5.6～ 7.0 mmol/L相比,进行心电图检查时被确诊高钾血症的概率更高.结论:高钾血症患者在进行心电图检查时的异常程度、被确诊的概率和血清的浓度息息相关.同血钾清检查相比,通过心电图检查的方式鉴别是否患有高钾血症有更高的准确率,检查操作也更便捷.通过研究可以确定在高钾血症中应用心电图检查具有临床价值,获得显著效果.     

血液透析抢救高钾血症58例临床应用及护理

目的探讨58例急、慢性肾功能衰竭患者共发生180例次高钾血症行血液透析抢救的临床疗效。方法回顾性分析58例急、慢性肾功能衰竭患者发生高钾血症时进行的血液透析治疗及护理。结果58例患者共发生180例次高钾血症,经血液透析抢救后血钾浓度均降至正常范围,心电图的高血钾图形消失,无死亡病例。结论血液透析抢救高钾血症是最快速、最有效的治疗方法。     

53例高钾血症心电图改变临床价值分析

目的通过对高钾血症的心电图特征进行分析,探讨心电图对诊断高钾血症的临床价值.方法 对53例高钾血症患者的心电图与血清钾浓度改变进行对照分析.结果 心电图异常改变和血清钾测定存在一定的差异,肾功能不全所致排钾困难有较好的一致性,而细胞内钾外移所致的血清钾升高无心电图改变.随着血清钾浓度的升高,心电图异常的发生率递增,合并多种电解质紊乱和酸中毒,会加重心电图改变.结论 高钾血症的心电图改变比血清钾测定更具有临床价值,是一种简单、快速诊断高钾血症的重要检查方法,对预后的判断也有重要意义.     

高钾血症心电图表现21例分析

目的:通过对高钾血症的心电图表现进行分析,探讨心电图对诊断高钾血症的临床价值.方法:对21例高钾血症患者的心电图与血清钾浓度改变进行对照分析.结果:心电图异常改变和血清钾测定存在一定的差异,肾功能不全所致排钾困难有较好的一致性,而细胞内钾外移所致的血清钾升高无心电图改变.随着血清钾浓度的升高,心电图异常的发生率递增,合并多种电解质紊乱和酸中毒,会加重心电图改变.结论:高钾血症的心电图改变比血清钾测定更具有临床价值,是一种简单、快速诊断高钾血症的重要检查方法,对预后的判断也有重要意义.     

心电图在高钾血症诊断中的应用价值分析

目的研究心电图在高钾血症诊断中的应用价值。方法选取高钾血症患者58例,采用电极法对患者血清钾浓度进行检测,采用十二导心电图机进行心电图检查。结果 58例高钾血症患者中,心电图出现特征性高血钾电生理变化者11例,符合率为18.97%,病因均为肾功能不全。血钾浓度为5.5~6.8 mmol/L时,出现心电图特征性改变者0例,血钾浓度为6.9~8.1 mmol/L时,出现心电图特征性改变者11例。结论不同程度和不同病因的高血钾,心电图的表现也不同,与血钾检测相比,心电图能更准确得鉴别假性高血钾,具有迅速、简便、无创、可重复的优势,为临床诊断和治疗提供重要依据。     

医源性高钾血症

医 源 性 高 钾 血 症附院急诊科王振杰关键词高钾血症，医源性；病因；治疗血钾浓度高于５．５ｍｍｏｌ／Ｌ称为高钾血症（ｈｙｐｅｒｋａｌｅｍａ）。患者在治疗过程中，由于用药不当而引起的高钾血症称为医源性高钾血症。常见于肾功能不全肾脏排钾功能障碍的治疗...     

慢性肾衰竭高钾血症患者临床分析及治疗

目的 分析出现高钾血症的慢性肾衰竭患者的临床资料,探讨其治疗方案.方法 回顾性分析笔者所在医院近4年抢救的一组慢性肾衰竭并发高钾血症患者的临床抢救治疗过程.结果病史发现未严格控制饮食中钾的摄入是慢性肾衰竭患者出现高钾血症的主要原因.有90例次患者经及时抢救,应用药物及血液透析治疗后,血清钾浓度恢复到正常范围内,高血钾的心电图改变消失,临床症状缓.2例患者抢救无效死亡.结论 慢性肾衰竭患者控制饮食中钾的摄入可减少高钾血症发生;应重视综合治疗,予以积极降钾及必要的生命支持治疗;血液透析是治疗高钾血症最直接有效的方法,效果确切,安全可靠,其他方法欠佳时应及早采用.     

心电图对高钾血症诊断价值的探讨

目的:通过对高钾血症的心电图特征进行分析,探讨心电图对诊断高钾血症的临床价值。方法:对53例高钾血症患者的心电图与血清钾浓度改变进行对照分析。结果:心电图异常改变和血清钾测定存在一定的差异,肾功能不全所致排钾困难有较好的一致性,而细胞内钾外移所致的血清钾升高无心电图改变。随着血清钾浓度的升高,心电图异常的发生率递增,合并多种电解质紊乱和酸中毒,会加重心电图改变。结论:心电图对高血钾改变的反映比血清钾测定更准确,可作为诊断、判定程度和观察疗效的重要指标。     

螺内酯在重症心力衰竭合并肾功能不全治疗中的临床观察

目的 观察在重症心力衰竭合并肾功能不全治疗中应用螺内酯所致高钾血症的发生情况。方法对40例重症心力衰竭合并肾功能不全患者同时口服螺内酯、速尿、悦宁定治疗重症心力衰竭，随访观察1年。结果 40例患者中发生高钾血症12例，为30％。结论螺内酯在重症心力衰竭合并肾功能不全患者治疗中，高钾血症具有较高的发生率，且随着肾功能损害的加重，高钾血症的发生率增加。     

心电图对高钾血症的鉴别意义

目的 探讨不同病因所致的高钾血症的心电图不同表现,为早期诊断、合理治疗提供帮助.方法 对23例高钾血症患者的病因、心电图和血清钾浓度进行分析.结果 由排钾障碍所致的高钾血症心电图改变与血清钾浓度有较好的相关性,而因钾的细胞内外分布异常所致的高钾血症心电图无高钾改变.结论 心电图对假性高钾血症鉴别比血清钾浓度测定更敏感、准确.     

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.     

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.     

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.