无创正压通气对慢性阻塞性肺疾病的影响

目的：探讨无创正压通气早期干预治疗对慢性阻塞性肺疾病急性加重（AECOPD）并Ⅱ型呼吸衰竭患者肺功能、血气分析等各项指标的影响。对象与方法：将56侧AECOPD并Ⅱ型呼吸衰竭患者随机分成普通治疗组（30例），与无创通气干预组（26例）。观察两组治疗前后肺功能、血气的变化。结果：1．两组患者均处于慢性阻塞性肺疾病急性加重期，存在Ⅱ型呼吸衰竭，治疗前各项指标无统计学差异。2．普通治疗组患者治疗后血PaCO2下降，pH、PaO2上升，但FEV1.0（％），FEV1.0／FVC无改善。（3）元创通气干预组患者在治疗后PaCO2、pH、PaO2均有改善，且较普通治疗组，还出现FEV1.0升高，均具有统计学意义（P〈0．01）。（4）两组治疗前后的各指标差值比较，元创通气干预组比普通治疗组在短期治疗后对于PaO2、PaCO2的改善更为明显，具有统计学意义（P〈0．05），而两组FEV1.0（％），FEV1.0／FVC的差值无统计学意义。结论：无创通气干预治疗能够改善PaO2、PaCO2及FEV1.0（％）指标，较普通治疗组具有优势。     

无创机械通气治疗AECOPD伴Ⅱ型呼吸衰竭的临床疗效

目的观察无创机械通气治疗AECOPD伴Ⅱ型呼吸衰竭的的疗效。方法选取我科收治的78例AECOPD合并呼吸衰竭患者,进行面罩双水平气道正压无创通气治疗,观察并比较患者通气治疗前后的意识状态、pH值、PaO2、PaCO2、呼吸频率、心率变化。结果 78例患者无创通气3～7d后症状明显改善,血气分析提示pH值、PaO2、PaCO2、心率、呼吸频率与治疗前比较,明显恢复,差异均有统计学意义（P〈0.05）。结论无创机械通气治疗AECOPD合并呼吸衰竭的疗效是肯定的,使患者通气功能和缺氧体征得到明显改善,值得临床推广和应用。     

BiPAP无创通气治疗AECOPD合并Ⅱ型呼吸衰竭的疗效观察

[目的]探讨应用双水平气道内正压（bi-level positive airway pressure,BiPAP）无创通气治疗慢性阻塞性肺疾病急性加重期（acute exacerbation of chronic obstructive pulmonary disease,AECOPD）合并Ⅱ型呼吸衰竭患者的临床疗效。[方法]AECOPD合并Ⅱ型呼吸衰竭患者54例随机分为治疗组（28例）和对照组（26例）,对照组给予常规治疗,治疗组在常规治疗的基础上接受BiPAP无创通气治疗,分析两组血气（PH、PaCO2、PaO2）、呼吸频率（RR）、心率（HR）变化情况。[结果]治疗组接受BiPAP无创通气治疗24h后、72h后血气分析,RR、HR改善明显,优于对照组,两组差异有统计学意义（P〈0.05）。[结论]BiPAP无创通气治疗AECOPD合并Ⅱ型呼吸衰竭疗效满意,值得临床推广。     

BiPAP无创通气在AECOPD并Ⅱ型呼吸衰竭疗效观察

目的探讨慢性阻塞性肺疾病急性发作期（AECOPD）并Ⅱ型呼吸衰竭患者使用BiPAP无创通气的疗效。方法 62例AECOPD并Ⅱ型呼吸衰竭患者分为治疗组和对照组各31例,2组均给予常规治疗（药物＋吸氧）,治疗组加用BiPAP无创通气。观察2组治疗前后临床和血气分析指标改善情况。结果治疗组给予无创通气治疗后动脉血气与对照组比较PaO2明显上升（P〈0.01）,PaCO2下降明显（P〈0.01）。结论慢性阻塞性肺疾病急性发作期并Ⅱ型呼吸衰竭患者应用BiPAP无创通气可以有效改善动脉血气,改善病情,降低气管插管率。     

无创正压通气治疗慢性阻塞性肺疾病急性加重期合并Ⅱ型呼吸衰竭效果观察

目的 观察无创正压通气治疗慢性阻塞性肺疾病急性加重期（AECOPD）合并Ⅱ型呼吸衰竭患者的临床疗效.方法 选择74例AECOPD合并Ⅱ型呼吸衰竭患者,分为两组,各37例,对照组给予常规治疗,观察组给予常规治疗并加用无创呼吸机正压通气治疗,比较两组动脉血气指标酸碱度（pH）、二氧化碳分压（PaCO2）、氧分压（PaO2）、心率、呼吸、血压及临床症状改善情况.结果 观察组治疗2h后PaCO2较治疗前明显降低,治疗24 h和7d后,pH、PaCO2及PaO2较治疗前均明显改善,差异均有统计学意义（均P＜0.05）;治疗7d后,观察组患者pH、PaCO2、PaO2、心率及呼吸各指标均优于对照组,差异有统计学意义（P＜0.05）;观察组有效率为81.1％,明显高于对照组的56.8％,差异有统计学意义（P＜0.05）.结论 无创正压通气治疗AECOPD合并Ⅱ型呼吸衰竭临床疗效确切,能够明显改善通气功能,纠正CO2潴留和低氧血症,值得临床推广.     

早期无创双水平正压通气治疗AECOPD并Ⅱ型呼吸衰竭的疗效分析

目的：评价早期无创双水平呼吸道正压通气治疗AECOPD并Ⅱ型呼吸衰竭患者的疗效。方法：90例AECOPD合并Ⅱ型呼吸衰竭患者,分为治疗组（46例）和对照组（44例）,对照组采用常规药物联合鼻导管吸氧治疗,治疗组采用常规药物联合应用无创BIPAP呼吸机治疗,对两组患者的呼吸频率、心率、血气分析进行比较。结果：治疗组治疗后3、24h患者的呼吸频率、心率、PaCO2下降,PaO2、pH较治疗前上升,同时期与对照组比较,差异均有统计学意义（P〈0.05）,有创机械通气治疗率、病死率、平均住院日均显著低于对照组（P〈0.05）。结论：早期应用无创BiPAP治疗AECOPD并Ⅱ型呼吸衰竭患者,治疗效果肯定,且是一种并发症、不良反应少的机械通气技术。     

无创正压通气治疗慢性阻塞性肺疾病急性加重期合并呼吸衰竭的临床观察

目的 观察无创通气(non-invasive positive pressure ventilation,NIPPV)在治疗AECOPD合并Ⅱ型呼吸衰竭患者中的临床疗效.方法 治疗组53例AECOPD合并Ⅱ型呼吸衰竭患者在常规治疗的基础上进行NIPPV治疗,对照组53例仅给予常规抗炎、解痉、吸氧等治疗,观察血气指标、心率、血压、呼吸频率及住院时间的变化.结果 治疗组和对照组在治疗后动脉血气pH值、PaCO2、PaO2、心率和呼吸频率与治疗前比较均有明显改善.治疗组在降低PaCO2、呼吸频率和提高PaO2方面比对照组效果更明显.结论 NIPPV治疗AECOPD合并Ⅱ型呼吸衰竭能更有效地降低PaCO2、呼吸频率,提高PaO2,减少有创机械通气的几率,缩短住院时间.     

无创机械通气治疗呼吸衰竭的临床应用进展

目的：探讨无创机械通气脱机治疗慢性阻塞性肺疾病（COPD）并呼吸衰竭临床疗效。方法：选取采用无创机械通气治疗的26例COPD并呼吸衰竭患者作为治疗组,选择同期采用传统方式治疗26例COPD并呼吸衰竭患者作为对照组,分析并比较两组患者机械通气前后动脉血氧分压（PaO2）、二氧化碳分压（PaCO2）、呼吸频率（R）、心率（HR）、并发症、死亡例数及住院时间。结果：两组不同时间段治疗前后R、HR、PaO2、PaCO2、pH值比较,差异均无统计学意义（P〉0.05）。治疗组并发症、死亡例数、住院时间及血气改善时间均小于对照组,差异有统计学意义（P〈0.05）。结论：无创机械通气能够达到支持肺泡通气、改善并维持氧合、缓解呼吸肌疲劳的目的,可显著降低并发症的发生,患者缓解率及满意度高。     

无创正压通气联合氧气驱动雾化吸入治疗COPD合并呼吸衰竭患者的临床疗效观察

目的观察无创正压通气联合氧气驱动雾化吸入在慢性阻塞性肺疾病（COPD）合并呼吸衰竭的临床疗效。方法60例COPD呼吸衰竭患者随机分为实验组和对照组各30例,实验组采用无创正压通气联合氧气驱动雾化吸入治疗;对照组采用无创正压通气联合常规雾化吸入常规治疗。观察两组患者的生命体征、血气分析指标、肺功能指标和并发症发生情况。结果实验组和对照组治疗后心率（HR）、呼吸频率（RR）、血二氧化碳分压（PaCO2）和呼吸困难指数均低于治疗前,差异均有统计学意义（均P＜0．05）;实验组治疗后HR、RR、PaCO2和呼吸困难指数均低于对照组,差异均有统计学意义（均P＜0．05）;实验组和对照组动脉血氧分压（PaO2）、动脉血氧饱和度（SaO2）、肺功能第1S用力呼吸容积与预计值的比值（FEV。％）、FEV。与用力肺活量（FVCC）的比值（FEV1／FVc）均高于治疗前,差异均有统计学意义（均P＜O．05）;实验组治疗后PaO2、SaO2、FEV,％、FEV。及FEV1／FVC均高于对照组,差异均有统计学意义（均P＜O．05）。治疗期间,实验组排痰困难发生率为3．33％,口感咽痛发生率为6．67％,均低于对照组,差异均有统计学意义（均P＜0．05）。结论对COPD合并呼吸衰竭患者使用无创正压通气联合氧气驱动雾化吸入治疗,可提高疗效,减少治疗并发症,值得临床进行推广应用。     

无创正压机械通气治疗支气管扩张症合并呼吸衰竭的回顾性分析

目的观察支气管扩张症合并呼吸衰竭患者应用无创正压机械通气（NPPV）治疗前后各项生理指标的变化,评价其疗效。方法选择2010年1月至2011年12月华北油田公司总医院收治的应用无创正压机械通气治疗的支气管扩张症合并呼吸衰竭患者36例,比较治疗前后患者的心率、呼吸频率（RR）、pH值、动脉血二氧化碳分压（PaCO2）、动脉血氧分压（PaO2）、氧合指数（PaO2／FiO2）、辅助呼吸肌评分、呼吸困难分级、第1秒用力呼气容积占预计值百分比（FEV,％pred）、第1秒用力呼气容树用力肺活量比值（FEV,／FVC）、插管率和病死率。结果经无创正压机械通气治疗后,患者的心率、RR、PaCO2、辅助呼吸肌评分和呼吸困难分级均明显下降,pH值、PaO2、PaO2／FiO2、FEV,％pred、FEV,／FVC均明显上升,与治疗前比较差异具有统计学意义（P〈0．05）。2例患者因病情恶化行有创机械通气治疗,插管率5．56％,其中1例患者死亡。结论合理选择应用NPPV可以改善支气管扩张症合并呼吸衰竭患者的肺通气功能。     

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.