桃红四物汤联合低分子肝素防治老年髋部骨折围手术期下肢DVT临床观察

目的:观察桃红四物汤联合低分子肝素防治老年髋部骨折围手术期下肢深静脉血栓(deep vein thrombosis,DVT)的临床疗效。方法:将80例老年髋部骨折患者按随机数字表法分为观察组和对照组,每组40例。对照组采用低分子肝素治疗,观察组在对照组治疗基础上加用桃红四物汤治疗。观察两组患者手术前、手术后DVT发生率,同时对两组患者手术前、手术后10 d血小板、血红蛋白计数以及血浆D-二聚体(plasma D-two polymer,D-Dimer)进行比较,采用视觉模拟评分法(visual analogue scale,VAS)疼痛评分评价两组患者疼痛程度,肿胀程度通过测量大腿、小腿的周径差进行评价。结果:观察组手术前、手术后DVT发生率分别为0.00%、10.00%、15.00%,均显著低于对照组(0.00%、22.50%、35.00%),差异均有统计学意义(P0.05);手术后10 d血红蛋白观察组显著高于对照组,观察组D-Dimer显著低于对照组,差异均有统计学意义(P0.05);手术后10 d治疗组血小板与对照组比较,差异无统计学意义(P0.05);两组患者手术前、手术后10 d大腿、小腿周径差以及疼痛VAS评分比较,差异均有统计学意义(P0.05),且观察组显著低于对照组,差异均有统计学意义(P0.05)。结论:老年髋部骨折围手术期采用桃红四物汤联合低分子肝素防治相对于单独使用低分子肝素更能降低DVT的发生率,桃红四物汤联合低分子肝素是中西医结合的治疗方法,中医治疗紧扣病机,西医治疗发挥抗凝血作用,能促进手术后血红蛋白恢复,减轻肿痛症状。     

压力泵对老年髋部骨折后下肢深静脉血栓的预防效果

目的:探讨压力泵对老年髋部骨折患者下肢深静脉血栓(deep venous thrombosis, DVT)的预防效果。方法:将200例老年髋部骨折患者随机数表法分为对照组和观察组,每组各100例。对照组于术前10 d静脉注射低分子肝素(low molecular weight heparin, LMWH),观察组在静脉注射LMWH同时联合患侧肢压力泵处理。统计两组术后1个月DVT发生率,观察术后肿胀疼痛程度、凝血功能及血液流变学情况。结果:术后1个月,观察组DVT发生率(3.00%)低于对照组(10.00%),差异有统计学意义(P<0.05);观察组肿胀程度分级优于对照组,疼痛NRS评分低于对照组,差异有统计学意义(P<0.05);术后2周,两组凝血功能指标均有明显改善(P<0.05),但组间比较,差异无统计学意义(P>0.05);术后2周,观察组血浆黏度、全血黏度下降较对照组更为显著,差异有统计学意义(P<0.05)。结论:LMWH联合压力泵预防老年髋部骨折术后DVT,可减轻患者肿胀疼痛和改善血液流变学,增益DVT预防效果,值得临床推广。     

运动性护理联合阿司匹林在预防妊高征患者下肢深静脉血栓形成

目的 观察运动性护理联合阿司匹林在妊高症患者下肢深静脉血栓形成(DVT)中的预防效果.方法 取医院妊高症分娩患者60例,随机分为对照组(n=30)和观察组(n=30).对照组采用阿司匹林预防下肢DVT,观察组联合运动性护理干预下肢DVT,比较两组预防效果.结果 两组护理前全血高切黏度、血浆黏度指标比较差异无统计学意义(P＞0.05);观察组护理后全血高切黏度、血浆黏度指标比较,低于对照组(P＜0.05);两组护理前后凝血功能指标差异无统计学意义(P＞0.05);观察组下肢DVT发生率,低于对照组(P＜0.05).结论 妊高症患者分娩后采用运动性护理干预联合阿司匹林预防下肢DVT有显著效果.     

分析低分子肝素钙预防老年下肢创伤骨折患者术后深静脉血栓(DVT)形成的临床效果

目的分析低分子肝素钙预防老年下肢创伤骨折患者术后深静脉血栓(DVT)形成的临床治疗效果。方法择取2017年1月至2018年1月我院收治的50例下肢创伤老年患者,随机均分为观察组与对照组,各为25例。对照组患者施以骨折术后常规治疗;观察组患者加用低分子肝素钙治疗。将两组患者不良反应发生率、凝血功能指标以及DVT形成率。结果观察组患者PT、TT、APTT、FIB均优于对照组(P0.05);观察组患者DVT形成率均明显少于对照组(P0.05);两组患者在治疗期间均未出现严重不良反应。结论低分子肝素钙能够有效改善与预防老年下肢创伤骨折患者术后深静脉血栓(DVT)形成,减少不良反应事件。     

盐酸替罗非班联合低分子肝素钙治疗短暂性脑缺血发作的临床疗效

目的:探讨盐酸替罗非班联合低分子肝素钙治疗短暂性脑缺血(TIA)发作的临床疗效.方法:TIA患者82例,随机均分为对照组和观察组,对照组应用司匹林肠溶片联合低分子肝素钙治疗,观察组TIA患者应用盐酸替罗非班注射液联合低分子肝素钙治疗,比较两组TIA患者治疗后临床疗效、不良反应、血小板内皮细胞黏附分子-1(PECAM-1)和血小板计数(PLT)、凝血酶原时间(PT)、活化部分促凝血酶原激酶时间(APTT)、纤维蛋白原(FIB)等凝血指标的变化.结果:观察组患者总有效率明显高于对照组,差异有统计学意义(P＜0.05);治疗前,两组TIA患者的凝血指标和PECAM-1比较,差异无统计学意义(P＞0.05);治疗后,凝血指标差异亦无统计学意义(P＞0.05),但观察组PECAM-1水平高于对照组,差异有统计学意义(P＜0.05);两组均未见皮肤、黏膜、消化道出血等不良反应.结论:盐酸替罗非班联合低分子肝素钙治疗TIA发作临床疗效优于阿司匹林肠溶片联合低分子肝素钙.     

空气压力波联合低分子肝素钙对COPD急性加重期患者下肢深静脉血栓的预防护理研究

目的 探讨空气压力波联合低分子肝素钙对COPD急性加重期患者下肢深静脉血栓(DVT)的预防护理效果。方法 选择我院2015年4月至2019年4月收治的COPD急性加重期患者105例,通过随机数表法分为观察组55例和对照组50例,在常规治疗基础上,对照组给予低分子肝素钙治疗,观察组联合空气压力波治疗仪治疗,均连续治疗1周。比较两组凝血、纤溶指标、血液流变学的变化、DVT发生率及不良反应。结果 治疗后1周,观察组活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、凝血酶时间(TT)均明显长于对照组(P0.05),观察组D-二聚体(DD)、纤维蛋白原(FIB)、全血高切黏度、全血低切黏度、血浆黏度均明显低于对照组(P0.05);观察组DVT总发生率明显低于对照组(P0.05);两组不良反应总发生率比较,差异无统计学意义(P0.05)。结论 空气压力波联合低分子肝素钙可有效改善COPD急性加重期患者凝血纤溶功能及血液流变学,在预防DVT的发生率中有明显作用,护理效果满意。     

低分子肝素与利伐沙班预防髋关节置换术后深静脉血栓形成的疗效比较

目的对比低分子肝素与利伐沙班预防髋关节置换术后深静脉血栓(DVT)形成的疗效及安全性。方法 100例在我院接受髋关节置换手术患者,随机分成低分子肝素组和利伐沙班组各50例,低分子肝素组皮下注射低分子肝素钠,5000IU/d,利伐沙班组口服利伐沙班片,10mg/d;记录并比较凝血指标、DVT发生率及并发症发生率。结果两组治疗后凝血指标PT、PLT和APTT水平对比差异无统计学意义(P0.05)。利伐沙班组形成DVT发生率8.0%,低分子肝素组的10.0%(P0.05),两者无明显差异。结论通过辅助使用气压治疗等物理措施后,预防髋关节置换术后DVT,低分子肝素与利伐沙班总体疗效相当,均能有效改善凝血指标,安全可靠。     

早期综合护理干预对预防长期卧床老年患者下肢静脉血栓的效果

目的探讨早期综合护理干预对预防长期卧床老年患者下肢深静脉血栓(DVT)的影响。方法取86例长期卧床老年患者为研究对象,根据早期护理干预推行时间将其分成研究组(A组,n=43)和对照组(B组,n=43)两组。B组予以常规护理,A组予以早期综合护理。比对两组患者DVT发生率,记录其干预前后大腿、小腿周径变化情况,观察其干预前后凝血酶原时间(PT)、活化部分凝血活酶时间(a PTT)等凝血指标、血浆粘度、D二聚体(D-D)等指标的变化。结果 1 A组干预后DVT发生率为11.6%,显著低于B组的39.5%(P0.05);2干预后,两组患者下肢周径水平均较干预前显著降低,其中A组降幅大于B组(P0.05);3干预后,两组患者PT、a PTT等凝血指标均较干预前上调,血浆粘度及D-D水平则较干预前下调(P0.05);其中A组各指标变化幅度均大于B组,差异具有统计学意义。结论对长期卧床的老年患者予以早期综合护理干预措施,可有效预防DVT的发生。     

延续性护理对脑出血恢复期并发深静脉血栓的预防效果

目的探讨延续性护理对脑出血恢复期并发深静脉血栓(DVT)的预防效果及相关原理。方法回顾性分析2013年10月到2015年3月入院就诊的所有恢复期脑出血患者临床资料,从接受延续性护理和未接受延续性护理的患者中各抽取44例,分别纳入延续性护理组和对照组。对比两组患者恢复期内DVT发生率及死亡率差异,分析其干预前后凝血指标及血液流变学指标变化情况。结果出院后6个月复诊时,两组死亡率对比无统计学意义(P0.05);延续性护理组DVT发生率显著低于对照组(9.1%VS 27.3%)(P0.05)。干预后,两组PT、aPTT等凝血指标检测结果均较干预前显著升高,且延续性护理组高于对照组(P0.05);两组全血黏度高切、血浆黏度、红细胞聚集指数等血液流变学指标检测结果均较干预前显著降低,且延续性护理组低于对照组(P0.05)。结论对恢复期的脑出血患者予以延续性护理干预措施,能有效降低DVT发生风险,利于改善患者血液流变学状态,促进预后恢复。     

膀胱癌患者化疗对血小板体积、凝血指标的影响

目的观察膀胱癌患者化疗对血小板体积、凝血指标的影响。方法选取2013年6月至到2018年6月医院收治的膀胱癌患者74例为研究对象,根据随机数表法均分为对照组和联合组,每组37例。两组在进行化疗前均常规口服昂丹司琼片,对照组给予吉西他滨注射液化疗,联合组在对照组的基础上给予顺铂注射液化疗。比较两组治疗效果、血浆指标、凝血指标及不良反应发生率。结果联合组治疗有效率83.78%高于对照组59.46%(P0.05);两组化疗前及化疗后血小板体积、纤维蛋白原含量差异无统计学意义(P0.05),两组化疗后血小板体积低于化疗前,纤维蛋白原含量高于化疗前(P0.05);两组化疗后凝血指标均高于化疗前,联合组化疗后凝血指标高于对照组(P0.05);联合组不良反应发生率62.16%高于对照组32.43%(P0.05)。结论膀胱癌患者进行化疗会减小血小板体积,凝血指标向低凝趋向发展。     

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.