山莨菪碱合并安定下行超声内镜检查的效果观察

目的：探讨山莨菪碱合并安定下行超声内镜检查的效果并观察检查的反应及耐受程度。方法对260例接受超声内镜检查的无青光眼患者，随机分为对照组与实验组进行对比研究，各130例。对照组为检查前肌注山莨菪碱，实验组为检查前肌注山莨菪碱和安定，2组患者从超声内镜检查开始到结束的时间进行对比，同时统计患者术前、术中及术后心率、呼吸、血氧饱和度的变化，操作完成的时间，观察术中的反应和耐受程度。结果检查前，2组患者的收缩压、舒张压、心率以及血氧饱和度差异无统计学意义。观察组患者的收缩压、舒张压、心率以及血氧饱和度检查前和检查后差异无统计学意义，对照组患者检查前后的收缩压、舒张压以及心率差异有统计学意义（P＜0.05），检查前后的血样饱和度差异无统计学意义。检查中患者的不良反应方面，实验组出现不良反应明显少于对照组（P＜0.05），检查完成的时间实验组也明显低于对照组（P＜0.05）,对照组中有1例患者因难以耐受而终止检查。结论超声内镜检查前应用山莨菪碱合并安定是一种相对安全、痛苦少、简便易行的检查方法，值得在临床推广使用。     

小剂量咪唑安定与异丙酚在胃镜检查中的疗效比较

目的 观察小剂量咪唑安定与异丙酚在胃镜检查中的效果和安全性.方法 胃镜检查的患者125例随机分为镇静组、对照组.镇静组60例先行咽喉部局麻,再予咪唑安定静注;对照组65例先静脉推注芬太尼,再行异丙酚静注,观察两组患者对检查感受的不适程度,检查中反应情况及检查前、中、后血压,心率和血氧饱和度的变化.结果 两组患者都能顺利完成胃镜检查,没有严重不良反应的发生.镇静组对检查感受的不适程度为6.7%,而对照组为1.5%,两组无统计学意义(P＞0.05),两组检查时间、检查前与检查后血压、心率、血氧饱和度变化均无统计学差异.结论 胃镜检查中应用小剂量咪唑安定与异丙酚静注后能使整个检查过程无痛苦反应,且安全性好.但是使用小剂量咪唑安定组费用明显降低.     

小剂量咪唑安定与异丙酚在胃镜检查中的应用

目的观察小剂量咪唑安定与异丙酚在胃镜检查中的效果和安全性。方法将120例胃镜检查患者随机分为镇静组、对照组。镇静组60例先行咽喉部局麻,再予咪唑安定静注;对照组60例先静脉推注芬太尼,再行异丙酚静注,观察两组患者对检查感受的不适程度,检查中反应情况及检查前、中、后血压,心率和血氧饱和度的变化。结果两组患者都能顺利完成胃镜检查,没有严重不良反应发生。镇静组对检查感受不适的比例为6.67%,而对照组为1.67%,两组差异无显著性(P>0.05),两组检查时间、检查前与检查后血压、心率、血氧饱和度变化差异均无显著性。结论胃镜检查中应用小剂量咪唑安定或异丙酚静注后能使整个检查过程无痛苦反应,而且安全性好。但是使用小剂量咪唑安定组费用明显降低。     

微量间歇性超声雾化吸入治疗小儿支气管肺炎

目的探讨微量间歇性超声雾化吸入治疗小儿支气管肺炎效果及总结相关护理体会.方法将支气管肺炎患儿124例,按照随机数字法分为观察组和对照组,每组各62例.2组患儿均接受常规抗感染治疗,在此基础上对照组给予传统超声雾化吸入治疗,观察组给予微量间歇性超声雾化吸入疗法,2组患儿在超声雾化吸入治疗后均接受物理护理干预.观察并比较两组患儿雾化吸入前后的呼吸、心率血氧饱和度变化、有效排痰时间、临床症状改善及不良反应情况.结果治疗后观察组在呼吸频率、血氧饱和度、有效排痰时、退烧和啰音消失时间均显著好于对照组(P<0.05),且住院时间为(10.8±2.3)d,总有效率达95.2%,均显著好于对照组(P<0.05).结论微量间歇性超声雾化吸入治疗及合理的护理策略能够有效加速支气管肺炎患儿临床症状的改善,提高治疗总有效率.     

肌肉注射咪唑安定联合肠道解痉剂在结肠镜检查中的应用

目的探讨肌肉注射咪唑安定联合肠道解痉剂行结肠镜检查的可行性,评价效果和安全性.方法将150例结肠镜检查患者随机分为2组:镇静组(90例)检查当天空腹服匹维溴胺100mg,检查前30分钟肌肉注射咪唑安定3mg后进行结肠镜检查;对照组(60例)按常规进行结肠镜检查.观察检查开始后5分钟、10分钟、检查结束时的血压、脉搏、血氧饱和度以及检查反应及入镜时间.结果检查过程中2组的平均动脉压、脉搏和血氧饱和度在相应各时段的变化均无显著性差异(P＞0.05).镇静组的检查反应明显优于对照组(P＜0.05),平均入镜时间镇静组比对照组缩短,但无显著性差异(P＞0.05).结论肌肉注射咪唑安定联合口服肠道解痉剂辅助结肠镜检查是安全有效的,其检查反应优于普通检查.     

阿托品联合奥美拉唑治疗急性胃炎患者的临床观察

目的探究阿托品联合奥美拉唑治疗急性胃炎患者的临床疗效.方法：选取100 例急性胃炎患者为研究对象,按照治疗方式的不同分为对照组与观察组,对照组患者给予山莨菪碱联合奥美拉唑治疗,观察组患者给予阿托品联合奥美拉唑治疗;观察两组患者的疗效及不良反应.结果：观察组与对照组患者相比,无论在腹部绞痛、恶心呕吐、腹泻症状改善时间,还是总有效率均有显著差异,P〈0.05;两组患者不良反应发生率比较无显著差异,P〉0.05.结论：阿托品联合奥美拉唑治疗急性胃炎疗效优于山莨菪碱联合奥美拉唑治疗,值得临床推广使用.     

咪唑安定应用于老年高血压病人无痛胃镜检查

目的 探讨联合应用丙泊酚和芬太尼及咪唑安定在老年高血压病人无痛胃镜检查中的有效性,安全性和优越性.方法 选择100例有胃镜适应症的老年高血压病人,分为两组,联合应用丙泊酚和芬太尼及咪唑安定的静脉复合麻醉的为实验组,普通检查的为对照组.观察两组患者的血压、心事、呼吸、血氧饱和度及不良反应.结果 实验组在检查过程中血压,心率、呼吸均较检查前明显下降(P<0.05),且血氧饱和度在检查前中后均无显著性差异(P>0.05).结论 丙泊酚和芬太尼及味唑安定的静脉复合麻醉应用于老年高血压病人胃镜检查是一种安全、有效、舒适、理想的方法.     

右美托咪定联合舒适护理模式对无痛支气管镜检查患儿SPO2、PCO2及生命体征的影响

目的 分析右美托咪定联合舒适护理模式对无痛支气管镜检查患儿血氧饱和度(SPO2)、二氧化碳分压(PCO2)及生命体征的影响.方法 2017年7月-2019年5月我院收治的60例需进行无痛支气管镜检查的患儿随机分为对照组和观察组,各30例.对照组采用利多卡因进行麻醉,观察组在对照组的基础上采用右美托咪定进行麻醉,检查期间2组均采用舒适护理模式护理至检查结束.比较2组不同时间点血氧饱和度(SPO2)和生命体征,检查前后镇静程度和检查后2组舒适度和不良反应发生情况.结果 T2、T3、T4观察组收缩压、舒张压和HR均呈逐渐降低趋势,并低于对照组(P＜0.05);T2、T3、T4观察组SPO2高于对照组(P＜ 0.05);T3、T4,观察组PCO2低于对照组(P＜0.05);检查后,观察组安静率显著高于对照组(P ＜ 0.05);检查后,2组警觉/镇静评分(OAA/S)评分和Ramsay镇静评分较检查前升高,观察组高于对照组(P＜0.05);检查后,观察组不良事件发生率显著低于对照组(P＜0.05).结论 右美托咪定联合舒适护理模式能显著改善无痛支气管镜检查过程中患儿生命体征和血气指标,同时有助于检查过程中患儿保持镇静.     

咪唑安定应用于老年高血压病人无痛胃镜检查

目的探讨联合应用丙泊酚和芬太尼及咪唑安定在老年高血压病人无痛胃镜检查中的有效性、安全性和优越性。方法选择100例有胃镜适应症的老年高血压病人,分为两组,联合应用丙泊酚和芬太尼及眯唑安定的静脉复合麻醉的为实验组,普通检查的为对照组。观察两组患者的血压、心率、呼吸、血氧饱和度及不良反应。结果实验组在检查过程中血压、心率、呼吸均较检查前明显下降（P〈0.05）,且血氧饱和度在检查前中后均无显著性差异（P〉0.05）。结论丙泊酚和芬太尼及咪唑安定的静脉复合麻醉应用于老年高血压病人胃镜检查是一种安全、有效、舒适、理想的方法。     

咪唑安定应用于老年高血压病人无痛胃镜检查

目的探讨联合应用丙泊酚和芬太尼及咪唑安定在老年高血压病人无痛胃镜检查中的有效性、安全性和优越性。方法选择100例有胃镜适应症的老年高血压病人,分为两组,联合应用丙泊酚和芬太尼及咪唑安定的静脉复合麻醉的为实验组,普通检查的为对照组。观察两组患者的血压、心率、呼吸、血氧饱和度及不良反应。结果实验组在检查过程中血压、心率、呼吸均较检查前明显下降(P&lt;0.05),且血氧饱和度在检查前中后均无显著性差异(P&gt;0.05)。结论丙泊酚和芬太尼及咪唑安定的静脉复合麻醉应用于老年高血压病人胃镜检查是一种安全、有效、舒适、理想的方法。     

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.