慢性阻塞性肺疾病合并阻塞性睡眠呼吸暂停低通气综合征患者的肺功能及睡眠监测分析

目的:探讨慢性阻塞性肺疾病合并阻塞性睡眠呼吸暂停低通气综合征(亦称重叠综合征,OS)与单纯COPD患者肺功能和睡眠结构的差异。方法:对32例COPD、28例重叠综合征患者分别进行多导睡眠图监测及肺功能测定,并对各组数据作统计学检验。结果:重叠综合征的第一秒用力呼气容积占预计值百分比(FEV1)、第一秒用力呼气容积占用力肺活量百分比(FEV1/FVC)、最大通气量(MVV)均显著低于COPD组(P<0.01,P<0.05);同时重叠综合征组的呼吸暂停低通气指数(AHI)、最长呼吸暂停时间(LAT)和浅睡眠所占百分率(S1+2)显著高于COPD组,而最低脉氧饱和度(LSaO2)、平均脉氧饱和度(MSaO2)、深睡眠所占百分率(S3+4)显著低于COPD组(P<0.01,P<0.05)。结论:重叠综合征患者睡眠结构显著改变,夜间缺氧及肺功能受损更严重。     

COPD合并OSAHS的临床研究

目的探讨慢性阻塞性肺病（chronic obstructive pulmonary disease,COPD）合并阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea hypopnea syndrome,OSAHS）亦称重叠综合征（overlap syndrome,OS）和COPD患者肺功能和睡眠结构的变化。方法对37例COPD、32例重叠综合征患者分别进行多导睡眠图（polysomnography,PSG）监测及肺功能测定,并对各组数据作统计学舱验。结果重叠综合征组的第一秒用力呼气容积占预计值百分比（forced expiratory volume in onesecond,FEV1％）,第一秒用力呼气容积占用力肺活量百分比（FEV1／FVC）,最大通气量（MVV）均显著低于COPD组（P〈0．01,P〈0．05）,而肺活量（vitalcapacity,VC）,弥散功能（DLco）两纽间元显著差异;同时重叠综合征组的呼吸暂停低通气指数（apnea hypopneaindex,AHI）、最长呼吸暂停时间（the longest apnea time,LAT）和浅睡眠所占百分率（S1＋2）显著高于COPD组,而最低脉氧饱和度（LSaO2）、平均脉氧饱和度（MSaO2）、深睡眠所占百分率（S3＋4）显著低于COPD组（P〈0．01和P〈0．05）。结论重叠综合征患者夜间缺氧加重,睡眠结构改变明显,肺功能受损严重：对夜间缺氧明显的COPD患者及时检测多导睡眠图．便于及早诊治重叠综合征。     

中重度阻塞性睡眠呼吸暂停低通气综合征患者肺功能的研究

目的：比较中重度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)、OSAHS合并慢性阻塞性肺病(CORD)简称重叠综合征息者的睡眠呼吸紊乱和肺功能变化的特点。方法：对经多导睡眠呼吸监测仪(PSC)、肺功能检查仪检查的53例受试者资料进行回顾性分析。结果：OSAHS组睡眠呼吸暂停低通气指数(AHI)、最长呼吸暂停时间(LAT)、最低血氧饱和度(LSaO2)、平均血氧饱和度(MSaO2)与重叠综合征组相比无明显差别，但前者肺功能受损程度轻于后者。OSAHS组肺功能受损主要表现为限制性通气功能受损(52．2％)，其次为小气道功能受损(21．7％)和阻塞性通气功能受损(8．7％)；重叠综合征组主要表现在阻塞性通气功能受损(100％)和小气道功能受损(100％)。两组患者AHI、LSaO2与肺功能指标受损之间均无明显相关关系。结论：OSAHS是一种以气道阻塞为特征的疾病状态。OSAHS患者有不同程度的肺功能受损，但睡眠呼吸紊乱严重程度与肺功能减损程度间无线性相关关系。     

阻塞性睡眠呼吸暂停综合征和重叠综合征的肺功能变化及其临床意义

目的 :探讨阻塞性睡眠呼吸暂停综合征 (OSAS)以及 OSAS合并慢性阻塞性肺病 (COPD) (以下称重叠综合征 )患者的肺功能变化及其与睡眠呼吸紊乱的关系。方法 :观察对象 14 1例 ,其中 OSAS组 6 2例 ,重叠综合征组 5 2例 ,正常对照组 2 7例 ,14 1例均行肺功能测定 ,并比较 3组的呼吸暂停低通气指数 (AHI)和肺功能指标、夜间睡眠最低血氧饱和度 (L Sa O2 )的变化和关系。结果 :OSAS组的用力肺活量 (FVC)、最大通气量 (MVV)明显低于正常对照组 (P均 <0 .0 1) ,重叠综合征组的 1s用力呼气容积 (FEV1)、FVC、MVV、最大呼气中段流量 (MMEF)均明显低于 OSAS组和正常对照组 (P均 <0 .0 1) ;两组患者的L Sa O2 均明显低于正常对照组 (P均 <0 .0 1)。 OSAS组 AHI与 FVC、MVV、功能残气量 (FRC)呈负相关 ,其 L Sa O2 与 FVC、MVV、FRC呈正相关 ;重叠综合征组 AHI与 FEV1、FVC、MVV、MMEF呈负相关 ,其 L Sa O2 与 FEV1、MVV、MMEF呈正相关 ,两组的 L Sa O2 与 AHI均呈负相关。结论 :睡眠呼吸暂停与肺功能变化及夜间低氧血症有关 ,OSAS患者睡眠呼吸暂停的严重程度及睡眠血氧饱和度下降与肺容量减少有关 ,重叠综合征患者因肺功能减低、气道阻力增高而加重睡眠呼吸紊乱和夜间低氧血症。     

OSAHS与COPD的临床相关性分析

目的:探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)与慢性阻塞性肺疾病(COPD)的临床相关性.方法:30例OSAHS患者依据是否伴发COPD分为单纯OSAHS组(n=12)和重叠综合征组(n=18),分别检测两组患者的肺功能和睡眠呼吸监测指标.结果:睡眠监测指标:重叠综合征组的最低SaO2%、AHI明显低于单纯OSAHS组(P＜0.01),Lat明显高于单纯OSAHS组(P＜0.01);两组日间SaO2%比较无明显差异(P＞0.05).肺功能指标:重叠综合征组的FEV1%、FEV1/FVC(%)明显低于单纯OSAHS组(P＜0.01,P＜0.05).结论:重叠综合征患者肺功能指标异常、夜间与睡眠有关的低氧血症较单纯OSAHS患者更为明显,应给予足够的重视和积极治疗.     

睡眠呼吸紊乱对慢性阻塞性肺病患者的影响

目的:探讨合并阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)的慢性阻塞性肺病(chronic obstructive pulmonary disease,COPD)患者的临床状况。方法:对Epworth嗜睡量表(Epworth sleep scale,ESS)评分≥10、夜间氧减饱和度指数(oxygen desaturation index,ODI)≥5的门诊及住院稳定期286例COPD患者进行多导睡眠图(polysomnograph,PSG)监测,比较门诊和住院患者的肺功能及睡眠监测相关指标。结果:住院COPD患者与门诊的COPD患者相比,体重指数(BMI)、脉氧饱和度低于90%的时间占总记录时间的百分比(SIT90)、夜间平均脉氧饱和度(meanSpO2)、夜间最低脉氧饱和度(miniSpO2)、呼吸暂停低通气指数(apnea hypopnea index,AHI)等指标显著偏低(P<0.05)。COPD合并OSAHS(即重叠综合征)患者的AHI、meanSpO2也显著低于单纯OSAHS患者(P<0.05)。结论:OSAHS...     

阻塞性睡眠呼吸暂停低通气综合征与慢性阻塞性肺疾病的相关性分析

慢性阻塞性肺疾病(COPD)是内科呼吸系统的常见病和多发病，肺功能呈不完全可逆性改变；阻塞性睡眠呼吸暂停低通气综合征(OSAHS)是以睡眠中发生反复上气道阻塞为特征的呼吸障碍。两者可单独存在，也可以合并存在，后者也称重叠综合征。为探讨OSAHS、COPD及重叠综合征之间的关系，本研究随机挑选20例单纯OSAHS、20例单纯COPD和20例重叠综合征患者，对其肺功能和睡眠呼吸多导分析资料分析如下。     

孟鲁司特钠片联合BiPAP呼吸机治疗老年重叠综合征临床疗效观察

目的：探讨孟鲁司特钠片联合BiPAP呼吸机治疗老年慢性阻塞性肺疾病（COPD）合并阻塞性睡眠呼吸暂停（OSAHS）重叠综合征（OS）患者的临床效果。方法60例老年OS患者,随机分为孟鲁司特钠片联合BiPAP呼吸机组（A组）30例、单用BiPAP呼吸机组（B组）30例;观察记录入院时及治疗6个月结束时患者的睡眠监测指标：呼吸暂停低通气指数（9AHI）、最长呼吸暂停时间（LAT）、最低脉氧饱和度（LSaO2）、平均脉氧饱和度（MSaO2）和肺功能指标：一秒量占预计值百分比（FEV1%）、一秒率（FEV1/FVC）有无差异。结果两组患者治疗后较治疗前AHI、LAT均显著降低,LSaO2、MSaO2、FEV1%和FEV1/FVC均显著升高,其差异均具有显著统计学意义（P〈0.01）,且治疗后A组AHI、LAT显著低于B组,LSaO2、MSaO2、FEV1%和FEV1/FVC显著高于B组,差异均具有显著统计学意义（P〈0.01）。结论孟鲁司特钠片联合BiPAP呼吸机治疗老年重叠综合征有较好的临床疗效。     

男性重度阻塞性睡眠呼吸暂停低通气综合征患者焦虑抑郁症状研究

目的探究男性重度阻塞性睡眠呼吸暂停低通气综合征患者焦虑抑郁症状。方法选取2018年8月至2019年8月本院收治的60例男性重度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者作为研究对象,根据病情严重程度分为轻度组、中度组和重度组,各20例。记录患者的临床资料,运用多导睡眠仪(PSG)检测患者AHI、睡眠呼吸暂停指数(AI)、睡眠呼吸低通气指数(HI)、夜间最低血氧饱和度(LSaO2)、夜间平均血氧饱和度(MSaO2),比较3组抑郁自评量表(SDS)、焦虑自评量表(SAS)评分。结果3组AHI、AI、HI、LSaO2、MSaO2指标比较差异有统计学意义(P<0.05);3组SAS、SDS标准分比较差异有统计学意义(P<0.05);SAS、SDS标准分与患者AHI、AI、HI、吸烟指数呈正相关,与LSaO、MSaO2呈负相关(P<0.05)。结论男性重度阻塞性睡眠呼吸暂停低通气综合征患者的焦虑抑郁标准分高于轻、中度OSAHS患者,男性OSAHS患者的抑郁焦虑标准分与患者的吸烟指数和PSG密切相关。     

128例儿童阻塞性睡眠呼吸暂停低通气综合征多导睡眠监测分析

目的 比较分析肥胖阻塞性与非肥胖睡眠呼吸暂停低通气综合征(OSAHS)患儿的多导睡眠监测(PSG)结果.方法 选取2015年6月至2016年6月在广西医科大学第一附属医院进行PSG检查的128例OSAHS患儿,按BMI分为肥胖与非肥胖组,对两组患儿的基本情况及主要PSG指标进行对比分析.结果 肥胖组的男性患儿比例、BMI、低通气指数(HI)较非肥胖组高,平均血氧饱和度(MSaO2)及最低血氧饱和度(LSaO2)均低于非肥胖组(P＜0.05).呼吸暂停低通气指数(AHI)或阻塞性呼吸暂停指数(OAI)与低氧血症程度呈正相关关系(P＜0.05).AHI与MSaO2、LSaO2呈负相关关系(P＜0.05).结论 肥胖OS-AHS患儿的低通气及血氧饱和度下降程度较非肥胖者严重.     

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.