CT立体定向手术治疗高血压脑出血

探讨ＣＴ立体定向手术治疗高血压脑出血的临床应用价值。方法 对４２例高血压脑出血病人行ＣＴ立体定向手术，抽吸血肿置管引流，有残余血肿的病人注入尿激酶溶妥，观察病人血肿清除，并发症及功能恢复情况。结果 以ＣＴ显示残余血肿量０－５ｍｌ为拔管标准，拔管时间为１２．０－１６８．０ｈ，平均６８．４ｈ。     

CT脑立体定向术、开颅术及保守疗法治疗高血压性脑内血肿的对比研究

作者自行设计了ＣＴ脑立体定向装置及螺旋吸引血肿清除器，经动物血肿模型抽吸试验证实此法安全，有效后用于临床，对２０例高血压性脑出血病人进行立体定向清除术，血肿清除率为６０％～９６％，１２例病人达到满意疗效。并与同期进行开颅手术及保守治疗各２０例高血压性脑出血病人进行对比观察，结果表明：立体定向手术组病人预后较其它两组好，病情恢复快，并发症少。     

脑立体定向血肿清除术治疗高血压脑出血的术后护理

目的 探讨立体定向血肿清除术治疗高血压脑出血术后护理对策.方法 对126例高血压脑出血病人立体定向血肿清除术后护理作回顾性分析.结果 10例12 h拔管,36例3 d拔管,52例3～5 d拔管,28例5 d 以上拔管.治愈40例,好转76例,死亡10例.结论 对高血压脑出血立体定向血肿清除术后并发症及术后再出血病人采取相应的护理对策可降低病死率.     

CT脑立体定向术,开颅术与保守疗法治疗高血压性脑内血肿…

作者自行设计ＣＴ脑立体定向装置及螺旋吸引血肿清除器，经动物血肿模型抽吸试验证实此法安全，有效后用于临床，对２０例高血压性脑出血人进行立体定向清除术，血肿清除率为６０％－９６％，１２例病人达到满意疗效。并与同期进行颅手术及保守治疗各２０例高血压性脑出血病人进行对比观察，结果表明：立体定向手术组病人预后较其方面两组好，情恢复快，并发症少。     

CT立体定向术治疗高血压丘脑出血(附2例报告)

目的；探讨高压血丘脑出血外科治疗的新方法。方法：采用CT立体定向血肿清除的外科方法对2例中度昏迷的丘脑出血病人进行治疗。结果；2例病人在术后一周神志逐渐清醒，瘫痪肢体功能部分恢复。其中1例已能生活自理。结论：CT立体定向血肿清除术治疗高血压丘脑出血具有创伤小，手术并发症少，疗效好的优点，可作为首选的外科治疗方法。     

超早期CT定位穿刺抽吸引流治疗高血压脑出血32例体会

目的 探讨超早期ＣＴ定位穿刺抽吸引流治疗高血压脑出血临床效果。方法 对３２例高血压脑出血病人发病后６ｈ内行ＣＴ定位穿刺抽吸引流加尿激酶溶解治疗，观察病人血肿清除及功能恢复情况。结果 死亡１例，存活３１例，颅内积血均在术后７２ｈ内彻底清除，近期随访恢复良好者１７例，重残者２例，收到满意疗效。结论超早期ＣＴ定位穿刺抽吸引流治疗高血压脑出血是行之有效的方法，明显降低了病人的病死率和病残率，提高了病人的生     

CT立体定向脑内血肿抽吸尿激酶溶解治疗脑出血

采用ＣＴ引导立体定向抽吸脑内血肿后置管，尿激酶注入血肿腔，溶解残余血肿的方法治疗脑出血４９例，取出良好的疗效，作者认为该方法创伤小，定位准确，操作简便，手术时间短，安全，血肿清除理想，达到脑出血手术的目的。     

简易立体定向多靶点置管治疗脑出血临床体会

目的总结多靶点立体定向置管治疗高血压脑出血的经验，探讨降低手术并发症的方法。方法对76例病人在局麻下行立体定向多靶点置管治疗脑出血，明显降低了手术并发症。结果平均住院时间9天，术后无脑部再出血、梗塞及颅内感染等并发症。术后完全恢复日常生活46例占60．53％，部分恢复可独立生活28例占36．84％，死亡2例。结论立体定向多靶点置管治疗脑出血，简单易行，置管准确，副损伤小，手术在局麻下进行，可利用最短的时间解除血肿对脑组织的压迫，充分减少病人的并发症。     

立体定向手术治疗高血压深部脑出血

目的:总结立体定向微创手术治疗高血压深部脑出血的经验。方法:应用立体定向技术对41例高血压深部脑出血进行微创治疗。结果:立体定向手术均获成功,无手术并发症及死亡。术后72h血肿清除率>70%～90%,存活34例,6～12个月恢复良好率79.4%。结论:立体定向置管抽吸引流术可降低高血压深部脑出血的残死率。     

用CT导向脑立体定向术治疗高血压性脑出血120例

高血压性脑出血多发于长期患有高血压动脉硬化症的中年人和老年人 ,这些病人常伴有心、肺、肝、肾等器质性病变 ,因此往往不能耐受全麻开颅手术 ,其常规开颅清除血肿手术死亡率高达 2 8%～ 48% [1 ,2 ] 。用ＣＴ导向脑立体定向血肿碎吸加尿激酶溶解术治疗高血压性脑出血 ,使死亡率明显降低[3] ,其优点在于方便、快捷、微侵袭、安全有效和便于推广。我科自 1 997年 1月～ 2 0 0 0年 8月采用北京海军总医院与北京理工科大学研制的脑立体定向仪 ,经ＣＴ导向脑立体定向血肿碎吸加尿激酶溶解术治疗高血压性脑出血 1 2 0例 ,取得较满意的效果 ,报…     

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.