急性颈髓损伤患者继发低钠血症的护理

目的 探讨急性颈髓损伤继发低钠血症的护理要点.方法 观察10例子急性颈髓损伤患者继发低钠血症的症状特点,正确补液、补钠及早期进行饮食干预.结果 除2例自动出院外,余7例经限水、补钠、激素治疗后全部治愈;另有1例经早期饮食干预后未发生低钠血症.结论 早期增加钠的摄入可以有效预防低钠血症的发生,出现低钠血症后正确补钠,监测血浆电解质和血浆渗量的变化、尿量和尿钠的改变,正确补液、补钠及早期进行饮食干预,可以及时纠正低钠血症.     

颈髓损伤患者低钠血症的临床特点

目的探讨颈髓损伤后低钠血症的临床特点、发病机制及治疗方法。方法总结分析26例颈髓损伤后低钠血症患者诊治情况。26例中,21例血钠<130 mmol/L,合并肺部感染者(6例)或脑外伤者(5例)均血钠<130 mmol/L,且2例血钠<120 mmol/L。结果23例患者经补液、补钠或严格限水、适当补钠等治疗后症状缓解,1例因肺部感染、呼吸衰竭而死亡,2例放弃治疗时低钠血症仍无明显缓解。结论颈髓损伤后低钠血症程度与感染、脑外伤等有关;抗利尿激素不适当分泌综合征或脑盐耗综合征是其主要发病机制;宜根据其不同发病机制选用不同的治疗方法。     

急性颈髓损伤继发水钠代谢紊乱17例诊治分析

目的探讨急性颈髓损伤继发水钠代谢紊乱的发病机制、诊断和治疗。方法对17例急性颈髓损伤继发水钠代谢紊乱进行回顾性分析。结果全组患者入院1-3d内血钠均低于130mmol/L,其中3例低于115mmol/L。14例患者经适当的补盐和限制水摄入量治疗,低钠症状2-3周内改善;3例发热患者因发热不能严格限制水摄入,其中1例2个月后恢复,1例失访,另1例补盐限水后病情加重,调整治疗方案后恢复。结论急性完全性颈髓损伤后常常继发低钠血症,多由抗利尿激素分泌异常综合征引起;颈髓损伤越重,损伤后低钠血症发生率越高;颈髓损伤后低钠血症适当补充钠盐和液体量是有效的治疗方法。     

急性颈髓损伤并发低钠血症的临床分析及治疗

目的:探讨急性颈髓损伤并发低钠血症患者的临床特点及治疗效果。方法:68例颈髓损伤患者按是否并发低钠血症分为低钠组和对照组,并对两组的临床资料进行比较,其中包括年龄、损伤平面、损伤程度、合并颅脑损伤、合并感染及使用呼吸机,同时分析低钠血症的治疗。结果:不同颈髓损伤平面、损伤程度、合并颅脑外伤、合并感染及是否行呼吸机辅助呼吸各项比较及各组别之间低钠血症发生率比较,差异均有统计学意义(P<0.05)。17例低钠血症患者经限制水摄入量和适量的补钠治疗,低钠症状1～2周内改善。结论:急性颈髓损伤后低钠血症的发生与颈髓损伤的平面、损伤程度、合并颅脑损伤、合并感染及使用呼吸机相关。限制水摄入量和适当补钠是安全有效的治疗方法。     

老年患者颈髓损伤后低钠血症的临床分析

目的探讨老年急性颈髓损伤导致低钠血症患者的病因、发病机制及治疗。方法回顾性分析总结2006年5月至2011年3月52例中老年急性颈髓损伤患者,其中男性41例,女性11例,年龄50-78岁（平均68．2岁）,所有患者均存在不同程度的低钠血症（血钠〈135mmol／L）,根据血钠水平将患者分组,分析不同因素在低钠血症中的表达。采用SPSS13．0统计软件进行统计学处理。结果轻度低钠血症14例,中度36例,重度2例。50例患者经扩容、补钠或限水补钠等治疗后症状缓解,2例患者因高位颈髓损伤伴严重肺部感染呼吸衰竭死亡。不同损伤程度患者血钠水平差异有统计学意义（P〈0．05）,血钠水平与年龄呈负相关（r〉1）。结论低钠严重程度与颈髓损伤程度、年龄等因素相关,在积极治疗原发损伤的同时,应区分低钠血症发生机制,从而制定相应治疗方案。     

急性颈髓损伤后低钠血症15例报告及文献复习

目的 探讨急性颈髓损伤后低钠血症的病因、发病机制、诊断和治疗。方法 回顾性分析2000年～2004年收治的急性颈髓损伤后低钠血症患者15例的临床资料。结果 全组患者入院24～72h内血钠低于130mmol／L，其中5例低于120mmol／L。14例尿钠40～68mmol／L，1例尿钠为148mmol／L；尿渗透压420～980mmol／L。12例患者经适当的补盐和限制水摄入量治疗，低钠症状2～3周内改善；2例发热患者因发热不能严格限制水摄入，其中1例2个月后恢复，另1例失访；1例患者补盐限水后病情加重，调整治疗方案后恢复。结论 颈髓损伤越重，损伤后低钠血症发生率越高；颈髓损伤后低钠血症多由抗利尿激素分泌异常综合征引起；血钠浓度，血、尿渗透压等是诊断依据；适当补充钠盐和液体量是有效的治疗方法。     

颈髓损伤并发低钠血症的临床分析及治疗

目的:探讨颈髓损伤并发低钠血症患者的临床特点并观察治疗效果。方法:2006年1月～2010年12月我院收治的120例颈髓损伤患者,分为低钠组和正常组,分析低血钠程度与颈髓损伤平面、损伤程度关系,观察低钠血症的治疗效果。结果:同一损伤部位完全性损伤者的血钠浓度与不完全性损伤者有显著性差异,同一损伤程度高位损伤者与低位损伤者比较有显著性差异。经限制水摄入量和适量的补钠治疗,低钠症状1～2周内改善。结论:颈髓损伤后低钠血症的发生与颈髓损伤的平面、损伤程度相关。限制水摄入量和适当补钠是安全有效的治疗方法。     

地震及其它外伤致颈髓损伤后低钠血症的动态观察与与治疗

 【目的】探讨地震及其它外伤致颈髓损伤后低钠血症的发病特点、发病机制和有效治疗方法。【方法】前瞻性观察2008年5月至2008年8月中山大学附属第一医院外科收治地震及其它外伤致颈髓损伤后低钠血症患者的发病特点、治疗及预后。【结果】①地震及其它外伤致颈髓损伤后低钠血症发生时间为伤后2-20 d，血钠可低至112 mmol/或更低，地震所致和车祸伤所致颈髓损伤低钠血症的临床特点未见不同；②颈髓损伤平面越高，血钠下降的严重程度越严重，并出现与低钠程度平行的血氯下降、血浆渗透压下降及尿量增多，血脑钠素明显增高并24小时尿钠排除增多。③醋酸去氨加压素、盐皮质激素和限制液体摄入未能改善低钠血症。根据需要增加补钠量至20-75.5 g/d, 并根据尿量加大补液量至3000-7195 mL/d后，患者血钠逐渐恢复正常。【结论】地震及其它外伤致颈髓损伤时损伤平面越高，低钠血症程度更重，发病机制符合脑耗盐综合症，积极补钠、补充血容量是治疗颈髓损伤后低钠血症的关键。     

地震及其它外伤致颈髓损伤后低钠血症的动态观察与治疗

【目的】探讨地震及其它外伤致颈髓损伤后低钠血症的发病特点、发病机制和有效治疗方法。【方法】对2008年5月至2008年8月中山大学附属第一医院外科收治地震及其它外伤致颈髓损伤后低钠血症患者的发病特点进行分析,并动态观察比较不同治疗方法对血钠、补钠量、尿钠的影响。【结果】①地震所致和车祸伤所致颈髓损伤低钠血症的临床特点未见不同,低钠血症发生时间为伤后2～20d,血钠可低至112mm01／L或更低,颈髓损伤平面越高。血钠下降的严重程度越严重;②患者出现与低钠程度平行的血氯下降、血浆渗透压下降及尿量增多,血脑钠素明显增高并24h尿钠排除增多;③醋酸去氨加压素、盐皮质激素和限制液体摄入未能改善低钠血症。根据需要增加补钠量至20—75．5g／d,并根据尿量加大补液量至3000—7195mL／d后,患者血钠逐渐恢复正常。【结论】。肾性水钠丢失过多是地震及其他外伤致颈髓损伤后低钠血症的主要发病机制。积极补钠、补充血容量是治疗颈髓损伤后低钠血症的关键。     

急性颈髓损伤继发低钠血症30例分析

目的: 探讨急性颈髓损伤继发低钠血症的发病机制和治疗方法。方法: 对30例急性颈髓损伤继发低钠血症患者的临床资料进行回顾性分析,分析发病机制及可行性治疗方案。结果: 30例患者中,2例因多器官功能衰竭死亡;1例血钠恢复缓慢,出院后失访;11例中度低钠血症患者经补水补钠治疗10~14天后,血钠恢复正常;另外16例重度低钠血症患者经补水补钠治疗2~3周,后血钠恢复近正常水平。结论: 急性颈髓损伤继发低钠血症的发生机制尚不明确,可能是颈髓脊神经损伤后引起神经调节系统、内分泌系统、血液动力学、肾排泄以及内环境的整体紊乱;应及早根据临床表现及实验室检查判断低钠血症的严重程度及临床类型,进而采取最合理的治疗方案。     

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.