封闭负压引流联合皮瓣修复下肢软组织严重缺损的疗效分析

目的探讨封闭负压引流联合皮瓣修复下肢软组织严重缺损的疗效。方法选择2014年1月至2015年3月南京医科大学附属淮安第一医院接诊的60例下肢软组织严重缺损患者为研究对象,按照随机数字表法分为观察组和对照组,各30例。观察组患者急诊清创后给予一期内固定联合封闭负压引流术并封闭创口,7~21 d后结合肉芽的生长情况进行二期缝合、皮瓣转移或植皮;对照组患者进行普通清创,给予皮瓣转移修复创面或二期内固定并植皮。比较两组患者的骨折与创面愈合时间、肢体功能恢复情况、住院时间、住院费用、满意率以及不良反应发生情况。结果观察组骨折愈合时间明显短于对照组[(6.3±1.9)个月比(9.8±3.0)个月],创面愈合时间也显著短于对照组[(20±6)d比(46±17)d],差异有统计学意义(P<0.01)。观察组的肢体恢复优良率为93.3%(28/30),显著高于对照组的63.3%(19/30),差异有统计学意义(P<0.01)。观察组的住院时间短于对照组,住院费用少于对照组,患者满意率高于对照组,差异有统计学意义(P<0.05或P<0.01);观察组的并发症发生率为0%,明显低于对照组的43.3%(13/30),差异有统计学意义(P<0.01)。结论封闭负压引流联合皮瓣修复下肢软组织严重缺损的临床疗效良好,值得临床推广。     

可冲洗负压封闭引流治疗腹部手术后感染伤口的临床观察

目的 探讨和评价可冲洗负压封闭引流治疗腹部手术后感染伤口的临床效果.方法 140例腹部手术后感染伤口,分为观察组(可冲洗负压封闭引流组)和对照组(无冲洗负压封闭引流组),每组70例,观察比较两组在浅部感染伤口、深部感染伤口中的愈合情况.结果 对于浅部感染伤口,观察组与对照组在伤口清洁时间、伤口愈合时间方面差异无统计学意义(P>0.05),但换药次数明显减少(P<0.05);而对于深部感染伤口,在伤口清洁时间、伤口愈合时间及换药次数等方面,观察组与对照组比较,差异均有统计学意义([ 6.6±2.1)d比(9.2±3.4)d,(14.3±4.3)d比(18.8±5.3)d,(1.8±0.3)次比(3.2±0.8)次,均P<0.05].结论 应用可冲洗负压封闭引流治疗腹部手术后感染伤口,尤其是深部感染伤口,其效果优于无冲洗负压封闭引流.     

负压封闭引流在毒蛇咬伤中的临床应用效果

目的 探讨负压封闭引流(VSD)在毒蛇咬伤中的临床效果。方法 选择2018年4月至2020年5月在我院诊断治疗的毒蛇咬伤患者60例为研究对象,随机分为观察组与对照组,每组各30例。对照组给予常规治疗,观察组在此基础上加用负压封闭引流。比较治疗后两组血清CK、CRP水平,肿胀程度,住院时间,随访瘢痕大小。结果 ①观察组治疗3 d、7 d血清CK为(272.2±51.3)U/L、(94.6±22.4)U/L、CRP为(44.8±10.2)mg/L、(12.6±3.0)mg/L水平均显著低于对照组,差异有统计学意义(P0.05)。②治疗7 d后,观察组肿胀程度显著轻于对照组,差异有统计学意义(P0.05)。③观察组住院时间为(9.4±2.1)d,显著短于对照组;瘢痕面积为(3.3±0.6)cm2,显著小于对照组,差异均有统计学意义(P0.05)。结论 负压封闭引流治疗毒蛇咬伤可有利于毒液的排出,缓解肿胀程度,缩短住院时间,减小瘢痕面积。     

改进引流方式PICC管较长时间胸腹腔留置的临床应用分析

目的 探讨改进引流方式PICC管在胸腹腔较长时间留置引流的临床实用性.方法 治疗组采用PICC管留置后连接负压引流袋进行胸腹水定时定量引流;对照组采用HCC管留置后连接尿袋定时定量放腹水.两组患者根据病情引流时间为7～30 d,观察两组引流速度、发生阻塞管时间等.结果 引流速度治疗组为(2.1±0.61)h/L,对照组为(2.9±0.98) h/L,两组比较差异有统计学意义(P＜0.001);治疗组发生管道阻塞13例,时间为(8±4.01)d,对照组为21例,时间为(5±5.6)d,两组比较差异有统计学意义(P＜0.05).结论 应用改进引流方式PICC管在胸腹腔较长时间引流具有安全、方便、速度快并且可控、易维护、患者痛苦小等优点.     

不同剂量阿托伐他汀与辛伐他汀用于老年冠心病合并高脂血症治疗的临床效果比较

目的：对比不同剂量阿托伐他汀与辛伐他汀治疗老年冠心病合并高脂血症的临床疗效。方法选取肇庆市高要区人民医院心血管内科2013年5月至2015年4月期间收治的123例老年冠心病合并高脂血症患者,以数字表法随机分为观察A组、观察B组和对照组各41例,观察A组给予阿托伐他汀10 mg/d治疗,观察B组给予阿托伐他汀20 mg/d治疗,对照组给予辛伐他汀20 mg/d治疗,8周为一个疗程,三组均治疗3个疗程,比较三组患者治疗前后的总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)水平,以及治疗过程中的不良反应情况。结果治疗后观察A组、观察B组和对照组患者的TC分别为(3.94±0.49) mmol/L、(3.16±0.47) mmol/L、(4.04±0.48) mmol/L,TG分别为(1.54±0.39) mmol/L、(1.31±0.37) mmol/L、(1.55±0.40) mmol/L、LDL-C分别为(3.24±0.38) mmol/L、(2.93±0.39) mmol/L、(3.17±0.39) mmol/L,均显著低于治疗前的TC (5.93±0.54) mmol/L、(5.92±0.53) mmol/L、(5.95±0.52) mmol/L,TG (1.99±0.43)mmol/L、(1.97±0.41) mmol/L、(1.96±0.40) mmol/L,LDL-C (3.98±0.41) mmol/L、(3.95±0.42) mmol/L、(3.97±0.40) mmol/L,差异均有显著统计学意义(P<0.01);治疗后观察A组、观察B组和对照组患者的HDL-C分别为(1.78±0.32) mmol/L、(1.75±0.34) mmol/L、(1.68±0.33) mmol/L,均显著高于治疗前的(1.06±0.34) mmol/L、(1.03±0.31) mmol/L、(1.04±0.33) mmol/L,差异均有显著统计学意义(P<0.01);治疗后对照组HDL-C显著低于观察A、B两组,观察B组TC、TG、LDL-C均显著低于观察A组与对照组,HDL-C显著高于对照组,差异均有显著统计学意义(P<0.01);观察B组患者的治疗有效率为95.1%(39/41),明显高于观察A组的78.0%(32/41)和对照组的65.8%(27/41),差异均有统计学意义(P<0.05或0.01);三组不良反应发生率分别为4.9%,7.3%,2.4%,差异无统计学意义(P>0.05)。结论阿托伐他汀与辛伐他汀均能够有效降低冠心病合并高脂血症患者的血脂水平,但阿托伐他汀20 mg/d的临床疗效明显优于10 mg/d与辛伐他汀,安全有效,值得推广。     

负压封闭引流技术联合清创术对肛周坏死性筋膜炎患者肛门功能的影响

目的 探讨负压封闭引流技术联合清创术对肛周坏死性筋膜炎患者肛门功能的影响.方法 回顾性分析2010年1月至2018年12月本院收治的80例肛周坏死性筋膜炎患者的临床资料,根据不同治疗方式分为对照组(采用清创术治疗)和观察组(采用负压封闭引流技术联合清创术治疗),每组40例.比较两组临床指标、肛门功能及并发症发生情况.结果 两组术中出血量、手术时间比较差异有无统计学意义;观察组清创次数少于对照组,创面愈合时间、体温恢复正常时间、住院时间均短于对照组,差异有统计学意义(P<0.05);术后,两组肛管静息压(ARP)、肛管最大收缩压(AMCP)水平均低于术前,且观察组低于对照组,差异有统计学意义(P<0.05);观察组并发症发生率为15.00％(6/40),略低于对照组的20.00％(8/40),但差异无统计学意义.结论 负压封闭引流技术联合清创术治疗有利于肛周坏死性筋膜炎患者创面愈合,改善患者肛门功能,且不增加并发症发生率,安全性较高.     

封闭式负压引流技术治疗骨科感染创面的护理体会

目的:研究封闭式负压引流技术在治疗骨科创面感染过程中的护理体会。方法:选择骨科创面感染100例患者,随机将患者分为对照组50例与观察组50例。观察组患者使用负压封闭引流通道创建和间断高浓度给氧护理技术,对照组患者采用常规护理,对两组患者的护理效果进行对比。结果:观察组患者的临床指标情况改善效果优于对照组,差异有统计学意义(P<0.05);护理之后,观察组患者面积缩小比对照组优,差异有统计学意义(P<0.05);护理前两组患者的疼痛评分差异无统计学意义(P>0.05),护理后,观察组患者疼痛评分比对照组轻,差异有统计学意义(P<0.05)。结论:使用负压封闭引流通道创建和间断高浓度给氧护理技术在骨科感染创面封闭式负压引流技术治疗中的护理具有良好的效果,能够缩短患者的住院时间,减少患者的住院费用,对患者的临床指标进行改善,值得临床推广使用。     

对比虹吸引流和分析负压引流在胃肠外科治疗中的运用

目的:分析在胃肠外科临床中应用虹吸引流和负压引流的效果。方法:选取80例患者为研究对象,按照抛掷硬币方式将其分成两组,观察组40例,临床中采用虹吸引流方式治疗,对照组40例,给予负压引流方式治疗。结果:观察组患者的术后引流量、引流时间(266.89±64.76)ml、(3.20±1.19)d,对照组分别为(273.25±60.80)ml、(2.97±1.33)d,组间比较差异无明显统计学意义(P>0.05),观察组、对照组患者的治疗费用分别为(66.60±15.28)元、(91.33±17.09)元,差异具有统计学意义(P<0.05);观察组的并发症发生率为2.5%,对照组为2.5%,两组比较差异无统计学意义(P>0.05);观察组患者术后的管道堵塞发生率为15.0%,对照组为30.0%,观察组明显低于对照组(P<0.05)。结论:虹吸引流应用于胃肠外科治疗效果明显,颇具临床应用价值,值得临床推广应用。     

改良间歇负压封闭引流治疗压疮疗效观察

目的探究改良间歇负压封闭引流治疗压疮的临床疗效。方法将60例压疮患者随机分为观察组及对照组,每组患者30例,对照组采取传统的持续负压引流,观察组在对照组基础上将1个厌氧包压在负压封闭引流敷料上,比较临床治疗效果。结果观察组临床治疗有效率为93.3%,对照组为90.0%;观察组治愈时间为(18.2±7.1)d,对照组为(20.0±6.2)d,两组差异无统计学意义(P0.05);观察组PSQI测评结果除了睡眠时间外其余考察因子得分均显著低于对照组,差异具有统计学意义(P0.05)。结论改良间歇负压封闭引流与常规的负压封闭引流相比具有相同的临床效果并避免持续吸引带来的噪音,对患者的睡眠更具有帮助。     

负压封闭引流技术联合局部加氧治疗糖尿病足慢性创面的临床研究

目的 研究负压封闭引流技术联合局部加氧治疗糖尿病足慢性创面的临床效果。方法 选取2017年6月～2018年8月于我院接受治疗的100例糖尿病足慢性创面患者作为研究对象,按照随机数字法则分为两组,每组50例,其中观察组采用负压封闭引流技术联合局部加氧治疗;对照组采用负压封闭引流技术治疗,然后对比两组治疗效果,治疗前后两组液氧分压、LDH和SDH活性、T淋巴细胞亚群。结果 观察组组织液氧分压(112.34±2.45)mmHg明显高于对照组的(60.34±1.28)mmHg,差异有统计学意义(P0.05)。治疗后观察组的总有效率为98.00%,明显高于对照组(74.00%),差异有统计学意义(P0.05)。治疗后,观察组LDH(132.23±1.23)U/L低于对照组,SDH(2.94±0.12)U/L高于对照组,差异有统计学意义(P0.05)。治疗后,观察组CD3+、CD4+、CD8+均高于对照组,CD4+/CD8+低于对照组,差异有统计学意义(P0.05)。结论 糖尿病足慢性创面以负压封闭引流技术联合局部加氧治疗,能够提高治疗有效性,值得研究和推广。     

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.