血透患者出血倾向的中西医结合治疗

目的 :在尿毒症血透患者中 ,由于本身凝血机制异常 ,且血透中用抗凝制剂 (肝素、低分子肝素 ,枸橼酸等 ) ,无疑将加重出血倾向。而通过不同透析方法和不同抗凝制剂的使用以及中西医结合治疗的各种措施来改善出血倾向。方法 :对有明显出血倾向的尿毒症血透患者 ,分别采用 1小剂量肝素 (药剂量减半 ,追加量控制在每小时 5 mg左右 ,或不用首剂量 ,透前用肝素盐水预充管道和透析器 ,追加量同前。如仍有出血倾向者 ,透后静推鱼精蛋白中和 )。 2低分子肝素 ,(根据体重选用不同单一剂量 ) ;3无肝素透析 (用肝素盐水充分预充管道和透析器 ,接管时弃…     

低分子肝素在出血倾向血透患者中的应用

目的探讨低分子肝素(low molecular weight heparin,LMWH)在有出血倾向的血透患者中的应用.方法根据SWARTZ分级,选择中、高危出血倾向患者120例,其中A组93例血透患者用LMWH抗凝,剂量为0.4～0.5ml/次;B组27例,用血仿膜透析及小剂量标准肝素抗凝,首剂为1 250U.同时观察临床表现、血清肌酐、尿素和凝血活酶时间(KPTT).结果 A、B两组病人均完成4～5h的血透,透析器及透析管道的凝血情况均为0～I级,血透效果两组相比无显著差别(P＞0.05),A组病人血透期间无1例出现出血症状明显加重,B组中有3例出血现象略有加重,A组透析2h与透析后KPTT值较透析前无显著延长(P＞0.05),而B组透析2h时KPTT值为69±24s,较透析前45±15s显著延长(P＜0.05).结论 LMWH具有良好的抗凝效果,保证透析顺利进行,同时不加重出血,较适用于中、高危出血倾向的血透患者.     

低分子肝素在出血倾向血透患者中的应用

目的探讨低分子肝素(lowmolecularweightheparin,LMWH)在有出血倾向的血透患者中的应用.方法根据SWARTZ分级,选择中、高危出血倾向患者120例,其中A组93例血透患者用LMWH抗凝,剂量为0.4～0.5ml/次;B组27例,用血仿膜透析及小剂量标准肝素抗凝,首剂为1250U.同时观察临床表现、血清肌酐、尿素和凝血活酶时间(KPTT).结果A、B两组病人均完成4～5h的血透,透析器及透析管道的凝血情况均为0～I级,血透效果两组相比无显著差别(P＞0.05),A组病人血透期间无1例出现出血症状明显加重,B组中有3例出血现象略有加重,A组透析2h与透析后KPTT值较透析前无显著延长(P＞0.05),而B组透析2h时KPTT值为69±24s,较透析前45±15s显著延长(P＜0.05).结论LMWH具有良好的抗凝效果,保证透析顺利进行,同时不加重出血,较适用于中、高危出血倾向的血透患者.     

无肝素血液透析的临床应用

要进行血液透析，必须建立体外循环，并要使用抗凝剂以防止血液凝结在体外循环，又不导致出血的发生。但是，尿毒症病人由于代谢产物肥类及酚类在体内蓄积，抑制了血小板的功能，造成血小板聚集能力降低。由于凝血功能障碍，常合并出血倾向。透析时使用肝素，使血小板、补体被激活，造成尿毒症血液透析患者的出血倾向加重，甚至可能大出血死亡。本文对有出血倾向维持性血液透析患者，行无肝素血液透析32例次，使用血仿膜透析器。透析前，肝素盐水透析超滤，使肝素充满膜内外及膜孔中；血流量维持在200mL／min以上，仅2例次因血流量＜160mL…     

维持性血液透析者急性上消化道出血时的处理对策

目的　探讨维持性血液透析者急性上消化道出血的处理。方法　急性上消化道出血 (AUGH)是尿毒症出血倾向最突出表现之一 ,本文总结 3 8例维持性血透者合并AUGH的治疗情况。结果　尿毒症合并AUGH者通过血透治疗常有所改善 ,但尿毒症本身血小板功能异常 ,加之酸中毒时毛细血管脆性增加等因素 ,以及血透中肝素化的影响 ,是该类患者止血治疗中不可忽视的问题。结论　探讨其处理对策 ,对提高止血效果 ,延长生存期有一定的临床意义。     

血小板聚集试验在尿毒症透析患者诊治中的应用

目的探讨血小板聚集试验在尿毒症透析患者诊治中的临床意义。方法以APACT2型血小板聚集仪用ADP为诱聚剂,检测60例正常人(对照组)及60例尿毒症患者(观察组)透析前、透析后血小板聚集率。结果观察组血液透析前的血小板最大聚集率为(32.4±8.2)%,透析后为(36.2±9.2)%,均明显低于对照组的(62.7±16.1)%(P<0.01);而透析前、后血小板聚集率差异无统计学意义(P>0.05)。结论血小板聚集试验简便、实用,可作为评价血小板聚集功能的初筛试验。血液透析不能改善尿毒症患者血小板功能。     

维持性血液透析患者血小板参数和血小板聚集功能的研究

目的 观察血液透析对尿毒症患者血小板功能、血小板参数的影响并探讨其作用机理.方法 应用血小板聚集仪观察尿毒症患者血液透析前后,血小板聚集功能和血小板参数的变化.结果 血液透析前,尿毒症组的血小板聚集率明显低于正常对照组;其血小板参数与对照组相比无明显差异.血液透析后,患者血小板聚集率无明显增加,但其血小板参数无明显变化.结论 血液透析不能改善尿毒症患者血小板功能.     

尿毒症血透后肺99mTC-DTPA清除率改变及意义

目的通过比较尿毒症患者血透前后肺99mTC -DTPA清除率 ,了解尿毒症患者肺通透性改变规律及其与肺、肾功能的关系。　方法 2 3名受试者 ,包括 11名健康人和 12名尿毒症患者 ,吸入肺99mTC -DTPA气溶胶后连续采集双肺放射性计数 30min ,计算T1/ 2 。　结果健康人与尿毒症患者血透前T1/ 2 分别为 77.9± 11.7min和 5 7.5± 17.2min(P <0 .0 1) ,尿毒症患者血透后T1/ 2 为 76 .0± 2 2 .0min ,与血透前比有显著差异 (P <0 .0 5 )。　结论尿毒症患者存在肺上皮通透性异常增高 ,血透能改善其通透性     

低相对分子质量肝素钠用于血液透析抗凝的疗效和安全性(摘要)

目的　观察低相对分子质量肝素(LMWH)钠应用于血液透析的抗凝疗效和安全性。方法　30例稳定的尿毒症维持性血透患者,随机分为未分组肝素(UFH)组和LMWH组。UFH首剂4～6mg/kg,追加6～8mg/h,透析结束前0.5h停用。LMWH3200IU透前一次性iv。结果　LMWH组透析器内纤维血栓形成显著较少;用药2和4h血浆aXa活性显著较高,且4与2h比较仅轻度下降;用药后2h血浆部分活化凝血激酶时间(APTT)显著延长,4h后恢复至正常范围,但UFH组用药后2和4h均显著延长,为LMWH组的2倍余;用药后4h血浆D二聚体浓度显著升高。结论　LMWH应用于血透时具有较UFH更好的抗栓作用,且有明确的纤溶作用,透析4.5～5h仅需1次用药。     

在国产简易可移动式血透机上应用无肝素血液透析技术治疗高危出血尿毒症

目的 :探讨在国产多泰MR 10 0型可移动式血透机上应用无肝素透析技术对合并高危出血尿毒症患者进行血透。方法 :4%肝素盐水冲洗透析器及管路并预冲 ,透析前弃去 ,高血流量 ,达 2 5 0ml/min以上。每 15min用 15 0ml生理盐水快速冲洗透析器 ,选用超滤系数 (kuf) 5ml/mmHg·h-1以上的透析器将进入体内的过多液体清除。结果 :2 3例急慢性肾衰患者进行了 3 6例次的透析未加重患者的出血 ,透析器及管路未见明显凝血 ,而且减轻了尿素氮的潴留 ,改善和纠正了水电解质酸碱平衡紊乱。结论 :在国产多泰MR 10 0型可移动式血透机上应用无肝素血液透析技术治疗高危出血尿毒症安全、有效、简便 ,在临床上有很高的实用价值。     

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.