间歇导尿联合隔盐灸神阙穴训练对脊髓损伤患者膀胱功能的影响

目的观察间歇导尿配合申时(15∶00-17∶00)膀胱经旺时予隔盐灸神阙穴治疗脊髓损伤神经源性膀胱患者的临床疗效。方法将55例脊髓损伤所致的神经源性膀胱机能失调患者随机分为观察组(28例)和对照组(27例)。观察组采用间歇导尿,同时每天申时予隔盐灸神阙穴;对照组采用传统留置导尿,比较两组患者膀胱功能恢复效果及泌尿系感染发生率。结果观察组患者自主排尿时间较对照组明显缩短,残余尿量较对照组明显减少,膀胱容量较对照组有所增加;观察组治疗总有效率明显高于对照组,尿路感染发生率明显低于对照组,差异均有统计学意义(P0.05)。结论间歇导尿联合申时隔盐灸神阙穴治疗脊髓损伤致神经源性膀胱机能失调患者能显著改善膀胱功能,可有效降低泌尿系感染的发生率。     

急性脊髓炎神经源性膀胱患者中不同导尿方式的应用比较

目的:比较留置导尿与间歇导尿两种导尿方式在急性脊髓炎神经源性膀胱患者中的应用效果.方法:选择2010年1月-2013年12月在神经内科住院治疗的急性脊髓炎患者42例,患者都合并神经源性膀胱.42例患者随机分为观察组21例和对照组21例,观察组给予间歇导尿,对照组给予留置导尿,测量膀胱残尿量判断膀胱功能,通过尿沉渣镜检和尿培养细菌计数确诊合并泌尿系统感染例数.结果:导尿4周后观察组膀胱残尿量、泌尿系统感染发生例数明显少于对照组,两组相比差异有统计学意义(P＜0.05).结论:间歇导尿治疗急性脊髓炎患者神经源性膀胱效果优于留置导尿,值得临床广泛推广应用.     

间歇导尿联合徒手膀胱功能训练治疗神经源性膀胱的疗效观察

目的 探讨间歇导尿联合徒手膀胱功能训练治疗神经源性膀胱的临床效果.方法 68例脊髓损伤导致神经源性膀胱患者,按随机数字表法分为对照组和观察组,每组34例;对照组给予常规间歇导尿训练,观察组给予间歇导尿联合徒手膀胱功能训练,疗程均为12周.比较两组患者治疗前后膀胱最大容量、膀胱残余尿量、首次排尿时间及导尿管拔除成功率.结果 两组治疗后膀胱最大容量均较治疗前增加,膀胱内残余尿量均较治疗前减少,且观察组以上指标均优于对照组(均P<0.05);观察组治疗后首次排尿时间短于对照组,且拔除尿管成功率高于对照组(均P<0.05).结论 间歇导尿联合徒手膀胱功能训练可显著改善神经源性膀胱患者的膀胱功能,提高拔除尿管成功率.     

间歇清洁导尿联合神经肌肉电刺激治疗神经源性膀胱的疗效观察

目的探讨间歇清洁导尿联合神经肌肉电刺激对脊髓损伤后神经源性膀胱的治疗效果。方法将2015年3月～2018年9月我院康复科收治的脊髓损伤伴有神经源性膀胱的68例患者随机分为对照组(34例)和观察组(34例),其中对照组34例患者在间歇开放导尿(保留导尿管)的基础上进行神经肌肉电刺激、盆底肌训练及行为疗法,观察组改用间歇清洁导尿,余同对照组。1个月后观察并比较两组患者残余尿量、自主排尿量、膀胱容量、膀胱顺应性及并发尿路感染情况,并根据排尿功能评定疗效。结果治疗后两组患者残余尿量、自主排尿量、膀胱容量、膀胱顺应性均优于治疗前;其中对照组患者与治疗前比较,残余尿量有所减少,自主排尿量、膀胱容量较前增加(P0.05),而膀胱顺应性较前稍有改善,差异无统计学意义;观察组上述各项指标与治疗前相比,均具有统计学意义(P0.05);且治疗后上述各项指标均优于对照组(P0.05);经治疗后根据排尿功能评定疗效,对照组显效5例,有效7例,无效22例;观察组显效8例,有效12例,无效14例,两组疗效比较,差异有统计学意义(P0.05);另观察组的尿路感染发生率明显低于对照组(P0.05)。结论采用间歇清洁导尿、神经肌肉电刺激,辅以盆底肌训练及行为疗法等综合疗法治疗神经源性膀胱疗效确切,值得临床推广、使用。     

清洁间歇导尿术结合干涉低频治疗对脊髓损伤膀胱控制障碍恢复的临床观察及护理

目的探讨清洁间歇导尿结合干涉低频治疗对脊髓损伤神经源性膀胱控制障碍恢复的影响,总结护理经验。方法将30例脊髓损伤神经源性膀胱患者随机分为对照组和观察组,对照组15例,观察组15例。对照组采用常规康复治疗加上清洁间歇导尿技术;观察组在一般康复常规治疗的基础上加用清洁间歇导尿术联合干涉低频治疗,观察两种治疗方法对脊髓损伤神经源性膀胱控制障碍恢复的临床疗效。结果对照组和观察组对脊髓损伤膀胱功能控制障碍恢复的总有效率分别为73.3%和93.3%,观察组明显优于对照组(P0.05),有统计学意义。结论清洁间歇导尿术结合干涉低频治疗对改善脊髓损伤膀胱控制障碍方面有协同作用,值得临床推广应用。     

以神经肌肉电刺激为主的综合治疗在神经源性膀胱中的临床研究

目的：研究神经肌肉电刺激配合间歇清洁导尿及行为疗法在脊髓损伤（SCI）后神经源性膀胱治疗中的疗效。方法选取50例神经源性膀胱功能障碍损伤患者,随机均分为对照组和实验组（n=25）,对照组采用膀胱功能训练法,实验组在对照组基础上加神经肌肉电刺激、间歇清洁导尿及行为疗法治疗,并对2组患者残余尿量、膀胱容量、自排尿量及因排尿的症状而影响生活质量评分（QOL）进行测评。结果治疗8周后,2组患者残余尿量、自排尿量及生活质量评分较治疗前均显著改善,差异均具有统计学意义（P＜0.05）;且残余尿量、自排尿量及生活质量评分均以实验组的改善幅度较显著,与对照组比较差异均具有统计学意义（P＜0.05）。治疗8周后,对照组膀胱容量较治疗前增加不显著,差异无统计学意义,而实验组膀胱容量较治疗前显著增加,差异具有统计学意义（P＜0.05）;实验组膀胱容量与对照组比较差异有统计学意义（P＜0.05）结论以神经肌肉电刺激配合间歇清洁导尿及行为疗法治疗脊髓损伤后神经源性膀胱,在一定程度上能恢复膀胱排尿功能、增加膀胱容量及减少残余尿量,并提高患者生活质量。     

针灸联合耳穴贴压治疗糖尿病神经源性膀胱患者的疗效分析

目的 分析针灸联合耳穴贴压治疗糖尿病神经源性膀胱患者的临床疗效.方法 选取糖尿病神经源性膀胱患者78例,随机均分为2组(n=39).对照组行常规对症治疗,观察组在对照组基础上采取针灸联合耳穴贴压治疗,比较2组的临床疗效.结果 实验组患者中医证候的积分、残余尿量明显优于对照组,差异有统计学意义(P<0.05);2组患者脂代谢的指标、糖代谢的指标比较,差异无统计学意义.结论 针对糖尿病神经源性膀胱患者,予以行针灸联合耳穴贴压治疗,不仅能有效改善患者的临床症状,还可疏导患者的膀胱气机,并不断振奋其气化,具有显著价值,值得临床推广应用.     

尿道外括约肌牵张治疗神经源性膀胱的临床观察

目的:观察尿道外括约肌牵张治疗神经源性膀胱排尿障碍的疗效。方法:选择存在神经源性膀胱的40例男性脊髓损伤患者,随机数字表法分为治疗组和对照组各20例,对照组患者仅进行单纯间歇导尿治疗,治疗组患者在单纯间歇导尿治疗的基础上加以球囊牵张尿道外括约肌治疗。观察治疗前后两组患者24 h间歇导尿次数、残余尿量、最大尿道压、排尿方式的变化。结果:经治疗后两组患者残余尿量、间歇导尿次数、最大尿道压及排尿方式等方面均有改善,但治疗组改善情况优于对照组,两组比较差异均有统计学意义(P<0.05)。结论:尿道外括约肌的牵张治疗神经源性膀胱可以减少间歇导尿次数、减小尿道流出道阻力、降低残余尿量,有利于自主排尿恢复;该技术具有安全简便易于操作,副作用小、不良反应少、选择性高等优点,便于推广使用。     

对比两种训练法在改善神经源性膀胱患者排尿功能方面的应用价值

目的对比两种训练法在改善神经源性膀胱患者排尿功能方面的应用价值。方法选择我院于2017年6月至2019年6月期间收治的100例神经源性膀胱患者为研究对象,以随机数字表为参考划分为观察组与对照组,每组各50例;对照组行间歇导尿术治疗,观察组行间歇导尿术+膀胱功能训练,对比分析两组患者治疗前后的自主排尿量和残余尿量。结果治疗前,两组患者的自主排尿量和残余尿量接近,组间差异不存在统计学意义(P0.05);治疗后,观察组的自主排尿量明显高于对照组,残余尿量则低于对照组,数据对比,组间差异有明显的统计学意义(P0.05)。结论联合应用间歇导尿术与膀胱功能训练,可以提高神经源性膀胱患者的自主排尿量,减少尿量残留,有利于改善患者的排尿功能。     

膀胱尿压测定评定系统在脊髓损伤神经源性膀胱患者中的应用效果

目的探讨膀胱尿压测定评定系统在脊髓损伤致神经源性膀胱患者中的应用效果。方法选取120例脊髓损伤致神经源性膀胱患者,按随机数字表法分为观察组和对照组,各60例。对照组采用常规康复护理及间歇导尿;观察组在对照组的基础上,采用膀胱尿压测定评定系统,对膀胱功能进行评定并根据测评结果制订个性化康复护理方案。观察两组患者治疗2个月后的膀胱容量、残余尿量及尿路感染发生率。结果干预2个月后,观察组尿路感染发生率低于对照组(P0.05);观察组膀胱功能疗效评定优于对照组(P0.05)。结论采用膀胱尿压测定评定系统对脊髓损伤致神经源性膀胱患者进行膀胱功能的评定,并根据测定评定结果采用个性化膀胱功能康复护理,有利于促进膀胱功能的恢复,提高患者的康复效果。     

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.