无创性机械通气治疗20例呼吸衰竭的临床观察与护理

目的探讨无创性机械通气治疗呼吸衰竭的临床护理要点。方法利用BiPAP呼吸机经面罩机械通气治疗20例呼吸衰竭患者，并进行临床和护理观察。结果20例呼吸衰竭患者中，15例呼吸因难症状明显改善，好转出院；3例呼吸困难轻微改善，而后病情继续恶化，其中2例行气管插管，1例气管切开，好转后出院；2例呼吸困难症状无改善，经治疗无效死亡。结论BiPAP呼吸机可明显提高呼吸衰竭患者的通气效率、改善呼吸困难症状，是抢救呼吸衰竭患者的有效手段．     

有创与无创序贯机械通气治疗心脏手术后呼吸衰竭

目的：总结对心脏术后严重呼吸衰竭患者进行机械通气的经验。方法：10例心脏术后严重呼吸衰竭患者,当循环功能稳定后,拨除气管导管,改用经鼻面罩无创机械通气。结果：8例顺利撤离呼吸机,两例患者由于并发肺部感染导致严重呼吸衰竭,重新接受经气管插管或气管切开机械通气。结论：心脏术后呼吸循环功能稳定的患者,能够平稳地接受由有创机械通气向无创机械通气治疗的转换。     

小儿呼吸衰竭人工机械通气的护理

目的:探讨小儿呼吸衰竭人工机械通气的护理方法。方法:我院儿科重症监护室对气管插管或气管切开并人工机械通气方法救治各种原因并发呼吸衰竭患儿35例,在不同时期采用一系列恰当、科学的护理措施。结果:经治疗30例脱机成功,占85.7%;2例因家长放弃治疗自动出院,占5.7%;死亡3例,占8.6%。呼吸机辅助呼吸时间为1~11天,平均5.6±3.7天。结论:对人工机械通气的呼吸衰竭患儿实施恰当的、科学的护理能帮助患儿转危为安,取得良好的治疗效果。     

经鼻气管插管机械辅助呼吸气道湿气救治呼吸衰竭102例

为探讨经鼻气管插管机械辅助呼吸气道湿化，长期留管救治呼吸衰竭的临床应用价值。采用一次性附有低压高容气囊的气管导管，对102例重型颅脑损伤并呼吸衰竭患者在麻醉喉镜引导下行经鼻气管插管机械辅助呼吸，气道湿化等措施，结果102例患者留管时间最长98天，平均留管时间12．5天，100％免气管切开，肺部感染控制在6．7％，气道湿化总有效率93．14％，病死率为30．4％，认为经鼻气管插管机械辅助通气优于经口气管插管或气管切开机械通气，前者具有耐受性好，创伤性小，留管时间较长，方便护理，并发症少等优点。     

机械通气治疗急性有机磷农药中毒并呼吸衰竭的体会

目的观察机械通气救治急性有机磷农药中毒（AOPP）合并呼吸衰竭的临床效果。方法 AOPP合并呼吸衰竭患者37例,均在常规治疗的基础上早期应用机械通气,均经口气管插管,其中1例改为气管切开。结果 37例中脱机成功,痊愈出院34例,抢救成功率为91.9%,平均脱机时间（3.2±1.5）d。死亡3例,其中1例入院时心跳、呼吸已停止,另2例死于多器官衰竭。结论常规治疗辅以机械通气是救治AOPP合并呼吸衰竭的重要抢救措施。     

经面（鼻）罩压力支持加呼气末正压通气治疗COPD慢性呼吸衰竭急性加重患者

目的：探讨压力支持(PSV)加呼气末正压(PEEP)通气模式对慢性阻塞性肺病(COPD)的治疗作用，探讨将该通气模式应用于无创通气能否减少或避免使用有创通气。方法：选择20例COPD慢性呼吸衰竭急性加重患者，随机将其分为实验组10例、对照组10例，实验组患者应用经面(鼻)罩PSV加PEEP进行无创通气治疗。结果：实验组10例患者经治疗后动脉血pH、PaCO2及呼吸频率、心率、呼吸肌动用情况均明显改善，皆在治疗时间内成功脱机，无需行气管插管或气管切开；对照组10例患者动脉血pH、PaCO2及呼吸频率、心率、呼吸肌动用情况无明显改善，气管插管3例，死亡2例。结论：经面(鼻)罩应用PSV加PEEP机械通气治疗COPD慢性呼吸衰竭急性加重患者疗效肯定，可避免使用有创通气进行治疗。     

无创正压通气治疗COPD合并Ⅱ型呼吸衰竭的疗效观察

目的：探讨双水平正压无创通气（BiPAP）对慢性阻塞性肺疾病（COPD）合并Ⅱ型呼吸衰竭的治疗价值。方法：20例慢性阻塞性肺疾病（COPD）合并Ⅱ型呼吸衰竭的患者给予常规抗感染、平喘、祛痰对症治疗，加无创机械通气（BiPAP）治疗，采用通气口鼻或鼻面罩，设定参数S／T模式。结果：慢性阻塞性肺疾病（COPD）合并Ⅱ型呼吸衰竭经无创机械通气（BiPAP）治疗后动脉血气分析中pH值和PaO2逐渐上升，PaCO2值下降，临床症状改善，减轻呼吸肌疲劳，减慢呼吸频率和心率，呼吸困难减轻。结论：本法治疗COPD合并Ⅱ型呼吸衰竭有肯定疗效，可减少气管插管或气管切开以及相应的并发症，减少患者的痛苦和医疗费用。     

有机磷中毒并发呼吸衰竭的护理

有机磷中毒并发呼吸衰竭时,病人病情多数较为危重,如抢救不及时,易危及生命,1997年1月-2000年8月我们共收治有机磷中毒42例,其中出现呼吸衰竭者9例,经给予扭邦E200呼吸机辅助呼吸,抢救成功8例,死亡1例。通过对该组病人的治疗与护理,我们体会到：（1）对有机磷中毒患者,应彻底洗胃,并早期、足量应用阿托品和胆碱酯酶复活剂。（2）应严密观察呼吸节律的变化,一旦出现呼吸衰竭的先兆,应及时给予气管插管或气管切开,辅以机械通气。（3）保持呼吸道通畅,及时清除呼吸道分泌物。（4）在使用呼吸机输助呼吸时,应做好血气和无创伤性SaO2监测,及时调节呼吸机各项参数,既要防止通气不足,也要防止通气过度。     

重度有机磷农药中毒急性呼吸衰竭的呼吸支持

目的探讨重度有机磷农药中毒(ASOPD)急性呼吸衰竭的呼吸支持疗效.方法对急性重度有机磷农药中毒30例并发急性呼吸衰竭,行气管插管或气管切开机械通气呼吸支持.结果30例患者予机械通气呼吸支持治疗,均抢救成功.结论对于急性重度有机磷农药中毒并发呼吸衰竭,行机械通气呼吸支持治疗是抢救成功的可靠方法.     

经鼻气管插管机械辅助呼吸气道湿化救治呼吸衰竭102例

为探讨经鼻气管插管机械辅助呼吸气道湿化 ,长期留管救治呼吸衰竭的临床应用价值 ,采用一次性附有低压高容气囊的气管导管 ,对 10 2例重型颅脑损伤并呼吸衰竭患者在麻醉喉镜引导下行经鼻气管插管机械辅助呼吸 ,气道湿化等措施。结果 10 2例患者留管时间最长 98天 ,平均留管时间 12 .5天 ,10 0 %免气管切开 ,肺部感染控制在 6 .7% ,气道湿化总有效率 93.14% ,病死率为 30 .4%。认为经鼻气管插管机械辅助通气优于经口气管插管或气管切开机械通气 ,前者具有耐受性好 ,创伤性小 ,留管时间较长 ,方便护理 ,并发症少等优点     

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.