金双歧治疗极低出生体重儿喂养不耐受的观察

目的探讨双歧杆菌乳杆菌三联活菌片（金双歧）治疗极低出生体重儿喂养不耐受的临床疗效。方法将极低出生体重儿喂养不耐受60例随机分为治疗组和对照组,各30例。对照组给予常规对症护理与治疗,治疗组在对照组基础上给予双歧杆菌四联活菌喂奶口服或鼻饲金双歧,干预周期为5 d。结果经过治疗后,治疗组和对照组的胃潴留和腹胀平均消失时间分别为（2.03±0.36）、（2.36±0.42）d;（5.36±1.11）、（6.00±0.95）d,治疗组的胃潴留和腹胀消失时间均明显少于对照组（均P〈0.05）。治疗组和对照组的平均恢复出生体重需要时间和住院天数分别为（8.32±3.63）、（10.26±5.23）d;（16.58±4.23）、（25.36±6.21）d,治疗组的恢复出生体重需要时间和住院天数均明显少于对照组（均P〈0.05）。结论金双歧治疗极低出生体重儿喂养不耐受能尽快从静脉营养过度到胃肠营养,加快极低出生体重儿的体重增长,促进胃潴留和腹胀症状的消失,缩短住院时间,值得推广应用。     

双歧杆菌三联活菌散联合游泳治疗VLBWI喂养不耐受效果分析

目的研究双歧杆菌三联活菌散联合游泳治疗极低出生体质量儿（VLBWI）喂养不耐受的效果。方法收集2008年6月～2010年6月住院部收治的92例VLBWI患儿,随机分联合组53例,对照组39例;两组均予静脉营养及早产儿配方奶喂哺,对照组在早产儿配方奶喂哺时添加双歧杆菌三联活菌散,0.5支/次,tid,联合组在双岐组治疗的基础上给予游泳锻炼;均观察21d;观察两三组的疗效,及出生后21d天体重,并进行统计分析。结果两组的疗效分别为88.68%和35.85%,出生21d天体重均数分别为（2291.2±67.4）g和（2146.3±71.8）g,出生21d增加了分别为（948.8±35.6）g和（794.7±28.9）g,两者间比较均有显著差异（P〈0.05）。结论双歧杆菌三联活菌散联合游泳治疗VLBWI喂养不耐受可提高疗效。     

双歧杆菌防治极低出生体重儿坏死性小肠结肠炎的作用研究

目的：观察应用双歧杆菌预防极低出生体重儿坏死性小肠结肠炎（NEC）的有效性。方法：回顾性分析2005年1月～2008年5月在我院NICU住院治疗的生后存活7 d并且开始胃肠道喂养的极低出生体重儿183例的临床资料。结果：预防组NEC发病率为2.10%（2/95）,对照组NEC发生率为11.36%（10/88）,两组比较差异有统计学意义（P〈0.01）。住院期间预防组每日体质量增加（8.108±2.205）g,对照组为（6.256±2.298）g,两组比较差异有统计学意义（P〈0.01）。治疗后7 d两组患儿肠道细菌总数、杆菌、球菌总数及杆球菌比值差异均有统计学意义（P〈0.01）。预防组治疗前、治疗后7 d杆球菌比值差异无统计学意义（P〉0.05）。治疗前两组患儿大便双歧杆菌数的比较差异均无统计学意义（P〉0.05）;治疗后7 d两组患儿大便双歧杆菌数的比较差异有统计学意义（P〈0.01）。预防组治疗前、治疗后7 d大便双歧杆菌数的比较差异有统计学意义（P〈0.01）;对照组治疗前、治疗后7 d大便双歧杆菌数的比较差异无统计学意义（P〉0.05）。结论：给予极低出生体重儿预防性口服双歧杆菌能够降低NEC发病率,促进其体质量增长。其机制与口服双歧杆菌后促进新生儿肠道正常菌群的定植和优势化、维持肠道正常菌群比率有关。     

极低出生体重儿早期经口微量喂养的临床研究

目的探讨早期经口微量喂养对极低出生体重儿营养状况、喂养并发症及远期预后的影响。方法将2002年1月至2004年12月收治的90例极低出生体重儿按随机编号分为:早期经口微量喂养组30例(采用早期经口微量喂养),胃管组30例(采用常规胃管喂养),全静脉营养组30例(采用全静脉营养)。比较3组的喂养不耐受发生情况、恢复出生体重时间、平均日增长克数、达到全肠道营养时间、住院天数及并发症等。结果早期经口微量喂养组、胃管组、全静脉营养组恢复出生体重的时间分别为(14·1±4·0)d、(13·8±3·5)d、(13·5±3·8)d,差异无统计学意义(P>0·05)。早期经口微量喂养组平均每日体重增长克数、达到全肠道营养时间、住院天数、喂养不耐受发生率分别为(20·8±7·0)g/d、(24·3±2·1)d、(28·7±3·5)d、27%,与胃管组及全静脉营养组相比,差异有统计学意义(P<0·01);其血糖紊乱发生率(33%)与胃管组(32%)相比差异无统计学意义(P>0·05),与全静脉营养组(68%)相比差异有统计学意义(P<0·05);发生喂养并发症如呼吸暂停、呕吐、腹胀、胃出血与胃管组相比差异有统计学意义(P<0·01);发生窒息、吸入性肺炎、腹泻、坏死性小肠结肠炎、胃穿孔与胃管组相比,差异无统计学意义(P>0·05)。随访结果表明,1·5岁时胃管组和全静脉营养组各有1例发生脑瘫,全静脉营养组有1例发生精神发育迟滞。结论对极低出生体重儿宜提倡早吸吮、早期微量喂养,以减少喂养相关并发症的发生,缩短住院天数,减少后遗症的发生。     

分段喂养方式在极低出生体重早产儿肠道内营养的应用研究

目的研究分段喂养方式对极低出生体重早产儿的喂养耐受性及喂养效果,探讨最适合极低出生体重早产儿的喂养方式。方法将50例胎龄30～33周,体重在1050～1450g活产极低出生体重儿中的25例给予分段喂养方式（分段喂养组）,将另25例给予持续、间歇胃管喂养,作为对照（对照组）,观察两组喂养的耐受情况、并发症、平均住院时间、达完全肠道内喂养时间、恢复出生体重时间。结果两组喂养在恢复出生体重时间、达完全肠道内喂养时间、平均住院时间相似,差异无显著性（p〉0.05）,而在喂养耐受、并发症的发生方面,分段喂养方法明显少于对照组,差异有显著性（p〈0.05）。结论极低出生体重早产儿采用分段喂养,喂养不耐受发生率低,并发症更少,优于持续、间歇胃管喂养,值得临床推广。     

谷氨酰胺对极低出生体重儿喂养不耐受的预防及对血浆胃动素的影响

目的：探讨肠内补充谷氨酰胺对极低出生体重儿喂养不耐受预防作用及对血浆胃动素水平的影响。方法：选取2012—01～2013—12间康华医院新生儿科收治极低出生体重儿40例为研究对象,随机将其分为干预组（n=20）和对照组（n=20）,两组患儿入院后均按照早产儿管理指南给予常规治疗,干预组在生后24h内口服或鼻饲谷氨酰胺0．1／kg．次,Q8H,连续28天。观察两组患儿喂养不耐受症状,记录每日体重增长值,记录恢复出生体重所需日龄及达到全肠内营养所需时间。采用放射免疫分析法测定开奶前,开奶后7d、14d两组患儿血胃动素水平,行组间对照分析。结果：干预组喂养不耐受发生率较对照组低（25．0％vs．55．0％）,达全胃肠喂养及恢复出生时体重时间短[（18．7±2．8）d VS．（21．7±2．7）d,（12．1±1．3）dvs．（15．3±1．2）d],干预组生后7d,14d血浆胃动素平均水平高于对照组,差异有统计学意义（P〈0．01）。结论：肠内补充谷氨酰胺可能促进极低出生体重儿血浆胃动素分泌,从而有效减少极低出生体重儿喂养不耐受的发生。     

间歇泵奶联合非营养性吸吮治疗极低出生体重儿喂养不耐受的临床效果观察

目的：探讨间歇泵奶联合非营养性吸吮在治疗极低出生体重儿喂养不耐受中的临床效果。方法将124例收治的极低出生体重儿随机均分为对照组、实验组,对照组给予常规鼻饲,实验组给予间歇泵奶联合非营养性吸吮,比较两组患儿疗效。结果实验组喂养不耐受患儿数量显著低于对照组（P〈0.01）;联合治疗组平均住院时间、胃管留置时间也明显少于对照组（P〈0.05）。结论间歇泵奶联合非营养性吸吮治疗极低出生体重儿喂养不耐受效果显著,值得临床广泛推广。     

小剂量红霉素防治极低出生体重儿喂养不耐受的临床对照研究

目的探讨小剂量红霉素防治极低出生体重儿喂养不耐受的疗效及安全性。方法85例胎龄≤31周,出生体重<1500g,并除外消化道先天畸形的极低出生体重儿随机分为对照组和用药组,用药组于生后第2天常规给予红霉素3～5mg/kg.d-1,共6～8天。结果用药组的喂养不耐受率(34.09%)低于对照组(58.54%),差异有显著性(χ2=4.17,P<0.05)。两组达到完全经肠道喂养的时间、黄疸持续时间和每天大便次数差异均有高度显著性(P<0.01),而住院时间的差异则无显著性。两组均无心律失常的发生。用药组未出现药物相关性肝功能损害。结论小剂量红霉素防治极低出生体重儿喂养不耐受是安全有效的。     

极低出生体重儿胃肠喂养不耐受的相关因素研究

目的研究极低出生体重儿(VLBWI)胃肠喂养不耐受的相关因素,总结有利于胃肠喂养成熟的因素。方法对新生儿监护室收治的极低出生体重且痊愈出院的33例婴儿的喂养相关因素和体重增长等情况进行调查。分为喂养不耐受和耐受两组,分析喂养不耐受的相关因素;并根据开始胃肠喂养时间的早晚分为早胃肠喂养组和晚胃肠喂养组,比较两组胃肠喂养的不耐受率及其他相关指标。结果33例极低出生体重儿胃肠喂养总的不耐受率为48%(16/33)。胃肠喂养耐受和不耐受组患儿的胎龄、出生体重、开奶日龄、胃肠道营养达418.4kJ·kg-1·d-1的日龄、开始经口喂养日龄及氨茶碱的使用率间差别均有显著性意义(P<0.05)。结论VLBWI的胃肠喂养不耐受率与患儿的胎龄、出生体重、开奶日龄等因素密切相关。早期微量喂养、缓慢加奶、谨慎禁食,可促进胃肠功能成熟,提高喂养耐受性。     

极低出生体重儿营养与支持治疗50例临床分析

目的：对极低出生体重儿的营养与支持治疗进行探讨。方法将极低出生体重儿50例作为研究对象,按数字奇偶法分为两组,每组25例,两组患儿均给予常规治疗,对照组行全静脉营养支持,研究组行早期微量喂养营养支持联合静脉营养支持;对比两组患儿喂养不耐受情况以及肠外营养监测、生长发育情况。结果研究组极低出生体重儿胆红素水平显著低于对照组,肠胃营养达到标准的概率显著高于对照组,差异有统计学意义（ P＜0.05）。研究组极低出生体重儿体重恢复至出生的时间以及达到完全胃肠喂养的时间比对照组明显缩短,体重增长的速度明显快于对照组,差异有统计学意义（ P＜0.05）。研究组极低出生体重儿喂养不耐受概率比对照组明显较低,差异有统计学意义（ P＜0.05）。结论对极低出生体重儿早期微量喂养营养支持可提高患儿治疗效果,降低不耐受情况,减少黄疸发生,缩短其恢复至出生体重时间,对其生长发育起着促进的作用,值得临床应用推广。     

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.     

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.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.     

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.