肠外营养和胃肠喂养治疗极低出生体重早产儿的临床观察

目的:探讨出生后早期全肠外营养(TPN)和胃肠喂养(EN)对极低出生体重早产儿的疗效.方法:将35例患儿随机分为2组.TPN组20例经静脉给予全营养混台液;EN组15例,经管饲间歇母乳或早产儿配方乳喂养.观察两组患儿7 d内体重变化、血浆蛋白、微量元素、血.脂、胆红素等指标.结果:TPN组3 d～7 d每日热能供给低于EN组,两组患儿7 d后恢复出生体重者分别占53.3%、80%(P＜0.05),平均每日体重增长18.5 g/kg±5.7 g/kg、25.5 g/kg±9.4 g/kg(P＜0.05).患儿7 d的前白蛋白、白蛋白、总蛋白及微量元素等均较出生时明显改善,两细.之间比较无统计学意义.结论:早期营养可为极低出生体重早产儿提供能量和氮量,但早期胃肠道喂养优点明显,可替代TPNT和部分静脉营养.     

极低体重儿的营养维持25例临床分析

目的提出简单易行的静脉营养及合理喂养方法，以提高极低体重儿（出生体重≤１５００ｇ）营养维持水平。方法回顾性总结２５例极低体重儿营养维持经验。结果本组出生体重在９１５～１５００ｇ，平均１３６２±１５８．７８ｇ。生后４～１５ｄ，平均９ｄ起体重开始增加。每天增重１９～４６ｇ，平均增重２８．１９±５．８９ｇ，超过了同胎龄儿宫内生长速度。存活率占本院同期极低体重儿的６１％。结论掌握适当的开奶时机，尽早喂奶，必要时辅以静脉营养可降低与喂养有关的并发症，降低极低体重儿病死率，促进生长发育。     

早期微量喂养联合静脉营养对早产极低出生体重儿的临床效果观察

目的 观察早期微量喂养联合静脉营养对早产极低出生体重儿的临床疗效.方法 对60例早产极低出生体重儿随机分为观察组(n=30)和对照组(n=30),观察组自生后1～3天开始微量喂养,对照组采用静脉补充能量.生后3天再喂养经口喂养.根据肠道耐受情况渐增奶量,期间能量不足部分由静脉营养补充.观察两组体重增长、呕吐、腹胀、胃内潴留发生情况及达到全程喂养时间.结果 观察组体重增长优干对照组,达到完全胃肠喂养需要时间短,呕吐、腹胀、胃内潴留发生情况少,两组比较有显著性意义(P<0.05).结论 早期微量喂养联合静脉营养能提高早产极低出生体重儿对喂养的耐受性改善胃肠道动力,能尽早适应胃肠喂养,有利于疾病的康复.     

部分静脉营养在极低出生体重儿中的临床应用

目的 探讨部分静脉营养对极低出生体重儿体重增长及并发症的影响.方法 将58例极低出生体重儿分成治疗组(26例)和对照组(32例).两组均及早胃肠喂养,监测并防治多种并发症.治疗组于生后3-5天开始静脉营养.对照组给予一般综合治疗.结果 治疗组在应用营养液期间体重增长每日(22.56±1.99)g,对照组同期体重增长每日(11.61±2.32)g,两组比较有显著性差异(P=0.0011).而两组血糖电解质紊乱、黄疸、呼吸暂停、晚期代谢性酸中毒、继发感染的发生情况均无显著性差异(P＞0.05).结论 部分静脉营养能促进极低出生体重儿体重增长,应用得当不会增加并发症的发生.尽早胃肠喂养对极低出生体重儿是有益的.     

早产极低体重儿两种静脉营养方式的对比研究

目的比较两种静脉营养方法的效果。方法将35例不能耐受全肠道静脉营养的符合条件早产极低出生体重儿随机分为两组,实验组采用早期静脉营养法,对照组采用传统静脉营养法,记录两组患儿生后1周内营养摄入及2周内体重增长情况、过渡到全肠道喂养时间、静脉营养相关并发症,并于生后第1、7天采静脉血测血清前白蛋白。于生后6个月测量身长和体重。结果实验组生后1周内每日摄入的非蛋白热卡量、2周内平均每日增重均高于对照组(P<0.05);相同日龄血清前白蛋白检测结果:第1天实验组与对照组无差异,第7天实验组[(86±10.8)mg/L]高于对照组[(72±10.9)mg/L];实验组与对照组过渡到全肠道喂养时间无差异;两组均无静脉炎、血栓形成、氮质血症、高脂血症及胆汁淤积的发生,两组呼吸暂停、高血糖、高胆红素血症的发生率差异无显著性(P>0.05)。随访生后6个月的体重,实验组高于对照组,但无统计学意义(P>0.05)。结论早产极低出生体重儿采用早期静脉营养比传统静脉营养摄入热卡多,体重增长快;可以避免早产儿早期营养不良的发生;对胃肠功能的恢复无明显作用;不会增加静脉营养相关并发症的发生。     

36例极低出生体重儿部分静脉营养临床分析

目的:了解部分静脉营养对极低出生体重儿体重增长及降低并发症所起的作用.方法:将70例极低出生体重儿分成治疗组(36例)和对照组(34例).治疗组均经外周静脉用微电脑输液泵24 h内均匀输入静脉营养液,对照组仅给予葡萄糖及一般综合治疗,两组均给予早期微量喂养.结果:治疗组平均每天体重增长(19.5±6.52)g;对照组平均每天体重增长(12.24±4.65)g,两组比较,有显著性差异(P＜0.05).治疗组并发症发生率为22.2%(8/36),对照组为82.3%(28,34),两组比较,有显著性差异(P＜0.05).结论:部分静脉营养对极低出生体重儿非常重要,能很好地促进体重增长,降低其并发症的发生率,提高生存质量和存活率.     

静脉营养在低出生体重儿中的临床应用

目的 静脉营养对低出生体重儿体重增长及预防并发症发生的作用.方法 将70例低出生体重儿分成观察组(35例)和对照组(35例),治疗组于出生后第1～2天开始全静脉营养(TPN)或部分静脉营养(PPN),对照组以常规方法进行治疗.结果 观察组出生后5～6天体重开始增长,每天增长10～30 g,平均(21.66±5.31)g,对照组出生后10～14天起体重开始增长,每天增加9～15 g,平均(11.31±4.69)g,两组比较有显著性差异(p＜0.05),观察组并发症发生率11.4%(4/35),对照组并发症发生率54.3%(19/35),两组并发症发生率经统计学处理有显著性差异(p＜0.05),观察组治愈率82.9%,对照组治愈率48.6%,经统计学处理两组有显著性差异(p＜0.05).结论 静脉营养对低出生体重儿非常重要,可促进体重增长,降低并发症发生率,提高存活率,提高生存质量,促进生长发育.     

极低出生体重儿40例实施早期微量喂养的体会

目的：探讨极低出生体重儿实行早期微量喂养的耐受性、体重增长情况。方法：极低出生体重儿40例随机分为两组。在常规静脉营养基础上治疗组25例生后24～72小时内予以微量喂养,对照组15例于生后1周内予以喂养。对照喂养中胃肠不耐受发生率、体重达到或超过出生体重。结果：两组相比,早期微量喂养组缩短了达到全胃肠道喂养的时间,体重增长优于对照组。结论：早期微量喂养是极低出生体重儿最理想的喂养方式。     

微量肠内喂养预防早产极（超）低体重儿胃肠外营养相关性胆汁淤积

月的探讨微量肠内喂养降低胎龄28-32周及体重≤1．5kg的早产极低体重儿及超低体重儿胃肠外营养相关性胆汁淤积（PNAC）发病率的效果。方法60例胎龄28-32周及体重≤1．5kg的早产极低体重儿在生后即分配到微量喂养组（持续喂养组）或静脉营养输注组（静脉营养组）研究其PNAC发生率。结果微量肠内喂养组早产儿PNAC发生率20．7％;静脉营养组早产儿PNAC发生率46．7％,两组早产儿PNAC的发生率差异有统计学意义。结论微量肠内喂养较静脉营养组能降低胎龄28～32周及体重≤1．5kg的早产极低体重儿PNAC发生率。     

极低体重儿的营养维持25例临床分析

目的 提出简单易行的静脉营养及合理喂养方法，以提高极低重儿（出生体重≤１５００ｇ）营养维持水平。方法 回顾性总结２５例极低体重儿营养维持经验。结果 本组出生体重在９１５￣１５００ｇ，平均１３６２±１５８．７８ｇ。生后４￣１５ｄ，平均９ｄ起体重开始增加。每天增重１９￣４６ｇ，平均增重２８．１９±８９ｇ，超过了同胎龄儿宫内生长速度。存活率占本院同期极低体重儿的６１％。结论 掌握适当的开奶时机，尽早喂奶     

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.     

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.