阿扎司琼预防月经期女性患者腹腔镜胆囊切除术后恶心呕吐

［摘要］目的　观察阿扎司琼预防月经期女性患者腹腔镜胆囊切除术后恶心呕吐（PONV）的效果．方法　选择ASAⅠ～Ⅱ级择期全麻下行腹腔镜胆囊切除术的月经期女性患者40例,采用随机数字表法,将患者随机分为对照组和阿扎司琼组,每组20例．2组患者均采用常规的麻醉诱导和维持．手术结束前30 min阿扎司琼组静脉注射阿扎司琼10 mg,对照组予等量生理盐水50 mL．观察术后48 h内2组患者PONV的发生率及严重程度． 结果　对照组和阿扎司琼组患者术后48 h内PONV的总发生率分别为90%和35%,阿扎司琼组48 h PONV总发生率明显降低（P＜0.01）;阿扎司琼组,术后恶心呕吐Ⅳ级的发生率也低于对照组（P＜0.05）．结论　阿扎司琼可以减少月经期女性患者行腹腔镜胆囊切除术后恶心呕吐的发生率及降低其严重程度．     

托烷司琼预防腹腔镜胆囊切除术后恶心呕吐的临床观察

目的：探讨托烷司琼预防在全身麻醉下患者行腹腔镜胆囊切除术后恶心和呕吐的临床效果。方法：60例在全身麻醉下行腹腔镜胆囊切除术的患者随机分为观察组30例和对照组30例,观察组给予托烷司琼,对照组给予甲氧氯普胺,观察比较术后24h两组患者恶心和呕吐情况。结果：观察组患者发生恶心3例,呕吐2例;对照组发生恶心11例、呕吐8例,两组患者恶心呕吐总发生率分别为16.67%和63.33%,差异存在统计学意义（P〈0.05）。两组患者均未见严重并发症。结论：托烷司琼可以有效预防在全身麻醉下行腹腔镜胆囊切除术后的恶心和呕吐发生率,安全副作用小,值得临床应用推广。     

免气腹悬吊式腹腔镜与常规腹腔镜胆囊切除术术后呕吐的研究

目的：研究悬吊式免气腹腹腔镜胆囊切除术术后发生恶心、呕吐的情况。方法：随机选择包头医学院第一附属医院2009年5月至2010年5月患有胆囊炎、胆囊结石或胆囊息肉入院的患者,随机分为免气腹腹腔镜胆囊切除术组（A 组）30例、传统腹腔镜胆囊切除术组（B 组）30例。结果：术后两组恶心、呕吐发生率随时间而降低,B 组各时间段恶心、呕吐发生率均高于 A 组,在术后24 h 内两组恶心发生率差异均有统计学意义（ P ﹤0.05）,在术后12 h 内两组呕吐发生率差异均有统计学意义（ P ﹤0.05）。结论：免气腹腹腔镜胆囊切除术恶心、呕吐发生率低于传统腹腔镜胆囊切除术。     

加速康复外科理念在腹腔镜胆囊切除术中的应用

[目的]探讨加速康复外科（FTS）理念在腹腔镜胆囊切除术中的应用效果。[方法]选取106例腹腔镜胆囊切除手术患者,随机分为快速康复组（FTS组）53例和常规治疗组（对照组）53例。比较两组术后的首次排气时间、进食时间、术后下床时间及恶心呕吐和手术并发症的发生率、住院时间、住院费用等指标。[结果]与对照组比较,FTS组术后首次排气时间缩短,术后进食和下床活动时间均提前,住院时间缩短,住院费用降低（P＜0．01或 P＜0．05）。两组术后恶心、呕吐发生率及手术并发症的发生率差异无统计学意义（P＞0．05）。[结论]加速康复外科可广泛应用于腹腔镜胆囊切除。     

内关穴位按摩预防胆囊切除术后疼痛及恶心呕吐

[目的]探讨内关穴位按摩预防腹腔镜胆囊切除术（LC）后疼痛及恶心呕吐的疗效及其机制。[方法]对择期行LC手术病人400例,随机分为穴位按摩组与对照组,穴位按摩组LC围手术期接受内关穴按摩刺激,对照组围手术期未接受其他处理。[结果]穴位按摩组与对照组患者术后切口及肩部疼痛在术后1h无显著差异,术后6h、12h、24h明显减少,具有统计学意义。患者在术后24h恶心呕吐明显减少,存在统计学差异。[结论]围手术期内关穴位按摩刺激可以有效预防LC术后疼痛及恶心呕吐的发生。     

托烷司琼预防腹腔镜胆囊切除术及胆道手术术后恶心呕吐的临床观察

[目的]观察托烷司琼预防腹腔镜胆囊切除术及胆道手术术后恶心呕吐的效果.[方法]选择2011年3月-6月择期行腹腔镜胆囊切除术及胆道手术患者60例,随机将患者分为对照组和托烷司琼组,每组30例.手术结束后拔管前,对照组静脉给予0.9％氯化钠溶液5mL,托烷司琼组静脉给予托烷司琼5 mg.观察术后6、12、24、48 h每...     

加速康复外科理念护理对腹腔镜胆囊切除术后恢复的影响

目的 研究加速康复外科理念（ERAS）对腹腔镜胆囊切除患者术后消化运动功能及不良反应的影响。方法 选取2018年1～12月入住芜湖市第二人民医院普外二科择期行腹腔镜胆囊切除术患者60例,采用随机数字表法分为ERAS组与对照组,每组30例。对照组给予常规围术期护理,ERAS组在常规围术期护理路径的基础上,引入ERAS理念。观察比较两组患者手术后消化运动功能、口渴、恶心呕吐及不同时间点视觉疼痛评分的差异。结果 ERAS组患者术后恢复通气时间[（11.00±2.32）h]、[JP]进食流质时间[（11.96±1.93）h]、排便时间[（12.52±3.68）h]及下床活动时间[（12.52±1.73）h ]均优于对照组,差异有统计学意义（P<0.05）。两组患者术后不同时间点视觉疼痛评分组内及组间比较,差异有统计学意义（P<0.05）。术后恶心呕吐、口渴感患者例数少于对照组,差异有统计学意义（P<0.05）。结论 腹腔镜胆囊切除围术期患者实施ERAS,能改善术后消化运动功能,降低手术应激,加快患者康复。     

恩丹西酮防治腹腔镜胆囊切除后不良反应的临床分析

目的总结恩丹西酮预防性治疗腹腔镜胆囊切除术后恶心呕吐的临床效果。方法60例择期腹腔镜胆囊切除术者随机分为恩丹西酮组（Ⅰ组）及生理盐水组（Ⅱ组）。两组麻醉诱导及维持方法相同，在胆囊取出时分别注射恩丹西酮8mg、生理盐水5ml。术后观察病人24h恶心、呕吐情况。结果Ⅰ组恶心呕吐发生率明显小于Ⅱ组（P〈O、05）。结论恩丹西酮能有效地减少腹腔镜胆囊切除术后的恶心呕吐。     

穴位电针联合耳穴埋豆对腹腔镜胆囊切除术后恢复的影响

目的观察穴位电针联合耳穴埋豆对腹腔镜胆囊切除术后恢复的影响。方法收集2016年8月~2017年8月来我院行"腹腔镜胆囊切除术"患者152例,随机将患者分配至治疗组和对照组,每组76例。对照组患者给予常规护理,治疗组在常规护理的基础上并行穴位电针及耳穴埋豆,记录2组患者肠鸣音恢复和首次排气时间,对其作疼痛视觉模拟评分法(VAS)评分,记录术后腹胀、恶心呕吐率。结果治疗组患者术后肠鸣音恢复及首次排气时间明显短于对照组。在术后12h后,治疗组患者的疼痛明显降低,VAS评分显著低于对照组(P0.05)。治疗组患者术后腹胀、恶心呕吐率显著低于对照组。结论穴位电针联合耳穴埋豆能显著促进腹腔镜胆囊切除术后患者的恢复。     

内关穴位按摩预防胆囊切除术后疼痛及恶心呕吐

[目的]探讨内关穴位按摩预防腹腔镜胆囊切除术(LC)后疼痛及恶心呕吐的疗效及其机制。[方法]对择期行LC手术病人400例,随机分为穴位按摩组与对照组,穴位按摩组LC围手术期接受内关穴按摩刺激,对照组围手术期未接受其他处理。[结果]穴位按摩组与对照组患者术后切口及肩部疼痛在术后1h无显著差异,术后6h、12h、24h明显减少,具有统计学意义。患者在术后24h恶心呕吐明显减少,存在统计学差异。[结论]围手术期内关穴位按摩刺激可以有效预防LC术后疼痛及恶心呕吐的发生。     

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.