急性脑卒中后继发顽固性呃逆患者90例临床分析

目的分析急性脑卒中后继发顽固性呃逆相关因素。方法回顾分析90例急性脑卒中继发顽固性呃逆患者的临床资料。结果 90例急性脑卒中并发顽固性呃逆者,重症患者77例(85.6%),发生消化道出血34例(37.8%),肺内感染46例(51.1%),电解质紊乱(低钙、低镁)50例(55.6%)。结论急性脑卒中后继发顽固性呃逆与卒中部位,卒中严重程度,肺内感染,上消化道出血,低钙低镁等离子紊乱相关。     

急性脑卒中后继发顽固性呃逆患者90例临床分析

目的分析急性脑卒中后继发顽固性呃逆相关因素。方法回顾分析90例急性脑卒中继发顽固性呃逆患者的临床资料。结果 90例急性脑卒中并发顽固性呃逆者,重症患者77例(85.6%),发生消化道出血34例(37.8%),肺内感染46例(51.1%),电解质紊乱(低钙、低镁)50例(55.6%)。结论急性脑卒中后继发顽固性呃逆与卒中部位,卒中严重程度,肺内感染,上消化道出血,低钙低镁等离子紊乱相关。     

急性脑外伤术后顽固性呃逆与低血钙关系观察

目的探讨急性脑外伤术后顽固性呃逆与血钙浓度的关系。方法收集该院综合ICU病房2003年急性脑外伤术后出现顽固性呃逆病人23例(呃逆组),随机抽取同年无顽固性呃逆相似病种病人30例作为对照组,测定两组病人血钙值并进行比较。结果呃逆组病人血钙值(0.96±0.23)mmol/L与对照组血钙值(1.21±0.31)mmol/L相比较有显著统计学差异(P<0.05)。结论急性脑外伤术后病人顽固性呃逆的发生与血钙浓度密切相关。     

脑卒中后顽固性呃逆与血钙、血镁关系的探讨

脑卒中后常伴发呃逆，多呈顽固性，临床治疗上颇为棘手。国内外曾有报道顽固性呃逆主要系低钙血症，其次是低镁血症所致。我科自2001年6月～2003年1月对60例住院后出现顽固性呃逆的脑卒中患常规作血清钙、镁检查，发现患普遍存在低钙血症、低镁血症，给予静脉补钙、补镁治疗后疗效显，现分析探讨如下。     

慢性肾脏病3-5D期患者血镁浓度与腹主动脉钙化的关系

目的 探讨慢性肾脏病(CKD)患者血镁浓度与腹主动脉钙化(AAC)之间的关系及干预钙化的措施.方法 选取CKD3-5D期患者共67例,收集患者临床资料,根据是否检出AAC分为钙化组和无钙化组,比较两组间指标差异,分析AAC的高危因素.结果 15例有AAC(22. 4％) ,52例无 AAC(77. 6％);钙化组年龄、血钙浓度、血磷浓度、钙磷乘积高于无钙化组(P<0.05),钙化组血镁水平低于无钙化组(2. 2 ± 0. 2 vs 2. 4 ±0. 4) mg/dl(P<0. 05);性别、体质量、血清白蛋白、碱性磷酸酶、全段甲状旁腺素(iPTH)、25羟维生素D、胆固醇和三酰甘油两组间均未见明显差异;二分类逻辑回归分析结果显示:年龄、血磷浓度、血镁浓度和钙磷乘积均为AAC独立的影响因素,血镁经过年龄、性别、磷、钙磷乘积和iPTH校正后差异有统计学意义(OR=0. 072,95％ CI: 0.006 ～0. 836 mg/dl,P=0. 035).结论 高龄、高磷及高钙磷乘积患者易发生AAC,低镁是除年龄、血磷和钙磷乘积外 AAC独立危险因素,提高体内血镁浓度可能有利于延缓 AAC进展.     

慢性肾脏病患者血镁与心血管事件相关性分析

目的 了解慢性肾脏病(CKD)患者血镁变化及其影响因素,探讨与心血管事件的相关性.方法 选取381例CKD 3~5期患者,包括住院患者293例,门诊维持性血液透析(MHD)患者88例.根据血镁水平分为低血镁组、非低血镁组,心脏彩超评估心脏瓣膜有无钙化.对患者进行3~21个月,中位数13个月的随访,记录有无心血管事件发生.结果 381例CKD患者中,CKD 3~4期50例,CKD 5期331例.低镁血症121例(31.76%),血镁正常245例(64.30%),高镁血症15例(3.94%).248例患者行心脏彩超检查,心脏瓣膜钙化74例,无心脏瓣膜钙化174例.低镁血症组患者心脏瓣膜钙化的发生率明显升高(P=0.001).两组患者年龄、性别构成无明显差别.低血镁组患者血红蛋白、血钙、血磷、血白蛋白水平明显下降,甲状旁腺激素明显升高,差异均有统计学意义(P<0.05).两组患者三酰甘油、胆固醇水平无明显差别.血镁水平与血红蛋白、血钙、血磷、质子泵抑制剂及利尿剂使用相关.对263例患者进行3~21个月不等的随访,发生心血管不良事件68例.COX分析显示心血管事件的发生与低血镁、心脏瓣膜钙化有关(P<0.05).结论 CKD患者低镁血症发生率高,可能参与心血管事件的发生与发展.     

顺铂化疗对血清镁、钾、钙的影响

观察以顺铂为主的化疗方案对恶性肿瘤患者血清镁、钾、钙的影响 .方法 :将含顺铂的化疗方案的患者分为实验组 ,无顺铂的为对照组 ,观察两组及组中化疗前后血清镁、钾、钙的浓度变化情况 .结果 :(1)实验组化疗后的血清镁明显低于化疗前 (P <0 0 1) ,且明显比对照组的低 (P <0 0 1) .(2 )实验组化疗后有 19例出现低镁血症 (4 7 5 % ) ,对照组仅 1例发生 (5 8% ) ,两组低镁血症的发生率有显著差异 (P <0 0 1) .(3)实验组低镁发生率随消化道反应程度增高而增加 .(4 )血清钾、血清钙的均值于治疗前后及两组间均无差异 (P >0 0 5 ) ,低钾血症和低钙血症的发生率两组间亦无差异 (P >0 0 5 ) .结果表明 :使用DDP化疗时 ,不仅要注意补钾 ,更应重视镁的补给 .     

补钙治疗脑卒中顽固性呃逆28例疗效观察

脑卒中常伴发呃逆 ,多呈顽固性 ,治疗较为困难。国内曾有报道脑卒中顽固性呃逆主要系低钙血症所致。据此 ,笔者对出现顽固性呃逆的脑卒中病人常规做电解质检查 ,发现患者普遍存在电解质紊乱 ,尤以低钙血症为著。给予补充钙剂后 ,取得满意疗效 ,现报告如下。1　临床资料1.1　一般资料　本组 2 8例中男性 18例 ,女性 10例 ,年龄 46～ 78岁 ;脑梗死 12例 ,脑出血 15例 ,蛛网膜下腔出血 1例 ,均符合全国第 4届脑血管病学术会议通过的诊断标准及经头颅CT证实。发病后 12 h～ 10 d出现呃逆、其中 2 4～ 96h以内出现者 2 1例。呃逆持续时间均在 48…     

低钙血症对全身炎症反应综合征患者预后的影响

目的　探讨低钙血症对全身炎症反应综合征(SIRS)患者预后的影响。方法　对收治的118例SIRS患者,在入ICU第2天测定血钙值并进行病理生理学及慢性健康状况评分(APACHEII) ,分为:①正常血钙组及低钙血症组:统计APACHEII评分值、多器官功能障碍综合征(MODS)发生率及病死率;②存活组及死亡组:统计两组血钙水平变化。结果　①正常血钙组与低钙血症组APACHEII评分比较差异有高度显著性(P <0 .0 1) ;②存活组血钙异常率低于死亡组,血钙水平明显升高(P均<0 .0 1)。结论　血钙水平反映SIRS患者的病情和预后,可作为判断SIRS预后简易可靠的指标之一。     

重度颅脑损伤并发低钙血症的机制及对预后的影响

目的 对重度颅脑损伤并发低钙血症的病例进行分析,探讨其发生机制及低钙血症对患者预后的影响.方法 回顾性分析158例重度颅脑损伤患者的临床及血清钙资料,将其分为血钙正常组和低钙血症组.同期120例健康查体者为对照组.数据处理采用X2检验.结果 (1)重度颅脑损伤组与对照组低钙血症发生率比较有显著性差异(P＜0.05);(2)重度颅脑损伤患者中,并发低钙血症组与血钙正常组的抽搐发生率及死亡率比较差异均极显著性(P＜0.01).结论 重度颅脑损伤患者伤后早期易发生低钙血症,合并低钙血症患者死亡率明显增加,临床应及时检测早期血清钙,发现异常及时纠正,从而降低死亡率.     

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.