术前膀胱功能训练对腰椎间盘脱出症术后尿潴留的影响

目的 评估术前膀胱功能训练对预防腰椎间盘切除术后尿潴留发生的效果.方法 将273例腰椎间盘突出症行间盘切除术患者随机分为试验组和对照组,试验组采用术前膀胱功能训练,对照组采用常规护理.比较两组预防术后尿潴留的效果.结果 术后第1次排尿时间,试验组和对照组分别为(3.15±4.68)min和(14.44±6.27)min,试验组第1次排尿时间短于对照组(P＜0.01).试验组与对照组术后尿潴留、导尿的发生率分别为12.9%、8.2%,试验组尿潴留导尿发生率高于对照组(P均＜0.01).结论 术前膀胱功能训练能有效预防腰椎间盘摘除术术后尿潴留的发生率和导尿率.     

尿动力学检查在诊断下尿路梗阻中的临床意义

目的 :探讨增生前列腺切除后仍有 1 0 %～ 1 5%的患者下尿路梗阻症状无明显改善的原因。方法 :采用 Dantec Menuet尿动力学测定仪 ,按标准方法对 78例由于前列腺增生症 (BPH)导致排尿异常的患者行尿流率、充盈期膀胱压力 -肌电图及排尿期压力 -流率测定。结果 :在 78例临床诊断为 BPH的病人中 ,59例 (75.6% )由 BPH引起膀胱出口梗阻 ;1 4例 (1 7.3% )由 BPH导致逼尿肌无力与逼尿肌不稳定 ;5例 (7.1 % )由神经源性病变引起排尿异常。结论 :尿动力学测定对 BPH手术适应证、手术时机选择、预测治疗效果和提高手术质量具有重要的临床意义     

同期经尿道手术治疗浅表性膀胱癌合并良性前列腺增生的临床观察

目的 探讨经尿道膀胱电切术(transurethral resection of bladder,TURBt)同期进行尿道前列腺切除术(transurethral resection of prostate,TURP)治疗的浅表性膀胱癌合并良性前列腺增生(benign prostate hyperplasia,BPH)的临床效果.方法 回顾性分析本院手术治疗的109例浅表性膀胱癌合并BPH患者的资料情况,其中采取TURBt同期行TURP治疗的患者57例(联合组)、仅采取TURBt资料52例(对照组),对比两组患者的手术效果就围手术期指标.结果 联合组的手术时间、术中出血量、术后留置导尿管时间、术后住院时间均显著的长于对照组患者,且差异具有统计学意义(P＜0.05);术后联合组的国际前列腺症状(international prostate symptom score,IPSS)评分、生存质量(quality of life score,QOL)评分、残余尿量(residual urine volume,PVR)测定值均显著的低于对照组患者(P＜0.05),联合组的Q max测定值显著地高于对照组患者(P＜0.05);术后24个月,联合组和对照组的肿瘤复发率差异无统计学意义(P＞0.05),联合组的尿道狭窄发生率(3.51％)显著低于对照组患者(17.31％),且差异具有统计学意义(P＜0.05).结论 TURBt同期TURP治疗的浅表性膀胱癌合并BPH虽然手术时间、出血量较多及术后恢复时间长较单纯TURBt,但是具有显著的改善患者术后排尿情况、生存质量及降低尿道狭窄发生率的作用.     

前列腺增生症患者的尿动力学分析(附357例临床报告)

目的:观察前列腺增生症(BPH)患者手术前后的尿动力学指标的变化,探讨尿动力学检查(UDS)对BPH诊断、术前评估、术后疗效评价的价值.方法:357例BPH患者术前均有严重的排尿梗阻症状,国际前列腺症状评分(I-PSS)为(27.8±3.5)分,UDS检查均提示BPH诊断.其中17例患者UDS检查发现伴有膀胱尿道功能性疾患(膀胱逼尿肌收缩力异常与不稳定收缩、尿道外括约肌收缩强度过高等),包括低顺应性膀胱5例、逼尿肌收缩无力6例、逼尿肌反射亢进1例、逼尿肌外括约肌协同失调8例、不稳定膀胱7例、逼尿肌排尿后持续低幅度收缩1例、尿道外括约肌痉挛2例.术后对所有患者进行随访及UDS检查.结果:术后1个月随访,340例术前UDS检查无膀胱尿道功能性疾患患者排尿通畅,无梗阻症状,I-PSS (2.3±1.5)分,UDS指标基本恢复正常(最大尿流率、平均尿流率、最大尿流率时间、总尿流时间、尿量及尿流曲线改善等);17例术前存在膀胱尿道功能疾患患者,术后排尿仍不满意,I-PSS(26.8±2.1)分,UDS示膀胱尿道功能疾患仍存在,膀胱与尿道外括约肌的异常收缩无显著改变,但尿道膀胱镜检查未发现机械性梗阻.结论:手术治疗能解除大部分BPH患者的机械性梗阻症状,但对功能性梗阻患者效果可能不明显,手术前后有必要进行UDS检查,以进一步明确诊断、选择手术时机并对术后疗效进行正确的评估.     

经尿道汽化电切治疗前列腺增生症104例临床观察

目的 探讨经尿道汽化电切术(TUEVAP)治疗前列腺增生症(BPH)的效果.方法 对104例BPH患者,施行TUEVAP术.结果 手术时间30～ 95 min,术中无1例输血,无电切综合征(TURS)发生,术后3～5d拔出导尿管,排尿通畅.随访30～90d,国际前列腺症状评分(I-PSS)由术前(28.1±2.1)分术后下降至(8.2±0.6)分(P＜0.01),最大尿流率由术前的平均(5.2±0.5)ml/s,术后升至(16.4±1.7)ml/s(P ＜0.01).结论 TUEVAP具有操作简单、止血效果好、并发症少、安全性高、恢复快、疗效显著等优点.     

经尿道等离子前列腺剜除术治疗大体积良性前列腺增生

目的评价经尿道前列腺等离子腔内剜除(PKEP)治疗大体积良性前列腺增生(BPH)的疗效和安全性.方法50例前列腺重量>100g患者行PKEP治疗,对患者术前、术后的国际前列腺症状评分(IPSS)、最大尿流率(Qmax)、剩余尿量(PVR)进行比较,分析手术时间、术中、术后血红蛋白和血清钠的变化、前列腺切除重量、膀胱冲洗时间、留置导尿管时间、住院天数及手术并发症.术后随访3个月.结果手术时间123~163 min,平均134.2 min,切除的标本组织重量96~147 g,平均118.5 g.术中视野清晰,出血极少,均无输血;整个手术经过平稳,无前列腺电切综合征和其它严重并发症发生.术后留置尿管3~5d,平均3.6d;术后膀胱冲洗时间2.6 d (1~4 d);术后住院3~7d,平均5.3d.术后随访3个月,排尿梗阻症状明显改善,IPSS由术前的23.5±3.6降至5.6±1.6(p<0.01).Qmax由术前的7.1±0.5升至25.5±4.9(p<0.01).PVR由44.1±8.7降至6.4±2.6(p<0.01).结论 PKEP治疗大体积前列腺增生高效、微创、安全、并发症少、住院时间短,是治疗大体积前列腺增生的一种安全而有效的方法.     

硬膜外自控镇痛泵治疗前列腺摘除术后膀胱痉挛的临床观察

目的 研究硬膜外自控镇痛泵(PCEA)对前列腺摘除术后膀胱痉挛的缓解作用以及对并发症的影响.方法 93例前列腺增生症(BPH)患者行耻骨上经膀胱前列腺摘除术后,根据自愿原则分为两组并采用不同的术后治疗方法.PCEA组52例,对照组41例.记录两组患者术后48 h膀胱痉挛次数、每次膀胱痉挛持续时间及术后肛门排气时间.结果 PCEA组缓解膀胱痉挛作用明显优于对照组( P ＜0.01);两组术后胃肠功能恢复差异无统计学意义( P ＞0.05).结论 前列腺摘除术后采用PCEA可有效地缓解膀胱痉挛症状,减轻患者痛苦,对老年患者减少术后并发症、安全度过围手术期有着积极的作用.     

术中膀胱造瘘低压灌注对前列腺增生患者的手术效果及并发症的影响

目的探讨术中膀胱造瘘低压灌注对前列腺增生(BPH)患者的手术效果及并发症的影响,为治疗BPH提供较好的微创手术方法。方法选择2011年2月-2012年5月新疆医科大学第六附属医院泌尿外科需手术治疗的62例BPH患者,其中36例(试验组)行低压(膀胱灌注压力为30cmH2O)灌注下经尿道四区分割法双极等离子体前列腺部分剜切术(FPKRP),26例(对照组)常规压力(膀胱灌注压力为60cmH2O)灌注下行FPKRP。观察并比较两组手术时间、术中出血量、术后留置导尿管时间及手术前后前列腺症状评分(IPSS)、生活质量评分(BPHQLS)、国际前列腺生活质量评分(ZPQoL)、剩余尿量(RUV)、最大尿流率(Qmax)的差异。结果试验组患者术后24h内拔出膀胱造瘘管,两组导尿管均在术后3～5d予以拔除,排尿通畅,术后患者5～7d出院。病理检查回报均符合前列腺结节样增生改变。术后随访3个月,试验组1例失访(因其它疾病死亡)。试验组手术时间短于对照组,术中出血量低于对照组,差异有统计学意义(P<0.05)。试验组和对照组术后RUV值较术前明显降低,而Qmax值较术前明显提高,差异有统计学意义(P<0.05)。试验组泌尿系感染发生率低于对照组,差异有统计学意义(P<0.05),两组术后尿道狭窄、尿失禁发生率差异无统计学意义(P>0.05)。两组术后IPSS、IPQoL较术前均明显降低,差异有统计学意义(P<0.05)。试验组术后IPSS低于对照组,而IPQoL与对照组比较差异无统计学意义(P>0.05),两组术后BPHQLS得分均得到提高,差异有统计学意义(P<0.05)。两组疾病维度与满意度提高最为明显,其次为生理、社会及心理维度,但试验组与对照组术后各维度比较差异无统计学意义(P>0.05)。结论低压灌注无前列腺电切综合征(TURS)的发生,既保证切割视野清晰,又保证膀胱低压充盈,提高患者耐受性,增加安全性。     

经尿道前列腺双极等离子切除术治疗高危良性前列腺增生症的疗效观察

目的 探讨经尿道前列腺双极等离子切除术(PKRP)治疗高危良性前列腺增生症(BPH)的临床效果和手术安全性.方法 采用PKRP治疗38例高危BPH患者,并对疗效进行分析.结果 手术时间40～120 min,平均60 min.切除前列腺组织15～80 g,平均47 g,术中未发生前列腺电切综合征,术后留置导尿管2～7 d,拔除导尿管后所有患者排尿症状均明显改善,4例患者出现暂时性轻度尿失禁.术后随访3～6个月,前列腺症状国际评分(IPSS)由术前的(25.4±6.6)分降至(8.6±4.2)分,最大尿流率(Qmax)由术前的(7.6±1.1) ml/s上升至术后(18.6±3.0)ml/s,差异均有统计学意义(t值分别为13.24和21.22,P＜0.05).结论 PKRP是一种值得推广的,能治疗高危BPH患者的方法,具有安全度大、疗效好等优点.     

两种电极行经尿道前列腺切除术(附178例报告)

目的:探讨良性前列腺增生症(BPH)的有效治疗方法.方法:采用片状电极行经尿道前列腺汽化电切(TUEVP)加经尿道前列腺电切术(TURP)联合治疗BPH患者178例.结果:手术时间30～130min,平均68min,切除前列腺重量8～62g,平均20.6g.无电切综合症发生.106例随访6月～2年,IPSS由术前26.5±2.0下降至术后7.4±0.3(P＜0.01),最大尿流率由术前平均(5.6±0.4)ml/s升至术后(16.5±1.8)ml/s(P＜0.01).结论:TUEVP加TURP联合治疗BPH可综合两者优点,改用片状电极行TUEVP,避免铲状电极的不足,提高了切割速度,减少了并发症,疗效显著,安全性高,是治疗BPH的有效方法.     

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.