酚妥拉明、阿拉明和西地兰联合治疗肺炎并心衰54例效果观察

为探讨小儿肺炎合并心力衰竭的治疗方法 ,将 96例婴幼儿肺炎合并心衰随机分为两组 ,治疗组在综合治疗基础上应用酚妥拉明、阿拉明和西地兰联合治疗 ,对照组给予抗生素、镇静、吸氧、西地兰等综合治疗。结果治疗组治愈率 94.4%、平均心衰纠正时间 19.6± 3 .18h ,均优于对照组的治愈率 78.6 %和平均心衰纠正时间 2 6 .4± 4.5 2h(P <0 .0 5 ) ,提示酚妥拉明、阿拉明和西地兰联合治疗肺炎合并心衰疗效较好 ,值得临床推广应用     

小儿支气管肺炎合并心力衰竭的护理干预应用效果观察

目的 探讨小儿支气管肺炎合并心力衰竭的护理干预应用效果.方法 选择90例小儿支气管肺炎合并心力衰竭患儿,按照随机数表法将其分为观察组和对照组,各45例.所有患者均给予对症治疗,观察组患者同时实施综合性的护理干预,对照组患者实施常规护理干预,观察两组患者的应用效果.结果 经治疗后,观察组患者的总有效率(95.56%)明显高于对照组(80.00%),两组比较差异具有统计学意义(P<0.05);观察组患者的心衰纠正时间和住院时间[(34.78±10.45)h、(9.38±3.07)d]明显短于对照组[(47.17±12.09)h、(11.54±4.23)d],两组患者比较差异具有统计学意义(P<0.05).结论 小儿支气管肺炎合并心力衰竭的护理干预应用效果显著,能够提高治疗有效率,缩短患者的心衰纠正时间和住院时间,值得在临床上推广和应用.     

纳洛酮治疗急性一氧化碳中毒46例疗效观察

目的　观察纳洛酮治疗急性一氧化碳中毒的临床疗效。方法　将 93例急性一氧化碳中毒患者随机分为对照组 ,采用常规治疗 ;治疗组在常规治疗的基础上给予纳洛酮 0 .8mg静注 ,每小时 1次 ,直到清醒或用药至 48小时为止。结果　中重度中毒患者治疗组平均促醒时间分别为 1.5± 0 .3和 9.2± 2 .6小时 ,低于对照组的 3 .6± 0 .8和 12 .8± 4.1小时 (P <0 .0 5～ 0 .0 1)。结论　纳洛酮治疗急性一氧化碳中毒疗效显著     

凝乳辅助治疗婴幼儿秋季腹泻疗效观察

目的 :观察凝乳对婴幼儿秋季腹泻的治疗效果。方法 :1 1 7例秋季腹泻患儿 ,随机分为 2组 ,治疗组 5 7例 ,对照组 60例 ,治疗组在常规治疗基础上加用凝乳按需喂养 ,对照组则口服思密达及妈咪爱 ,详细记录退热时间、止泻时间、脱水纠正时间及住院天数。结果 :治疗组与对照组止泻时间分别为 2 5 0± 1 49d、4 98± 1 2 9d(t=9 63 9,P <0 0 0 1 ) ;脱水纠正时间 1 45± 0 76d、1 69± 0 93d(t=2 0 71 ,P <0 0 5 ) ;退热时间 1 2 2± 0 5 4d、1 3 6± 0 5 6d(t=0 740 ,P >0 0 5 ) ;住院天数 4 870± 1 5 0d、6 5 9± 2 2 8d(t=4 794,P <0 0 0 1 )。结论 :凝乳辅助治疗秋季腹泻 ,可明显缩短止泻时间 ,脱水纠正时间及住院天数 ,但不能缩短退热时间。     

充血性心衰大鼠严格限钠后肾素-血管紧张素系统的变化

目的　观察充血性心衰大鼠严格限钠后循环与局部肾素 -血管紧张素系统 (RAS)的变化 .方法　将充血性心衰大鼠随机分为 3组 :心衰组、心衰限钠组、心衰补钠组 ,假手术大鼠为对照组 ,用放射免疫分析法和原位杂交技术分别测定各组血浆和心肌血管紧张素 (Ang ) ,醛固酮 (Ald)含量及心肌血管紧张素原 m RNA表达水平 .结果　心衰限钠组血浆 Ang ,Ald含量 [(2 2 5± 2 0 ) ng· L- 1 和 (4 76± 6 2 )μg·L- 1 ]及心肌 Ang 含量 [心房 (2 0 .1± 4.5 ) ng· g- 1 ,心室(2 7.3± 5 .9) ng· g- 1 ]显著高于心衰组 [(180± 2 9) ng· L- 1 ,(2 48± 5 8) μg· L- 1 及 (17.5± 3.6 ) ng· g- 1 ,(2 0 .1± 3.7)ng· g- 1 ](P<0 .0 5 ,P<0 .0 1) ,心室肌 Ang原 m RNA表达水平 (12 .6± 2 .3)也显著高于心衰组 (8.6± 1.7) (P<0 .0 5 ) ,血钠较心衰组下降 5 % (P<0 .0 5 ) ;心衰补钠组心肌血管紧张素原 m RNA表达水平与心衰组无显著差别 ,其余指标与对照组无显著差别 .结论　心衰后限钠进一步激活循环和局部RAS,加重钠水潴留     

莪术油加西瓜霜联合治疗婴幼儿手足口病临床观察

目的　为观察莪术油加西瓜霜联合治疗婴幼儿手足口病的治疗效果。方法　选择 6 0名 8个月 - 3岁患手足口病的婴幼儿按就诊顺序分为治疗组和对照组各 30例。治疗组应用莪术油葡萄糖注射液静滴加西瓜霜喷剂喷口腔。对照组应用病毒唑静滴及常规口腔护理治疗。结果　治疗组平均退热时间为 1.2 2± 0 .4 4天 ,对照组为 2 .15± 0 .72天 ,差异显著 (P <0 .0 1) ;口腔溃疡及皮疹消失时间 ,治疗组为 2 .8± 0 .714天 ,对照组为4 .2 7± 1.1天 ,差异非常显著 (P <0 .0 1)。结论　莪术油加西瓜霜联合治疗婴幼儿手足口病疗效满意 ,能有效地缩短病程 ,且无明显不良反应     

氨力农对重度充血性心力衰竭患者血浆内肿瘤坏死因子的作用

目的 :研究氨力农对重度充血性心力衰竭 (CHF)的肿瘤坏死因子 (TNFα)的影响 ,探讨氨力农治疗重度充血性心力衰竭的机制。方法 :重度CHF6 5例随机分为氨力农组 (35例 ) ,对照组 (30例 )观察两组病人在治疗前后血浆TNFα及心脏排血指数 (CI)的变化。结果 :心脏排血指数 (CI) :氨力农组、对照组治疗前后对比明显升高分别是为 (1.86± 0 2 1,2 .17± 0 .4 2 )和 (1.88± 0 .2 2 ,2 .18± 0 .5 8)P <0 .0 5有显著性差异 ;治疗前两组比较 (1.86± 0 .2 1,1.88± 0 .2 2 )P >0 .0 5无显著性差异 ;治疗后两组比较 (2 .17± 0 .4 2 ,2 .18± 0 .5 8)P >0 .0 5无显著性差异。肿瘤坏死因子 (TNFα)在两组治疗前后比较有明显下降 ,氨力农组 34.2± 10 .88降到 2 4 .6±6 .6 3,对照组 33.4± 10 .4 6降到 2 8.2± 7.84均P <0 .0 5有显著性差异 ;两组治疗前 (34.2± 10 .88,33.4±10 .4 6 ,P >0 .0 5 )无显著性差异 ;治疗后氨力农组与对照组 (2 4 .6± 6 .6 3,2 8.2± 7.84 )P <0 .0 5有显著性差异 ,氨力农组TNFα水平明显低于对照组。结论 :氨力农治疗重度CHF除了改善血流动力学 ,纠正心衰 ,降低TNFα外 ,可能还通过其他途径抑制或减少重度CHF的TNF2水平 ,达到调节CHF细胞因子的作用。     

钠摄入量对心力衰竭大鼠心脏肾素-血管紧张素系统与心钠素的影响

目的　观察钠摄入量对心力衰竭大鼠心脏局部肾素-血管紧张素系统与心钠素的影响 .方法　经动 -静脉分流术造成大鼠充血性心衰模型 ,分为心衰组、心衰限钠组、心衰补钠组 ,假手术大鼠为对照组 ,用放射免疫分析法和原位杂交技术分别测定各组血浆和心肌血管紧张素 、心钠素含量及心肌血管紧张素原 m RNA表达水平 (吸光度 A值 ) ,同时检测心功能 .结果　心衰限钠组心房和心室血管紧张素 含量(2 0 .1± 4 .5 )和 (2 7.3± 5 .9) ng· g- 1、血管紧张素原 m RNA表达 (6 .4± 1.2 )和 (12 .6± 2 .3)显著高于心衰组 (17.5± 3.6 )和 (2 0 .1± 3.7) ng· g- 1 ,(6 .2± 1.9)和 (8.6± 1.7) (P<0 .0 5 ,P<0 .0 1) ,心室心钠素 (42 3± 6 8) ng· g- 1 也显著高于心衰组 (337± 86 ) ng· g- 1 (P<0 .0 5 ) ,心房心钠素 (6 7± 19)μg· g- 1显著低于心衰组 (85± 15 ) μg· g- 1 (P<0 .0 5 ) ;心衰补钠组心房和心室血管紧张素原 m RNA表达水平、心室血管紧张素 和心钠素与心衰组无显著差别 ,心房血管紧张素 与对照组无显著差别 ,心房心钠素 (10 1± 17) μg· g- 1 显著高于心衰组 (P<0 .0 1) .结论　心衰时不同钠摄入量可通过改变心脏局部肾素 -血管紧张素系统与心钠素的平衡状态在心衰发展进程中发挥作用     

老年人急性左心衰抢救体会

目的 :了解老年急性左心衰患者的抢救效果。方法 :回顾性分析了抢救的 97例老年急性左心衰患者 ,平均年龄(6 8± 7.5 )岁 ,治疗时取端坐位、吸氧、镇静、强心、利尿、扩血管、抗泡沫及血液透析等。结果 :85例心衰迅速纠正 ,用药至症状缓解平均时间 (1.0± 0 .2 )h ,用药至症状消失平均时间 (2 .6± 0 .4 )h ,抢救成功率 87.6 % ;死亡 12例 ,住院病死率 12 .4 %。结论 :上述抢救措施在老年人急性左心衰抢救中成功率较高     

胺碘酮治疗心衰合并心律失常患者临床分析

目的 探讨胺碘酮对心力衰竭合并心律失常患者的疗效.方法 方便选取该院2014年6月—2016年6月收治的168例心衰合并心律失常患者分别进行常规治疗和胺碘酮治疗,每组84例,观察2组疗效.结果 观察组总有效率为94.1%,明显优于对照组77.4%(P<0.05);治疗后观察组心率(76.8±7.1)次/min、收缩压(126.2±11.3)mmHg、舒张压(78.5±6.1)mmHg明显优于对照组(P<0.05).结论 胺碘酮治疗心衰合并心律失常可有效纠正患者心律失常,缓解心衰症状,提高心功能,值得临床应用.     

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.     

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.     

Electro-Acupuncture Combined with the Trigger Point Needle-Embedding for Treatment of Primary Trigeminal Neuralgia in 31 Cases

In recent years, the author of this essay has applied electro-acupuncture combined with the trigger point needle-embedding for treatment of primary trigeminal neuralgia in 31 cases, yielding satis- factory results as reported in the following.     

Investigation of Matrix Metalloproteinase -1, 2 and tissue inhibitor of matrix metalloproteinases-1 in Endometriosis

Objective： To explore the role of matrix metalloproteinase-1,2 （MMP-1, MMP-2） and tissue inhibitor of matrix metalloproteinases-1 （TIMP-1） in endometriosis. Methods： The eutopic and ectopic endometria from 40 subjects suffering from endometriosis and regular.endometria from 40 subjects （excluding endometriosis） were collected and examined by in situ hybridization technology and western blot assay. Results： Both expressions of MMP-1 and -2 were stronger in ectopic endometrium and eutopic endometrium than in normal endometrium. On the contrary, the expression of TIMP-1 in ectopic endometrium and eutopic endometrium was lower. The differences were significant （P 〈 0.01 ）. Moreover, there was no relationship among the expressions of MMP-1, 2 and TIMP-1 in ectopic endometrium. Conclusion： The expressions of MMP-1, 2 and TIMP-1 lose balance and lack of periodic changes in ectopic endometrium , which explains the biological invasive behavior of endometriosis. It was suggested-that regulating the balance between the MMPs and TIMP-1 should be an ideal therapeutic target to endometriosis.     

Shi Da-zhuo (史大卓) —An outstanding cardiologist of integrative medicine

Prof. SHI Da-zhuo, Ph.D., male, was born on March 20, 1960. Prof. SHI entered the Ph.D. program in 1990 at the China Academy of Chinese Medical Sciences under the supervision of Prof. CHEN Ke-ji, majoring in the treatment of cardiovascular diseases. After receiving his Ph.D. degree in 1993, Prof. SHI started working at the Cardiovascular Center in Xiyuan Hospital affiliated to China Academy of Chinese Medical sciences.     

Persist in and Carry Forward the Integrative Medical Research——Speech at the 6th National General Congress of Chinese Association of Integrative Medicine by Academician CHEN Zhu,Minister of Ministry of Health

The 6th National General Congress of Chinese Association of Integrative Medicine （CALM） was convened at 19-20, April 2008 in Beijing. Academician CHEN Zhu, the minister of Ministry of Health indicated at the congress that the integration of Chinese and Western medicine is very well in keeping with the situation of our country and the general rule of development in medical science; and as a good integration of Chinese medicine and Western medicine, it is mutually beneficial and advantageous to both of them. Seeing the creativity shown in integrative medical investigation in theoretic and methodological sides, we should and must persist in and develop it.