血必净注射液联合持续血液净化在重症脓毒症患者中应用对炎症反应水平的影响

目的 探讨血必净注射液联合持续血液净化在重症脓毒症患者中应用对炎性因子、肾功能等指标的影响。方法 回顾性选取我院2014年2月～2018年10月期间因重症脓毒症需住院治疗患者140例,按入院时间分为观察组和对照组,每组70例,观察组予以血必净注射液联合持续血液净化治疗,对照组予以持续血液净化治疗,疗程为1周,比较两组治疗后炎性因子、肾功能、多器官功能障碍（MODS）发生率、脓毒症休克发生率。 结果 观察组治疗后白细胞介素-6（IL-6）和肿瘤坏死因子-α（TNF-α）水平均低于对照组,血肌酐（Scr）、血尿素氮（BUN）水平低于对照组,MODS发生率和脓毒症休克发生率低于对照组,差异均有统计学意义（P＜0.05）。 结论 血必净注射液联合持续血液净化治疗重症脓毒症临床效果较好,减轻炎症反应,改善肾功能,降低MODS和脓毒症休克发生率,保护多器官功能,推荐临床推广应用。     

血必净注射液对重症肺炎患者的影响研究

目的 观察血必净注射液对重症肺炎患者炎性因子IL-6、IL-8、肿瘤坏死因子α(TNF-α)及C反应蛋白(CRP)、白细胞计数、二氧化碳分压(PCO2)和氧分压(PO2)的影响.方法 62例患者随机分为2组,对照组30例予常规治疗,治疗组32例在常规治疗基础上加用血必净注射液静脉滴注.对比两组治疗效果及两组血清炎性因子IL-6、IL-8、TNF-α含量以及CRP、白细胞计数、PCO2、PO2水平.结果 治疗组总有效率为93.75%,对照组为73.33%,差异有统计学意义(P＜0.05).两组治疗效果总体分布不同,差异有统计学意义(P＜0.05).治疗后3 d及治疗后7 d治疗组IL-6、IL-8、TNF-α及CRP水平较治疗前均明显降低,差异有统计学意义(P＜0.05).治疗后3 d及治疗后7 d治疗组以上四项均较对照组明显降低,差异有统计学意义(P＜0.05).治疗后3 d及治疗后7 d治疗组白细胞计数、PCO2、PO2水平较治疗前均明显降低,差异有统计学意义(P＜0.05).治疗后3 d及治疗后7 d治疗组以上三项较对照组明显降低,差异有统计学意义(P＜0.05).结论 血必净治疗重症肺炎疗效显著,可抑制早期炎性因子释放,下调炎性递质水平,改善微循环,促进炎症吸收,使已受损的组织脏器得到修复,起到改善患者预后的作用.     

血必净注射液联合持续血液净化在重症脓毒症患者中的应用及对炎症反应水平的影响

目的探讨血必净注射液联合持续血液净化在重症脓毒症患者中应用对炎性因子、肾功能等指标的影响。方法回顾性选取我院2014年2月～2018年10月期间因重症脓毒症需住院治疗患者140例,按入院时间分为观察组和对照组,每组70例,观察组予以血必净注射液联合持续血液净化治疗,对照组予以持续血液净化治疗,疗程为1周,比较两组治疗后炎性因子、肾功能、多器官功能障碍(MODS)发生率、脓毒症休克发生率。结果观察组治疗后白细胞介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)水平均低于对照组,血肌酐(Scr)、血尿素氮(BUN)水平低于对照组,MODS发生率和脓毒症休克发生率低于对照组,差异均有统计学意义(P0.05)。结论血必净注射液联合持续血液净化治疗重症脓毒症临床效果较好,减轻炎症反应,改善肾功能,降低MODS和脓毒症休克发生率,保护多器官功能,推荐临床推广应用。     

血必净注射液对脓毒症合并急性肾损伤患者的肾功能及血清IL-6、TNF-α的影响

目的：探讨血必净注射液对脓毒症合并急性肾损伤（AKI）患者的肾功能及血清IL-6、TNF-α的影响。方法38例脓毒症合并AKI患者随机分为两组,对照组予常规治疗,观察组在此基础上联合应用血必净注射液,比较治疗前后肾功能及血清IL-6、TNF-α的变化及需要血液净化治疗的比例和死亡率的差异。结果治疗7 d后,观察组肾功能指标Scr、BUN及炎症指标IL-6、TNF-α水平均明显低于对照组,差异有统计学意义（P＜0.05）;观察组接受血液净化治疗的比例为21.05%,明显低于对照组的47.37%,差异有统计学意义（P＜0.05）;两组患者死亡率比较差异无统计学意义（P＞0.05）。结论血必净注射液可降低脓毒症AKI患者血清IL-6、TNF-α的水平,改善患者肾功能指标,对肾功能具有明显的保护作用。     

乌司他丁血必净联合治疗对脓毒血症凝血功能及全身炎性反应影响研究

目的研究乌司他丁、血必净联合治疗对脓毒血症凝血功能及全身炎性反应的影响。方法选取该院2010年2月‐2012年2月脓毒血症患者80例,随机抽签分为观察组与对照组,每组40例,对照组患者给予常规静脉滴注血必净注射液,观察组在对照组治疗的基础上给予乌司他丁治疗,比较两组患者治疗前后活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、纤维蛋白原(FIB)及血小板(PLT)等凝血功能指标变化情况,比较治疗前后肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)及白细胞介素-8(IL-8)等炎性因子水平。结果观察组APTT、PT水平较对照组显著较低(P0.05),FIB、PLT水平较对照组显著较高(P0.05);观察组TNF-α、IL-6、IL-8炎性因子水平较对照组显著较低(P0.05)。结论乌司他丁与血必净联合应用治疗脓毒血症患者效果显著,患者凝血功能得到有效改善,全身炎性反应显著降低,对患者的器官有较好的保护作用,应予以临床应用推广。     

前列腺素E1联合血必净注射液对Ⅳ期糖尿病肾病患者尿蛋白及炎性因子的影响

目的 观察并探讨前列腺素E1(PGE1)注射液联合血必净注射液对Ⅳ期糖尿病肾病(DN)患者尿蛋白及炎性因子的影响.方法 将2013年1月至2015年6月入选的132例Ⅳ期DN患者分为观察组(67例)和对照组(65例),两组均予基础治疗,对照组加用血必净注射液,观察组在对照组基础上加用PGE1注射液,疗程均为14 d,比较治疗前后两组肾功能、尿蛋白及炎性因子变化情况.结果 治疗后,两组血清尿素氮(BUN)、血清肌酐(Scr)、24 h尿微量总蛋白(24 h Upro)、24 h尿微量清蛋白(24 h mAlb)、微量尿蛋白排泄率(UAER)均较治疗前显著下降(P＜0.05);观察组治疗后BUN、24 h Upro、24 h mAlb、24 hUAER数值显著低于对照组,差异有统计学意义(P＜0.05).两组治疗后肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)、C反应蛋白(CRP)水平均较治疗前明显下降(P＜0.05),超氧化物歧化酶(SOD)明显上升(P＜0.05);观察组治疗后TNF-α、IL-6、CRP数值均明显低于对照组(P＜0.05),SOD明显高于对照组(P＜0.05).观察组、对照组治疗期间药物不良反应比较,差异无统计学意义(P＞0.05).结论 PGE1联合血必净注射液治疗Ⅳ期DN可有效减轻肾脏炎症反应、减少尿蛋白、改善肾功能.     

血必净注射液对脓毒症患者全身炎症反应的影响

目的探究血必净注射液对脓毒症患者全身炎症反应的影响。方法选取本院2012年8月至2017年5月收治的60例脓毒症患者作为研究资料,随后将全部患者分成两个组:观察组(30例)与对照组(30例),两组患者均给予抗感染、对症支持治疗;同时观察组给予注射用血必净治疗,对两组患者的治疗效果进行对比。结果两组治疗前后IL-6及TNF-α、CRP水平比较:两组患者治疗前的IL-6和TNF-α、CRP水平进行对比,无显著的统计学差异(P0.05)。在治疗后,2组IL-6及TNF-α、CRP均明显下降(P0.05),观察组患者改善更为明显(P均0.05)。结论对于脓毒症患者给予注射用血必净治疗能够有效减轻全身炎症反应,值得推广应用。     

血府逐瘀汤在老年骨关节多发伤多脏器保护中的应用研究

目的:观察血必净注射液对严重多发伤患者脏器功能损害的保护作用。方法:2007年5月-2013年11月收治的76例老年骨关节多发伤患者随机分为对照组和观察组,各38例。两组均给予急诊多学科救治,观察组加用血必净注射液100ml加生理盐水100ml静脉滴注,2/d,疗程7d,观察两组治疗前后凝血功能、С-反应蛋白含量变化,肝肾功能。结果:与治疗前比较,治疗第7天观察组凝血功能明显改善,С-反应蛋白含量显著降低(P0.05),且观察组上述指标改善优于对照组(P0.05)。结论:血必净注射液通过改善凝血功能、降低炎性介质的释放来保护、改善老年骨关节多发伤患者重要脏器的功能。     

血必净联合抗凝治疗急性呼吸窘迫综合征的临床观察

目的研究血必净联合抗凝治疗急性呼吸窘迫综合征(ARDS)的临床疗效。方法选取我院2013年11月至2015年11月ARDS患者86例,随机分为观察组与对照组两组,每组43例,给予对照组患者抗凝治疗,观察组在对照组治疗基础上联合血必净治疗,比较两组患者治疗前后气道峰压(PAP)、氧合指数(PaO_2/FiO_2)水平变化,肿瘤坏死因子α(TNF-α)、C反应蛋白(CRP)、白介素6(IL-6)、白介素8(IL-8)等炎性因子水平变化以及凝血酶原时间(PT)、活化部分凝血活酶时间(aPTT)、纤维蛋白原(Fbg)、血小板计数(PLT)等指标变化,比较两组患者机械通气时间、ICU住院时间及死亡率。结果治疗后观察组PAP水平较对照组显著较低,PaO_2/FiO_2水平较对照组显著较高(P0.05);观察组TNF-α、CRP、IL-6、IL-8等炎性因子水平较对照组显著降低(P0.05);观察组患者机械通气时间和ICU平均住院时间较对照组显著较短(P0.05);观察组患者死亡率为16.28%较对照组34.88%显著较低(P0.05)。结论血必净联合抗凝治疗ARDS临床疗效显著,患者的炎性因子水平显著降低,凝血功能得到改善,肺通气功能提高,死亡率降低。     

血必净注射液对脓毒症患者的炎性反应和凝血功能的影响

目的：对比分析血必净注射液对脓毒症患者炎性反应和凝血功能的影响,以指导临床治疗。方法：纳入 ICU 住院治疗的脓毒症患者80例,随机均分为两组各40例：对照组予常规综合治疗,观察组加用血必净注射液。持续治疗1周后,对比两组治疗前后外周血炎性反应指标,包括肿瘤坏死因子-α（TNF-α）、白细胞介素（IL）-8、IL-10、淋巴细胞亚群比例（CD4+/CD8+）、NK 细胞水平;凝血功能指标,包括血小板计数（PLT）、凝血酶原时间（PT）、纤维蛋白原（FIB）、活化部分凝血活酶时间（APTT）。结果：治疗前两组患者外周血炎性反应指标及凝血功能接近,差异无显著意义。治疗后所有患者 IL-10、CD4+/CD8+、PLT、FIB 均有上升;TNF-α、IL-6、APTT、PT 均有下降;对照组 NK 细胞水平出现下降,观察组出现上升,上述指标与治疗前相比,差异有显著性意义;治疗后观察组上述指标均优于对照组,差异有显著性意义。结论：血必净注射液有助于下调脓毒症患者促炎因子水平、提升抗炎因子水平、提升免疫功能、纠正凝血功能紊乱,这对改善脓毒症患者预后有积极意义。     

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.