20例经鞘内镇痛系统注射吗啡治疗癌性疼痛疗效评估

目的观察经鞘内镇痛系统注射吗啡治疗重度癌痛的疗效及并发症。方法 20例视觉模拟评分(VAS)重度癌性疼痛患者,经鞘内镇痛系统注射吗啡。观察患者术前、术后第1,3,7和30天各时间点的VAS评分、术后第1,3,7与30天各时间点鞘内吗啡用量、不良反应发生率。结果 20例癌性疼痛患者鞘内注射吗啡后各时间点与术前比较VAS评分存在统计学差异(P0.05),第7天及第30天鞘内吗啡用量与术后第1天和第3天比较有统计学差异(P0.05),不良反应发生率降低。结论经鞘内镇痛系统注射吗啡可以有效地治疗重度癌痛,副作用少,值得推广。     

强阿片类药物对不同胃肠功能状态下的晚期中、重度癌痛患者镇痛效果的比较

目的：比较强阿片类药物对不同胃肠功能状态下中、重度疼痛的晚期癌症患者的镇痛效果。方法动态评估和随访1～2个月的有完整随访资料的104例中、重度晚期癌症疼痛患者，依消化系统源性与非消化系统源性肿瘤分组，再依大便间隔时间长短不同进一步分组，分析各组癌痛严重程度、癌痛类型、PS评分、癌痛控制状况以及日均消耗吗啡当量的差异。结果在晚期中、重度癌痛患者104例中，重度疼痛72例（69％），躯体痛74例（71％），内脏痛31例（30％），神经病理性疼痛2例（2％）。强阿片类药物疼痛控制满意79例（76％），日均消耗吗啡当量为（66．92±38．42）mg。其中消化系统源性恶性肿瘤53例（51％），非消化系统源性肿瘤51例（49％），消化系统源性与非消化系统源性恶性肿瘤患者间重度疼痛比例、镇痛治疗后PS稳定或改善比例、镇痛治疗后PS达到0～1分比例、疼痛控制满意比例以及日均消耗吗啡当量差异均无统计学意义（ P＞0．05）；而消化系统源性肿瘤患者内脏痛比例、镇痛治疗前大便时间间隔＞3d比例、用芬太尼贴剂作为主要维持用药比例均较非消化系统源性肿瘤患者明显增加（ P＜0．05）。在消化系统源性恶性肿瘤患者中，大便时间间隔≤3 d者与＞3 d者重度疼痛比例、日均消耗吗啡当量差异均无统计学意义（P＞0．05），而疼痛控制满意比例在大便时间间隔≤3 d者中较优（P＝0．011），而在非消化系统源性恶性肿瘤患者中，大便时间间隔＞3 d者重度疼痛病例比例、疼痛控制不满意比例和日均消耗吗啡当量均较大便时间间隔≤3 d组显著增多（P＜0．05）。结论晚期中、重度癌痛患者使用芬太尼透皮贴剂或口服缓释剂型强阿片类药物均可获得较满意的镇痛效果。消化系统源性与否和大便时间间隔＞3d与否可作为晚期中重度癌痛患者胃肠功能状态的简易参考指标。大便时间间隔＞3d与否是强阿片类药物镇痛疗效的影响因子。对于消化系统源性恶性肿瘤、大便时间间隔＞3d者，芬太尼贴剂作为主要维持用药是适宜选择。     

全植入式鞘内药物输注系统治疗难治性癌痛患者的镇痛疗效及其不良反应

目的:观察全植入式鞘内药物输注系统治疗难治性癌痛患者疼痛的疗效及其不良反应。方法:选择2018年6月至2020年12月华中科技大学协和深圳医院收治的41例确诊晚期恶性肿瘤伴难治性癌痛患者为观察对象,对其在常规全身麻醉或椎管内麻醉联合局部麻醉下进行全植入式椎管内药物输注系统,按照吗啡口服量300mg=静脉量100mg=硬膜外腔用量10mg=鞘内用量1mg给药。评价全植入式鞘内药物输注系统对患者的视觉模拟评分(VAS)、生活质量影响及记录其不良反应情况。结果:术前患者的VAS评分为(7.29±0.22)分,术后3d患者的VAS评分缓解至(3.78±0.15)分,疼痛程度较治疗前明显降低(t=13.21,P<0.01);全植入式鞘内药物输注系统植入术后患者疼痛缓解明显,生活质量评分较前明显升高(P<0.01),大部分患者在术后1周缓解为轻中度疼痛;31例(73.8%)患者在2周后随访疼痛程度为轻度(VAS≤3分),其余患者均为中度疼痛;随访30d,28例患者(66.7%)疼痛程度为轻度,3例患者进展为中度疼痛;植入1个月后,恶心、呕吐、便秘、尿潴留患者人数分别为6例、6例、7例、0例,植入后恶心、便秘不良反应患者较前明显减少(P<0.05)。结论:全植入式鞘内药物输注系统能快捷、有效、安全地缓解患者的癌痛程度。     

罗哌卡因联合吗啡鞘内注射对顽固性癌痛的治疗效果分析

目的 探究罗哌卡因联合吗啡鞘内注射治疗顽固性癌痛的临床效果.方法 选取2018年2月至2019年3月于本院肿瘤科住院的癌症患者160例作为研究对象,所有患者均实施罗哌卡因联合吗啡鞘内注射治疗,治疗前及治疗后2、4周,采用疼痛数字分级法(NRS)评估患者疼痛反应,同时,记录吗啡日用量,采用中文版生命质量测定量表(EORTC QLQ-C30)评估患者生命质量.结果 治疗后2、4周,患者NRS评分均明显低于治疗前(P<0.05).治疗后,患者功能领域、症状领域及总体生活质量评分均明显低于治疗前(P<0.05).结论 对顽固性癌痛患者采用罗哌卡因联合吗啡鞘内注射治疗可有效缓解患者疼痛,减少吗啡用量,提升生命质量,具有较高的临床应用价值.     

自控蛛网膜下腔吗啡镇痛治疗难治性晚期癌痛

目的观察患者自控蛛网膜下腔吗啡镇痛治疗难治性癌痛的临床效果及不良反应。方法晚期癌症患者12例,在蛛网膜下腔置管,将导管埋入皮下隧道,外接PCA泵,药盒内每100 ml 生理盐水含吗啡20mg,采用首量+连续+自控模式(LCP),首剂量吗啡0.5mg,维持量吗啡20-30 μg/h, PCA为20 μg/次,锁定时间20 min。结果镇痛时间最短为10日,最长为32d,治疗前12例VAS评分均>5分,治疗后1-14d 10例疼痛完全缓解,均为0分,有2例为1-2分,14d后有9例仍为0分,吗啡平均用量为(1.3±0.5)mg/d。不良反应有恶心、呕吐、尿潴留、皮肤瘙痒,发生率以第1周多见,两周过后各种不良反应明显下降,无感染发生。结论患者自控蛛网膜下腔吗啡镇痛用于晚期癌痛治疗, 药物剂量小、镇痛效果确切,是难治性晚期癌痛WHO三阶梯药物治疗以外的一种良好的辅助及补救方法。     

阿霉素背根神经节注射治疗晚期癌痛临床研究

目的：探讨介入下经椎旁阿霉素背根神经节注射治疗晚期癌痛的可行性。方法：42例椎体转移瘤患者在X线介入下经椎旁背根神经节注射0．33％阿霉素1～1．5mL/节,观察术后1天、1周、1月、3月、6月视觉模拟评分（VAS）及疗效评估,术前、术后1周吗啡用量及相关并发症。结果：术后1天、3月VAS评分较术前有显著降低（P〈0．05）、术后1周、1月较术前有非常显著降低（P〈0．01）;术后1天、1周、1月、3月、6月疗效优良率分别为59．5％、83．3％、76．2％、58．5％、33．3％;吗啡用量术后较术前有非常显著降低（P〈0．01）。结论：经椎旁背根神经节注射阿霉素治疗晚期癌痛效果确切,操作简单、并发症少,中、远期效果不稳定。     

鞘内植入镇痛输液港治疗晚期癌痛的效果观察

目的：探讨鞘内植入镇痛输液港治疗晚期癌痛的效果。方法：选取2021年11月-2022年10月河北医科大学第四医院收治的80例晚期癌痛患者作为研究对象，根据随机数字表法分为试验组与对照组，各40例。对照组采用静脉输注吗啡治疗，试验组采用鞘内输注吗啡治疗。比较两组镇痛效果、疼痛情况、并发症发生情况、生活质量、睡眠情况。结果：试验组镇痛总有效率高于对照组，差异有统计学意义(P<0.05)。治疗前，两组视觉模拟评分法(VAS)评分比较，差异无统计学意义(P>0.05)；治疗后，试验组疼痛分低于对照组，差异有统计学意义(P<0.05)；试验组疼痛发作次数少于对照组，差异有统计学意义(P<0.05)。治疗前，两组生活质量和睡眠指数评分比较，差异无统计学意义(P>0.05)；治疗后，试验组生活质量评分高于对照组，睡眠指数评分低于对照组，差异有统计学意义(P<0.05)。试验组并发症发生率低于对照组，差异有统计学意义(P<0.05)。结论：鞘内植入镇痛输液港治疗晚期癌痛的效果显著，且安全性高，可提高患者的生活质量和睡眠质量。     

吗啡联合罗哌卡因硬膜外自控镇痛在晚期癌痛治疗中的应用

目的评价吗啡联合罗哌卡因硬膜外自控镇痛（PCEA）对晚期癌痛的临床疗效。方法晚期癌痛患者39例,采用PCEA方法用于镇痛,配方为0．075％～0．125％罗哌卡因100ml,加吗啡10～30mg、氟哌利多5mg、地塞米松10mg,锁定每次注液量及间隔时间。记录并统计治疗后的VAS、镇静评分（Ramsay）、生活质量评分（QOL）及不良反应发生率。结果癌痛完全缓解33例（84．6％）,部分缓解6例（15．4％）,缓解率为（100．0％）。治疗前后疼痛程度差异有统计学意义（P〈0．01）,患者治疗后生活质量较治疗前明显改善（P〈0．05）,不良反应明显少。结论PCEA治疗晚期顽固性癌痛疗效确切,方便、安全,且能增强镇静和抗焦虑作用,改善癌症患者的生活质量。     

规范化护理方案在改善癌性疼痛患者疼痛中的作用

目的：探讨规范化护理方案在改善癌痛患者疼痛中的作用。方法利用便利抽样的方法选取2014年1月至2015年1月于我院肿瘤科就诊的癌性疼症患者60名，然后采用自身前后对照的两阶段实验方案，即阶段1在患者入院后的第1天至第12天进行常规癌性疼痛护理，阶段2为第13天至第24天在常规护理的基础上进行规范化护理，并观察疼痛控制障碍、最痛评分、疼痛持续时间、自我效能等指标。结果患者在第2阶段末的疼痛控制障碍总分（1．85±0．80）、最痛评分（3．84±1．30）、平均疼痛评分（2．55±1．15）、疼痛持续时间[（3．60±1．45） h]、吗啡日用量[（73．17±22．10） mg]、自我效能感总分（73．87±10．73），均显著优于患者在阶段1中接受的常规护理，差异有统计学意义（P＜0．05）。规范化护理干预后的疼痛控制障碍、最痛评分、平均疼痛评分、疼痛持续时间等均与患者的自我效能感呈负相关（P＜0．05），而吗啡日用量与患者的自我效能感呈正相关（P＜0．05）。结论规范化护理能够增强患者的自我效能感，有效地促进患者的控制疼痛，改善了患者的身心状态。     

微量吗啡鞘内注射用于高龄患者全髋置换术后镇痛的观察

鞘内吗啡作为术后镇痛己广泛地应用于临床,但对80岁以上高龄患者鞘内注射微量吗啡的研究未见报道。鉴于高龄患者痛阈升高和对麻醉药物的敏感性增加,2008年6月-2009年11月,我们选取了以往研究认为鞘内镇痛效果不明显的微剂量吗啡0．05mg作为高龄患者的术后镇痛剂量,观察到这种剂量的吗啡鞘内注射对高龄患者具有安全有效的镇痛作用,现报告如下。     

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.