扩髓及髓腔内固定引发肺脂肪栓塞病理变化的实验研究

目的：探讨临床股骨骨折内固定或人工全髋关节置换术中扩髓，髓腔内固定导致的肺脂肪栓塞的病理变化。方法：精雄性SPF大鼠14只。分为实验组及对照组，每组7只，对照组除扩髓髓腔内固定外，皆同实验组。分别测定两组不同时间的动脉血气，血像，实验后取大鼠左肺行髓过氧化物酶（MPO）检查，大鼠右肺采用肺灌注后行HE染色，光镜下观察。计数骨碎片及骨髓脂肪组织栓塞的肺小动脉及毛细血管数，白细胞栓子形成的肺内血管数，伴有血管周围水肿（“水肿袖”）的血管数，肺泡水肿，肺泡扩张破坏面积，由此计算出肺损伤分数.结果：（1）运用因气显示两组动物在扩髓髓腔内固定后即150min时，Po2差异显著（P＜0．05）；(2)MPO差异显著（P＜0．05）。（3）肺损伤分数两组差异显著（P＜0．05）。结论：扩髓髓腔内固定导致肺小动脉及毛细血管 内骨碎片及骨髓脂肪组织的机械栓塞，以及肺内血管白细胞栓子形成， 中性粒细胞，巨噬细胞浸润等炎性改变，并由此引起肺损伤。     

北京地区养殖果子狸SARS冠状病毒调查

目的模拟临床肺血管严重充血的病因,建立弥漫性肺出血幼龄大鼠模型以期有助于对新生儿肺出血的研究。方法 24只幼龄大鼠随机分为2组,每组12只。实验组皮下注射0．1％肾上腺素,每日2次,第一天剂量每次0．2 mg/kg,第2天每次0．3 mg/kg,以此逐渐增加至第7天 0．8 mg/kg。对照组以同样容量及方法注射生理盐水。实验组每死亡一只大鼠,对照组即随机处死一只大鼠。肉眼观察肺出血情况,将结果分为5级。Ⅰ级正常肺,Ⅱ级肺水肿,Ⅲ级点状肺出血, Ⅳ级局灶性肺出血,Ⅴ级弥漫性肺出血,并作光镜及电镜观察。结果平均用药天数5．24±1．82 d。肉眼观察实验组10只大鼠肺呈Ⅴ级改变,Ⅲ、Ⅳ级改变各一只,对照组12只大鼠肺均为Ⅰ级 (RIDIT分析,x2=18．00,P<0．01)。光镜见Ⅴ级肺有多处小叶融合性出血,出血区肺泡内充满红细胞,间质也出血,小血管及毛细血管重度扩张、瘀血。电镜示Ⅴ级肺肺泡Ⅰ型上皮局部崩解, 气血屏障变薄及全层断连,肺泡腔内充满红细胞。结论采用肾上腺素皮下注射可成功制作严重肺血管充血所致弥漫性肺出血幼龄大鼠模型。     

高氧致CLD新生大鼠肺组织肾素-血管紧张素系统的动态变化及其意义

目的 观察高氧致CLD新生大鼠肺组织血管紧张素转换酶（ACE）、血管紧张素Ⅱ（AngⅡ）及Ⅰ型胶原含量的动态变化。方法 足月新生Wistar大鼠120只，随机分为实验组和对照组。各60只。实验组将足月新生wistar大鼠（连同母鼠）生后即置于有机玻璃氧舱内持续吸入高浓度氧（FiO2：0．9）14、21d造成高氧肺损伤模型，对照组吸入空气。每组分别于实验开始后的第1、3、7、14和21天随机选取6只麻醉后处死。肺组织采用酶联免疫吸附法（ELISA）测定Ⅰ型胶原的含量，用日产7170全自动生化分析仪测定ACE的活性，用放免法测定AngⅡ的含量。用逆转录聚合酶链反应（RT—PCR）检测肺组织ACE、AngⅡ、Ⅰ型胶原的动态变化并同时观察肺组织形态学变化。结果 两组肺组织ACE、AngⅡ及Ⅰ型胶原含量及mRNA表达在实验组第1、3及7天与对照组比较差异无统计学意义（p〉0．05）第14天明显升高，第21天达高峰（p〈0．05，p〈0．01）。肺组织形态学改变：实验组第1天同对照组，第3d肺泡壁毛细血管扩张，肺间隔水肿。肺间隔及肺泡腔内有中性粒细胞浸润，第7天部分肺泡腔变狭长，肺间隔增宽，肺间质细胞增多，第21天正常肺泡结构消失，残留肺泡直径明显缩小。结论 高氧致CLD新生大鼠肺组织ACE、AngⅡ和Ⅰ型胶原含量及mRNA表达在高氧后14、21d明显高于对照组。与肺组织形态学改变一致。     

股骨干骨折扩髓腔髓内钉固定对凝血机能和肺换气功能的影响

目的：探讨股骨干骨折扩髓与不扩髓髓内钉固定对凝血机能和肺换气功能的影响。方法：28例股骨干骨折分别采用扩髓（RFN）和不扩髓（UFN）髓内钉固定，在手术开始前至术后48h内7个不同时间段监测血小板、纤维蛋白原、凝血酶原时间（PT）和部分凝血活酶激活时间（APTT）的变化，并动脉血气分析，计算肺泡－动脉血氧分压递差[P(A-a DO2)].结果：RFN组，扩髓后血小板开始减少，P（A－a DO2)升高（P＜0．05）；髓钉插入后30min纤维蛋白原减少，PT、APTT延长（P＜0．05）；UFN组表现出同样的趋势；两组各各项指标均在24－48h内恢复正常；动脉血气分析各时间段和组间差异无显性（P＞0．05）。结论：扩大髓腔的髓内钉固定，和不扩髓相比，并不影响肺换气功能，对凝血机能的影响是一个自限过程，单纯股骨干骨折，可耐受扩髓固定手术。     

扩髓带锁内钉治疗胫骨骨折150例

目的为了总结扩髓带锁髓内钉治疗胫骨骨折的经验。方法对150例胫骨骨折患者采用扩髓带锁髓内钉内固定治疗的方法。结果全组150例经随访1-3a，依据Johner-wruh评分标准确定优132例，良14例,中、差各2例，其中感染4例；无脂肪栓塞和骨筋膜室综合症，无髓钉与锁钉断裂现象。结论扩髓带锁内钉内固定有固定牢靠和并发症少等优点。     

骨折合并脂肪栓塞的护理

脂肪栓塞是骨科的严重并发症，一旦发生病情发展很快，可引起患者死亡。脂肪栓塞一般指在成人骨干骨折处髓腔内血肿张力过大，骨髓被破坏，脂肪滴进入破裂的静脉窦内，随血流进入肺组织。引起栓塞，或进入脑组织，引起脂肪栓塞等，造成患者意识障碍，昏迷、呼吸困难、呼吸窘迫，低氧血症及皮肤点状出血多特征的临床急性综合征。需早发现积极救治。     

涂有rhBMP-2的克氏针对长管状骨骨折愈合作用的影响

目的：观察涂有重组人骨形态发生蛋白-2（recombinant human bone morphogenetic protein 2,rhBMP-2）克氏针对骨折愈合影响。方法：36只新西南大白兔,随机分成两组,在其双侧胫骨制作骨折模型,扩髓,实验组胫骨骨折髓腔内插入rhBMP-2/左消旋聚乳酸（poly-D,L-lactide,PDLLA）涂层的克氏针固定骨折,对照组髓腔内插入单纯PDLLA涂层的克氏针固定骨折,术后分别于4、8、12周处死大白兔,取胫骨骨折标本进行骨形态学分析和生物力学测定,比较两组骨折处新骨形成、生物力学情况。结果：实验组新骨形成优于对照组;实验组断裂应力、最大应力高于对照组（P<0.05）。结论：rhBMP-2、PDLLA混合后涂抹在克氏针表面来固定骨折,随着PDLLA降解,缓慢释放rhBMP-2,促进骨折愈合,缩短骨折愈合时间。     

下肢骨折并发脂肪栓塞综合征的观察与急救护理

下肢长骨骨折,包括股骨干骨折与胫腓骨骨折。由于严重骨折创伤,骨髓组织及破裂的脂肪细胞内的脂肪小体受机械挤压进入附近破裂而开放的静脉中;或由于髓内钉的固定、髓腔内操作及手术挤压,使局部压力增大,脂肪细胞或骨髓组织内的脂肪小滴被直接挤入附近开放的静脉中，从而形成脂肪栓塞综合征（fat embolism syndrom，FES）。栓塞的主要病变多发生在肺，其次是脑。其主要特征是进行性低氧血症、呼吸衰竭，弥漫性血管内凝血是致死的主要原因。由于其发病急骤、病势凶险，所以死亡率较高，是骨折创伤后威胁患者生命的严重并发症之一。我科于2003年2月～2007年9月，共收治下肢骨折并发FES的患者6例，临床获得一定的护理经验，现报道如下：     

扩髓或不扩髓绞锁髓内钉治疗胫骨骨折的疗效比较

目的 :探讨扩大髓腔或不扩大髓腔对胫骨干骨折愈合的影响及可能机制。　方法 :采用扩髓或不扩髓绞锁髓内钉治疗闭合性胫骨骨折 37例 ,并进行临床随访和分析。　结果 :31例得到随访的患者骨折均愈合 ,愈合时间(14.9± 2 .6 )周。对于胫骨中段及中下段骨折 ,不扩髓的绞锁髓内钉固定可以明显缩短骨折愈合时间 (P <0 .0 5 ) ,最终治疗效果根据Johner Wruhs标准进行评分 ,优 2 8例 ,良 3例。　结论 :应用绞锁髓内钉治疗胫骨骨折可以获得优良的临床疗效。对于胫骨中下段骨折 ,推荐使用对胫骨髓内血供影响较小的不扩髓绞锁髓内钉固定。     

扩髓交锁髓钉治疗老年股骨干萎缩性骨折32例分析

目的：探讨扩髓交锁髓内钉治疗老年股骨干萎缩性骨折的效果。方法：对32例股骨干萎缩性患者采用扩大髓腔的交锁髓内钉内固定。结果：经0．5—2年随访,骨折全部愈合,关节功能明显改善。结论：扩大髓腔的交锁髓内钉内固定是治疗老年股骨干萎缩性骨折的理想方法。     

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.     

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.