笑气吸入联合利多卡因及米索前列醇应用于人工流产的临床观察

目的：探讨笑气吸入联合利多卡因及米索前列醇对人工流产术的镇痛作用及宫颈松弛度等临床效果。方法：将180例宫内妊娠40d～65d，年龄24岁～40岁的妇女分为观察组和对照组各90例。观察组术前半小时舌下含服米索前列醇0.2mg。术中宫颈注射2％利多卡因5mL。同时嘱受术者吸入笑气两大口。观察两组的镇痛效果、宫颈松弛、术中出血量。结果：观察组的镇痛效果、宫颈松弛度均较对照组效果好，且术中出血量较对照组少（P〈0．01），不良反应发生率无差异（P〉0．05）。结论：笑气联合利多卡因与米索前列醇用于人工流产术中镇痛效果明显。     

不同给药途径的米索前列醇配伍宫血宁在无痛人工流产术中的应用

目的：探讨宫血宁对无痛人工流产的效果。方法：在笑气人工流产术中，米索前列醇分别以舌下和阴道方式给药，配伍（实验组）或不配伍（对照组）宫血宁联合笑气用于无痛人工流产，观察宫颈扩张情况，宫缩幅度、术中出血量及术后出血时间。结果：试验组和对照组宫颈扩张差异无统计学意义（P〉0．05）其它指标实验组均优于对照组（P〈0．01）。结论：宫血宁可明显提高米索前列醇舌下和阴道用药联合笑气人工流产术效果。     

笑气在人工流产手术中的临床疗效观察

目的：探讨米索前列醇、利多卡因联合笑气吸入在手术期间是否起到明显的镇痛作用以及对受术者的具体影响,以揭示在人工流产手术中应用米索前列醇、利多卡因联合笑气进行镇痛的可行性。方法：选择我院2006年6月-2010年6月因各种原因自愿要求终止妊娠,妊娠时间为4-8周,孕囊为5-40mm,无用药禁忌证的妊娠妇女968例。根据知情同意原则分为单纯使用米索前列醇、利多卡因组及加用笑气吸入组,各484例,进行人工流产手术,观察临床效果。结果：米索、利多组术中镇痛效果好363例（75．0％）,有效97例（20．04％）,差24例（4．96％）;米索、利多联合笑气组镇痛效果好421例（86．98％）,有效53例（10．95％）,差10例（2．07％）,两组比较,差异有统计学意义（P〈0．05）。结论：米索前列醇、利多卡因联合笑气在人工流产手术中的镇痛效果显著。     

不同麻醉方式及给药途径对人工流产术镇痛效果影响的研究

目的探讨静脉缓慢推注丙泊酚联合阴道后穹窿放置米索前列醇、笑气吸入联合阴道后穹窿放置米索前列醇、利多卡因联合阿托品宫颈旁局部阻滞麻醉三种不同的麻醉方式及给药途径在人工流产术中的镇痛效果。方法随机选择在曹妃甸区妇幼保健院妇产科门诊就诊的360例早孕自愿接受人工流产术者,将这360例孕妇随机分成四组,每组90例。分别为A组丙泊酚联合米索前列醇组,B组笑气联合米索前列醇组,C组利多卡因联合阿托品组,D组对照不采取任何干预措施,观察各组的镇痛效果。结果A、B、C三组镇痛效果、宫颈松弛程度、人工流产综合征的发生率,结果差异有统计学意义（P〈0．05）,A组静脉缓慢推注丙泊酚联合阴道后穹窿放置米索前列醇效果最佳。结论静脉缓慢椎注丙泊酚联合阴道后穹窿放置米索前列醇应用于人工流产术镇痛效果最佳;笑气吸入联合阴道放置米索前列醇用于人流工流术产效果次之;利多卡因联合阿托品宫颈旁局部阻滞麻醉用于人工流产术效果一般。     

米索前列醇联合利多卡因在人工流产术中的作用

目的观察舌下含服米索前列醇联合利多卡因宫颈旁注射用于人工流产术中的效果,以选择最佳的人工流产方法。方法将170例早孕拟行人工流产术的妇女,随机分为A组（舌下含服米索前列醇）、B组（舌下舍服米索前列醇联合利多卡因宫颈旁注射）、C组（行常规人工流产术）,观察三组镇痛效果、人工流产综合征反应、宫颈松弛程度、扩张宫颈的时间及术中出血量。结果B组镇痛有效率明显,与A、C两组比较差异有统计学意义（P〈0．01）,A、B两组宫颈松弛、人工流产综合征发生率低,扩宫时间短,术中出血少,与C组比较差异有统计学意义（P〈0．01）。结论米索前列醇联合利多卡因用于人工流产术中,镇痛效果好,人工流产综合征发生率低,宫颈松弛,扩宫时间短,术中出血少,值得推广。     

米索前列醇配伍笑气用于人工流产术的临床分析

目的 探讨米索前列醇和笑气配伍在人工流产术中的应用价值.方法 从2003年8月至2004年9月抽取到我站要求进行人工流产的育龄妇女,年龄在44岁以下,孕龄在65 d以内共311例.分成使用米索前列醇配伍笑气观察组、单独使用米索前列醇对照组以及空白对照组.结果 使用米索前列醇配伍笑气观察组镇痛效果优于对照组和空白对照组（P〈0.01）,而观察组与空白组比较,人流综合征（PAAS）、宫口松弛、出血情况差异均有显著性（P〈0.01）.结论 米索前列醇配伍笑气用于人工流产术对减轻术者下腹疼痛、减少人流综合征（PAAS）、松弛宫颈口、减少出血、促进宫缩等方面具有明显的优势,在临床中有非常好的应用前景.     

笑气联合米索前列醇在无痛人流术中的临床应用

目的：探讨笑气联合米索前列醇在人工流产中的作用。方法：将笑气联合米索前列醇应用于1000例研究组（A组）,同时设对照组1000例（B组）。结果：A组中镇痛总有效率、手术时间及出血量、人工流产综合征发生率与B组比较都有显著差异性（P〈0.01）,同时宫颈扩张情况及子宫深度明显优于B组。结论：笑气联合米索前列醇在人工流产中镇痛及宫颈扩张方面的作用确切,是一种理想的无痛人工流产方法。     

地西泮、米索前列醇、利多卡因联合行无痛人工流产

目的探讨减轻人工流产时孕妇疼痛的方法。方法将100例接受人工流产手术的孕妇分为2组，每组50例。观察组术前阴道填塞米索前列醇，静脉注射地西泮，宫颈注射利多卡因；对照组不用任何药物。观察2组孕妇术中镇痛效果、宫颈松弛程度、术中出血情况和人工流产综合征（RAAS）发生率。结果观察组孕妇术中镇痛效果和宫颈松弛明显优于对照组（P均〈0.01），RAAS发生率明显低于对照组（P〈0．05）；2组术中出血量差异无显著性（P〉0．05）。结论地西泮、米索前列醇、利多卡因联合应用于人工流产方法简便、安全，能有效减轻孕妇人工流产术的疼痛，减少RAAS的发生。     

米索前列醇舌下含服在人工流产的应用

[目的]探讨舌下含服米索前列醇（米索）应用于早孕人工流产术前的可行性、安全性及有效性。[方法]将198例拟行人工流产的妇女随机分为口服米索组96例（A组）、舌下含服米索组102例（B组）。A组术前2h口服米索前列醇400μg，B组术前0．5h舌下含服米索前列醇400μg。观察并比较两组不良反应发生率、宫颈扩张效果、术中出血量、镇痛效果及人工流产综合征发生情况。[结果]B组不良反应发生率低于A组，差异有显著性（x^2=9．62～23．8，P〈0．01）；两组宫颈扩张效果、术中出血量、镇痛效果及人工流产综合征发生率均无显著性差异（P〉0．05）。[结论]米索前列醇舌下含服可作为人工流产术前扩张宫颈的理想给药方法。     

米索前列醇联合笑气在人工流产中的应用

目的:探讨笑气与米索前列醇并用镇痛在人工流产术中的临床应用价值。方法:将320例未产早孕妇女,随机分为两组,A组为米索前列醇联合笑气160例;B组为单用笑气160例,观察各组术中宫颈口扩张情况、镇痛效果、手术时间、术中出血量、术中恶心呕吐情况。结果:米索前列醇联合笑气组镇痛效果显著,手术时间短,术中出血量少,术中无一例恶心、呕吐发生与对照组比较差别均有非常显著性(P<0.01)。结论:笑气用于人工流产有较好的镇痛作用,加用米索前列醇宫颈软化及镇痛效果更为理想。     

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.