外伤性肠系膜损伤33例诊治体会

目的　提高对闭合性肠系膜损伤的认识。方法　对 3 3例外伤性肠系膜损伤病例进行回顾性分析。结果　 3 3例中术前伴有休克 17例 ,合并脾破裂 2例 ,右肾破裂 1例 ,颅脑损伤 1例 ,胸外伤 2例 ;术中 2 1例行肠切除术 (63 .64 % ) ;肠系膜上静脉结扎 2例 (6.0 6% ) ;肠系膜上静脉修补 4例 (12 .12 % ) ;肠系膜修补术 6例 (18.18% )。死亡 1例 ,切口感染 3例 ,切口裂开 1例 ,盆腔包裹积液 1例。结论　肠系膜损伤诊断较困难 ,早期诊断处理及时手术治疗能有效降低病死率及并发症发生率。     

肠系膜上静脉大出血一例

医源性肠系膜上静脉损伤多为切口暴露不充分视野不清所致,且出血较凶猛,如不及时处理后果较严重,术中要充分暴露手术野,仔细解剖,尽量避免损伤,如出现肠系膜上静脉损伤出血,应果断充分延长切口,压迫肠系膜根部止血并迅速解剖出肠系膜上静脉,找出血管损伤处并进行修补止血。1病例简介     

医源性肠系膜上血管损伤原因与处理

<正>本院1988~1995年因手术造成的肠系膜上血管损伤5例,现就损伤原因及处理讨论如下。临床资料一、病史摘要例1系胰体囊肿患者,行胰体尾切除术,在游离胰颈下缘时将肠系膜上静脉横断,即刻发现,行对端吻合治愈。例2系胰头癌,行胰十二指肠切除术,术中肠系膜上静脉撕裂,修补成功。     

闭合性十二指肠损伤24例诊治分析

目的探讨闭合性十二指肠损伤的诊断及术式选择,提高其外科诊治水平。方法对我院1997年6月～2006年6月收治的475例闭合性腹外伤患者的病例资料进行回顾性分析。结果475例闭合性腹外伤患者中24例为闭合性十二指肠损伤,行单纯分层修补12例。单纯全层修补6例,十二指肠空肠Roux—Y吻合3例,十二指肠憩室化2例,胰十二指肠切除1例。术后十二指肠瘘4例,胆瘘2例,胰瘘l例,切口感染4例,术后死亡4例。结论闭合性十二指肠损伤容易延误诊断或漏诊,早期诊断、早期手术甚为重要。早期剖腹探查需要极为细心,以便根据份睛选择术式,有效降低死亡率。     

腹部闭合性损伤抢救的体会

目的探讨腹部闭合性损伤的抢救方法及治疗效果。方法回顾分析笔者所在医院收治的60例腹部闭合性损伤患者的临床资料。结果在本组患者中,保守治疗5例,手术探查55例。其中脾切除39例,脾修补2例,肝修补4例,膀胱修补3例,小肠切除1例,小肠修补2例,小肠、升结肠部分切除吻合1例,左肾切除1例,肠系膜修补止血1例,下腔静脉修补1例。死亡2例。结论早期明确诊断,正确评估伤情,有效对症处理,及时剖腹探查是提高抢救腹部闭合性损伤治疗效果的重要途径。     

外伤性闭合性十二指肠损伤16例诊治体会

目的探讨外伤性闭合性十二指肠损伤患者治疗的诊断要点和术式选择。方法对我院1996年1月～2003年12月收治的16例闭合性十二指肠损伤的回顾性分析。结果本组闭合性十二指肠损伤术前确诊6例，剖腹探查后确诊10例。单纯缝合修补加十二指肠减压12例，转流术2例，带蒂游离空肠肠片修补1例，胰十二指肠切除1例。治愈15例，死亡1例。结论闭合性十二指肠损伤容易延误诊断或漏诊，早期剖腹探查甚为重要，不必过分强调术前确诊。术式选择应根据损伤部位、程度、时间长短、复合伤及全身情况而定。其原则是缝合修补肠壁裂口；十二指肠造瘘减压或转流旷置术，充分引流。     

闭合性二尖瓣损伤的诊断与治疗

作者报告３例闭合性二尖瓣损伤的诊断与治疗的经验与教训。２例为外伤性二尖瓣腱索断裂，分别行二尖瓣瓣环环缩术加二尖瓣腱索修补术和二尖瓣置换术治愈。１例为二尖瓣置换术后８年，外伤性人工机械瓣瓣钩断裂，致急性心衰，未及时手术而死亡。尸检证实诊断。认为闭合性二尖瓣损伤临床上易误诊，一旦确诊宜早期手术，发生急性心衰时，应急症手术     

腹部闭合性损伤小肠破裂44例临床报告

目的：探索提高腹部闭合性损伤小肠破裂的诊断治疗水平的方法。方法：对44例腹部闭合性损伤小肠破裂临床资料进行回顾性分析。结果：44例均施行剖腹探查，肠破裂修补36例，损伤肠段切除吻合8例。死亡2例，多发性肠间隙脓肿1例，盆腔脓肿3例，切口裂开1例。11例有不同程度的腹痛、腹胀，5例因粘连性肠梗阻再住院治疗1～3次。结论：提高对闭合性腹部损伤小肠破裂的认识，做到早诊断、早治疗、早手术。损伤小者行破裂修补术，损伤重者行肠段切除吻合，彻底冲洗腹腔，有效引流，注重围手术期治疗。改进外科技术，可提高治愈率，减少并发症、后遗症的发生。     

腹部闭合性损伤25例治疗体会

目的探讨腹部闭合性损伤手术治疗的临床效果。方法对25例腹部闭合性损伤患者做术前检查、确诊,采用手术治疗,术后观察患者的疗效和预后。结果25例均接受手术治疗,包括脾切除、肝脏切除、肝修补、小肠部分切除吻合术和破裂修补术、肠系膜修补止血术、肾切除、脾胰尾联合切除术等。本组病例手术治疗后,临床治愈22例,死亡3例。结论腹部闭合性损伤是一种危重性疾病,应及时诊治,手术治疗是一种有效的方法。     

闭合性十二指肠损伤26例诊治体会

目的探讨闭合性十二指肠损伤的临床特点和手术方式的选择,提高该病的外科治疗水平。方法回顾性分析我院2008年6月～2009年7月收治的26例闭合性十二指肠损伤患者的临床资料。结果采用单纯十二指肠修补、十二指肠空肠Roux-Y吻合、十二指肠憩室化、胰十二指肠切除等术式,病例数分别为18例,3例,3例和2例。术后十二指肠瘘4例,死亡2例。结论闭合性十二指肠损伤易误诊或漏诊,治疗的关键是早期诊断、选择合适的术式及充分的十二指肠引流。     

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.