改良悬雍垂腭咽成形术加舌根电波刀消融术的临床疗效观察

目的：探讨改良悬雍垂腭咽成形术加舌根电波刀消融术联合治疗阻塞性睡眠呼吸暂停低通气综合症（obstructive sleep apnea hypopnea syndrome,OSAHS）的疗效。方法：对32例中、重度有腭咽部和舌根平面阻塞的OSAHS患者采用改良悬雍垂腭咽成形术加舌根电波刀消融术治疗。术前、术后随访均进行了纤维鼻咽镜检查和多道睡眠监测（polysomnography,PSG）。结果：术后半年复查PSG显示睡眠呼吸暂停低通气指数（apnea hyponea index,AHI）,最低血氧饱和度（LSaO2）。术前PSG检查AHI平均值为46．2±18．5,LSaO2平均值为0．66±0．11。手术后AHI平均值为18．4±3．6,LSaO2平均值为0．86±0．79。手术前后AFII和LSaO2经统计学处理,差异有统计学意义（P〈0．01）,较术前明显改善;舌根平面变宽。总有效率为87．5％（28／32）。结论：对腭咽平面及舌根平面均有狭窄的OSAHS患者,应用改良悬雍垂腭咽成形术加舌根电渡刀消融术治疗,取得较好疗效,电波刀消融舌根简便安全。     

改良悬雍垂腭咽成形术及影响疗效因素分析

悬雍垂腭咽成形术（uvulopalatopharyngoplasty,UPPP）是治疗阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea-hypopnea syndrome,OSAHS）的主要手术方法,因其经典手术易发生腭咽关闭不全等并发症,近几年对其进行改良,采用完全保留悬雍垂的腭咽成形术可避免此并发症的发生[1]。虽然导致OSAHS的主要阻塞部位在腭咽部及口咽部,多数适于行UPPP手术,     

阻塞性睡眠呼吸暂停综合征手术127例的麻醉处理

引言 阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者睡眠时存在不同程度的气道狭窄或阻塞,悬雍垂腭咽成形术（UPPP）作为治疗OSAHS的主要方法,对于重度患者易发生意外甚至危及生命．在近5a里我们共实施127例UPPP手术,麻醉处理取得良好效果．     

悬雍垂腭咽成形术治疗阻塞性睡眠呼吸暂停综合征

悬雍垂腭咽成形术（UPPP）是目前外科治疗阻塞性睡眠呼吸暂停综合征（OSAS）的主要手段。现将我院2003—2008年实施UPPP治疗的54例病例,报告如下。     

不同治疗方法对重度OSAS患者生存质量的影响

目的:比较不同治疗方法对重度阻塞性睡眠呼吸暂停综合征(OSAS)患者生存质量的影响。方法:选取48例重度OSAS患者作为研究对象,将其随机分为观察组25例和对照组23例,观察组患者行经鼻持续正压通气(n CPAP)治疗,对照组患者则采取悬雍垂腭咽成形术(UPPP)手术治疗,通过SAQLI和ESS问卷方式对所有患者进行治疗前后生存质量评估。结果:患者治疗后SAQLI、ESS评分和AHI较治疗前均有所改善。观察组患者在SAQLI总分、症状及日常生活维度方面改善程度均高于对照组(P<0.01)。结论:正压通气法改善重度阻塞性睡眠呼吸暂停综合征患者生存质量优于悬雍垂腭咽成形术治疗,有临床推广价值。     

重症阻塞性睡眠呼吸暂停低通气综合征的手术效果

目的探讨采用不同手术方式治疗重症阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的临床疗效。方法对68例OSAHS患者,按解决口咽平面狭窄的手术方法不同分为4组,第1组采用经典的UPPP术(即悬雍垂腭咽成型术),第2组采用改良UPPP术(即悬雍垂塑形 腭咽成型术),第3组采用射频消融悬雍垂腭咽成型术,第4组采用腺样体切除 扁桃体摘除术。结果1,2,3组患者手术总有效率分别为82.1%,83.3%,75%,4组患者手术有效率100%。结论重症阻塞性睡眠呼吸暂停低通气综合征患者多数为多平面阻塞,通过解决鼻腔鼻咽平面狭窄,处理舌根肥厚及配合UPPP和改良UPPP手术均能取得满意手术疗效,小儿重症阻塞性睡眠呼吸暂停低通气综合征仅行腺样体切除 扁桃体摘除术也能取得良好疗效。     

阻塞性睡眠呼吸暂停低通气综合征患者单个核细胞对血管内皮细胞凋亡的影响

目的：探讨阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者血管内皮细胞的损伤机制。方法：按多导睡眠监测仪检查结果将研究对象分为正常对照组（n=20）、轻度OSAHS组（n=21）、中度OSAHS组（n=24）和重度OSAHS组（n=20）。所有研究对象睡醒后（约6点30分左右）采外周静脉血,分离单个核细胞（MNC）。分离的MNC与人脐静脉内皮细胞ECV304共同培养48h,培养后收集上清液及内皮细胞,ELISA检测上清液中的TNF-α、IL-6,流式细胞仪检测内皮细胞的凋亡率、Fas蛋白表达。结果：正常对照组、轻、中及重度OSAHS患者MNC细胞产生肿瘤坏死因子α（TNF-α）分别为（0．80±0．10）μg／L、（1．20±0．30）μg/L、（1．40±0．50）μg/L及（2．10±0．60）μg/L,多组比较（F=69．65,P〈0．01）;产生白细胞介素6（IL-6）分别为（23．50±6．50）μg/L、（49．60±2．80）μg/L、（46．90±10．80）μg／L及（64．80±9.90）μg／L,多组比较（F=182．83,P〈0．01）。MNC细胞产生TNF-α及IL-6均高于正常对照组（均P〈0．01）;而重度OSAHS患者MNC产生TNF-α及IL-6均高于轻度及中度（均P〈0．01）,轻度与中度OSAHS患者之间差异无统计学意义。内皮细胞的凋亡率：正常对照组、轻、中及重度OSAHS患者分别为8．3％±3．2％、9．2％±3．0％、19．3％±6,3％及19．6％±3．8％,多组比较（F=39．36,P〈0．01）;中、重度OSAHS患者较正常对照组升高（P〈0．01）;而轻度OSAHS患者与正常对照组比较,中度与重度OSAHS患者组比较,差异均无统计学意义。内皮细胞表达Fas蛋白各组问差异无统计学意义。内皮细胞凋亡率与OSAHS患者AHI呈正相关（r=0．58913,P=0．0106）、与夜间最低血氧饱和度呈负相关（r=-0．50737,P〈0．01）。结论：OSAHS患者血管内皮细胞损伤过程中,单个核细胞可能起重要作用,且这种作用同病情严重程度、夜间缺氧密切相关。     

重度OSAHS并高血压患者行悬雍垂腭咽成形术前后血压变化分析

目的：观察重度阻塞性睡眠呼吸暂停低通气综合征（OSAHS）并高血压患者行悬雍垂腭咽成形术（UPPP）治疗前后血压变化。方法选择重度OSAHS同时合并高血压的患者32例,均有口服降压药3年以上而血压仍控制不佳病史。治疗采用改良UPPP手术,分别于手术前及手术后6个月时行多导睡眠图（PSG）监测和24 h动态血压监测,进行数据对比。结果①改良 UPPP手术6个月后睡眠呼吸暂停低通气指数（AHI）、呼吸暂停指数（AI）、微觉醒指数（MAI）中位数均明显降低（P＜0．05）;平均血氧饱和度（SaO2）和最低血氧饱和度（LSaO2）则明显升高（P＜0．05）;②UPPP术后6个月24 h动态血压监测发现,24 h平均收缩压（SBP）、舒张压（DBP）,日间、夜间的平均SBP、DBP均明显降低,与术前比较差异有统计学意义（P＜0．05）。结论行UPPP对于重度OSAHS合并高血压患者的血压控制,效果显著。     

重度OSAHS多平面手术治疗效果观察

目的探讨多平面手术治疗重度阻塞性睡眠呼吸暂停低通气综合征（OSAHS）的临床疗效。方法选取60例重度OSAHS患者,随机分为观察组和对照组,对照组仅采用悬雍垂腭咽成形术（UPPP）,观察组采用多平面手术,比较两组患者治疗的有效率、睡眠呼吸暂停通气指数（AHI）、最低血氧饱和度（LSaO2）、氧减指数（ODI）、Epworth嗜睡评分（ESS）。结果对照组治疗总有效率为56.7%,观察组总有效率为86.7%,观察组疗效明显优于对照组（P〈0.05）;观察组AHI、LSaO2、ODI和ESS等指标明显优于对照组（P〈0.05）。结论采用多平面手术治疗重度OSAHS可提高临床疗效,值得临床推广使用。     

改良悬雍垂腭咽成形术联合鼻腔手术治疗阻塞性睡眠呼吸暂停综合征38例

目的探讨改良悬雍垂腭咽成形术（H—UPPP）联合鼻腔手术（下鼻甲骨黏膜下切除术、鼻中隔矫正术）治疗中、重度阻塞性睡眠呼吸暂停低通气综合征（OSAHS）的效果。方法对中、重度OSAHS患者（有腭咽和鼻腔平面阻塞）38例半随机按入住床位分为A、B两组。A组先行H-UPPP术，后行鼻腔手术；B组相反。术后1—6个月复查鼻声反射、鼻通气阻力和PSG。所有结果用SPSS10.0软件行统计分析。结果所有患者6个月之后，打鼾、憋气、头痛及嗜睡等症状均明显减轻或消失。两组各阶段手术后呼吸暂停低通气指数（AHI）、最低血氧饱和度（LSaO2）、呼吸暂停低通气时间指数（AHTI）较术前均有明显改善，差异有统计学意义（P〈0．01）；鼻腔通气道重建术后，鼻声反射结果提高、鼻通气阻力测试结果减小（P〈0．01）。结论H—UPPP扩大了软腭成形的范围及咽部左右径和前后径；术中无腭咽关闭不全或闭锁发生；单独施行H—UPPP或鼻腔手术均能改善AHI、LSaO2和AHTI，联合治疗更能显著提高疗效。先行鼻腔手术尤能增加行H-UPPP时的麻醉方便和安全。     

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.