硝普钠联合欣维宁对 PCI 术中无复流的疗效观察

目的：观察冠状动脉内注射硝普钠和欣维宁对经皮冠状动脉介入治疗（PCI）术中无复流的治疗效果。方法：将PCI术中发生无复流现象的患者63例随机分为硝普钠与欣维宁联合用药组（A组,n=32）和欣维宁组（B组,n=31）。2组患者使用相同的PCI手术方法,对术中判断为无复流的患者,A组给予冠状动脉内注射硝普钠和欣维宁,B组注射欣维宁。观察2组患者用药后即刻及用药后5min的造影图像,分析TIMI血流分级和校正的TIMI帧计数（CTFC）,同时观察术中血压变化,术后1周氨基末端B型利钠肽（NT—proBNP）、左室射血分数（LVEF）及术后半年主要心血管事件（MACE）发生率和再次住院率。结果：A组患者TIMI3级获得率、CTFC值均优于B组（P〈0．05）,术后1周A组患者NT-proBNP低于B组而LVEF明显高于B组（P〈0．05）,术后6个月主要心血管事件发生率差异无统计学意义（P〉0．05）,但A组患者再次住院率明显低于B组（P〈0．05）。结论：冠状动脉内注射硝普钠联合欣维宁能明显改善PCI术中的无复流现象,并可能部分改善患者的远期预后。     

选择性冠状动脉内注入硝普钠对冠状动脉介入治疗中无复流的影响

目的 评价选择性冠状动脉内注射硝普钠对经皮冠状动脉介入治疗（PCI）中无复流现象的影响.方法 选择PCI治疗中存在无复流现象者56例,并分为3组.选择组（A）20例患者采用经微导管选择性冠状动脉靶病变远端注射法,普通组（B）19例患者及对照组（C）17例患者采用常规指引导管内注射法.A,B组药物均采用硝普钠100μg,C组采用硝酸甘油100μg,2s内＂弹丸式＂快速注射完毕.10min后复查冠状动脉造影,评定冠状动脉心肌梗死溶栓试验血流（TIMI）分级及校正的TIMI血流记帧法（CTFC）.结果 3组均可改善PCI后的无复流现象,选择组85%患者血流均恢复TIMI 3级,CTFC帧数由用药前的（84.0±7.3）帧降至（26.0±6.2）帧,与常规组及对照组相比较,差异有统计学意义（P〈0.01）.结论 选择性冠状动脉内快速注射硝普钠能更有效地改善PCI中无复流现象.     

血栓抽吸导管内注入硝普钠对经皮冠状动脉介入后无复流现象的影响

目的：观察血栓抽吸导管内注入硝普钠对经皮冠状动脉介入术（ PCI）中无复流现象的影响。方法选取需行PCI的急性心肌梗死（ AMI）患者120例,依据随机数字表法分为硝普钠组和常规组,每组60例,两组患者PCI前均给予常规血栓抽吸治疗,硝普钠组患者在血栓抽吸后经导管注入硝普钠;随访6个月,观察两组患者术前术后靶病变血管血流分级（TIMI）、白细胞、淋巴细胞计数和术前、术后1、2、3个月的心室射血分数（EF）及不良心血管事件（主要包括再发心肌梗死、心绞痛、心力衰竭、心律失常、猝死）发生情况。结果术后硝普钠组患者TIMI分级、白细胞、淋巴细胞计数及白细胞／淋巴细胞比值均明显优于常规组（P＜0．05）,不良心血管事件发生率明显低于常规组（P＜0．05）;硝普钠组患者术后1、2、3个月EF水平明显高于常规组（ P＜0．05）。结论血栓抽吸导管内注射硝普钠可有效促进PCI后AMI患者恢复冠脉复流,减少不良心血管事件发生率,改善心功能,提高疗效。     

替罗非班与硝普钠治疗急性冠脉综合征介入术后无复流的临床疗效比较

目的 比较替罗非班与硝普钠治疗急性冠脉综合征介入术后无复流的临床疗效.方法 选取经皮冠状动脉介入术后无复流的急性冠脉综合征患者64例随机分为治疗组和对照组,每组各32例.对照组给予硝普钠,治疗组给予替罗非班,比较两组患者心肌梗塞溶栓治疗（TIMI）血流分级、心电图及主要心脏不良事件（MACE）.结果 治疗组MACE发生率为6.2％,对照组MACE发生率为37.5％,两组比较差异有统计学意义（P＜0.05）;治疗组TIMI血流分级、心电图均明显优于对照组,两组比较差异有统计学意义（P＜0.05）.结论 替罗非班治疗急性冠脉综合征介入术后无复流现象疗效确切,值得临床推广使用.     

替罗非班在急性冠脉综合征介入治疗中无复流的临床观察

目的：评价冠状动脉内应用替罗非班对急性冠脉综合征（ACS）患者经皮冠状动脉介入治疗（PCI）中无复流的临床疗效。方法：将行PCI治疗中发生无复流的急性冠脉综合征（ACS）患者62例随机分为替罗非班组（n=32）和对照组（n=30）。两组手术方法相同,出现无复流现象后分别经冠状动脉内注入替罗非班和硝酸甘油。观察两组注射药物后首次和PCI中末次造影图像,评估心肌梗死溶栓试验（TIMI）血流分级、校正的TIMI帧数（CTFC）,同时观察术后1周左室射血分数（LVEF）、术后60d内主要心血管事件（MACE）发生率及出血并发症等情况。结果：替罗非班组2次冠状动脉造影TIMI 3级血流获得率、CTFC均明显优于对照组（P〈0.05）,术后1周LVEF、出血并发症高于对照组,PCI术后60d内MACE发生率低于对照组,但差异无统计学意义（P〉0.05）。结论：替罗非班在不增加严重出血并发症的前提下可明显降低和改善ACS患者PCI后无复流现象,是一种有效的PCI辅助治疗手段。     

地尔硫卓和硝普钠改善急性冠脉综合征患者经皮冠状动脉介入治疗中无复流现象的效果评价

目的 比较地尔硫卓和硝普钠在改善急性冠脉综合征（ACS）患者经皮冠状动脉介入（PCI）治疗中无复流现象的效果。方法 选取2008年1月-2014年6月于江西省人民医院接受PCI治疗且术中出现无复流现象的ACS患者80例为研究对象,采用随机数字表法将患者分为地尔硫卓组（40例）和硝普钠组（40例）。两组于PCI术中经微导管冠状动脉靶病变远端2 s内"弹丸式"快速分别给予地尔硫卓、硝普钠200～600 μg,分别于给药后10、20 min后复查冠状动脉造影,评价心肌梗死溶栓治疗（TIMI）血流分级和校正的TIMI血流帧数（CTFC）,同时记录给药前及给药后10、20 min有创血压及心率的变化。分别于PCI术前及术后7、30 d记录左心室收缩末内径（LVESD）、左心室舒张末内径（LVEDD）及左心室射血分数（LVEF）。于PCI术前及术后7、30 d测定N末端B型脑钠肽前体（NT-proBNP）及细胞因子超敏C反应蛋白（hs-CRP）、白介素6（IL-6）及细胞间黏附分子-1（ICAM-1）水平。记录两组术后30 d内主要心血管事件（再发心绞痛、再发急性心肌梗死及心力衰竭发作）和其他心血管事件（恶性心律失常及猝死）的发生情况。结果 不同药物对TIMI血流分级、CTFC、收缩压、舒张压及心率的影响比较,差异无统计学意义（P＞0.05）。两组用药后10、20 min TIMI血流分级、CTFC与用药前比较,差异有统计学意义（P＜0.05）。不同药物对LVESD、LVEDD、LVEF的影响比较,差异无统计学意义（P＞0.05）。两组术后30 d LVESD、LVEDD及LVEF与术前比较,差异有统计学意义（P＜0.05）。不同药物对NT-proBNP、hs-CRP、IL-6及ICAM-1的影响比较,差异无统计学意义（P＞0.05）。两组术后7、30 d NT-proBNP、hs-CRP、IL-6、ICAM-1水平均低于术前,差异有统计学意义（P＜0.01）。两组术后30 d内主要心血管事件及其他心血管事件发生率比较,差异均无统计学意义（P＞0.05）。结论 地尔硫卓和硝普钠均能够有效改善PCI术中TIMI血流分级及CTFC,降低炎性因子和NT-proBNP水平,改善心功能,两者改善无复流现象的效果相当。     

冠状动脉内注入替罗非班对急诊PCI术中无复流现象的临床疗效

目的：观察冠状动脉内注入替罗非班对ST段抬高型心肌梗死（ STEMI ）行经皮冠状动脉介入治疗（ PCI）术中无复流的临床疗效。方法 STEMI行PCI术中出现无复流患者68例,随机分成观察组35例和对照组33例,两组患者均在出现无复流现象后注射硝酸甘油,观察组加用注射替罗非班。结果观察组首次注射药物后5 min冠脉造影及PCI术结束前末次冠脉造影的TIMI 血流分级3级和心肌灌注分级（ TMPG）3级的左室射血分数比例明显高于对照组,而矫正的TIMI帧数（cTFC）明显低于对照组（P＜0．05）;观察组ST段完全回落率、术后1周左室射血分数均明显高于对照组,而肌酸激酶同工酶峰值、肌钙蛋白I峰值、心血管不良事件发生率均明显低于对照组,差异有统计学意义（P＜0．05）;两组住院期间并发症发生率比较差异无统计学意义（P＞0．05）。结论冠状动脉内注射替罗非班能有效改善STEMI患者PCI术中出现无复流后的冠状动脉血流及心肌组织灌注,且安全性较高。     

替罗非班对AMI介入治疗术中无复流的效果和安全性观察

目的：观察冠状动脉内注射替罗非班对急性心肌梗死(acute myocardial infarction,AMI)患者冠状动脉介入治疗(percutaneous coronary intervention,PCI)术中无复流的疗效。方法：选择本院2009年1月—2013年12月收住的AMI行急诊PCI术中出现无复流的52例患者的临床资料。随机分为替罗非班治疗组(n=27)和维拉帕米组(n=25),评估心肌梗死溶栓试验(thrombolysis in myocardial infarction,TIMI)血流分级、矫正的 TIMI 帧数(corrected TIMI from countc,cTFC)、PCI术后14 d左心室射血分数(left ventricular ejection fraction,LVEF)、PCI术后60 d内主要心脏不良事件(major adverse cardiac events,MACE)。结果：冠状动脉内用药后首次及PCI术结束前末次冠状动脉造影均显示：替罗非班组TIMI 3级血流比率均高于维拉帕米组(均P＜0.05),cTFC帧数均少于维拉帕米组(P＜0.01);替罗非班组术后14 d LVEF高于维拉帕米组(P＜0.05),PCI术后60 d内,替罗非班组MACE发生率明显好于维拉帕米组(均P＜0.05)。结论：替罗非班可明显改善AMI行PCI术中无复流冠状动脉血流,是治疗无复流的一种有效的措施。     

硝普钠联合替罗非班对急性心肌梗死患者急诊经皮冠状动脉介入术中无复流及预后的影响

目的研究硝普钠联合替罗非班对急性心肌梗死(AMI)患者急诊经皮冠状动脉介入术(PCI)中无复流及预后的影响。方法选取2013年6月至2016年7月在平顶山市第二人民医院行PCI术中出现无复流的急性心肌梗死78例患者,随机数表法分组,各39例。对照组予以硝酸甘油+替罗非班治疗,观察组予以硝普钠+替罗非班治疗。对比用药后两组血流分级(TIMI)情况;3个月后随访,比较两组心血管不良事件发生情况。结果用药前两组TIMI 0级、Ⅰ级患者比较,差异无统计学意义(P>0.05),用药后观察组TIMIⅡ级、Ⅲ级患者多于对照组,差异有统计学意义(P<0.05);观察组心血管不良事件发生率为5.13%(2/39),低于对照组25.64%(10/39),差异有统计学意义(P<0.05)。结论普钠联合替罗非班应用于急性心肌梗死患者行急诊经皮冠状动脉介入术中,可明显改善患者无复流现象,并降低预后不良心血管事件发生率。     

急性心肌梗死急诊冠状动脉介入治疗中无复流现象的分步处理

目的：分析急性心肌梗死（AMI）行急诊冠状动脉介入（PCI）治疗，术中并发的梗死相关冠状动脉（IRCA）无复流（no-reflow）现象，探讨处理对策，减少AMI住院期死亡率。方法：对我院1999年10月-2004年12月期间接受急诊PCI治疗的156例AMI患者，术中20例IRCA出现无复流。经过应用冠脉内硝酸甘油，钙拮抗剂，溶栓荆治疗，前向血流有不同程度改善。结果：15例即时恢复前向血流TIMIⅡ级，植入支架临床效果良好，5例即时恢复前向血流TIMI0-Ⅰ级，其中1例死亡，4例在血流无明显改善情况下应用UK行冠脉溶栓，1周后，冠脉造影复查IRCA的血流TIMIⅢ级。结论：AMI急诊PCI时出现，IRCA的无复流现象应为紧急综合性处理，使用硝酸甘油、钙拮抗剂及溶栓剂药物分步治疗。     

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.