定时膨肺吸痰对心脏直视术后机械通气患者肺不张的影响

目的:初步探讨定时膨肺吸痰法对心脏直视手术后机械通气患者肺不张的影响。方法:将107例心脏直视手术后行呼吸机机械通气患者随机分为定时膨肺吸痰组(47例)和常规吸痰组(60例),定时膨肺吸痰组每8 h内用膨肺吸痰法吸痰1次,其余时间按常规吸痰法操作。比较两组患者吸痰后30 min Pa O2、Pa CO2、Sa O2等血气指标的变化;治疗后1周常规行胸片或肺部CT检查,观察比较两组肺不张的发生率。结果:定时膨肺吸痰组患者吸痰后低氧血症较常规吸痰组明显改善(P<0.05),肺不张发生率显著低于常规吸痰组(P<0.05)。结论:定时膨肺吸痰能改善心脏直视术后机械通气患者的低氧血症,减少肺不张的发生率,值得临床推广。     

胸部术后床旁纤支镜吸痰灌洗治疗的护理配合

目的探讨胸部术后患者床旁纤支镜吸痰灌洗治疗的护理配合。方法对182例胸部术后患者的排痰困难,痰液阻塞气道而致呼吸困难、低氧血症,在加强呼吸道管理的基础上,配合纤支镜吸痰及灌洗,从治疗前准备,治疗中配合及治疗后观察等总结护理经验。结果 182例胸部术后患者床旁纤支镜吸痰、吸痰灌洗治疗均顺利进行,呼吸道痰液阻塞、肺不张、低氧血症、呼吸困难,经皮氧饱和度（SpO2）等均有不同程度的改善。结论床旁纤支镜吸痰灌洗是解除胸部术后患者肺不张、痰液阻塞的一种简单易行,安全有效的治疗技术。     

慢性阻塞性肺疾病睡眠低氧血症的临床观察

目的：探讨慢性阻塞性肺疾病睡眠低氧血症的影响因素。方法：选取我院2011年3月至2013年3月收治的慢性阻塞性肺病43例病人为观察组，统计其平均血氧饱和度、夜间最低血氧饱和度、睡眠时动脉血氧饱和度＜90％的时间占睡眠时间百分比，与以同期40例肺功能正常者组成的对照组。结果：43例病人平均血氧饱和度、夜间最低血氧饱和度均低于对照组，睡眠时动脉血氧饱和度＜90％的时间占睡眠时间百分比明显高于对照组。结论：慢性阻塞性肺疾病氧饱和度、夜间最低血氧饱和度、睡眠时动脉血氧饱和度＜90％的时间占睡眠时间百分比均低于正常值，有不同程度的睡眠低氧血症的发生，需要积极治疗，及时观察，防止睡眠低氧血症的发生。     

吸痰对气管切开患者SpO2的影响

目的探讨气管切开术后吸痰对血氧饱和度的影响。方法选择20例气管切开患者随机分为A组和B组,对A组在吸痰前、吸痰后5min分别测SpO2;B组在吸痰前和吸痰结束后5min给予5min的高浓度氧气吸入并且在吸痰后5min分别测血氧饱和度。结果经过比较分析,两组吸痰结束后5min与吸痰前血氧饱和度相比较无明显升高,吸痰前吸氧与吸痰结束后吸氧,对患者血氧约饱和度影响不大。结论在气管切开患者呼吸道管理中,及时有效的吸痰能迅速纠正低氧血症,与吸氧无直接关心。     

密闭气道负压吸痰法联合氨溴索肺灌洗在ICU气道清除的应用

目的观察密闭气道负压吸痰法联合氨溴索肺灌洗在ICU清除气道的吸痰效果,探讨其可行性和安全性。方法选择已行气管插管或气管切开的患者50例,按随机数字表随机分成观察组和对照组(n=25),观察组采用密闭气道负压吸痰法联合氨溴索肺灌洗,对照组采用常规开放式吸痰法。观察和记录吸痰量、吸痰前后SpO2、临床有效率及相关并发症发生率。结果吸痰量观察组(30.53±5.41)ml明显高于对照组(15.56±5.24)ml,差异具有统计学意义(P<0.001)。吸痰前后SpO2组内比较观察组吸痰后明显回升(P<0.001),吸痰后两组间比较观察组(95.88±2.54)回升明显优于对照组(91.68±6.35)(P<0.05)。吸痰有效率观察组96.00%明显优于对照组40.00%(P<0.001)。并发症发生率观察组24.00%(6例),对照组44.00%(11例),并发症发生率比较组间差异无统计学意义(P>0.05)。结论密闭气道负压吸痰法联合氨溴索肺灌洗在ICU清除气道中能充分、有效地清除气道内分泌物,效果显著,尤其适用于咳痰无力、昏迷等患者,且操作简单、经济实用,值得临床特别是基层医院推广。     

浅谈大容量全肺灌洗术治疗尘肺患者的护理

目的总结大容量全肺灌洗术治疗尘肺患者的护理体会。方法回顾性分析我院25例尖肺患者采用大容量全肺灌洗术治疗的护理情况。结果所有患者灌洗术后通过采取正确和有效的护理措施症状明显改善。体质体力增强。X线或CT检查显示病灶明显减轻,血氧饱和度明显升高。结论大容量全肺灌洗术治疗尘肺病疗效肯定,安全可行,能明显提高患者的生活质量。     

纤维支气管镜在低氧血症方面的应用

目的 探讨低氧血症形成时纤维支气管镜在改善低氧血症方面的作用.方法 对69例低氧血症患者进行纤维支气管镜检查及治疗,观察治疗前后动脉血PaO2的改善情况及导致低氧血症的原因,对有创机械通气时普通吸痰与纤维支气管镜吸痰对改善低氧血症及高碳酸血症的差别.结果 低氧血症的急性加重形成大多是由于支气管分泌物阻塞所至,纤维支气管镜吸痰较普通吸痰更彻底、更确切.可明显改善气道通气功能,改善低氧血症,纠正呼吸衰竭.结论 低氧血症患者可常规行纤维支气管镜检查,对有创机械通气患者也应常规行纤维支气管镜检查及治疗.纤维支气管镜吸痰较普通吸痰更彻底、更确切、更有效.纤维支气管镜吸痰可减少有创机械通气的使用及缩短使用时间.纤维支气管镜在低氧血症方面的应用是安全和有效的.     

纤支镜床边吸引和灌洗术在呼吸衰竭治疗中的应用与护理

江苏省中医院ICU自2003-2006年对21例呼吸衰竭患者行床边纤支镜吸引和灌洗术,取得了很好的辅助治疗效果,提高了抢救成功率,促进了康复。本组患者咳嗽能力下降,咯痰无力,痰液粘稠、痰痂形成或异物阻塞气道,肺通气功能严重受损,肺通气／血流比例失调,肺内动一静脉分流增加,引起呼吸衰竭。一般吸痰管吸痰只能吸去较大气道内分泌物,对肺叶以下支气管内的分泌物则无法吸除,而床边纤支镜吸引和灌洗术是在直视下操作,既可稀释和吸引痰液,又可以局部治疗,对去除分泌物、改善肺通气功能起到了作用,常有立竿见影的效果,对促进患者康复,促进抗生素治疗效果,缩短住ICU或住院时间,起到了良好的积极作用,所以床边纤支镜吸引和灌洗术对以分泌物阻塞气道为主的呼吸衰竭患者为一有效的辅助治疗方法,且有一定的安全性。本组21例患者在操作过程中均有不同程度的心率增快,血氧饱和度下降,给以间断吸引和灌洗、间断呼吸机支持后,无一例发生严重并发症,故值得在ICU病房推广和应用。体会：首先主张预防为主,人工气道建立患者,由于呼吸道生理结构改变,呼吸道湿化、适时吸痰尤为重要;中风球麻痹患者做好指导工作,禁止经口进食,避免侥幸而尝试,给以鼻饲饮食;外科手术后鼓励患者有效咳嗽,有效咯痰,定时翻身叩背,减少肺不张发生。在临床中一旦发现有明确气道阻塞、排痰困难者,及时应用纤支镜床边吸引和灌洗术。     

慢性阻塞性肺疾病睡眠低氧血症的临床观察

目的:探讨慢性阻塞性肺疾病睡眠低氧血症的影响因素。方法:选取我院2011年3月至2013年3月收治的慢性阻塞性肺病43例病人为观察组,统计其平均血氧饱和度、夜间最低血氧饱和度、睡眠时动脉血氧饱和度90%的时间占睡眠时间百分比,与以同期40例肺功能正常者组成的对照组。结果:43例病人平均血氧饱和度、夜间最低血氧饱和度均低于对照组,睡眠时动脉血氧饱和度90%的时间占睡眠时间百分比明显高于对照组。结论:慢性阻塞性肺疾病氧饱和度、夜间最低血氧饱和度、睡眠时动脉血氧饱和度90%的时间占睡眠时间百分比均低于正常值,有不同程度的睡眠低氧血症的发生,需要积极治疗,及时观察,防止睡眠低氧血症的发生。     

支气管灌洗术治疗慢性阻塞性肺疾病急性加重期40例临床分析

目的:分析支气管灌洗术在慢性阻塞性肺疾病急性加重期(AECOPD)治疗中的效果。方法:回顾性分析40例慢性阻塞性肺疾病急性加重期患者,经纤支镜吸痰、支气管灌洗术治疗并局部给药丁胺卡那0.4g的治疗情况。结果:通过纤支镜灌洗并注药治疗,患者经皮血氧饱和度明显上升,咳嗽、咳痰明显减轻、肺部感染能较快有效控制。结论:支气管灌洗术治疗慢性阻塞性肺疾病急性加重期效果显著且安全可行。     

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.