急性胰腺炎的诊疗体会

目的:总结急性胰腺炎的诊疗体会,为提高急性胰腺炎的诊疗效果提供临床资料。方法:以我院2011年1月～2012年1月期间收治的67例急性胰腺炎患者为研究对象。根据临床诊断分型,将67例患者分为急性水肿型胰腺炎和急性出血坏死型胰腺炎。其中15例急性出血坏死型胰腺炎患者行手术治疗;52例急性水肿型胰腺炎患者行药物治疗。结果:本组52例水肿型胰腺炎经过药物治疗后均治愈。15例急性出血坏死型胰腺炎患者14例患者经全面的手术治疗后痊愈;1例患者合并多脏器功能衰竭的患者术后病情无缓解死亡。结论:加强急性胰腺炎诊断的准确性,应用手术和药物综合治疗体系可有效提高急性胰腺炎的治疗效果。     

螺旋CT在急性胰腺炎分型诊断中的应用分析

目的分析螺旋CT在急性胰腺炎分型诊断中的应用价值。方法选取2013年1月至2015年12月周口市人民医院收治的70例急性胰腺炎患者作为研究对象,对所有患者螺旋CT检查结果进行有效分析。结果螺旋CT诊断急性胰腺炎的总检出率为92.9%,其中急性水肿型胰腺炎检出率为90.9%,急性坏死型胰腺炎检出率为96.2%。结论螺旋CT能够为临床治疗急性胰腺炎提供更加直观的诊断数据,具有较高的准确性,有助于对急性胰腺炎患者进行早期的诊断与治疗,值得推广。     

16排CT检查在急性胰腺炎诊断中的临床应用

目的分析在急性胰腺炎诊断中采用16排CT检查的效果。方法将2017年6月至2019年6月在我院就诊的180例急性胰腺炎患者纳入研究,所有患者均接受16排CT扫描检查,观察急性胰腺炎在CT图像中的病变显示。结果通过扫描结果得知,所有患者中有70例患者为急性坏死性胰腺炎,59例患者为急性水肿型胰腺炎,51例患者为合并假性囊肿。结论 16排CT检查应用于急性胰腺炎的诊断中,可有效判断各类并发症,为后期治疗提供准确依据,应用价值较高。     

观察急性胰腺炎消化内科治疗的临床疗效

目的研究急性胰腺炎患者接受消化内科治疗的临床疗效。方法本次研究选取的研究对象为2016年1月1日-2016年12月31日期间在本院消化内科进行治疗的急性胰腺炎患者58例,均接受消化内科对症治疗,对急性胰腺炎患者的治疗效果进行观察,并将治疗前后急性胰腺炎患者的相关指标水平进行比较。结果急性胰腺炎患者的临床总有效率为96.55%;治疗后急性胰腺炎患者的APACHE-Ⅱ评分、血蛋白酶、WBC、白蛋白水平分别为(8.01±1.42)分、(430.15±87.36)U/L、(11.05±1.24)×109/L、(3.97±0.78)g/L,均同治疗前相比存在高度差异(P0.05)。结论急性胰腺炎患者采用消化内科治疗取得的效果优越。     

16层螺旋CT扫描在急性胰腺炎诊断中的临床应用

目的分析16层螺旋CT扫描诊断急性胰腺炎疾病的价值。方法选取2015年4月至2017年2月我院收治的57例急性胰腺炎患者为本次研究对象,所有患者行16层螺旋CT扫描,回顾分析其临床资料。结果 57例胰腺炎患者中,43例患者为急性单纯水肿型胰腺炎,14例急性出血性坏死胰腺炎。结论 16层螺旋CT诊断急性胰腺炎价值较高,值得应用。     

红细胞分布宽度评估急性胰腺炎严重程度的价值

目的 探讨红细胞分布宽度(RDW)对急性胰腺炎(AP)严重程度的评估价值.方法 回顾性研究收集2013年5月~2016年5月南方医科大学南方医院消化内科住院的急性胰腺炎患者527例,按疾病严重程度分为轻度(MAP)组、中度(MSAP)组、重度(SAP)组,纳入同期非急性胰腺炎患者105例作为对照组,收集患者的一般资料及RDW,以经典评估指标"血糖"和"血钙"为对比进行统计与分析.结果 急性胰腺炎组与对照组之间RDW、血糖(Glu)、血钙(Ca)差异有统计学意义(P<0.05);SAP患者的RDW、Glu明显高于MAP及MSAP患者,Ca则明显低于MAP及MSAP患者(P<0.05);RDW(P<0.05,OR=3.374)、Glu(P<0.05,OR=2.343)、Ca(P<0.05,OR=2.182)均为急性胰腺炎的独立危险因素;ROC曲线预测SAP曲线下面积为RDW(0.801)>Glu(0.658)>Ca(0.227).结论 RDW是评估急性胰腺炎严重程度的有效指标.     

重症急性胰腺炎患者腹高压危险因素分析

目的:探讨重症急性胰腺炎患者腹高压危险因素,分析腹高压对重症急性胰腺炎患者治疗预后的影响.方法:选取2013年6月至2015年6月我院诊治的58例急性炎患者资料进行分析,采用经尿道膀胱测压法间接监测腹内压,持续腹内压≥12 mmHg者视为腹高压,研究重症急性胰腺炎患者腹高压危险因素,分析腹高压对重症急性胰腺炎患者治疗预后的影响.结果:经过Logistic回归分析结果显示:重症急性胰腺炎患者24 h液体平衡、APACHEⅡ以及白蛋白值均为其独立危险因素(P<0.05);重症急性胰腺炎患者住院时间、ICU时间,显著长于急性胰腺炎者(P<0.05);重症急性胰腺炎患者和急性胰腺炎患者治疗前证候积分差异不显著(P>0.05);重症急性胰腺炎患者治疗后证候积分,显著高于对照组(P<0.05).结论:重症急性胰腺炎患者腹高压危险因素相对较多,患者治疗时应该及时解除可能引起腹内压升高的因素,提高患者临床治疗效果.     

重症急性胰腺炎普外科治疗的临床研究

目的研究对重症急性胰腺炎患者选择的外科治疗方案。方法随机择取2015年6月至2017年6月在本院接受治疗的50例重症急性胰腺炎患者作为研究对象,采用回顾性分析法对他们的临床资料和方法进行分析和总结。结果所选取的50例重症急性胰腺炎患者中没有死亡病例,均得到痊愈效果。结论重症急性胰腺炎早期治疗以非手术治疗方案为主,辅以手术疗法,在减少并发症发生可能性的同时提高临床疗效。     

CT诊断急性胰腺炎的临床价值研究

目的:对CT诊断急性胰腺炎的临床价值进行研究。方法:选取2012年3月-2013年2月我院收治的急性胰腺炎患者57例,对患者临床治疗资料进行回顾性分析,所有患者均给予CT检查诊断。结果:57例患者经CT检查,急性坏死性胰腺炎患者为14例(24.56%),急性水肿性胰腺炎患者为43例(75.43%)。所有患者经CT检查诊断后进行对症治疗,治愈有效率为96.49%。结论:运用CT检查技术对急性胰腺炎患者进行诊断,能及时发现和确诊病症,为患者的后续治疗提供保障。     

CT在急性胰腺炎中的应用与诊断价值分析

目的对CT在急性胰腺炎中的应用以及诊断价值进行深入的探究,以及分析急性胰腺炎的CT表现,从而提高医疗的诊断水平。方法选择2010年1月至2013年1月来我院进行急性胰腺炎治疗的80例患者作为研究对象,对其影像学资料进行回顾性分析,观察患者的CT变现特征以及病变范围,全部患者都进行腹部CT平扫。结果经过研究可以发现,大部分急性胰腺炎患者表现为胰腺局限性或者弥漫性肿大,边缘不清晰;急性水肿型胰腺炎轻度患者的CT表现为形态的僵直,密度没有显著的变化。急性胰腺炎重症患者的CT表现为胰腺的明显肿大、轮廓的外突,部分还可以看见出血灶。结论放射科CT检查是一种较为安全、准确、无创性的检查方法,可以有效地诊断出急性胰腺炎以及并发症。增强CT扫描可以准确掌握急性胰腺的坏死、出血等情况,在指导临床上的诊断以及制定正确的治疗方案中起着重要的作用,值得临床上的推广应用。     

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.