高血压病规范化健康档案管理疗效与评估

目的：探讨社区卫生服务中心对高血压患者实施团队式健康管理的效果。方法：选取北外及万寿山庄辖区内原发性高血压患者500例为研究对象,一级管理组229人;二级管理组206人;三级管理组65人;根据管理前后高血压患者知晓率、血压控制率、服药依从性、血脂改变,不良生活方式改变等情况,来评价管理的效果。结果：三组级别高血压年度管理评估及临床评估对比变化与管理前比较,差异有统计学意义（P〈O．01）：高血压患者规范化管理后优良率年度评估明显提高、尚可率、不良率明显降低,差异有统计学意义（P〈O．01）;高血压患者管理前后血脂生化检测,总胆固醇、低密度脂蛋白指标较管理前均有明显改善,差异有统计学意义（P〈O．01）,但高密度脂蛋白、三酰甘油、体重指数无明显变化（P〉O．05）;管理后高血压患者的生活方式均有明显改善,与之前比较差异有统计学意义（P〈0．01）。结论：以社区团队模式开展对高血压患者进行健康管理,可有效控制患者血压,降低危险因素,对患者的知、信、行及治疗是有效的管理模式。     

血压管理在社区高血压患者中的防治作用

目的 探讨血压管理在社区高血压患者中的防治作用.方法 对登记的高血压患者120例患者进行血压综合管理,包括建立家庭档案、定期家访、定期测量血压、饮食干预、心理干预、运动干预、行为干预及用药干预,随访1年,比较干预前后血压情况、依从性及血压控制达标率的改变.结果 120例患者干预前后收缩压及舒张压差异均有统计学意义（均P＜ 0.05）.干预前治疗依从49例（40.83％）,干预后治疗依从82例（68.33％）,差均有统计学意义（P＜0.05）.干预前血压控制达标率为23.4％（28/120）,干预后为76.7％（92/120）,差均有统计学意义（P＜0.01）.结论 血压管理在社区高血压患者中具有很好的防治作用,是一种有效的管理模式.     

东莞市某社区高血压患者社区综合干预效果评价

目的：探索以社区卫生服务机构全科医师为主体的团队对高血压患者干预的管理模式、管理效果及其存在问题,探讨促进高血压患者健康的有效措施,为社区高血压综合干预对策提供依据。方法：整群抽取东莞市石排镇社区卫生服务中心辖区内的968名（资料完整者965名）高血压患者为研究对象,通过全科医师团队对其进行为期1年的综合干预,比较管理前后高血压患者的知晓率、服药率和血压控制率。结果：管理后高血压患者的知晓率、服药率、控制率分别从管理前的61．5％、69．7％、41．2％提高到98％、92．6％、82．3％,差异均有统计学意义（ P ＜0．01）。结论：以社区卫生服务中心全科医师团队为主体的社区综合干预措施,可以提高高血压患者的知晓率和依从性、改变不良生活方式,控制患者的血压,降低其死亡率、并发症发生率,提高生活质量,值得推广。     

社区健康教育对高血压患者血压控制及遵医行为的影响

目的：探讨社区健康教育对高血压患者血压等指标及遵医行为的影响。方法：采用方便抽样的方法抽取100名原发性高血压患者且愿意合作者,对其进行社区健康教育。观察随访6个月。结果：对100例原发性高血压患者进行社区健康教育后,病人的血压、体重、甘油三酯、总胆固醇各指标与教育前相比,均有明显下降（P〈0．01）,遵医行为与教育前相比有显著提高（P〈0．01）。结论：对高血压患者实施社区健康教育后,使病人的血压、体重等指标明显下降,遵医行为显著改善。     

非洛地平联合健康教育治疗高血压的临床分析

目的：分析非洛地平联合健康教育治疗高血压的临床疗效。方法：随机将116例高血压患者分为A组和B组，两组各有58人。B组实施常规降压药物治疗，A组使用非洛地平联合健康教育治疗，分析两组患者治疗效果。结果：A组与B组治疗总有效率为96．6％、82．8％，数据差异（P＜0．05）。A组用药依从性优良率为94．8％，B组优良率为69．0％，依从性对比（P＜0．01）。结论：非洛地平联合健康教育治疗高血压具有显著疗效，可有效控制患者血压，提高患者服药依从性。     

社区综合干预1068例高血压病效果评估

目的：探索以社区卫生服务中心全科医师团队为主体的高血压患者的管理模式、管理效果及其存在问题,为社区高血压综合干预对策提供依据。方法：选取本中心辖区内60岁及60岁以上原发性高血压患者1068例进行社区综合干预,干预期为1年,比较管理前后高血压患者的知晓率、服药依从性、控制率、对全科医生管理满意度、不良生活方式的改变情况。结果：①管理后高血压患者的知晓率、服药依从性、控制率分别从管理前的71.4%、49.7%、41.2%提高到100%、92.6%、82.3%,差异均有统计学意义（P〈0.001）;②管理后高血压患者的生活方式均有明显改善,与管理前比较差异有统计学意义（P〈0.001）。结论：以社区卫生服务中心全科医师团队为主体,对高血压患者进行社区综合干预可以提高患者管理依从性、改变不良生活方式,控制患者的血压,降低其死亡率、并发症自残率,提高生活治疗。     

老年高血压危险因素分析与社区综合护理干预的效果研究

目的：分析发生老年高血压的危险因素,探讨社区综合护理干预对老年高血压患者生活质量的影响。方法选取社区57例老年原发性高血压患者为研究对象,分析发生老年高血压的危险因素,在社区对其实施综合护理干预6个月,对研究对象干预前后进行相关情况问卷调查及 SF-36生活质量表测评,研究患者的生活质量与社区综合护理干预的相关性。结果实施综合护理干预6个月后患者的治疗有效率（血压达标80.7%、血压有效87.7%、合理饮食82.5%、用药依从性87.7%、合理运动80.7%、抑郁症5.3%）与干预前（血压达标35.0%、血压有效43.9%、合理饮食52.6%、用药依从性45.6%、合理运动40.4%、抑郁症17.5%）比较差异有统计学意义（P 〈0.01）;患者的生活质量在 SF-36生活质量测评表上显示干预后比干预前明显提高（P 〈0.05）。结论社区综合护理干预可提高老年高血压患者的遵医依从性和修正或改变自身的不良生活习惯,是控制高血压的有效途径;社区综合护理干预可大大提高老年高血压的防治水平,从而进一步提高老年高血压患者的生活质量。     

社区高血压病患者568例服药依从性调查及管理对策

目的调查社区高血压病患者服药的依从性,探讨管理对策。方法对上海市彭浦新村街道社区卫生服务中心821弄社区站点568例高血压病患者进行问卷调查。调查的内容包含患者的一般情况、高血压治疗服药的依从性。结果高血压规范管理后,患者服药依从性良好率从管理前的76．23％提高至91．37％（P〈0．01）;血压控制优良率、尚可率从管理前的24．30％、32．75％提高至40．49％、41．37％,而不良率由管理前的34．33％下降至26．76％,差异有统计学意义（P〈0．01）。结论社区医护人员采用群体和个体相结合的规范管理方式,严格遵医嘱服药原则,可有效提高高血压病患者的服药依从性。     

综合护理干预对出院高血压患者降压效果的影响

目的：评价综合护理干预措施对出院高血压患者降压效果的影响。方法：对照组实施常规出院指导,干预组采用综合护理干预措施。结果：干预后,干预组 SBP、DBP 水平明显优于对照组,差异有统计学意义（P ＜0．05）;干预组规律用药、合理饮食、合理运动、监测血压以及定期复查的依从性均明显优于对照组,差异有统计学意义（P ＜0．05）;干预组护理满意度明显高于对照组,差异有统计学意义（98．36％ VS 87．70％,P ＜0．05）。结论：综合护理干预措施可以有效的保持高血压患者出院后的血压水平,提高患者的治疗依从性以及护理满意度,值得进行广泛的推广应用。     

正常高值血压人群中高血压危险因素的社区干预研究

目的：对正常高值血压人群中的高血压危险因素进行社区干预并评价其效果。方法：对10个不同社区的646例正常高值血压者进行相关因素的调查,并进行1年的社区综合管理及健康干预。结果：该646例正常高值血压者经社区健康服务中心管理干预后,知、信、行的掌握人数较干预前明显增多,知识掌握人数增长32．81％,干预前后比较,有显著性差异（P〈0．01）;不良行为（吸烟、饮酒、氯化钠摄入过多、饮食不合理、不参加体育锻炼）人数较干预前显著减少（P〈0．01）;血压控制水平比干预前明显改善（P〈0．01）;体重指数则干预前后无明显变化（P〉0．05）。结论：对正常高值血压人群经社区健康服务中心综合管理进行社区干预,能够减少该人群的不良行为习惯,建立科学良好的生活方式．从而达到促进和维护健康的目的。     

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.