运用系统性心理护理 提高献血服务质量

目的探讨对献血者实施系统性心理护理以提高献血服务质量的效果评估。方法调查2008年9月献血者献血过程的心理状态：制定系统性心理护理措施;将2008年10月的献血者随机分为试验组（行系统性心理护理）和对照组（一般性心理护理）。比较两组献血者心理咨询满意率,工作人员技术水平、服务态度满意率、献血反应发生率、再次献血意愿率。结果行系统性心理护理献血者心理咨询满意率X^2=80,P〈0．005,差异有显著性;工作人员技术水平、服务态度满意率X^2=68．7,P〈0．005,差异有显著性;献血反应发生率X^2=19．1,P〈0．005,差异有显著性;再次献血的意愿率X^2=85．1,P〈0．005,差异有显著性。结论对献血者实施系统性心理护理能有效提高献血服务质量。     

骨髓腔给药靶向治疗急性非淋巴细胞白血病临床研究

目的比较柔红霉素联合阿糖胞苷骨髓腔给药诱导缓解急性非淋巴细胞白血病（简称急非淋）的疗效和不良反应。方法用随机对照的方法将60例初治急非淋患者分为骨髓腔给药组（A组，30例）和静脉给药组（B组，30例）。观察两组的疗效和不良反应。结果A组与B组完全缓解率分别为70．0％、33．3％。总有效率分别为86．7％、50．0％。A组比B组高，差异均有统计学意义（P〈0．05）。不良反应：A组心脏毒性、胃肠道反应发生率比B组低，差异有统计学意义（P〈0．05）。A组与B组骨髓抑制发生率相近，差异无统计学意义（P〉0．05）。结论骨髓腔给药诱导缓解急非淋有较高的缓解率和较低的毒副反应。     

循证护理用于经皮肾镜取石术中预防低体温的效果观察

目的探讨循证护理对经皮肾镜取石术中低体温的预防效果。方法60例患者随机分为常规护理组（A组）和循证护理组（B组）,A组实施常规护理,B组采用循证护理制定预防低体温的护理干预措施,观察两组患者手术前后体温的变化程度及低体温、寒战等不良反应发生率。结果A组术后体温平均降低0．8℃,低体温发生率为20．0％,寒战发生率为30．0％;B组术后体温平均降低0．5℃,低体温发生率为3．3％,寒战发生率为6．7％,B组效果优于A组（P均〈0．05）。结论循证护理可有效地减轻经皮肾镜取石术中体温的降低程度。     

海南省2002～2008年无偿献血人群梅毒感染状况调查

目的调查海南省无偿献血者梅毒感染状况。方法用ELISA法对2002—2008年海南省342965名无偿献血者进行梅毒抗体检测,并将献血人群分为学生、现役军人组和其他职业组,采用）（2检验对梅毒抗体检测及分组结果进行统计分析。结果342965名无偿献血者中,梅毒抗体阳性2940例,感染率为0．86％,2002—2008年的梅毒抗体阳性率分别为1．16％、1．23％、1．15％、0．82％、0．59％、0．67％、0．64％,其中学生、现役军人献血人群梅毒抗体阳性278例,占其献血人数的0．26％,其他无偿献血人群梅毒抗体阳性2662例,占其献血人数的1．12％。结论海南省2002—2008年无偿献血者梅毒抗体阳性率逐年下降,学生、现役军人献血人群梅毒感染率较低,X2=633．852,P〈0．05,今后可重点从学生、现役军人群体中招募血源。     

直接冠状动脉内支架置入术治疗非ST段抬高的急性冠脉综合征

目的探讨非ST段抬高的急性冠脉综合征患者，行直接冠脉内支架治疗的可行性及远期效果。方法对2002.12月-2004．12月共104例冠脉造影显示无严重钙化、扭曲及较长病变的急性冠脉综合征患者进行随机、对照临床研究。患者分为直接冠脉内支架组（A组）和常规经皮冠状动脉腔内成形加支架术组（B组），并于6个月时随访。结果A组成功率为98％、B组成功率为94.4％（P〉0．05），手术相关死亡两组均为0，直径大于1mm分支血管闭塞发生率A组2％、B组14．8％（P〈0．05），肌钙蛋白2倍以上升高发生率A组为2％、B组为14.8％（P〈0．05），无复流发生率A组为2％、B组为7．4％（P〉0．05），内膜撕裂A组为2％、B组为9．25％（P〉0．05）。急性心肌梗塞发生率A组0％、B组1％（P〉0．05），6个月时死亡率A组0％、B组2％，心绞痛发生率A组为4％、B组为16．67％（P〉0．05）。结论无严重钙化、严重成角、较长病变的非ST段抬高的急性冠脉综合征患者，可行直接冠脉内支架治疗。直接冠脉内支架治疗可减少分支闭塞和术后肌钙蛋白升高。     

预防性应用纳洛酮对极低出生体重儿的影响

目的观察纳洛酮防治极低出生体重儿（VLBWI）呼吸暂停的效果。方法VLBWI30例（A组），发生周期性呼吸时给予纳洛酮治疗，观察其出生后1周内呼吸暂停发生率、药物不良反应发生率以及给氧时间。并与26例（B组）使用氨茶碱的VLBWI进行比较。结果A组呼吸暂停发生率为30．0％，B组为34．6％，两组比较差异无统计学意义（P〉0．05）。A组出现不良反应2例（6．7％），B组10例（38．5％），B组不良反应发生率高于A组（P〈0．01）。A组给氧时间为（7．2±3．9）d，B组为（6．0±4．1）d，两组比较差异无统计学意义（P〉0．05）。结论纳洛酮能降低VLBWI呼吸暂停的发生率，并能缩短用氧时间，不良反应少。     

阿奇霉素联合头孢丙烯治疗儿童上呼吸道感染的疗效分析

目的：评价阿奇霉素联合头抱丙烯治疗儿童上呼吸道细菌性感染的疗效和安全性。方法：采用随机双盲对照的方法,分3组,每组40例,A组口服抒罗康,B组口服施复捷,C组口服抒罗康和施复捷。结果：A组（抒罗康组）总有效率77．5％,不良反应发生率5％B组（施复捷组）总有效率80％,不良反应发生率5％,C组总有效率95％,不良反应发生率7．5％。均未因不良反应而中断治疗．A组与B组之间疗效比较,X2=0．08,P〉0．05,差异无显著性;A组与C组之间疗效比较,F=5．16,P=0．023,差异有显著性;B组与C组之间疗效比较,X2=4．11,P=0．0425,差异有显著性,C组不良反应发生率与A组或B组比较（A组和B组的不良反应发生率相同）,X2=0．17,P〉0．05,差异无显著性．结论：阿奇霉素治疗儿童上呼吸道细菌性感染有效,头孢丙烯治疗儿童上呼吸道细菌性感染有效,阿奇霉素联合头孢丙烯治疗儿童上呼吸道细菌感染疗效更好,优于单药给药,不良反应并未因联合治疗而增多,安全性好。     

米非司酮联合甲氨蝶呤与单纯甲氨蝶呤保守治疗异位妊娠对比观察

目的：比较甲氨蝶呤单次肌肉注射联合米非司酮与单纯甲氨蝶呤保守治疗早期异位妊娠的疗效和不良反应。方法：将确诊为异位妊娠并有药物治疗指征的患者128例，随机分为A、B两组。A组采用单次甲氨蝶呤肌肉注射、口服米非司酮，B组静滴甲氨蝶呤＋四氢叶酸钙。比较两组有效率、B—HCG降至正常的时间及不良反应。结果：A、B两组有效率分别为92．19％，78．13％．A组明显高于B组，P〈0．05；B—HCG降至正常时间A组明显低于B组，P〈0．01；而不良反应发生率B组明显高于A组，P均〈0．01。结论：两药联合应用保守治疗异位妊娠，疗效较单纯应用甲氨蝶呤好，不良反应少。     

5-羟色胺再吸收抑制剂合并认知疗法治疗伴抑郁障碍慢性前列腺炎的疗效观察

目的比较5-羟色胺再吸收抑制剂（SSRIs）合并认知疗法与单用SSRIs治疗伴抑郁障碍慢性前列腺炎（CP）的疗效。方法164例CP患者随机分为A（81例）、B（83例）2组，在泌尿系统常规治疗的基础上，再分别给予SSRIs合并认知疗法治疗或SSRIs治疗8周，比较2组对CP临床症状的总体疗效和对情绪症状的疗效。结果临床总体有效率，A组为83．1％，B组为59．0％（P〈0．05）；对情绪症状的疗效，A组有效率为81．5％，B组为67．5％（P〈0．05）。治疗8周后汉密顿抑郁量表（HAMD）总分均比治疗前显著降低（P〈0．05），治疗8周后HAMD总分A组显著低于B组（P〈0．01）。结论SSRIs合并认知疗法对慢性前列腺炎疗效优于单用SSRIs，值得临床推广。     

甲氨蝶呤在未破裂型异位妊娠中的疗效及不良反应分析

目的对比研究甲氨蝶呤在未破裂型异位妊娠中的疗效及不良反应。方法将120例未破裂型异位妊娠患者根据随机数字表法分为三组,A组以20mg甲氨蝶呤＋5％葡萄糖注射液500mL隔日静滴,并结合四氢叶酸解毒,B组采用50mg甲氨蝶呤单次肌注治疗,C组在B组的基础上联合50mg米非司酮,1次,d,持续7d进行治疗。结果治愈率A、B、C三组分别为67．5％、90．O％和92．5％,B、C组不同治疗时期血β-人绒毛膜促性腺激素下降率及治愈率比较差异无统计学意义（P〉0．05）,但均明显优于A组（P〈0．05）;B组和C组异位妊娠包块缩小超过50％者显著高于A组（P〈0．05）;不良反应发生率分别为20．0％、22．5％和45．0％,C组高于A、B两组（P〈0．05）。结论甲氨蝶呤单次肌内注射治疗方案较多次静脉滴注的治疗效果更好．虽有一定不良反应。但在停药后均能很快恢复正常,而加用米非司酮的方案未增加疗效,反而带来了更高的不良反应风险。     

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.