吲哚美辛栓预防胆总管结石患者ERCP术后胰腺炎的临床观察

目的观察吲哚美辛用于预防胆总管结石患者行内镜下逆行胰胆管造影术(ERCP)后胰腺炎的效果情况。方法研究开展自2018年1月至2019年6月,研究对象是该期间内来我院接受ERCP术治疗的胆总管结石患者198例,按硬币法随机进行分为二组,对照组为术后单用抑制胰酶分泌药物,预防组为在术后抑制胰酶分泌药物基础上术前30 min肛塞吲哚美辛栓,对比指标包括血淀粉酶水平、高淀粉酶血症和胰腺炎发生率。结果术前二组血淀粉酶水平无显著差异(P 0.05),但术后4 h及12 h预防组淀粉酶水平显著低于对照组(P0.05);预防组ERCP术后高淀粉酶血症发生率8.1%低于对照组的18.2%,胰腺炎发生率2.0%也低于对照组的5.1%,差异值皆具统计学意义(P0.05)。结论预防性肛塞吲哚美辛有利于降低胆总管结石患者ERCP术后淀粉酶水平,减少高淀粉酶血症,降低胰腺炎发生率。     

胰管支架置入联合吲哚美辛栓纳肛预防困难胆管插管患者逆行胰胆管造影术后胰腺炎的临床研究

目的 探讨胰管支架置入联合吲哚美辛栓纳肛对困难胆管插管患者内镜下逆行胰胆管造影术(endoscopic ret-rograde cholangio-pancreatography,ERCP)术后胰腺炎的预防作用.方法 选取2012年1月至2016年11月我院ERCP术中发生困难胆管插管的患者108例,按随机数字表法随机分成4组,A组:单纯行胰管支架置入,B组:单纯行吲哚美辛栓纳肛,C组:胰管支架置入联合吲哚美辛栓纳肛,D组:无预防ERCP术后胰腺炎(post-ERCP pancreatitis,PEP)措施.分别检测术前、术后4 h、术后24 h血清淀粉酶水平,采用视觉模拟评分法(visual analogue score,VAS)对腹痛程度进行评分.对比各组ERCP术后患者血清淀粉酶水平、PEP发生率及术后腹痛评分.结果 术后4 h血清淀粉酶水平B组和C组均明显低于D组(P<0.05),术后24 h血清淀粉酶水平A组、B组和C组均明显低于D组(P<0.05).术后24 h PEP发生率A组和C组均为0%,明显低于D组7.4%(P<0.05).术后4 h、24 h各组疼痛程度VAS评分均明显高于术前(P<0.05);B组和C组术后4 h、24 h均明显低于D组(P<0.05);B组术后4 h、24 h均明显低于A组(P<0.05);A组仅术后24 h明显低于D组(P<0.05).结论 胰管支架置入联合吲哚美辛栓格纳肛可减少ERCP术后高淀粉酶血症的发生,可减少PEP发生率,减轻ERCP术后患者的腹痛评分,可以有效预防PEP和高淀粉酶血症.     

吲哚美辛栓直肠给药预防ERCP术后胰腺炎的临床分析

目的:探讨直肠应用吲哚美辛栓剂对内镜逆行胰胆管造影术(ERCP)术后胰腺炎的预防作用。方法:将ERCP手术的287例患者随机分为吲哚美辛术前组、吲哚美辛术后组以及对照组。观察术后血尿淀粉酶变化情况、术后胰腺炎及高淀粉酶血症发生率。结果:术后胰腺炎发生率:吲哚美辛术前组(6.3%)低于吲哚美辛术后组(12.6%)及对照组(13.4%),有统计学差异(P<0.05);术后24h血清淀粉酶情况:吲哚美辛术前组121±107μ/L、低于吲哚美辛术后组187±139μ/L及对照组201±301μ/L,有统计学意义(P<0.05);术后高淀粉酶血症发生率:吲哚美辛术前组15.7%明显低于吲哚美辛术后组24.2%及对照组25.8%,有统计学意义(P<0.05)。结论:术前30min吲哚美辛栓剂直肠给药可有效预防ERCP术后胰腺炎及高淀粉酶血症的发生率。     

直肠应用吲哚美辛在预防ERCP术后胰腺炎中作用的研究

目的：观察直肠应用吲哚美辛对ERCP术后胰腺炎（PEP）及高淀粉酶血症的预防作用。方法将行 ERCP检查的260例患者随机分为吲哚美辛组和对照组,吲哚美辛组在 ERCP术前60min直肠内给予吲哚美辛栓剂100mg ,对照组在ERCP术前不予直肠内治疗。观察ERCP术后患者有无腹痛,并于术后4、24、48h做血清淀粉酶测定。结果吲哚美辛组PEP发生率（6．9％）与对照组PEP发生率（22．3％）有统计学差异（ P ＜0．05）,吲哚美辛组ERCP术后高淀粉酶血症发生率（20．8％）显著低于对照组（52．3％,P ＜0．05）。结论直肠应用吲哚美辛可以预防ERCP术后胰腺炎（PEP）和高淀粉酶血症的发生。     

吲哚美辛预防老年胆总管结石ERCP术后胰腺炎和高淀粉酶血症的临床观察

目的:探讨通过直肠给药的方式应用吲哚美辛预防老年胆总管结石内镜逆行胰胆管造影术(ERCP)术后胰腺炎和高淀粉酶血症的临床效果.方法:70例需行ERCP的老年胆总管结石患者随机分为吲哚美辛组和安慰剂组,每组35例.吲哚美辛组患者ERCP术前30min直肠内给予吲哚美辛栓剂,安慰剂组患者ERCP术前30min直肠内给予安慰剂栓剂.分别于术前,术后3h、术后24h检测患者血清淀粉酶,并判定患者是否出现胰腺炎和高淀粉酶血症.结果:吲哚美辛组患者术后3h、24h的血清淀粉酶水平均明显低于安慰剂组(P<0.05).吲哚美辛组患者术后胰腺炎、高淀粉酶血症的发生率分别为5.71％(2/35)和17.14％(9/35),均明显低于安慰剂组(P<0.05).结论:ERCP术前直肠应用吲哚美辛能够显著降低老年患者急性胰腺炎和高淀粉酶血症的发生率,值得临床推广.     

调胃承气汤与吲哚美辛栓防治老年胆总管结石患者ERCP术后胰腺炎和高淀粉酶血症疗效的对比研究

【摘要】目的 观察调胃承气汤防治老年胆总管结石ERCP术后胰腺炎和高淀粉酶血症的疗效。方法 共纳入261例年龄≥60周岁患胆总管结石行ERCP取石治疗老年患者,患者随机分为对照组85例、西药组（吲哚美辛栓组）88例、中药组（调胃承气汤组）88例,各组术前均予常规治疗外,西药组于ERCP术前半小时吲哚美辛栓100mg纳肛;中药组：术前和术后口服调胃承气汤。对三组的ERCP术后胰腺炎和高淀粉酶血症发生率进行比较,检测术前术后超敏C反应蛋白（CRP）水平及差值、术后6 小时、24 小时血清淀粉酶水平及差值等指标进行比较;记录并对比三组通便时间及住院时间;记录三组术中出汗、低钾血症等不良反应发生情况。结果 与对照组比较,西药组、中药组术后胰腺炎、高淀粉酶血症发生率均明显降低（均 P<0.05）,西药组发生术中出汗、低钾血症发生率较高,中药组术后排便时间及住院明显缩短（P<0.05）。结论 调胃承气汤可有效降低术后胰腺炎及高淀粉酶血症的发生率,疗效与吲哚美辛栓相当,加快术后排便恢复时间,缩短住院时间,且发生出汗、低钾血症等不良反应少,安全有效。     

直肠应用吲哚美辛预防ERCP术后高淀粉酶血症的研究

目的 观察直肠应用吲哚美辛对ERCP术后高淀粉酶血症的预防作用.方法 将行ERCP检查的60例患者随机分为吲哚美辛组和对照组各30例,吲哚美辛组在ERCP术前60min直肠内给予吲哚美辛栓剂100mg,对照组在ERCP术前不予直肠内治疗.ERCP术后观察患者有无腹痛,并于术后4h、24h及48h做血清淀粉酶测定.结果 吲哚美辛组ERCP术后高淀粉酶血症发生率(23.3％),显著低于对照组(60％)(P＜0.01).结论 直肠应用吲哚美辛可以预防ERCP术后高淀粉酶血症的发生.     

胰管支架预防高危患者逆行胰胆管造影术后胰腺炎

目的 探讨胰管支架置入在预防高危患者经内镜逆行胰胆管造影（ERCP）术后胰腺炎（PEP）及高淀粉酶血症中的作用。方法 回顾性分析2013年1月至2014年12月间我院行ERCP治疗的160例PEP高危患者的临床资料。依据是否置入胰管支架,将其分为胰管支架组82例（放置支架）和对照组78例（未放置支架）。观察术后患者腹痛情况,监测术后3h、24h血清淀粉酶水平, 比较两组术后胰腺炎、高淀粉酶血症的发生率。结果 胰管支架组术后腹痛发生率、腹痛评分[19.5% （16/82）、(1.24±0.58)]均低于对照组[43.6%（34/78）、(1.68±0.97)],差异有统计学意义（P=0.001）。胰管支架组术后3h和术后24h血清淀粉酶分别为（184.89±257.33）U/L和（268.07±344.73）U/L,均低于对照组（305.35±371.81）U/L和（465.86±639.94）U/L,差异有统计学意义（P<0.05）。胰管支架组急性胰腺炎、高淀粉酶血症发生率[2.4%（2/82）、17.1%(14/82)]显低于对照组[11.5%(9/78)、30.8%(24/78)],差异有统计学意义（P<0.05）。结论 胰管支架置入可有效预防高危患者ERCP术后胰腺炎及高淀粉酶血症的发生。     

消炎痛栓预防胆总管结石ERCP术后胰腺炎的效果

目的观察直肠应用消炎痛栓预防胆总管结石病人内镜下逆行胰胆管造影术(ERCP)术后胰腺炎、高淀粉酶血症的效果。方法将符合标准的胆总管结石病人113例随机分为2组,预防组60例,对照组53例。预防组术前1h给予消炎痛栓100mg塞肛,对照组不给予消炎痛栓。测定两组病人术前及术后6、24h血清淀粉酶水平,观察ERCP术后高淀粉酶血症、急性胰腺炎的发生率。结果预防组ERCP术后6、24h血清淀粉酶水平明显低于对照组(t=-2.31、-2.20,P<0.05)。预防组胰腺炎及高淀粉酶血症发生率明显低于对照组(χ2=3.902、5.316,P<0.05)。结论直肠应用消炎痛栓可以预防胆总管结石病人ERCP术后高淀粉酶血症及胰腺炎的发生。     

生长抑素及胰管支架置入预防内镜逆行胰胆管造影术后胰腺炎的临床研究

目的：探讨预防性应用生长抑素及术后放置胰管支架对经内镜逆行胰胆管造影（ERCP）术后胰腺炎（PEP）及高淀粉酶血症的预防效果。方法将120例行ERCP诊治的高危患者随机分为3组,生长抑素组36例,胰管支架组48例,对照组36例。观察PEP、高淀粉酶血症的发生情况、病情恢复情况。结果3组患者中PEP总发生率为17.5%（21/120）,高淀粉酶血症为4.2%（5/120）。对照组PEP、高淀粉酶血症发生率（30.6%、8.3%）明显高于生长抑素组（16.7%、2.8%）和胰管支架组（8.3%、2.1%）,差异有统计学意义（P 〈0.05）。胰管支架组两者的发生率低于生长抑素组（P 〈0.05）。术后6 h 生长抑素组血清淀粉酶（467±631）U/L、胰管支架组为（501±405）U/L,明显低于对照组[（1323±461）U/L],差异有统计学意义（P 〈0.05）;但3组术后24 h血清淀粉酶水平无明显差异（P 〉0.05）。生长抑素组及胰管支架组胰腺炎患者腹部症状体征消失时间、白细胞计数降至正常时间、平均住院日均较对照组明显缩短,差异有统计学意义（P 〈0.05）。结论生长抑素、胰管支架置入均可有效预防PEP及高淀粉酶血症的发生。     

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.