毁损肺手术血液保护措施及麻醉气道管理

目的：评价单侧毁损肺手术患者采用多项血液保护措施，血红蛋白（ Hb）≥70 g／L时按需输血的效果和安全性。方法符合入选的2013年1月至2016年1月86例患者为观察组，回顾2008年1月至2012年12月98例患者为对照组。观察组应用氨甲环酸、液体加温超声刀等多项血液保护措施，输血条件为Hb＜100 g／L，≥70 g／L。对照组则根据患者术前情况，手术出血500～700 mL时按经验输血。比较两组患者手术出入量及围术期不良事件发生率。结果观察组术中出血量、红细胞、血浆用量、术后胸腔引流量与对照组比较减少，差异有统计学意义（P＜0.01），观察组输血时Hb值为（77±5）g／L。两组围术期均无严重并发症。结论无严重心肝肾功能障碍毁损肺患者，恰当的气道管理及血液保护措施、按需输血，可减少术中出血，无不良反应。     

皮下注射重组人红细胞生成素治疗失血性贫血临床研究

目的 观察皮下注射重组人红细胞生成素（rHuEPO）治疗上消化道出血后失血性贫血的可行性，减少病人对异体输血的需求。方法 对确诊为上消化道出血后失血性贫血的患者240例，血红蛋白（Hb）50．4，62．7g/L。根据患者对贫血的耐受情况进行分组，临床症状严重者80例为A组，输浓缩红细胞，其余160例对贫血状况耐受好，随机分为两组：B组8l例，使用rHuEPO治疗，A、B两组治疗期间同时补充铁剂；C组79例，不用rHuEPO仅补充铁荆。3组均于治疗后第3d、第7d、第10d测定网织红细胞计数（RC），每周测定1次Hb、HCT。结果 （1）B组RE于用药后第3d开始升高，第7d明显增高，第10d比用药前升高2倍。A、C两组RE也有升高，但差异明显（P〈0．05）。（2）经4周治疗后B组Hb平均由56．8g／L升至106．1g／L，A组Hb平均由56．5g／L升至105．2g／L，C组Hb平均由56．6g／L升至65．2g／L。A、B两组结果经统计学分析差异无显著性（P〉0．05），B、C两组结果经统计学分析差异有显著性（P〈0．05），并经临床观察，B组副作用轻而少，能耐受。结论 用皮下注射rHuEPO治疗上消化道出血后失血性贫血比不用rHuEPOHb恢复加快，3-4周末可达到与输血相同的效果，说明减少病人对异体输血的需求，用药物治疗是可行的。     

INTERTAN治疗老年股骨粗隆间骨折围手术期隐性失血的初步分析

目的分析InterTan治疗老年股骨粗隆间骨折的围手术期失血量,提高对其隐性失血的认识。方法回顾性分析本院在2010年12月～2013年5月,采取治疗的65例股骨粗隆间骨折患者手术前后的红细胞压积（Hct）变化,计算围手术期失血量。结果65例患者中围手术期未输血的44例,男17例,女27例;平均年龄76．1岁,平均手术时间73．9min,术中显性失血及术后引流量共172．0mL,术前血红蛋白（Hb）平均118．6g／L,术后93．7g／L,降低了24．9g／L;术前Hct平均33．1,术后25．2,降低了7．9;采取输血支持的21例,男9例,女12例;平均年龄81．5岁,平均手术时间72．4min,术中显性失血及术后引流量共179．8mL,平均输血量624mL,术前Hb平均98．1g／L,术后94．5g／L,降低了3．5g／L;术前Hct平均30．1,术后28．1,降低了2．0。按方程计算,两组围手术期失血量分别为877mL和884mL,其中隐性失血分别占80．2％和81．2％。结论隐性失血的原因是多方面的,围手术期应特别注意补充血容量。对隐性失血的正确认识有助于提高围手术期安全性。     

合并糖尿病的普外科手术患者围手术期的处理

目的：探讨合并糖尿病的普外科手术患者的围手术期处理方法。方法：回顾性分析42例普外科手术患者合并糖尿病在围手术期控制血糖的方法。结果：术时血糖浓度控制在7．0-8．0mmol／L。切口Ⅰ期愈合40例（95．2％）；切口感染Ⅱ期愈合2例（4．8％），均安全度过手术期。结论：合并糖尿病的普外科手术患者，围手术期保持血糖稳定，是手术成功的关键因素之一。     

异丙酚-瑞芬太尼靶控输注对妇科腹腔镜手术病人血流动力学影响

目的：观察3．5μg／ml效应室浓度异丙酚联合1．5ECe50（3．6ng／ml）瑞芬太尼效应室靶控输注在妇科腹腔镜手术中对血流动力学的影响，并与吸入麻醉进行比较。方法：30例ASAⅠ级择期腹腔镜手术病人，随机分为两组，即异丙酚联合瑞芬太尼双道静脉效应室靶控输注组（PR组）及七氟烷-氧化亚氮吸入组（SN组），每组15例。监测两组病人围术期的血压、心率（HR）和BIS值；并采用CO2重吸入法测定手术期间的每搏输出量（SV）、心输出量（CO）、体循环阻力（SVR）等血流动力学参数的变化。结果：PR组15例病人血压波动均在适宜麻醉范围内，1例病人在气腹5min时心率低于50次／min而需用阿托品处理；术中PR组所有血流动力学指标均在正常范围内，SN组15例病人中有9例术中血压超出适宜麻醉范围而需静注异丙酚并加大七氟烷吸入浓度加深麻醉；PR组术中气腹15min内各时间点的血压与HR均低于SN组（P〈0．05或0．01），PR组术中气腹后的CO与CI均低于SN组（P〈0．05或0．01）。结论：吸入麻醉腹腔镜手术中呈高血流动力学状态，异丙酚-瑞芬太尼联合靶控输注麻醉的组合模式比传统吸入麻醉可更有效地控制麻醉和手术操作所带来的血流动力学变化。     

术后贫血对生活质量的影响

目的　观察手术出血致术后贫血对病人生活质量的影响 ,探讨其健康教育与护理要点。方法　 6 0例直肠癌根治术、子宫内膜癌根治术等择期手术患者以围手术期输血标准不同分为Hb≤ 70 g/L输血组 (试验组 )与 70 g/L相似文献   

贫血诊断中红细胞分布宽度的临床应用

应用全自动血细胞分析仪对500例贫血患者红细胞分布宽度（RDW）、血红蛋白（Hb）、红细胞压积（HCT）进行检测．RDW增高分别为：DHb〈90g／L且HCT〈0．25为98％；2）Hb：90～100g／L且HCT：0．25～0．30为97．3％；3）Hb：100～110g／L且HCT：0．30～0．35为84％；4）Hb：110～120g／L且HCT：0．35～0．45为80％。结果表明：RDW诊断贫血先于Hb，可早期发现贫血，特别是可作为缺铁性贫血的早期诊断指标，     

去白细胞血液输血与肿瘤术后感染及切口愈合的关系

目的：研究去白细胞悬浮红细胞输注对肿瘤术后感染及伤121愈合的影响。方法：将108例各种肿瘤患者分为3个组。输注去白细胞悬浮红细胞组35例,输注悬浮红细胞组35例,未输血组（对照组）38例,观察3个组患者术后感染、伤口愈合情况。结果：感染率比较：术后感染率输注去白悬浮红细胞组5．7％,输注悬浮红细胞组28．6％,两组差异显著（P〈0．05）;输注去白细胞悬浮红细胞组与未输血组（5．1％）对比无明显差异（P〉O．05）。术后切口愈合率：输注去白细胞悬浮红细胞组95．6％,输注悬浮红细胞组74．6％,两组对比有明显差异（P〈0．05）;输注去白细胞悬浮红细胞组切口愈合率与未输血组（96．3％）对比无明显差异（P〉0．05）;输注悬浮红细胞组切口愈合率（74．6％）与未输血组（96．3％）对比有明显差异（P〈0．05）。结论：围术期输血对患者免疫功能有影响,去白细胞悬浮红细胞在一定程度上能阻止输血的免疫抑制作用,从而降低术后感染率,提高术后切口愈合率。     

靶控技术在食管癌术后乳糜胸再手术麻醉中的应用

目的探讨食管癌术后乳糜胸再手术麻醉的最佳方案．方法采用随机抽样单盲比较的统计方法．比较实验组和对照组两组间围手术期各项生命体征（HR、1Bp、CVP、SpO2、R、ECG）及术后病人恢复情况结果经统计学处理两组间存在显著性差异（P〈0．05），结论靶控技术（TCI）在食管癌术后乳糜胸再手术中有良好的可控性，对血流动力学的影响小，有利于病人围手术期生命体征的平稳，适于临床推广。     

肾病患者抗-B抗体缺乏1例

1临床资料患者，男，62岁，既往无输血史，因肾病贫血来我院就诊，诊断为肾衰。实验室检查：Hb5．3g／L；血清白蛋白25g／L，球蛋白70g／L；血清免疫球蛋白：IgG39．60g／L，IgA0．15g／L，IgM1．31g／L；尿蛋白（＋＋＋）。因贫血严重拟输血，正定血型为A型，血清与A、B、O、AB型红细胞均不发生凝聚，进一步做吸收放散试验，证明该患者为A型，血清中缺乏抗-B抗体。     

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.