严重胸部创伤高血糖患者极化液个体化临床干预效果研究

目的探讨严重胸部创伤高血糖患者极化临床干预效果。方法将我院胸心外科ICU病房收治的严重胸部创伤患者381例。随机分为极化液组195例及液基础对照组186例。监测两组患者血糖水平，并根据血糖水平、体重以及输注的葡萄糖量。观察极化液组及其对照组MODS发生率、感染率以及死亡率变化。结果极化液组195例发生多器官功能不全综合征（MODS）50例。MODS发生率为25．64％，基础对照组186例发生MODS74例，MODS发生率为39．78％，极化液组MODS发生率明显低于基础对照组（P〈O．01）。极化液组195例发生感染86例．感染率为44．10％，基础对照组186例发生感染120例，感染率为64．52％。极化液组感染率明显低于基础对照组（P〈0．01）。极化液组195例发生死亡20例，病死率为40．OO％。基础对照组186例死亡44例。病死率为59．46％，极化液组病死率明显低于基础对照组（P〈0．05）。结论极化液个体化临床干预可作为胸部创伤患者MODS的重要防治辅助措施。     

创伤死亡不同血糖水平患者存活时间、感染率和MODS发生率病历调查

目的研究创伤死亡不同血糖水平患者院前创伤评分(revised trauma score,RTC;glasgow coma scale,GCS)、3 d后死亡构成比、感染率和多器官功能不全综合征(multipe organ dysfunction syndrome,MODS)发生率的变化.方法随机抽查本院1999年1月至2005年1月455份住院创伤死亡病历,根据空腹血糖水平及正常参考范围分为创伤死亡正常血糖组57例和创伤死亡高血糖组298例.统计创伤死亡不同血糖水平组RTC、GCS、3 d后死亡构成比、感染率和MODS发生率及的变化,并计算创伤死亡患者血糖与MODS相关定量指标的相关系数.结果①创伤死亡高血糖组RTC为6.31±1.04,GCS为4.23±0.52;创伤死亡正常血糖组RTC为4.43±0.22,GCS为2.21±0.34.创伤死亡高血糖组院前创伤评分明显高于创伤死亡组正常血糖(P＜0.01).②创伤死亡高血糖组3 d后死亡构成比为67.34%,创伤死亡正常血糖组3 d后死亡构成比为17.54%.创伤死亡高血糖组3 d后死亡构成比明显高于创伤死亡正常血糖组(P＜0.01).③创伤死亡高血糖组感染率为83.92%,MODS发生率为71.86%;创伤死亡正常血糖组感染率为21.05%,MODS发生率为10.53%.创伤死亡高血糖组感染率和MODS发生率均明显高于创伤死亡正常血糖组(P＜0.01).④455例创伤死亡患者血糖水平与血ALT、AST、BUN、CRE、PCO2、CK明显正相关(P值均＜0.01).结论创伤死亡高血糖患者院内存活时间长,感染率和MODS发生率高.创伤死亡正常血糖患者伤情重,存活时间短,感染率和MODS发生率低.创伤高血糖患者死亡因素以感染和MODS为主,创伤正常血糖患者死亡因素以非MODS因素(大出血和颅脑直接损伤等)为主.创伤血糖水平升高可作为创伤MODS预警指标,但血糖正常预后也不一定好.     

应激性高血糖与急性心肌梗死并发心律失常相关性探讨

目的探讨急性心肌梗死时应激性高血糖与心律失常的关系。方法对86例既往无糖尿病病史的急性心肌梗死患者入院后次日测空腹血糖分组,分为血糖正常组（空腹血糖≤6．1mmol／L）和血糖增高组（〉6．1mmol／L）,并持续进行心电监护,比较两组之间心律失常发生率。结果血糖增高组的急性心肌梗死患者心律失常的发生率明显高于血糖正常组（P〈0．01）。结论应激性血糖升高的急性心肌梗死患者心律失常的发生率明显增高,预后差。     

非糖尿病急性心肌梗死患者不同血糖水平对预后的影响

目的 探讨非糖尿病急性心肌梗死(AMI)患者血糖水平对预后的影响.方法 将122例AMI患者随机分为正常血糖组46例(空腹血糖≤6.1 mmol/L)和血糖升高1组(6.1 mmoL/L<空腹血糖≤8.0 mmoL/L)38例、血糖升高2组(8.0 mmoL/L<空腹血糖≤11.1 mmoL/L)27例和血糖升高3组(空腹血糖>11.1 mmoL/L)11例,在入院第4周统计2组患者肌酸激酶(CK)、门冬氨酸转氨酶(AST)、乳酸脱氢酶(LDH),心电图ST段恢复时间以及恶性心律失常、心力衰竭、心源性病死发生率的差异.结果 与正常血糖组比较,血糖升高1组在心肌酶和心电图恢复时间,恶性心律失常、心力衰竭和心源性病死率无明显差异(P>0.05);血糖升高2组CK、AST恢复时间明显延长,恶性心律失常和心源性病死率明显升高,有显著性差异(P<0.05);血糖升高3组CK、AST、LDH和ST段恢复时间明显延长,恶性心律失常、心力衰竭和心源性病死率明显升高,有显著性差异(P<0.05).结论 非糖尿病AMI患者血糖>8.0 mmol/L以上时,随着血糖升高,预后越差.     

基础血糖水平分布与重症患者危重程度及预后关联性研究

目的研究重症患者早期基础血糖水平分布特点,分析其与危重病程度及预后间的相关性。方法根据入科监测的基础血糖值,将207例重症患者分成三组：A组,血糖〈4．5mmol／L;B组,血糖4．5—8．3mmol／L;C组,血糖〉8．3mmol／L,统计分析各组患者危重程度及预后指标。结果①入组患者血糖范围在0．58—22．08mmol／L,平均血糖水平为（7．39±3．05）mmol／L;②B组患者的APACHEⅡ评分（10．30±6．23）及乳酸值（1．46±0．99）mmol／L,均显著低于A组患者的（22．544-13．46）及（5．07±2．98）mmol／L和C组患者的（14．74±8．49）及（2．82±1．74）mmol／L,差异有统计学意义（P〈0．05）;③A组患者MODS发生率、感染发生率、血管活性药物使用率、28日生存率分别为75％、62．5％、50％、54．2％,与B、C组患者比较差异有统计学意义（P〈0．01）;④A组患者基础血糖水平与APACHEⅡ、GCS、MODS和SOFA评分及多巴胺用量均存在显著相关性,而C组仅与APACHEⅡ、GCS评分相关（P〈0．01）。结论重症患者的基础血糖分布在4．5—8．3mmol／L范围具有较好的安全性,可能是最合理的控制水平。血糖浓度低于4．5mmoL／L时可作为对患者病情及预后判断的重要指标。     

创伤及大手术后感染并发高血糖和MODS患者血浆内毒素与胰岛β细胞功能不全的关系

目的探讨严重创伤及大手术后感染并发高血糖和多器官功能不全综合征（MODS）患者血浆内毒素与胰岛β细胞功能不全之间的关系。方法创伤后及大手术后感染并发高血糖和MODS患者60例，根据预后情况分为两组：生存组23例和死亡组37例。采用重组C因子基质显色法测定血浆内毒素，用放射免疫法测定血浆胰岛素，用酶法测定血糖。并观察两组患者血浆内毒素（LPS）、稳态模式评估法胰岛素分泌指数（HOMA-β）、糖负荷30min。后胰岛素增量和血糖增量比值（△INS30／△GLU30）和稳态模式评估法胰岛素抵抗指数（HOMA-IR）变化，并分析血浆内毒素与HOMA-β，△INS30／△GLU30和HOMA-IR相关性。结果死亡组血浆内毒素、空腹血糖水平和HOMA-IR均明显高于生存组（P均〈0.01），HOMA-β和△INS30／△GLU30均明显低于生存组（P均〈0.01）。60例创伤及大手术后感染并发高血糖和MODS患者血浆内毒素与HOMA—β和△INS30／△GLU30呈明显负相关（r分别为-0．7340，-0.8115，P均〈0．01），与空腹血糖呈明显正相关（r=0．7556，P〈0.01）。结论严重创伤后感染高血糖MODS患者血浆内毒素在胰岛G细胞功能缺陷中可能发挥重要作用。     

高血糖合并急性心肌梗塞的临床分析

目的糖尿病可促使动脉硬化的发生和发展．且与心肌梗塞的预后密切相关。了解伴血糖增高的急性心肌梗塞（AMI）,患者的临床特征及预后。方法对116例AMI患者早期血糖测定结果进行分析。结果116例患者中80例有不同程度的血糖升高,其中血糖＜7.8mmol／L（B组）24例,血糖介于7.8与9．0mmol／L之间（C组）15例,血糖≥9．0mmol／L（D组）41例。结论高血糖无痛性心肌梗塞及感染的发生率明显高于血糖正常人,死亡率也显著增加。     

强化胰岛素治疗对严重胸部创伤患者近期预后的影响

目的观察强化胰岛素治疗（IIT）对严重胸部创伤患者预后的影响。方法将42例严重胸部创伤患者（AIS≥3）随机分为IIT组（n=21,血糖控制于4．4～6．1mmol／L）和常规治疗（CIT）组（n=21,血糖控制于10．0～11．1mmol／L）。观察2组治疗后住院期间的病死率,院内感染发生率,机械通气时间、ICU入住、胸腔引流管拔管和白细胞计数下降至正常所需时间。结果2组无住院死亡,无低血糖反应。与CIT组相比,IIT组院内感染发生率、机械通气时间、ICU入住时间、白细胞计数下降至正常所需时间均降低,差异有统计学意义（P〈0．05）;2组在胸腔闭式引流管拔管时间、低血糖反应方面,差异均无统计学意义（P〉0．05）。结论对严重胸部创伤患者IIT治疗可改善预后。     

S—T段抬高型心肌梗死患者早期血钾水平的检测及其监护

目的：研究S—T段抬高型急性心肌梗死（AMI）患者早期低钾血症的发生情况及其监护。方法：对123例S—T段抬高型AMI患者于入院时抽血测定血钾、肌酸激酶同工酶（CK—MB）、肌钙蛋白I（cTnI）,根据血钾水平分为低血钾组（血K^＋〈3．5mmoL／L）和正常血钾组（血K^＋3．5—5．5mmoL／L）,同时在1周内严密加强监护,观察住院期间室性心动过速、心室颤动和猝死等严重不良事件的发生情况。结果：低钾血症的总发生率为30．1％,低血钾引起严重不良事件发生率（32．9％）明显高于正常血钾组（10．8％）。结论：低钾血症对AMI患者的预后影响较大,加强临床监护具有重大的意义。     

糖尿病人群不同基线空腹血糖水平对肾功能的影响

目的：探讨糖尿病人群中基线空腹血糖水平对肾功能的影响。方法：采用前瞻性队列研究方法,以2006年至2007年度参加开滦集团健康体检的9489例糖尿病者为观察队列,排除正在透析及eGFR＜60mL／min?1．73m2、死亡及各种原因未参加2010年至2011年度健康体检者共5170例,最终纳入统计分析者为4319例,按照基线空腹血糖水平分为4组（第一组：＜7．0mmoL／L组,第二组7．0～9．0mmoL／L组,第三组9～11mmoL／L组,第四组≥11mmoL／L组）,采用多因素logistic回归分析基线空腹血糖水平对肾功能的影响。结果：2010年至2011年度健康体检结束时观察队列中新发肾功能不全者为196例,4组间发生率分别为3．35％、3．89％、4．74％、6．43％（ P for trend ＜0．05）。多因素logistic回归分析结果显示,与第一组比较,二、三、四组发生肾功能不全事件的 OR 值（95％CI ）分别为：1．33（95％CI ：0．75～2．36,P＝0．322）、1．58（95％CI：0．85～2．93,P＝0．151）、2．43（95％CI：1．35～4．39,P＝0．003）。结论：血糖升高可增加糖尿病人群肾功能不全的发病风险。     

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.     

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.     

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.