结直肠癌患者术后并发静脉血栓栓塞的相关影响因素及预防措施分析

目的：探讨结直肠癌患者术后静脉血栓栓塞(VTE)发生的影响因素及预防措施。方法：回顾性分析我院2020年1月—2022年1月收治的87例结直肠癌患者临床资料。所有患者均开展结直肠癌根治术治疗，术后依据是否发生VTE分为VTE组与非VTE组。收集两组年龄、性别、体质量指数、饮酒史、心血管疾病、糖尿病、术后并发症、制动时间、手术时间、术中出血量、术后美国癌症联合会(AJCC)分期、VTE病史、高脂血症、术前放疗、术前化疗、疾病类型、静脉穿刺次数等多方面资料，先行单因素分析，将有统计学差异的项目纳入Logistic回归分析系统，获得影响结直肠癌术后VTE发生的独立危险因素。结果：87例结直肠癌患者术后发生11例VTE,发生率为12.64%;单因素显示，年龄、心血管疾病、糖尿病、制动时间、手术时间、术中出血量、VTE病史、高脂血症、静脉穿刺次数与结直肠癌术后VTE发生相关(P<0.05);多因素显示，年龄≥65岁、有心血管疾病、有糖尿病、制动时间≥2d、手术时间≥3h、术中出血量≥100ml、有VTE病史、有高脂血症、静脉穿刺次数≥5次为结直肠癌术后VTE发生的独立危险因素(OR>...     

结直肠癌患者术后并发静脉血栓栓塞的影响因素分析

目的探讨结直肠癌患者术后并发静脉血栓栓塞(VTE)的影响因素。方法选取2016年1月至2018年12月我院收治的结直肠癌患者60例,入组患者均接受结直肠癌切除手术治疗,术后对其进行相应的护理干预,分析其发生术后静脉血栓的影响因素。结果干预后患者血浆黏度、纤维蛋白原以及D二聚体水平均明显低于干预前(P0.05);经单因素分析,结直肠癌术后并发静脉血栓与高血压史、静脉血栓栓塞史、糖尿病史以及心血管疾病史、手术时间、出血量、血浆黏度、纤维蛋白原浓度以及D二聚体浓度有关,差异有统计学意义(P0.05);经多因素回归分析得出,结直肠癌术后并发静脉血栓的独立危险因素包含有高血压史、有静脉血栓栓塞史、有糖尿病史以及心血管疾病史、手术时间长、血浆黏度高、纤维蛋白原浓度高以及D二聚体浓度高,差异有统计学意义(P0.05)。结论结直肠癌术后并发VTE的独立危险因素包含有高血压史、有静脉血栓栓塞史、有糖尿病史以及心血管疾病史、手术时间长、术后制动时间长、血浆黏度高、纤维蛋白原浓度高以及D二聚体浓度高。但术后对患者采取相应的干预措施,可以有效降低患者血浆黏度、D二聚体浓度以及纤维蛋白原浓度,降低术后并发VTE的危险。     

结直肠癌患者术后并发静脉血栓栓塞的影响因素分析

目的 结直肠癌患者术后并发静脉血栓栓塞(VTE)的影响因素分析。方法 我院选取2016年8月～2017年9月收治的结直肠癌患者60例作为研究对象,按照术后是否发生VTE为分组标准,对照组患者为未发生VTE,研究组患者为发生VTE。采用单因素、多因素Logistic回归的方法,分析影响患者术后并发VTE的因素。结果 研究组患者的血栓防止治疗、低相对分子质量肝素使用、术后并发症、住院时间方面于对照组相比,均存在显著差异(P 0. 05);以结直肠癌患者术后是否发生VTE为因变量,以VTE既往史、心脑血管疾病、呼吸系统疾病、输血为自变量,分析结果显示,四项自变量与因变量均存在回归关系(P 0. 05)。结论 患者VTE既往史、心脑血管疾病、呼吸系统疾病、输血等方面与发生VTE有紧密的联系。     

循证护理模式对直肠癌患者预防DVT的影响

目的:探讨循证护理干预对预防直肠癌术后患者下肢深静脉血栓(DVT)形成的疗效。方法:选择2014年6月至2018年6月在我院进行结直肠癌根治术治疗的150例患者,随机分为对照组和干预组,对照组实施常规护理,干预组给予循证护理干预,观察两组患者护理一月后DVT并发率、凝血功能情况以及预防DVT疗效。结果:护理一月后干预组DVT并发率低于对照组(P<0.05),aPTT、PT、TT等凝血功能指标高于对照组(P<0.05),Fbag水平低于对照组(P<0.05),此外干预组预防DVT疗效总有效率高于对照组(P<0.05)。结论:循证护理干预能有效降低直肠癌术后患者DVT并发率,改善凝血功能和提升预防DVT疗效。     

快速康复护理理念在结直肠癌手术患者围术期护理中对胰岛素抵抗的影响

目的分析快速康复护理理念在结直肠癌手术患者围术期护理中对胰岛素抵抗的影响。方法随机选取我院2012年5月~2014年5月收治的结直肠癌择期手术患者82例,采用随机数字表法分为两组:观察组和对照组,每组各41例。观察组采用快速康复护理理念进行围手术期护理,对照组采用常规护理模式;观察对比两组患者术后各项指标恢复情况、术后并发症发生情况以及胰岛素抵抗指数(HOMA-IR)。结果观察组术后胃管留置、尿管留置、进食、肛门排气时间、首次排便时间及住院时间均较对照组明显缩短,观察组医疗费用也较对照组明显减少,但是二者尿管重新安放例数和再住院例数相差无几;观察组不良反应发生率为9.76%,而对照组高达29.27%,差异具有统计学意义(P=0.026);观察组FPG、FINS以及HOMA-IR分别为(5.1±0.6)mmol/L、(2.3±0.4)μU/m L、(1.0±0.1),对照组分别为(6.3±0.7)mmol/L、(2.6±0.3)μU/m L、(1.2±0.2),观察组FPG、FINS和HOMA-IR均较对照组明显降低,差异具有统计学意义(P0.05)。结论采用快速康复护理理念在结直肠癌患者围手术期护理中可以有效缩短患者术后恢复时间,降低不良反应发生率和胰岛素抵抗水平,成效显著,值得推广。     

循证护理联合心理干预对结直肠癌患者术后护理效果的临床研究

目的:探讨循证护理联合心理干预对结直肠癌患者术后的护理效果。方法:将本院70例行结直肠癌手术患者按照随机数字表法分成对照组(n=35)和观察组(n=35);对照组术后采用常规护理,观察组术后采用循证护理联合心理干预;比较两组患者术后生活质量、心理状态、肠蠕动恢复时间、护理满意率和并发症发生率等指标。结果:观察组护理后生活质量、护理满意率、心理状态、肠蠕动恢复时间和并发症发生率优于对照组(P<0.05)。结论:循证护理联合心理干预能够改善行结直肠癌手术的患者的负面情绪,减轻不适感,降低并发症发生率,更好配合术后护理干预,达到提升患者术后生活质量的效果。     

循证护理在腹腔镜结直肠癌手术中的应用

目的探讨循证护理在腹腔镜结直肠癌手术中的应用。方法选择2011年6月~2013年6月在我科行腹腔镜结直肠癌患者120例,随机分为观察组(n=60)和对照组(n=60),观察组用循证护理方法,对照组用常规护理方法,观察两组不同护理方法的效果。结果观察组患者的健康知识掌握情况及满意度较对照组高,平均住院日短,术后首次排气时间及下床活动时间早,术后输液天数短,术后尿潴留、切口感染少,差异均有统计学意义(P<0.05);两组患者的住院费用差异无统计学意义(P>0.05)。结论腹腔镜结直肠癌手术患者实施循证护理,可增强患者对健康知识掌握情况,提高患者对护理的满意度,缩短平均住院日,加快术后恢复,减少术后尿潴留及切口感染并发症。     

结直肠癌围术期并发静脉血栓栓塞的影响因素

目的 对结直肠癌围术期静脉血栓栓塞(VTE)发生的相关影响因素进行研究,以指导预防和治疗。方法 研究为前瞻性队列研究,纳入2021年6月—2022年4月在本院行结直肠癌根治术的102例患者,获取暴露指标,并观察结局,采用单因素分析和多因素Logistic回归分析结直肠癌围术期发生静脉血栓栓塞的影响因素。结果 纳入者中共有20例患者在围术期发生了VTE。经单因素分析,两组患者在年龄、是否合并有糖尿病、既往VTE病史等方面比较,差异有统计学意义（P＜0.05）;在性别、BMI、是否合并冠心病、是否合并高血压、术前4周是否行抗凝治疗、手术方式、手术时间、手术体位、术后是否行物理预防、术后实验室检查指标上差异无统计学意义（P＞0.05）。多因素Logistic回归分析得出年龄与结直肠癌围术期并发VTE有回归关系(P=0.005,OR=1.136)。结论 结直肠癌围手术期的VTE发生率高达19.6%;对于年龄（72.95±9.44）岁以上、患有糖尿病、既往有VTE病史的患者,围术期应当加强干预措施,预防静脉血栓栓塞的形成,对于手术时间、手术体位等更值得关注的指标,还需要本中心更大的样本来进一步说明     

空气压力治疗仪结合低相对分子质量肝素预防结直肠癌术后深静脉血栓形成的效果

目的探究空气压力治疗仪结合低相对分子质量肝素(LMWH)预防结直肠癌术后深静脉血栓形成(DVT)的效果。方法选取我院2014年9月至2016年5月期间择期行结直肠癌根治术的患者94例,随机分为观察组和对照组,每组47例。两组均行腹腔镜结直肠癌根治术,手术麻醉及术后护理干预相同,并均予以皮下注射LMWH治疗,观察组在此基础上加用空气压力治疗仪行物理治疗。分别于术前、术后3 d检测和计算血流动力学和血液流变学相关指标水平,并观察两组术后DVT等并发症发生情况。结果两组术前各项相关指标水平比较均无统计学意义(P0.05),术后两组HCT、nbl、nbh、Fbg、D-D均明显升高(P0.05),但术后观察组HCT为(41.06±4.71)%、nbl为(8.29±1.96)m Pa/s、nbh为(6.00±1.25)m Pa/s、Fbg为(339.27±35.21)g/L、D-D为(0.84±0.15)mg/L,升高幅度均显著小于与对照组(P0.05)。观察组并发症发生发生率12.77%明显低于对照组29.79%(P0.05),其中DVT发生率4.26%明显低于对照组17.02%(P0.05)。结论空气压力治疗仪结合LMWH治疗对结直肠癌术后患者术后DVT的预防效果显著。     

循证护理干预对结直肠癌术后留置管路患者医源性感染及护理满意度的影响

目的观察循证护理干预对结直肠癌术后留置管路患者医源性感染及护理满意度的影响。方法选取本院2017年5月至2018年5月收治的结直肠癌患者66例,根据入院先后顺序进行分组,分为观察组和对照组各33例,对照组给予常规护理,观察组实施循证护理干预,对比两组护理效果。结果观察组护理满意度96.97%、医源性感染3.03%、脱管6.06%发生率、均优于对照组78.79%、15.15%、21.21%,对比有统计学意义(P0.05);观察组生活质量各维度评分优于对照组,对比存在差异,有统计学意义(P0.05)。结论对结直肠癌术后置流管路患者实施询证护理干预效果显著,值得推广。     

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.     

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.     

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.