空肠造瘘管与鼻饲管在肠内营养应用中的比较

目的合理选择肠内营养的方式.方法回顾2009年3月~2011年9月收治的147例全胃切除手术患者,根据其肠内营养方式分为两组,A组患者术后行空肠造瘘术进行肠内营养,B组患者术后采用鼻饲管进行肠内营养.分析比较两组患者术后出现呼吸道、消化道及其他各类不适的比例.结果两组患者具有可比性,其术后出现呼吸道、消化道及其他各类不适的比例有统计学意义.结论空肠造瘘管和鼻饲管两种肠内营养方式各有其优缺点,应根据患者具体情况合理选择     

延期留置空肠穿刺造口管肠内营养在老年胃癌患者术后营养状态恢复中的应用

目的探讨延期留置空肠穿刺造口管肠内营养在老年胃癌患者术后营养状态恢复中的应用。方法56例老年胃癌根治术患者随机分为2组：A组和B组，组28例。2组患者均在术后经空肠穿刺造口管行早期肠内营养支持治疗。B组术后行早期肠内营养支持治疗至出院时结束，A组术后行早期肠内营养支持治疗至出院后2周。观察2组患者营养状况的恢复及并发症的发生情况。结果A组出院前白细胞计数（WBC）、血红蛋白（Hb）、血清白蛋白（Alb）、前白蛋白（PA）、转铁蛋白（TRF）水平与B组比较差异均无统计学意义（P均〉0．05）。A组出院后WBC、Hb、Alb、PA、TRF水平与B组比较差异均有统计学意义（P均〈0．05）。A组体质量与B组比较差异无统计学意义（P〉0．05）。A组导管堵塞5例（17．9％），导管脱落l例（3．6％），腹壁局部软组织感染1例（3．6％）；B组无并发症发生。结论延期留置空肠穿刺造口管肠内营养可以促进老年胃癌患者术后营养状态的恢复。     

改良式空肠造瘘配合早期肠内营养的临床价值

目的探讨改良式空肠造瘘配合术后早期肠内营养支持的可行性及效果。方法49例空肠造瘘患者，分成治疗组（n=32）和对照组（n=17）。治疗组行改良式空肠造瘘并给予早期肠内营养；对照组行常规空肠造瘘并在肛门排气后给予肠内营养。两组患者分别于术前1d、术后9d进行营养指标监测、免疫指标监测，并记录肛门排气时间。结果治疗组并发症少、肛门排气时间短；术后9d营养指标、免疫指标治疗组较对照组改善明显。结论改良式空肠造瘘配合早期肠内营养，可减少术后并发症、改善患者的营养状况、提高患者的免疫功能。     

早期肠内营养对胃癌患者术后并发症的影响

目的：观察术后早期肠内营养支持对胃癌患者手术后并发症的影响。方法：107例胃癌根治术后患者随机分为两组。观察组（59例）：术后早期24 h经空肠营养管行肠内营养;对照组（48例）：行静脉输液补充营养。观察两组患者术后首次肛门排气排便时间,术后住院日以及术后并发症发生率的差异。结果：早期肠内营养组与对照组相比,术后首次肛门排气时间[（52±18）h vs （81±35h）]、首次排便时间[（73±26） h vs （102±19） h]明显提前,术后住院时间[（9．7±4．1）d vs （13．2±6．4）d]明显缩短,两组比较差异显著（P＜0．05）。观察组切口感染并发症（1/59,1．7％）显著低于对照组（7/48,14．6％）（P＜0．05）;观察组术后感染总发生率（6/59,10．2％）显著低于对照组（12/48,25％）（P＜0．05）;总体并发症比较,观察组（14/59,23．7％）稍低于对照组（13/48,27．1％）,但无统计学差异（P ＞0．05）。结论：胃癌患者术后早期行肠内营养支持是安全有效的,可促进术后胃肠功能恢复,缩短住院时间;并不增加术后并发症发生率,同时可以显著减少感染并发症的发生。     

空肠造瘘双向置管在胰-十二指肠切除术后肠内营养的临床应用

目的评价胰-十二指肠切除术后应用空肠造瘘双向置管行肠内营养支持的临床疗效。方法随机选取40例胰-十二指肠切除术中行空肠造瘘双向置管,术后经短时间静脉营养(肠道排气后),即通过空肠造瘘管行肠内营养;随机选取40例胰-十二指肠切除术中未行空肠造瘘双向置管者给予常规输液治疗。分为造瘘组和对照组,观察临床反应和测定血糖、肝肾功能、电解质和营养指标,比较两组患者营养状况、术后并发症、术后平均住院日和住院平均营养费用。结果造瘘组营养状况,术后并发症,术后平均住院日,住院平均营养费用均好于对照组。结论空肠造瘘双向置管可在胰-十二指肠切除手术中使用,肠内营养支持安全可靠,费用低廉,并有利于术后患者早日康复。     

胃癌术后早期肠内营养的护理干预

目的：探讨早期利用肠内营养对胃癌根治术后患者营养状况和胃肠功能恢复的影响以及针对肠内营养所引起的诸多并发症的护理要点。方法：将60例胃贲门癌根治术患者,随机分为观察组（术中留置空肠营养管并给予肠内营养液）30例,对照组（未留置空肠营养管）30例,比较两组疗效。结果：观察组患者平均肠鸣音恢复时间、肛门排气时间和术后第7 d血清白蛋白水平均明显优于对照组（P〈0.05）。结论：早期肠内营养支持,辅以合理的护理措施,可以提高胃癌患者术后营养状况,加快胃肠功能恢复。     

鼻饲空肠营养管与空肠造口营养管临床应用效果分析

目的:探讨鼻饲空肠营养管与空肠造口营养管在胃、十二指肠及胰腺术后肠内营养治疗的临床应用效果。方法:对9例应用鼻饲空肠营养管或空肠造口营养管的胃、十二指肠及胰腺手术患者的临床资料进行回顾性分析。结果:4例应用空肠造口营养管患者,其中3例发生并发症,均经再次手术治愈;另1例无不良反应痊愈出院。5例应用鼻饲空肠营养管患者,术后均无不良反应痊愈出院。结论:胃、十二指肠及胰腺术后的患者,应根据具体情况选择鼻饲空肠营养管或空肠造口营养管给予肠道内营养,术中处理得当能有效减少术后并发症的发生率。     

胃癌手术后早期肠内营养与肠外营养疗效比较

目的：探讨肠内营养应用于胃癌手术后的可行性、安全性和应用价值。方法：2007年6月～2009年6月共行胃癌切除术50例,分为肠内营养组（30例）和肠外营养组（20例）,分析两组病人术后肛门排气时间和住院时间、营养相关费以及比较术前与术后（营养指标）血清白蛋白、血清前白蛋白、血红蛋白的差异。结果：术后肛门排气时间和住院时间、营养相关费用肠内组比肠外组减少（P〈0．01）。术后第8天肠内营养组各项营养指标较肠外营养组增高明显（P〈0．05）。结论：肠内营养应用于胃癌手术后安全可行,既经济、符合生理要求,促进肠道功能恢复,又可改善病人术后营养状况。     

8例高龄食管癌患者食管癌术后经空肠造瘘实施肠内营养的护理体会

目的 探讨食管癌患者术后早期经空肠造瘘实施肠内营养支持的效果及护理体会.方法 回顾性分析8例高龄食管癌患者术后经空肠造瘘实施肠内营养支持的护理.结果 8例患者均可耐受,且患者恢复肛门排气时间较早.治疗过程中,1例患者胃排空障碍.患者体重交术前无明显差异.结论 高龄食管癌患者术后经空肠造瘘管早期肠内营养支持使用简单,安全.费用低廉并有效减少并发症发生.肠内营养护理是值得临床广泛应用.     

食管癌术后的肠内营养治疗护理

目的探讨食管癌术后并发症的肠内营养治疗护理效果。方法对20例食管癌术后并发症患者进行空肠造瘘管或鼻饲管肠内营养治疗,护理,病情观察。结果 20例食管癌术后并发症患者进行空肠造瘘管或鼻饲管肠内营养治疗改善了全身情况,改善了生活质量和存活率。讨论早期的肠内营养支持,有利于改善病人的营养状况,并可有效保护肠黏膜的屏障功能,促进肠蠕动,有利于机体康复及术后并发症的防治,减少住院天数,减轻病人痛苦。     

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.