胃镜操作时心电图分析180例

目的：探讨胃镜操作时患者ECG变化及其发生机制。方法：本院180例胃镜检查者随机分为两组，60岁以上组80例。60岁以下组100例，均于术前、术中、术后进行ECG记录。结果：在胃镜操作时，心率增快者60岁以上组75％，60岁以下组82％，两组比较无显著性差异（P〉0．05）；心律失常及ST—T改变者60岁以上组为38．8％，60岁以下组9．0％．两组比较有显著性差异（P〈0．05），术后ECG均很快恢复到术前状态。结论：胃镜操作虽然可以诱发多种ECG改变。但仍然是一种相对安全、不可替代的消化系统疾病诊治手段。     

全麻无痛性技术应用于胃镜检查的安全性探讨

目的 探讨全麻无痛性胃镜的安全性。方法 观察700例无痛性胃镜检查的患者在静脉麻醉下生命体征的变化，对胃镜插入刺激的耐受性以及药物的副作用。结果 麻醉检查前后生命体征变化无显著性差异(P＞0．05)；胃镜插入，呛咳、屏气、呃逆发生率分别为1．86％、5．71％、1．29％，未发生不良后果；药物副作用少，清醒质量高。结论 胃镜检查中由麻醉医师实施全麻无痛性技术是安全、快速、有效的，它消除了常规检查给患者带来的不良刺激，有利于检查和治疗，普及性良好。     

探讨小儿全麻胃镜术中影响血氧饱和度变化的因素

目的：探讨小儿全麻胃镜术中影响血氧饱和度变化的因素。方法：报告486例小儿全麻胃镜术中影响血氧饱和度变化的因素及对应的预防和处理。结果：486例中有66例血氧饱和度〈95％。影响血氧饱和度变化的因素有麻醉药的作用．患儿头颈部体位，呼吸道、口腔分泌物，患儿自身疾患，供氧障碍、监护仪接触不良等。通过严格掌握适应证，常规吸氧，缓慢推注丙泊酚，轻、中度缺氧时需加大氧流量，头颈部后仰，托起下颌，及时吸痰。放置口咽通气道等措施，一般均能纠正；对重度呼吸抑制缺氧忠儿，应立即停止诊疗，积极进行抢救，给患儿面罩加压给氧，呼吸器人工呼吸，必要时气管插管，呼吸机辅助呼吸以及时纠正呼吸抑制。结论：通过血氧饱和度的观察，及时发现和处理不良反应，绝大部分患儿能顺利完成全麻胃镜检查，明显提高了全麻胃镜检查的成功率。     

食管癌、贲门癌术后心律失常4l例原因分析

目的：探讨食管癌、贲门癌术后心律失常的发生原因。分法：对169例食管癌、贲门癌术后患者进行连续心电监护，4l例发生各种类型心律失常。比较年龄、术前心电图表现及食管、胃的吻合部位与术后心律失常发生的关系。结果：术后心律失常发生率为24．3％。其中60岁以上发生率33．3％，60岁以下19．3％；术前心电图异常者发生率38．7％，正常者21．0％；弓上吻合者发生率35．6％，弓下吻合者12．2％，差异均有显著性(P＜0.05—P＜0．005)。结论：食管癌、贲门癌术后心律失常的发生率与患者的年龄、术前心电图是否正常、食管胃吻合的部位有关。     

稳心颗粒对胃镜检查心律失常的影响

目的 探讨稳心颗粒的应用对胃镜检查心律失常的影响.方法选择190例需要行胃镜检查患者,随机分为实验组（103例）和对照组（87例）,治疗组术前连续3 d口服稳心颗粒9 g/次,3次/d,对照组服用安慰剂,做胃镜前、后10 min常规测血压、心率及心电图,术中Ⅱ导联心电图连续描记.结果 术中,实验组较对照组血压、心率水平升高不明显,两组结果差异有统计学意义（P＜0.05）;实验组心律失常发生率为6.80%,低于对照组心律失常发生率29.90%（P＜0.05）;实验组ST段变化率为4.09%,明显低于对照组心律失常发生率17.20%（P＜0.05）.结论稳心颗粒在预防胃镜检查中出现心律失常具有显著作用.     

丙泊酚静脉麻醉在小儿胃镜检查中的应用

目的：使受检患儿能够愉快地接受胃镜检查，提高检查的成功率。方法：对45例受检患儿先施行丙泊酚静脉麻醉再进行胃镜诊治，观察受检患儿对胃镜检查的耐受程度；受检患儿麻醉前（T0）、胃镜检查中（T1）、检查结束时（T2）、苏醒时（T3）、苏醒后半小时（T4）收缩压（SBP）、舒张压（DBP）、心率（HR）、血氧饱和度（Spo2）的变化；受检患儿苏醒时及苏醒后半小时对胃镜检查的遗忘程度。结果：45例受检患儿均顺利完成胃镜诊治，其中44例在检查过程中Ramsymin分级达4～6级；T1-T4时的SBP、DBP、HR、Sp02与T0时比较，差异均无统计学意义。受检患儿无一例出现胃镜及麻醉并发症。结论：经丙泊酚静脉麻醉后进行胃镜检查，受检患儿耐受性良好，可以提高检查成功率。     

42例食管静脉曲张套扎术临床疗效观察

目的：探讨采用胃镜套扎止血治疗肝硬化食管静脉曲张破裂出血患者的疗效。方法：对42例肝硬化患者进行常规的胃镜检查,确诊食管静脉曲张,随后在胃镜下对曲张静脉进行急诊、择期单次或多次套扎,其中20例食管静脉曲张破裂出血患者进行急诊胃镜检查并行胃镜下套扎术,22例进行择期胃镜下套扎术。结果：42例肝硬化食管静脉曲张套扎术患者中38例（90．48％）在术后2～3周复查胃镜,静脉曲张程度均明显减轻,部分患者静脉曲张完全消失,急诊抢救及择期胃镜下套扎术止血成功率均在90％以上。结论：胃镜下食管静脉曲张套扎术是治疗食管静脉曲张破裂出血及预防出血的有效措施。     

硝苯啶预防胃镜检查时心律失常的初步报告

心律失常是胃镜检查术中的常见并发症之一,严重时可导致检查中断,偶致猝死。我们用硝苯啶代替阿托品作为胃镜检查术前用药,明显地减少了胃镜检查术中心律失常发生率。现将结果初步报告如下。     

无痛胃镜与普通胃镜检查的临床对照及护理

目的：探讨胃镜检查时有效的护理方法。方法：对146例无痛胃镜检查组和普通胃镜检查组患者进行护理和观察，评价效果。结果：无痛胃镜组检查前、检查中心率、血压的变化明显低于普通胃镜。结论：无痛胃镜检查是一种安全、有效的检查方法，配合护理人员的有效护理，使胃镜检查顺利完成。     

237例纤维胃镜检查术的护理体会

２３７例纤维胃镜检查术的护理体会俞文慧（广西柳江造纸厂医院柳江县５４５１００）关键词纤维胃镜；检查；护理随着现代医疗水平的不断提高，纤维胃镜检查术在临床应用中日趋广泛。收集１９９０～１９９４年２３７例门诊及住院患者作了此项检查，成功率为１００％，确诊...     

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.