抑郁发作精神分裂症与神经症的脑电波对照研究

目的比较抑郁发作、精神分裂症与神经症脑电波的特点。方法通过数字化脑电图记录各波功率值及总波功率值 ,对 3 0例抑郁发作、3 0例精神分裂症、3 0例神经症与 3 0例正常人的脑电波进行对照研究。采用受试者运筹曲线 (ROC)获取鉴别诊断的阈值。结果四组间的总波功率值和α波值存在显著性差异 ( P <0 .0 5 )。抑郁发作组总波功率值低于精神分裂症组 ( P <0 .0 1)及正常组 ( P <0 .0 5 ) ,θ波、α波和α波 /SMR波低于精神分裂症组 (P <0 .0 5 ) ,抑郁发作组还有α波低于神经症组 (P <0 .0 5 )及正常组 (P <0 .0 1)。θ波与α波合并值作为区别抑郁发作与精神分裂症两组患者的最佳截断值有 4个 :92 2 .5 3、994.67、10 66.3 8、1162 .84(灵敏度 46.7%～ 5 6.7% ,特异度 80 %～ 90 % )。结论总波功率值、θ波及α波可作为抑郁发作临床诊断参考指标 ,尤其α波降低意义更大。θ波与α波合并值 10 0 0可以作为临床鉴别是否为抑郁状态的参考阈值。     

重症急性胰腺炎伴多器官功能不全综合征的治疗体会

重症急性胰腺炎 (severe acute pancreatitis,SAP)是一种全身性外科疾病。多器官功能不全综合征 (multiple organ dysfunction syndrome,MODS)是 SAP常见的严重甚至是致死性并发症。关于 SAP伴 MODS的治疗方案有不同的看法 ,本文对自 1991年 1月 -2 0 0 0年 1月我院收治的 SAP伴 MODS 5 4例进行回顾性分析。1　临床资料1.1　一般资料本组男 3 2例 ,女 2 2例 ;年龄 2 5～ 65岁。暴饮暴食 ,酗酒引起 3 6例。合并胆道梗阻 2 8例 ,完全性胆道梗阻 13例。既往有糖尿病病史者 1例。入院时血淀粉酶升高 5 2例 ,尿淀粉酶升高45例。B超、C…     

手足口病患儿的临床表现与脑电图特点研究

目的观察手足口病(HFMD)患儿的临床特点改变和脑电图表现,评价脑电图检查的临床应用价值。方法对686例手足口病患儿的临床特点及脑电图结果进行回顾性分析,对异常脑电图的例数进行统计。结果手足口病主要的发病时间在7~9月份,3岁以下的婴幼儿占71.3%(489例),病例1(0~3岁)组的异常率为1.8%(9/489);病例2(4~14岁)组的异常率为79.7%(157/197),轻度异常表现为以θ波增高为主,中度异常表现为θ、δ波并存,重度异常表现为广泛δ波;对照组的异常率为30.0%(56/200),皮疹和发热是主要的临床表现,少数患儿可合并脑炎。病例2组与对照组比较,患儿脑电图弥漫性慢波异常的出现率及异常程度差异有统计学意义(P<0.05)。结论脑电图检查敏感性高,且具有无创、操作简便等特点,可有效发现HFMD患儿是否合并脑组织损伤,可早期协助诊断脑炎,减少漏诊和误诊,可以作为HFMD患儿的常规检查。     

脱髓鞘性脑病的临床和病理特征研究

目的探讨脱髓鞘性脑病的临床表现与病理特征.方法回顾性分析54例脱髓鞘性脑病患者的临床和病理资料.结果患者伴有明显的精神障碍(70%)和运动障碍(78%),脑脊液检查26例(48%)异常,IgG升高7例(13%).影像学检查显示脑白质多处不规则病灶,脑电图多表现弥漫性异常(91%),以θ波、δ波增多为主.3例病理学活检显示神经纤维髓鞘破坏、脱失,并有炎性细胞浸润.经治疗痊愈37例(69%),好转9例(17%),恶化5例(9%),死亡3例(5%).结论脱髓鞘性脑病形式复杂多变,临床易误诊,结合影像学、脑电图、生化等检测有助于及早确诊和治疗.     

重症急性胰腺炎合并胰性脑病的诊治体会

目的 报告68例重症急性胰腺炎(SAP)中8例合并胰性脑病(PE)的诊断和治疗经验.方法 通过对我院普通外科、ICU收治的68例SAP回顾调查,了解SAP并发PE的发生、发病机制及诊断和治疗情况对SAP预后的影响.结果 68例SAP中8例并发PE(10.2%).其中胆源性5例,酒精性1例.死亡3例(37.5%);8例均为出血坏死性胰腺炎,经手术治疗6例.8例中3例因病情危重合并多器官功能衰竭(MSOF)而死亡.行手术治疗的患者中有2例在术后10～12 d发生PE,2例均死亡.结论 胰性脑病,为SAP病程中出现的一系列神经精神障碍症候群,胰性脑病出现时间为急性胰腺炎起病后3～15 d,手术前后均可出现,死亡率较高.胰性脑病治疗关键在于重症胰腺炎的治疗,目前胰性脑病临床治疗尚无特效疗法有待进一步研究.     

脑脓肿病人脑电图的特征及定位价值(附60例分析)

对60例经手术证实的脑脓肿病人进行了脑电图(EEG)检查.结果表明,60例EEG均表现不正常.其中以多形性δ波定位38例(63.3%),平坦波定位10例(16.6%),持续性θ波1例,总定位率81.6%.以上49例为大脑半球脓肿,定位率100%.广泛不正常不能定位者11例(18.3%),为颅后窝及中线脓肿,其中呈广泛θ波+δ波5例,θ波增多3例,双半球后部高幅δ皮2例,一侧半球α节律不好1例.提示EEG对大脑半球脑脓肿有较高定位价值.因为脑脓肿病变较肿瘤发展快,易形成包膜包块,导致脑中线移位,使EEG易出现局限性慢波灶.     

神经性障碍与抑郁症患者脑电图比较分析

目的　探讨神经性障碍患者脑电图改变 ,了解神经性障碍与抑郁症脑电图改变有无区别 ,为临床诊断提供资料。方法　对临床诊断为神经性障碍和抑郁症且未服精神药物的患者脑电图进行分析和比较。结果　神经性障碍患者脑电图异常率为 16 .3% ,其异常主要表现为α波频率、波幅和波形调节不佳 ,以θ波活动增多为主 ,并在不规则脑电图中混有少量δ活动 ,偶见θ波弥散或弥漫出现和θ波阵发出现。部分患者脑电图两侧不对称 ,各型神经性障碍脑电图异常率无统计学显著差异 (P>0 .0 5 ) ,其脑电图改变与抑郁症相近似。结论　神经性障碍患者脑电图改变无特异性     

地塞米松治疗重症胰腺炎并发多器官功能障碍综合征疗效观察

目的 探讨糖皮质激素(GC)治疗重症急性胰腺炎(SAP)并发多器官功能障碍综合征(MODS)的临床效果.方法 将37例SAP并发MODS患者随机分为常规治疗组(对照组,n=18)和地塞米松治疗组(治疗组,n=19).对照组给予常规治疗;治疗组在常规治疗的基础上,于MODS发生前后1～3 d,给予地塞米松10 mg,2～3次/d,3～5 d后停药.结果 治疗组患者的体温、血氧分压(PaO2)、心率、腹痛缓解时间、血淀粉酶、血胆红素及急性生理学及慢性健康状况Ⅱ(APACHEⅡ)评分均较对照组明显下降(P<0.05),住院时间显著缩短(P<0.01),PaO2较对照组明显升高(P<0.05).治疗组治疗后各项观察指标也较治疗前明显改善.结论 在治疗SAP并发MODS过程中,早期、足量使用地塞米松类药物,可明显减轻症状,缩短病程.     

青年肺心病合并多器官功能障碍综合征20例

青年肺心病合并多器官功能障碍综合征(MODS)临床报道甚少。为了解其发病情况、临床特点及近期预后 ,现将我院近 1 0年来收治的 40岁以下的慢性肺心病合并MODS 2 0例报告分析如下。1　临床资料1 .1　一般资料　青年肺心病急性发作期 42例 ,合并MODS 2 0例 ,其中男 1 4例 ,女 6例 ,年龄 2 5～ 40岁 ,平均 3 2 .5岁。所有病例均有不同程度的急性呼吸道感染表现 ,其中 4例发生感染性休克。本组病例中 ,合并脑功能障碍 6例 ,肝功能障碍 2例 ,肾功能障碍 1例 ,合并脑、胃功能障碍 1例 ,脑、肝功能障碍 3例 ,肾、胃功能障碍 1例 ,脑、肾功能障…     

急性冠脉综合征患者发病前感染发生情况调查

目的　观察冠心病患者急性发病前感染发生情况及急性冠脉综合征 (ACS)患者C反应蛋白(CRP)水平。方法　 2 0 0 1年 10月～ 2 0 0 2年 4月 ,采用病例对照研究的方法 ,共调查上海市 16所二、三级医院心内科住院的稳定型心绞痛 (SAP)、不稳定型心绞痛 (UAP)及急性心肌梗死 (AMI)患者 184 7例 ;将UAP和AMI患者合并为ACS组 (114 3例 ) ,SAP患者作为对照 (SAP组 ,6 4 4例 )。结果　ACS组急性发病前感染发生率(4 2 .4 3% )显著高于SAP组 (2 7.33% ,P <0 .0 1) ;发病前病因谱主要是上呼吸道感染和肺炎 ,大部分ACS患者的感染均发生在急性发病前 2周内 (78.76 % ) ,而SAP患者的感染时间无特殊分布 ;ACS组CRP增高患者的比例(6 1.0 6 % )高于SAP组 (4 2 .35 % ,P =0 .0 0 1) ,ACS组CRP增高者中 5 8.75 %有发病前感染史 ,而CRP正常者中仅 4 0 .98% (P <0 .0 5 )。结论　ACS患者的急性起病与发病前急性感染可能存在相关性 ,而CRP作为炎症标志对ACS的发生有预测价值。     

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.