体位引流联合支气管肺泡灌洗术治疗脑血管病后遗症合并肺部感染疗效分析

目的探讨体位引流联合支气管肺泡灌洗术治疗脑血管病后遗症合并肺部感染的疗效。方法将2007年1月至2008年4月我院78例脑血管病后遗症合并肺部感染患者随机分成两组。治疗组40例，采用体位引流联合支气管肺泡灌洗术治疗加常规抗茵药物治疗；对照组38例，采用常规抗茵药物治疗。分别观察其临床疗效、肺部感染吸收天数、住院天数。结果治疗组的临床疗效明显高于对照组（P〈0．05），治疗组的肺部感染吸收天数和住院天数明显小于对照组（P〈0．01）。结论以体位引流联合支气管肺泡灌洗术的局部与全身抗生素联合治疗策略，是脑血管病后遗症合并肺部感染的有效方法。     

支气管肺泡灌洗术联合体位干预对重症监护病房院内获得性肺炎疗效的观察

目的 探讨支气管肺泡灌洗术联合体位干预对重症监护病房(ICU)脑血管病患者院内获得性肺炎疗效的影响.方法 将106例脑血管病合并院内获得性肺炎患者分为两组,进行前后对照.在药物治疗的基础上,实验组53例采用支气管肺泡灌洗术联合体位干预;对照组53例采用一般的治疗.分别观察其临床疗效、肺部感染吸收天数、入住重症监护病房天数.结果 实验组的有效率明显高于对照组(P＜0.05),而平均肺部感染吸收时间和平均住ICU时间明显少于对照组(P＜0.05).结论 以支气管肺泡灌洗术联合体位干预为基础的局部治疗与预防联合的策略,是治疗ICU脑血管病合并院内获得性肺炎的有效方法.     

支气管肺泡灌洗术治疗老年脑卒中合并肺部感染的临床价值

目的 探讨支气管肺泡灌洗术治疗老年脑卒中合并肺部感染的临床价值.方法 对50例老年脑卒中合并肺部感染患者按卒中类型、意识障碍程度、基础疾病及感染细菌种类随机分为治疗组与对照组,治疗组在敏感抗生素等治疗的基础上应用纤维支气管镜行支气管肺泡灌洗术治疗,对照组仅敏感抗生素等治疗.结果 治疗组与对照组的平均住院日分别为l4.3 d和21.6d(P<0.01),治疗组与对照组的总有效率分别为84%,32%(P<0.01).结论 应用纤维支气管镜行支气管肺泡灌洗术治疗老年脑卒中并肺部感染疗效显著,值得临床推广应用.     

支气管肺泡灌洗术治疗老年人脑梗塞并吸入性肺炎的疗效观察

目的 观察支气管肺泡灌洗治疗术对老年人脑梗塞合并吸入性肺炎的临床疗效.方法 回顾性分析50例老年脑梗塞合并吸入性肺炎患者,随机分为治疗组26例和对照组24例;其中对照组根据临床经验或者病原学药敏结果选择有效抗生素进行抗感染治疗,治疗组在此基础上予以支气管肺泡灌洗术.分别进行两组患者的临床疗效的观察;同时比较两组患者咳嗽好转的时间、肺部啰音基本消失的时间、感染后抗菌药物使用的天数以及患者胸部影像学肺部炎症影基本吸收的时间.结果 治疗组的有效率是92.3％,对照组的有效率是66.6％,发现两组之间的差异有统计学意义（P＜0.05）;治疗组患者咳嗽好转的时间、肺部啰音基本消失的时间、抗菌药物使用的天数及患者胸部影像学肺部炎症影基本吸收时间均较对照组缩短,差异上有统计学意义（P＜0.05）.结论 支气管肺泡灌洗术对于老年患者出现脑梗塞后合并吸入性肺炎的治疗效果确切,有一定的临床疗效.     

纤支镜肺泡灌洗在支气管扩张并感染中的治疗价值

目的探讨对支气管扩张合并肺部感染患者经纤支镜支气管肺泡灌洗治疗的临床疗效.方法将50例支气管扩张合并肺部感染患者随机分为灌洗组及对照组,灌洗组25例,对照组25例,均在全身应用抗菌药物、祛痰及体位引流的基础上,灌洗组进行纤支镜吸痰及支气管肺泡灌洗术治疗,观察临床治疗效果.结果对于支气管扩张合并感染患者,纤支镜下行肺泡灌洗能明显提高疗效,灌洗组治疗后显效11例,好转12例,有效率为92%;对照组显效8例,好转10例,有效率为72%,两组有效率比较,P<0.05.结论纤支镜肺泡灌洗术治疗支气管扩张并感染效果好,安全可行,值得推广.     

50例小儿严重肺部感染支气管肺泡灌洗术疗效分析与对照研究

目的：探讨纤维支气管镜下肺泡灌洗术对小儿严重肺部感染的治疗作用及效果评价。方法：采用治疗组与对照组各50例临床对照研究。对照组予全身抗感染治疗,治疗组在此基础上,联合支气管肺泡灌洗术、影象学变化,观察咳嗽、发热症状及肺部啰音消失情况。结果：治疗组显效率82%（41例）,对照组显效率10%（5例）,两组比较x2=53.42,P〈0.001。说明治疗组患者经过支气管肺泡灌洗疗效显著。结论：支气管肺泡灌洗术联合全身抗感染治疗,对小儿严重肺部感染疗效肯定。     

盐酸氨溴索支气管肺泡灌洗对慢性阻塞性肺疾病合并肺部感染的疗效

目的：探讨经电子支气管镜注入盐酸氨溴索支气管肺泡灌洗治疗对慢性阻塞性肺疾病（ COPD）合并肺部感染的疗效及安全性。方法将82例COPD合并肺部感染患者随机分成观察组42例,对照组40例;对照组采用常规治疗,观察组在常规治疗的基础上使用电子支气管镜盐酸氨溴索支气管肺泡灌洗治疗;比较两组患者治疗前后白细胞计数（WBC）、降钙素原（PCT）、C反应蛋白（CRP）的变化,两组患者肺内炎性病灶吸收情况、住院时间。结果观察组治疗后PCT、CRP浓度较对照组明显下降（P＜0.05）,观察组肺部炎症吸收时间、住院时间均短于对照组（P＜0.05）,无严重并发症发生。结论经电子支气管镜注入盐酸氨溴索支气管肺泡灌洗治疗COPD合并肺部感染安全有效。     

纤维支气管镜肺泡灌洗治疗心脏术后并发肺部感染患者的临床观察

目的探讨纤维支气管镜肺泡灌洗治疗心脏术后并发肺部感染的临床效果。方法对我院的41例心脏术后合并肺部感染的患者进行回顾性分析,将其随机分为对照组（21例）和研究组（20例）,分别给予常规内科治疗和支气管肺部灌洗,分析治疗后的总有效率、感染控制时间、细菌培养阳性率、出院时间以及肺部感染评分情况。结果①研究组的显效率、总有效率优于对照组（P〈0.01）;②研究组的感染控制天数（P〈0.01）、住院天数（P〈0.05）均小于对照组,细菌培养阳性情况优于对照组（P〈0.05）;③研究组治疗后的肺部感染评分低于对照组（P〈0.01）,在＂0~4＂范围的人数小于对照组（P〈0.01）,＂5~8＂和＂9~12＂的分布均小于对照组（P〈0.05）。结论纤维支气管镜肺泡灌洗治疗心脏术后并发肺部感染患者的效果较好,不仅降低了肺部感染评分,而且从根本上减少肺部细菌情况。     

肺泡灌洗术对机械通气患者的临床价值

目的：探讨纤维支气管镜肺泡灌洗术对机械通气患者的价值。方法：收集ICU科行机械通气治疗过程中合并肺部感染患者87例,按是否接受纤维支气管镜肺泡灌洗术治疗分为两组。结果：纤维支气管镀肺泡灌洗治疗组在机械通气治疗时间、感染控制时间、平均住院天数和病死率等方面均显著低于对照组。结论：纤维支气管镜肺泡灌洗术有利于危重患者缩短机械通气时间,减少住院时间,改善预后。     

抗菌药物联合肺泡灌洗术对重症脑卒中合并肺部感染的疗效及对细菌清除率的影响

目的 研究探讨抗菌药物联合肺泡灌洗术对重症脑卒中合并肺部感染的疗效及对细菌清除率的影响。方法 选取2019年1月—2021年1月某院收治的520例重症脑卒中合并肺部感染患者,随机数字表法分为观察组、对照组,每组260例。对照组给予常规抗感染治疗,观察组给予抗菌药物联合肺泡灌洗术治疗。评估比较两组患者的临床疗效、细菌清除率、症状消退时间、住院时间、炎症因子水平、不良反应发生率等指标。结果 观察组临床总有效率高于对照组,差异有统计学意义(χ²=13.606,P<0.01)。相比对照组,观察组各项症状消退时间更快、住院时间更短。相比对照组,观察组超敏C-反应蛋白(high sensitivity C-reactive protein, hs-CRP)、白介素-1(Interleukin-1,IL-1)、降钙素原(procalcitonin, PCT)降低幅度更为明显。观察组细菌清除率高于对照组,差异有统计学意义(χ²=10.417,P<0.01)。两组治疗期间不良反应发生率均较低,且差异无统计学意义(χ²=0.89...     

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.