肝移植术后急性肺损伤危险因素分析

目的 探讨肝移植术后急性肺损伤(ALI)的相关危险因素.方法 60例肝移植患者术后分ALI组和非ALI组,对11项临床资料进行单因素及多元逐步Logistic回归分析,确定肝移植术后急性肺损伤危险因素.结果 16例患者发生ALI,发生率为26.67%.单因素分析结果表明术前低氧血症、术中无肝期≥60 min、输液量≥8000mL,血制品输入量≥4000mL、气管带管时间≥72 h以及肺部感染,两组间比较差异有统计学意义,多元逐步Logistic回归分析结果表明,术前低氧血症、术中无肝期≥60 min是ALI发生的危险因素.结论 术前低氧血症和无肝期长是发生ALI的相关危险因素.     

肝癌患者术后合并肺部感染的危险因素分析

目的：探讨肝癌患者术后合并肺部感染的危险因素。方法120例原发性肝癌患者分为感染组（12例）和非感染组（108例）,比较两组患者在性别、年龄、术前是否合并基础疾病及手术时间、术中出血量、术中输血量、机械通气时间指标的差异,并对其危险因素进行Logistic回归分析。结果120例肝癌患者术后发生肺部感染12例（10.0%）。在年龄、术前是否合并基础疾病、手术时间、术中出血量、术中输血量、机械通气时间方面感染组与非感染组比较,差异有统计学意义（P〈0.05）。结论年龄＞60岁、术前合并基础疾病、手术时间长、术中出血量多、术中输血量多、机械通气时间长为肝癌患者术后发生肺部感染独立的危险因素。     

肝移植术后早期肺部并发症的危险因素分析及预防

目的探讨肝移植术后早期肺部并发症的危险因素。方法回顾性分析154例肝移植患者的临床资料。选取围手术期22个独立变量进行单因素分析及Logistic回归分析,筛选出与肝移植术后早期肺部并发症相关的危险因素。结果肝移植术后早期共98例患者发生肺部并发症,发生率为63.6%。单因素分析并发症组与对照组的各项参数,结果发现术前肝功能Child-Pugh评级为C级、术中出血量>2 L、输液总量>10 L、术后前3 d补液至少1 d液体平衡≤-500 mL、低蛋白血症、输注血制品>4 L、重症监护室(ICU)留观时间≥5 d及术后前3 d补液至少2 d液体平衡≤-500 mL共8项有统计学意义。将以上有统计学意义的8个因素作为自变量,术后肺部并发症作为应变量进行Logistic回归分析发现,术前低蛋白血症、术中输注血制品>4 L、ICU留观时间≥5 d及术后前3 d至少有2 d的液体平衡≤-500 mL具有统计学意义。结论低蛋白血症、术中输注血制品>4 L及ICU留观时间≥5 d是术后发生肺部并发症的危险因素。肝移植术前改善低蛋白血症,术中控制输注血液制品量,减少ICU留观时间及术后尽早实现液体出人量的负平衡可减少术后肺部并发症的发生率。     

肝癌术后肺部并发症危险因素分析

目的探讨肝癌术后发生肺部并发症的相关因素分析,以期为减少或避免术后肺部并发症的发生提供思路。方法选取行肝癌根治术的肝癌患者105例,其中22例（观察组）术后发生肺部并发症,83例（对照组）术后未发生肺部并发症。比较两组患者的一般资料（性别、年龄、吸烟指数、高血压病史、呼吸系统病史、糖尿病史、术前2周呼吸道感染史、肺部听诊情况）、术前检查结果（肿瘤位置、肿瘤大小、侵犯门静脉、侵犯肝静脉、门静脉癌栓、门静脉宽度、胆红素水平、白蛋白水平、凝血酶原时间、腹水、Child评分、Child分级、ALT、AST、GPT、AFP、血红蛋白水平、血小板、血氧饱和度、ASA分级）以及手术信息（手术切口、手术方式、手术时间、麻醉时间、术中输血量）。对上述比较差异有统计学意义的相关因素,采用非条件二元多因素Logistic回归分析其与肝癌术后肺部并发症的相关性。结果单因素分析显示：低蛋白血症、手术时间、麻醉时间及术中输血量是肝癌术后发生肺部并发症（胸腔积液、肺炎）的危险因素（P＜0.05或0.01）。多因素Logistic回归分析结果显示术前白蛋白水平是发生术后肺部并发症的独立危险因素（P＜0.05）。结论术前白蛋白水平是肝癌术后肺部并发症的独立危险因素。     

肝移植术后早期死亡的危险因素分析

目的:从肝移植患者术前、术中和术后早期的各项指标中筛选肝移植术后早期（术后至出院）死亡的高危因素,为提高肝移植术后生存率奠定基础。方法：回顾性分析长征医院2001年5月至2005年9月间307例肝移植患者围手术期临床资料,单因素分析术后早期死亡的可能危险因素,对有价值的指标进行多因素Logistic回归分析,筛选确切的高危因素。结果：4例患者因资料不全剔除,303例参与此次回顾性分析。单因素分析结果提示性别、Child分级、肝性脑病、肝肾综合征、早期拔管时间、白细胞计数、术前血红蛋白（Hb）、血尿素氮、血肌酐、凝血酶原时间、血钠、血钾、腹水量、手术时间、术中尿量、大量输血、术中输碳酸氢钠量、吸空气时动脉氧分压（PaO2）、胆红素、术前终末期肝病模型（MELD）评分等20项因子是术后早期死亡危险因素。多因素Logistic回归分析结果显示,女性、低血钠、手术时间长、大量输血（>7 500 ml）、术前高MELD分值等5项因子是肝移植术后早期死亡的独立危险因素。结论：女性、低血钠、手术时间长、大量输血者、术前高MELD评分的患者肝移植术后早期病死率较高,临床应根据患者具体情况采取针对性的措施。     

肝癌切除术后并发肺部感染的危险因素分析

目的：：探讨肝癌切除术后并发肺部感染的相关危险因素。方法：收集2009年1月至2014年6月在我科住院治疗的226例肝癌患者的临床资料。根据术后是否并发肺部感染将患者分为感染组与非感染组,对可能与术后肺部感染发生有关的因素进行单因素分析,将单因素分析有统计学差异的因素纳入多因素 Logistic 回归分析,以期找出与肝癌切除术后并发肺部感染的危险因素。结果：226例肝癌患者中,术后并发肺部感染25例(11.06%)。单因素分析显示,感染组合并糖尿病比例高于非感染组,血清白蛋白水平低于非感染组,术中出血量和输血量均多于非感染组,腹腔引流管留置时间长于非感染组,两组上述指标比较,差异均有统计学意义(均P<0.05)。多因素 Logisti回归分析显示,合并糖尿病、血清白蛋白水平、术中输血量和腹腔引流管留置时间是肝癌切除术后并发肺部感染的独立危险因素(均P <0.05)。结论：对于肝癌切除术患者,应控制或改善与感染发生相关的危险因素,将有助于预防或减少术后肺部感染的发生。     

食管癌术后患者肺部感染发生原因及护理对策分析

目的 调查研究食管癌患者术后肺部感染的发生原因,并总结护理对策。方法 选择赣州市肿瘤医院2021年1—9月诊治食管癌术后入住重症监护室（intensive care unit,ICU）的86例患者为研究对象,均接受食管癌根治术治疗,术后并发肺部感染纳入观察组,术后未发生肺部感染纳入对照组。收集2组患者的相关临床资料,调查术后肺部感染发生的危险因素,总结防治肺部感染的护理对策。结果 2组患者性别、饮酒史、肿瘤分期比较,差异无统计学意义（P>0.05）;2组患者年龄、体质量指数（body mass index,BMI）、吸烟史、肺部病史、肿瘤部位、手术方式、手术时间、术中出血量和术后营养状况比较,差异有统计学意义（P<0.05）。经多因素回归分析显示,年龄≥60岁、有吸烟史、有肺部病史、开胸手术、中上段肿瘤、手术时间≥3 h和术后营养不良都是食管癌患者术后发生肺部感染的危险因素（P<0.05）。结论 食管癌患者术后发生肺部感染的原因众多,高龄、手术时间长、有肺部病史等因素都是术后并发肺部感染的危险因素。医护人员应加强对高危人群的筛查,加强围术期的护理管理工作,降低肺部感染...     

老年腹部手术患者肺部感染的围手术期危险因素分析及护理对策

目的 探讨老年患者腹部手术后肺部感染的围手术期危险因素及护理对策.方法 收集行腹部手术的107例患者为研究对象,根据患者术后至出院期间是否发生肺部感染分为感染组(19例)和对照组(88例).对可能影响患者术后发生肺部感染的围手术期危险因素进行单因素和多因素Logistic回归分析.结果 107例患者中,发生肺部感染的患者19例(17.76％),未发生肺部感染的患者88例(82.24％).单因素分析提示:感染组患者麻醉时间、手术时间、术中补液量、术中失血量、术后留置鼻胃管时间和上腹部手术比例均大于对照组,差异有统计学意义(P＜0.05).组间急诊手术、术中气管置管、术后静脉置管分布无差异(P＞0.05).多因素Logistic回归分析提示:上腹部手术(OR=5.26,95％CI:1.18～23.48)、手术时间长(OR=10.259,95％CI:2.56～41.04)和置胃管时间长(OR=4.00,95％CI:1.68～9.49)是影响老年腹部肿瘤手术术后肺部感染的独立危险因素;并且均会增加术后肺部感染的风险(P＜0.05).结论 上腹部手术、手术时间长和置胃管时间长可能增加老年腹部手术患者术后肺部感染的风险;采用综合护理措施可降低术后发生肺部感染的风险.     

乳腺癌术后肺部感染危险因素及其外周血细胞因子的变化

目的探讨乳腺癌术后肺部感染危险因素及其外周血细胞因子的变化。方法 选择我院2016 年4 月～2020 年4 月乳腺癌改良根治术72 例患者,按照术后是否出现肺部感染分为两组,其中感染组13 例,未感染组59 例,观察两组患者术后肺部感染的单因素、危险因素、血清肿瘤标志物水平、炎症因子水平,危险因素与其他之间的相关性。结果 两组患者的年龄、是否合并糖尿病、TNM 分期、术中出血量、术后引流量比较,差异无统计学意义（P＞0.05）;未感染组BMI、手术时间、置管时间均低于感染组,差异有统计学意义（P＜0.05）。BMI、手术时间、置管时间均是肺部感染的主要危险因素（P＜0.05）。未感染组患者CA153、CA125、TPS 均低于感染组（P＜0.05）。未感染组患者CRP、PCT、IL-6 均低于感染组,未感染组血CTCs 阳性表达率（8.47%）低于感染组的23.08%。乳腺癌术后肺部感染的发生与CA153、CA125、TPS、CRP、PCT、IL-6、CTCs 存在正相关（P＜0.05）。结论 乳腺癌术后肺部感染主要是因BMI、手术时间、置管时间造成的,会直接影响患者的血清肿瘤标志物与炎症因子水平变化,为了保证术后患者情况,需要采取良好的术前措施,保证手术效果。     

肝移植术后胸腔积液的原因分析及防治措施

目的：探讨原位肝移植术后病人胸腔积液的原因及相应防治措施。方法：回顾45例行原位肝移植的病例的资料,分析其术后胸腔积液发生率、危险因素及相应处理措施。结果：术后32例次（32/45,71.1%）发生胸腔积液。单因素分析结果显示,术前肺功能异常、术中输液量、术中输血总量〉1000 ml、机械通气时间〉12 h、手术时间、术后再次手术、术后合并肺感染、术后合并腹水是术后发生胸腔积液的高危因素。Logistic回归分析：术前肺功能异常、术中输血总量〉1000 ml、术后机械通气时间〉12 h、术后再次手术、术后合并肺感染、术后合并腹水与胸腔积液的发生密切相关。结论：原位肝移植术后病人胸腔积液的原因是多样的。术前改善肺功能、术中尽量减少出血,控制输血量,术后积极预防感染可有效地控制胸腔积液。     

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.