微创术和亚低温脑保护联合治疗高血压脑出血的临床研究

目的 :探讨微创术和亚低温脑保护联合治疗高血压脑出血的临床疗效 ,以提高高血压脑出血的治疗效果。方法 :内科保守治疗组 (简称对照组 ) 30例采用内科综合治疗 ,微创术和亚低温治疗组 (简称治疗组 ) 30例在内科综合治疗的基础上采用颅内血肿微创清除术和亚低温 (头戴冰帽、睡水循环式降温毯 ,肛温控制 33～ 35℃ )治疗。比较两组之间及治疗前后神经功能缺损 (CSS)评分、两组治疗效果和两组治疗后 3个月随访 Barthel指数。结果 :治疗组有效率为 83.33% ,病死率为 6 .6 7% ,对照组有效率为 5 0 .0 0 % ,病死率为 2 6 .6 7% ,两组比较差异有统计学意义 (P <0 .0 1和 P <0 .0 5 ) ;两组治疗前后不同期 CSS评分比较 ,治疗组于治疗后 7、14、2 1d CSS评分均低于对照组 (均 P <0 .0 1)。两组患者日常生活活动能力 (ADL )用功能评定量表 (Bathel指数 )分级比较 ,治疗组极度严重残疾 1例 ,严重残疾 5例 ,中度残疾 6例 ,轻度残疾 10例 ,ADL自理 6例 ,而对照组分别为 3、11、4、3和 1例 ,两组比较差异有统计学意义 (P <0 .0 1)。结论 :微创术具有操作简单、安全、可靠、损伤小、术后恢复快 ;亚低温具有脑保护功能 ,加快神经功能恢复。微创术和亚低温联合治疗高血压脑出血有利于提高疗效 ,降低脑出血的病死率及致残     

体温控制对高血压性脑出血术后患者预后的影响

目的 研究体温控制对高血压性脑出血术后患者预后的影响.方法 将30例高血压性脑出血术后患者随机分为体温控制组(体温控制在36.5～37.5 ℃)、亚低温组和常规降温组,每组10例.监测患者的生命体征、颅内压、血气、血小板和凝血常规,术后第4天复查颅脑CT观察有无颅内再出血和梗死,评价术后3个月患者日常生活活动能力(ADL).结果 常规降温组患者的心率高于体温控制组和亚低温组,差异有统计学意义(P＜0.05).3组患者的血氧饱和度(SpO2)及血气分析指标[pH、动脉血氧分压(PaO2)和动脉血二氧化碳分压(PaCO2)]间差异无统计学意义(P＞0.05).术后第3天,亚低温组血小板计数(PLT)低于体温控制组和常规降温组,差异有统计学意义(P＜0.05);亚低温组凝血酶原时间(PT)延长,高于体温控制组和常规降温组,差异有统计学意义(P＜0.05).与常规降温组比较,体温控制组和亚低温组术后颅内再出血和脑梗死发生率更低,ADL良好率更高,病死率降低,差异均有统计学意义(P＜0.05).结论 高血压性脑出血患者术后将体温控制在36.5～37.5 ℃,可降低术后病死率,提高患者生存质量.     

亚低温对实验性大鼠脑出血后脑组织中兴奋性氨基酸含量的影响

目的 :研究亚低温对实验性大鼠脑出血后脑组织中兴奋性氨基酸含量的影响。方法 :将成年雌性 Wistar大鼠 5 0只随机分为 3组 :亚低温组 2 0只 ,常温组 2 0只 ,假手术对照组 1 0只。亚低温组动物采用冰袋包裹腹部降温至 33± 0 .3℃ ,并维持 1～ 2 h。用自体血脑内注射法建立脑出血动物模型 ,对照组行相应操作 ,但不向脑内注血。术后 30 min断头取脑 ,取血肿周围脑组织适量 ,秤重 ,加两倍等渗盐水 ,做成脑匀浆待测。结果 :脑出血后大鼠脑匀浆中兴奋性氨基酸含量显著升高。与常温组相比 ,亚低温组脑匀浆中兴奋性氨基酸含量明显偏低 ,且有显著性差异 ( P<0 .0 1 ) ,但仍较假手术对照组高。结论 :亚低温能显著抑制脑出血后脑组织中兴奋性氨基酸含量的升高。     

亚低温治疗高血压性脑出血的临床观察

目的观察亚低温脑保护对高血压性脑出血的治疗效果。方法将170例高血压性脑出血患者随机分为亚低温和常温治疗组（对照组），对照组85例给予控制血压、降颅压、营养脑细胞等常规治疗，亚低温组除常规治疗外，加用32～35℃亚低温治疗，3个月后对两组的病死率、生活自理能力进行评测。结果亚低温组病死率为17、6％。常温组病死率28．2％。生活自理能力亚低温组为23％，常温组为16％，两组差异有统计学意义P〈0．05。结论结合有关文献，动物实验和临床研究已经证实亚低温在脑出血治疗中有肯定的脑保护作用，展现了广阔的临床应用前景。     

降温毯不同温度对重型颅脑损伤伴中枢性高热的干预效果

目的:观察降温毯不同温度对重型颅脑损伤伴中枢性高热患者的干预效果.方法:选取重型颅脑损伤伴中枢性高热患者52例按数字表法随机分为治疗组与对照组,每组26例,治疗组采用降温毯进行亚低温(32～35 ℃)处理,对照组采用降温毯常温(36.5～37.5 ℃)处理,观察两组患者体温下降的效果.结果:治疗组在使用降温毯后1,2,4,8 h各时间点的体温均低于对照组,且降温过程平稳,两者比较差异均有统计学意义(P<0.05).结论:降温毯亚低温可以明显、安全、迅速、有效地降低重型颅脑损伤伴中枢性高热患者体温,并降低并发症的发生,改善预后,值得临床推广.     

微创颅内血肿清除术联合亚低温治疗高血压脑出血

目的:探讨微创颅内血肿清除术联合亚低温治疗对高血压脑出血患者预后的影响。方法:回顾分析39例高血压脑出血患者的临床资料,其中16例行微创手术,23例行微创手术联合亚低温治疗。比较两组患者病死率及格拉斯哥评分。结果:微创手术联合亚低温组意识恢复程度明显优于微创组,病死率明显降低。讨论:微创颅内血肿清除术联合亚低温治疗高血压脑出血可明显降低病死率和致残率。     

亚低温治疗仪在脑出血患者降温治疗中的应用与护理体会

目的:探讨亚低温治疗仪应用于脑出血患者降温治疗的临床疗效。方法:回顾性总结16例脑出血患者使用亚低温治疗仪进行降温治疗的效果。结果:16例脑出血患者均与入院后24小时内立即使用亚低温治疗仪进行降温治疗,降温时间3—7天,明显降低了脑出血患者伤后的致残率,大大减轻了护士的工作量,也能维持较好的降温效果。结论:应用亚低温治疗仪能迅速降低患者体温,降低脑代谢,减轻脑缺氧,更有利于脑功能的恢复,且操作简单,安全有效,极大减轻护理工作量。     

亚低温疗法治疗大面积脑梗死患者的疗效观察

目的 观察亚低温疗法对大面积脑梗死患者的临床治疗效果。方法 把92例大面积脑梗死并发高热的患者随机分为亚低温治疗组和对照组各46例。亚低温治疗组给予33～35℃的低温治疗，对照组给予常规物理和药物降温治疗。10d后评定2组患者的体温、心率等指标；1个月后根据死亡率及神经功能缺损评分评估患者的预后。结果 亚低温治疗组患者的体温、心率均低于对照组，死亡率亦低于对照组，神经功能改善（P＜0．05），预后较好。结论 亚低温疗法治疗大面积脑梗死患者安全有效，能够改善患者预后。     

微创血肿清除术联合亚低温疗法治疗老年高血压脑出血的临床护理

目的 探讨老年高血压脑出血患者在微创血肿清除术后行亚低温治疗的效果及护理配合.方法 将53例老年重型高血压脑出血患者随机分为实验组和对照组.实验组27例,术后3 h时内行亚低温治疗,对照组26例术后行常规治疗.监测两组患者的生命体征、血氧饱和度、颅内压、血糖、乳酸、血气和电解质.比较两组患者的死亡率、生存质量、并发症、颅内压、生命体征及血糖、血乳酸、血气电解质的变化等.结果 实验组患者术后死亡率、颅内压、血糖、乳酸等均显著低于对照组(P<0.05),其他则无统计学意义(P>0.05).结论 老年重型高血压脑出血患者术后适时应用亚低温治疗能够有效地降低颅内压,减轻脑水肿,降低死亡率,有利于提高患者生存质量.     

亚低温配合等容量血液稀释治疗急性重型颅脑损伤的临床研究

目的 :研究亚低温配合等容量血液稀释对急性重型颅脑损伤的治疗作用及临床效果。方法 :将 70例患者随机分为治疗组和对照组。治疗组 35例 ,均于伤后 2 4 h内行亚低温治疗 ,温度控制在 34～ 35 .5℃ ,持续 2～ 10 d;同时于伤后 4 8h内行等容量血液稀释方法 (IHD)治疗。对照组 35例 ,行常规治疗。监测病人生命体征、GCS评分、颅内压 (ICP)、血糖、红细胞比容(HCT)、全套血液流变学指标、血气、电解质等。结果 :与对照组相比 ,治疗组病人伤后早期高 ICP、高血糖、高 HCT、高血黏度均显著下降 (P <0 .0 5 ) ;血气、血电解质无统计学意义 (P >0 .0 5 ) ;恢复良好率明显提高 (P <0 .0 5 ) ;病死率明显下降 (P <0 .0 5 )。结论 :亚低温配合 IHD治疗急性重型颅脑损伤安全有效 ,可降低 ICP、改善血液流变学指标 ,降低病死率 ,提高生活质量。     

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.