婴儿维生素K缺乏的临床干预研究

目的探讨口服维生素K1对广西婴儿VKD的控制效果.方法3607例活产婴随机分为干预组1655例(出生～3月龄口服维生素K12.5mg共10次),对照组1952例(不用维生素K1),观察生后4个月内两组发生VKDB情况.对住院分娩的足月新生儿随机抽样分别口服维生素K12.5mg、5mg及不服药各60例,生后3天测定G-6-PD酶活性及观察黄疸、消化道、皮肤等反应.结果干预组无1例发生出血,对照组发生VKDB 11例(5.63%,P＜0.01).口服维生素K的足月新生儿对G-6-PD酶活性均无影响(P＞0.05),无黄疸加重、过敏及胃肠道不良等反应.结论婴儿小剂量10次口服维生素K1预防VKDB是简便、易行、经济、安全、有效的干预措施.     

早期干预与G-6-PD缺乏新生儿胆红素脑病的关系

目的 :探讨红细胞葡萄糖 - 6 -磷酸脱氢酶 (G- 6 - PD)缺乏新生儿黄疸并发胆红素脑病的高危因素。方法 :以 1 991～ 2 0 0 0年G- 6 - PD缺乏新生儿黄疸并发胆红素脑病足月儿 31例为观察组 ,2 0 0 0年 G- 6 - PD缺乏新生儿黄疸无胆红素脑病足月儿 31例为对照组 ,比较两组血清胆红素、间接胆红素 /白蛋白 (B/ A)、出生体重、开始治疗时间等与胆红素脑病的关系。结果 :开始治疗时间 >4 8h、足月小样儿、血清胆红素、B/ A比值 >0 .5均与胆红素脑病密切相关。结论 :对 G- 6 - PD缺乏新生儿黄疸进行早期干预是预防 G- 6 - PD缺乏胆红素脑病的关键     

婴儿晚发性维生素K 缺乏症颅内出血的CT表现

晚发性维生素 K缺乏症指新生儿晚期 (生后 2 0～ 90 d)小婴儿由于维生素 K缺乏引起的出血性疾病。本文对 12例维生素 K缺乏症引起的婴儿颅内出血的 CT表现进行分析。1　临床资料1.1　一般资料 :12例均为我院 1995年 1月至 2 0 0 1年 5月收治的维生素 K缺乏症致颅内出血的婴儿 ,男 7例 ,女 5例 ,年龄 4 0～ 70 d,平均 5 0 d。病程最短 1d,最长 2 1d,平均 3 .4d。均为足月顺产 ,无窒息、产伤史。所有患儿均为全母乳喂养 ,发病前未用过维生素 K,无外伤史及家族史 ,临床表现为贫血 8例 ,呕吐 10例 ,抽搐 8例 ,昏迷 2例 ,发热 4例 ,黄疸 2例 ,…     

婴儿维生素K缺乏及其预防

维生素K缺乏(简称VKD)是新生儿和婴幼儿出血性疾病的主要原因,其发病急,病死率和致残率高,严重危害婴儿生命健康.近40年来,尤其是近20年,国内外相继出现众多婴儿维生素K缺乏出血症(简称VKDB)的报道,认为VKDB是全世界婴儿死亡的重要原因,尤其是迟发型VKDB,主要死因是颅内出血,幸存者多留神经系统后遗症,防治工作因此日益受到重视.     

新生儿黄疸早期干预的临床观察

目的:探讨新生儿黄疸早期干预的临床效果。方法:将在我院足月分娩的,体重在2 .5kg以上,阿氏评分≥8分的1 0 0例新生儿作为研究对象,随机分为观察组(早期干预组) 5 0例和对照组(非干预组) 5 0例。观察组在新生儿出生后第一天始采用苯巴比妥粉剂5mg ,每日两次口服,对新生儿黄疸进行早期干预性用药,对照组出生后3天内未给任何处理。两组均采用性能良好的国产HD - 36 8型经皮测定黄疸仪(TBC)测定黄疸指数。对比两组新生儿TBC读数。观察组若TBC读数≥1 2 ,则给予新生儿输白蛋白和蓝光照射退黄治疗。结果:观察组的黄疸发病率对照组明显降低(P <0 .0 1 )。结论:新生儿黄疸进行早期干预性用药效果显著。     

早期干预对新生儿黄疸预防临床观察

目的 探讨对新生儿黄疸进行早期干预的效果.方法 我院产科出生的单胎足月适于胎龄儿100例,除外有宫内窘迫、窒息、头颅血肿、新生儿红细胞增多症、地中海贫血、新生儿ABO溶血病,G-6PD酶缺乏症等并发症患儿.母亲孕期无特殊用药史及家族遗传病史等因素.分为实验组(早期干预组)50例和对照组(非早期干预组)50例进行回顾性比较分析.结果 干预组黄疸发病率明显低于对照组,转入新生儿病房例数低于对照组.两组差异有极显著意义(P>0.01).结论 对新生儿黄疸进行早期干预,能有效地降低新生儿黄疸的发病率,有利于预防新生儿胆红素脑病的发生,有利于提高围产儿生命质量.     

晚期维生素K缺乏性出血症10例分析

目的　分析晚期维生素K缺乏性出血症的临床特点与治疗。方法　系统分析 1 0例维生素K缺乏出血症的临床症状、体征及实验室检查结果。给予维生素K 1 0mg静注 ,1～ 2次 /d ,连用 3～ 5d ,输新鲜冰冻血浆 2 5mL ,1次 /d ,连用 3d。结果　应用维生素K11 0mg 2d ,各种异常的实验室指标恢复正常。 6例治愈 ,3例好转 ,1例死亡。结论　国外采用维生素K 2mg ,新生儿 1次性注射 ,对预防此症有一定价值 ;国内采用对新生儿生后第 1d开始口服维生素K 2 5mg ,连用 1 0d预防晚期维生素K缺乏出血症 ,能有效预防出血症的发生。     

新生儿G-6PD缺陷合并高胆红素血症对光疗效果的影响

目的探讨新生儿G-6PD缺陷合并新生儿高胆红素血症对光疗效果的影响。方法184例患高胆红素血症的足月顺产新生儿,除外早产、低体重儿;胎盘、脐带、羊水异常;窒息、肺炎、内脏出血、头颅血肿、败血症;ABO溶血症、红细胞增多症、婴儿肝炎综合征等疾病。根据G-6PD活性分为3组：G-6PD轻度缺陷组45例,重度缺陷组33例,感染组（G-6PD正常组）106例。入选患儿给予蓝光治疗,按常规保护好眼睛和会阴部后,置双面蓝光治疗箱,每天照射12小时,连续5天。光疗前3天,每次给予苯巴比妥片和维生素B2片各5mg,每日3次,口服。在光疗前、光疗后3天和5天各取静脉血3ml,测定血常规、红细胞G-6PD活性、高铁血红蛋白还原率、血清总胆红素、直接胆红素、胆汁酸、转氨酶和γ-谷酰转肽酶。结果光疗前总胆红素水平在3组之间无显著性差异（P均〉0．05）;光疗5天后G-6PD重度缺陷组总胆红素水平显著高于G-6PD轻度缺陷和感染组（P〈0．05）;G-6PD重度缺陷组血红蛋白水平显著低于G-6PD轻度缺陷组和感染组（P〈0．05）;γ-谷酰转肽酶的水平在3组之间无显著性差异（P均〉0．05）。结论光疗可能会加重G-6PD缺陷患儿溶血的风险,应从严掌握光疗指征。     

早期干预对新生儿黄疸的临床疗效观察

目的探讨枯草杆菌二联活菌颗粒联合茵栀黄口服液早期口服预防足月正常新生儿黄疸的效果。方法将剖宫产出生的生后第2天出现黄疸的足月正常新生儿120例随机分成干预组和对照组。干预组予以枯草杆菌二联活菌颗粒联合茵栀黄口服液口服,对照组不予任何药物口服。观察、检测并记录两组新生儿生后1～7 d经皮黄疸指数,同时记录严重黄疸的例数。结果干预组与对照组比较,生后第1天、第2天经皮黄疸指数差别无统计学意义(P>0.05),第3～7天经皮黄疸指数均明显下降,差异有统计学意义(均P<0.05);干预组严重黄疸(经皮黄疸指数≥15 mg/dl)发生率明显低于对照组,两组比较差异具有统计学意义(P<0.05)。结论早期予以枯草杆菌二联活菌颗粒联合茵栀黄口服液口服可减轻足月正常新生儿黄疸的程度,减少新生儿高胆红素血症的发生率,从而减少胆红素脑病的发生率。     

早期给予维生素E对新生儿黄疸的影响

目的 :了解对新生儿早期给予维生素E能否有效降低新生儿黄疸的水平。方法 :治疗组自生后连续三天每日给予 10mg维生素E并与对照组一起抽血测定其血清胆红素并进行对比。结果 :治疗组血清胆红素水平较对照组低 (P <0 .0 5 )。两者有显著差异。结论 :新生儿生后给予一定剂量的维生素E能有效减轻新生儿黄疸的程度。建议对所有新生儿早期给予小剂量的维生素E。     

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.