脑卒中患者吞咽困难的康复护理

目的急性脑卒中患者发病后约50%伴有程度不同的吞咽困难,轻者仅有吞咽不畅或误咽,严重者可能会导致吸入性肺炎,甚至窒息而危及生命。观察脑卒中患者吞咽困难的康复护理效果。方法对2008年5月～2009年5月入住我科的66例伴吞咽困难的脑卒中患者,在基础治疗护理后,实施康复护理。结果实施康复护理后患者的吞咽功能及摄食情况明显改善。结论康复护理能显著改善脑卒中后吞咽困难患者的吞咽功能,减少并发症。     

脑卒中发生部位对卒中患者摄食-吞咽功能及预后的影响

目的 探讨脑卒中部位对患者的摄食-吞咽功能障碍预后的影响,为临床预测摄食-吞咽功能及其恢复可能提供依据.方法 对卒中单元901例患者按脑卒中部位进行分组:脑干组、双侧半球受损组、单侧半球受损组及脑干+半球受损组,在其进食前行吞咽困难的筛选,如确定存在摄食-吞咽障碍,则行吞咽功能评估,并由康复医师及言语治疗师给予相应的康复训练,出院时再次行吞咽功能评价.结果 卒中单元患者急性期摄食前咽障碍的发生率为33.1%,其中脑干组80.0%,双侧大脑半球受损组75.6%,单侧大脑半球受损组17.7%,脑干+半球受损组87.5%.康复治疗后,卒中单元患者仍有7.8%存在摄食-吞咽障碍,基本都发生在脑干组、双侧半球受损组及脑干+半球受损组.结论 脑卒中急性期患者常并发摄食-吞咽障碍,经过治疗和康复训练,大部分患者可安全进食,但卒中部位位于双侧半球、脑干或脑干+半球的患者摄食-吞咽功能恢复欠佳,与单侧半球组相比,预后较差.     

脑卒中吞咽困难给予喂养指导和吞咽功能训练观察

目的 分析喂养指导联合吞咽功能训练对脑卒中吞咽困难患者吞咽功能恢复及生存质量的影响.方法 收集2015年1月-12月我院收治的70例脑卒中吞咽困难患者为研究对象,随机将其分为对照组与观察组,对照组给予喂养指导,观察组给予喂养指导联合吞咽功能训练.比较2组患者吞咽功能恢复情况及生存质量.结果 治疗后,观察组患者洼田饮水试验评分、生存质量评分均优于对照组,差异显著(P＜0.05).结论 脑卒中吞咽困难患者接受喂养指导联合吞咽功能训练可有效改善其吞咽功能及生存质量.     

脑卒中后吞咽障碍与预后的评估研究

目的:探讨脑卒中后吞咽障碍与脑卒中预后的关系。方法:选取441例急性脑卒中患者,入院后2d内及入院治疗2周时行吞咽障碍评定,根据洼田式饮水试验方法分为吞咽困难组与无吞咽困难组,入院时根据格拉斯哥昏迷量表评分(GCS评分)评价神经功能受损程度,入院2周时根据美国国立卫生研究院卒中量表(NIHSS评分)及改良Rankin评分评估神经功能缺损的恢复程度,记录住院时间与肺炎发生率进行对比;根据影像学不同病变部位分组,记录分析吞咽障碍与脑卒中部位的关系。结果:(1)卒中后吞咽困难组洼田式饮水试验方法评分阳性率显著高于无吞咽困难组(P<0.05);(2)两周后NIHSS评分及改良Rankin评分卒中后吞咽困难组显著高于无吞咽困难组(P<0.05),提示卒中后吞咽困难不利于神经功能缺损的恢复,影响预后;(3)卒中后吞咽困难组较无吞咽困难组住院时间显著延长,肺炎发生的机率也明显增加;(4)不同部位发病在住院不同时期吞咽困难发生率不同,卒中患者各个部位受损均可出现吞咽困难,其中延髓和双侧大脑半球受损的患者吞咽困难的发生率较高,常规卒中治疗后仍有部分患者存在吞咽困难。结论:不同病变部位的脑卒中患者均可出现吞咽功能障碍,它不利于预后,应给予重视。     

吞咽及摄食训练治疗脑卒中后吞咽困难的疗效观察

目的：探讨实施吞咽及摄食训练对急性脑卒中后吞咽困难的疗效。方法将180例脑卒中后吞咽困难患者随机分为观察组和对照组,每组90例。2组均采用神经内科常规治疗,观察组同时给予吞咽及摄食功能训练。30 d后给予疗效评估。结果观察组总有效率92.2%,对照组总有效率78.9%,观察组显著高于对照组,组间比较差异有显著意义（P<0.05）。结论吞咽及摄食训练可明显改善早期脑卒中后吞咽困难患者的吞咽功能,提高临床疗效,值得推广应用。     

床边吞咽困难筛查在急性脑卒中患者中的应用及干预治疗

目的探讨床边吞咽困难筛查在急性脑卒中患者中的应用及综合干预治疗的疗效.方法将我院确诊为急性脑卒中合并吞咽困难患者95例随机分为两组,治疗组55例予针灸联合吞咽训练治疗,对照组40例仅给予常规处理,观察两组临床疗效,采用洼田饮水试验评分评估两组患者治疗前后吞咽困难改善情况.结果治疗组的临床总有效率96.36%,明显高于对照组的77.50%,差异有统计学意义(P<0.05);治疗前,两组洼田饮水试验评分无统计学差异(P>0.05),综合干预治疗后,治疗组洼田评分为2.74±0.22,显著低于对照组的3.24±0.31,差异有统计学意义(P<0.05).结论早期筛查急性脑卒中患者吞咽困难情况,并给予综合治疗,可显著改善患者吞咽功能,提高生活质量.     

急性脑卒中患者合并吸入性肺炎的原因分析及护理对策

急性脑卒中患者入院时45%（30%～65%）存在吞咽困难,其中约一半于发病6个月时仍不能恢复正常的吞咽功能。43%～54%有吞咽困难的卒中患者出现误吸;在这些患者中,37%进一步发展为肺炎,4%因肺炎而死亡。本文收集了2007年7月至2010年7月我科收治的65例急性脑卒中合并吸入性肺炎的患者资料进行回顾性分析，并对其危险因素及护理对策进行探讨。     

脑卒中吞咽困难患者的康复护理

目的:探讨综合康复护理治疗对脑卒中伴吞咽困难患者的作用。方法:对双侧卒中后吞咽障碍患者进行摄食、吞咽、训练干预及护理。结果:吞咽困难患者96例中,49例正常进食,35例缓慢进食,12例呛咳明显减轻。结论:正确有效的康复,可有益于脑卒中伴吞咽困难患者吞咽功能的改善。     

护理干预对脑卒中吞咽困难患者的临床价值分析

目的探讨护理干预对脑卒中吞咽困难患者的临床价值分析.方法50例脑卒中后吞咽困难患者纳入研究,分为吞咽训练结合针灸干预的观察组及吞咽训练的对照组,疗程结束后进行疗效、吞咽评分评定.结果治疗后,观察组治愈5例,显效7例,有效10例,有效率为80.00%,对照组治愈3例,显效7例,有效7例,有效率为68.00%,两组有效率比较,观察组优于对照组,差异具有统计学意义(P<0.05).且观察组的吞咽功能障碍评分,较之对照组下降明显,差异具有显著统计学意义(P<0.01).结论吞咽训练结合针灸治疗可有效改善脑卒中后吞咽困难,临床疗效明显具有临床推广价值.     

脑卒中与吞咽困难严重度的关系

目的探讨急性脑卒中部位及范围对吞咽困难轻重程度的影响。方法对166例住院治疗的脑卒中患者随机进行饮水试验和X线电视透视吞咽钡荆造影（VF）检查及临床评估，吞咽困难评级分为正常、轻度、中度和重度。结果急性脑卒中患者吞咽困难发生率为50．00％（83／166），脑干卒中发生率为73．68％（14／19），双侧大脑半球卒中发生率为73．33％（33／45），单侧大脑半球卒中发生率为42．86％（36／84）。重度吞咽困难多见于脑干卒中和双侧大脑半球卒中。结论急性脑卒中后吞咽困难发生率与卒中损害部位和面积有关。脑干卒中者及双侧大脑半球卒中吞咽困难发生比例大，尤以脑干卒中者为甚。     

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.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

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.     

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.