经皮内镜下胃造瘘术治疗脑梗死合并吞咽障碍患者的疗效观察

目的：观察经皮内镜下胃造瘘术（perutaneous endoscopic gastrotomy,PEG）治疗脑梗死合并吞咽障碍患者的临床疗效,并评估其临床应用价值及安全性。方法选取2012年2月-2013年1月湘潭市第三人民医院收治的23例脑梗死合并吞咽障碍患者,对其实施PEG,观察其临床疗效及并发症情况。结果成功实施PEG 23例,平均耗时（15.3±2.6）min。经造瘘管饲后,患者的营养状态明显改善。3例患者造瘘管局部出现红肿和脓性分泌物,1例患者造瘘管周围肉芽组织过度生长。除此之外未出现造瘘管脱出、坏死性筋膜炎、腹膜炎、胃肠穿孔及吸入性肺炎等严重并发症。结论经皮内镜下胃造瘘术对脑梗死合并吞咽障碍患者来说是一种安全有效的肠内营养方法。     

护理干预在经皮内镜下胃造瘘术中的应用

目的:探讨护理干预在经皮内镜下胃造瘘术(PEG)患者中的应用。方法:通过护理干预,对7例吞咽障碍及2例食管癌晚期不能进食而胃肠道功能正常的患者实施经皮内镜下胃造瘘术。结果:9例患者均顺利实施了胃造瘘术,无气腹、胃肠道出血、感染及造瘘管滑脱等并发症。结论:PEG术是肠内营养的非手术途径,具有操作简便、并发症少、风险低、创伤小等优点,而及时充分的护理干预是PEG术成功的关键。     

经皮内镜下胃造瘘术21例临床应用

目的探讨经皮内镜胃造瘘术（PEG）的临床应用价值。方法 2000年6月—2009年12月对需要胃肠营养而无法进食的21例患者行PEG治疗。结果 21例共行PEG 23例次（2例造瘘管阻塞置换）,均成功,3例次出现造瘘管周围皮下感染,所有患者置入瘘管后营养迅速恢复。21例患者随访1个月~18个月无严重并发症发生。结论 PEG作为肠内营养替代鼻饲的一种新的治疗方法,能够有效地改善患者的营养状况,促进康复,是内镜治疗的经典之作。     

经皮内镜胃造瘘和小肠造瘘术

目的探讨经皮内镜胃造瘘术（PEG）和经皮内镜小肠造瘘术（PEJ）建立肠内营养的方法。方法2006年6月至2008年8月PEG和PEJ共治疗18例病人,其中14例行PEG胃肠营养,4例行PEG胃肠减压加PEJ小肠内营养。结果18例共行PEG,PEG加PEJ4例次,其中PEG16例次（2例行造瘘管置换）,PEG加PEJ4例次,手术成功率100%,3例次出现造瘘管周围皮下感染。所有患者造瘘管置入后营养迅速恢复,停止静脉补液。18例病人随访1～24个月无严重并发症发生。结论PEG和PEJ是作为胃肠减压和肠内营养替代鼻饲的一种新的治疗方法,安全、有效、降低医疗费用和并发症少。     

经皮内镜下胃造瘘术的临床应用

目的探讨经皮内镜下胃造瘘(percutaneousendoscopicgastrostomy,PEG)的临床应用价值。方法对12例需要鼻饲的患者进行PEG治疗。结果全部患者均成功置管,平均耗时17min,所有患者造瘘管置入后营养迅速恢复,停止静脉补液。造瘘管最短留置时间3.5月,最长3年3个月,其中2例(2/12%)发生造瘘管周围皮肤感染,1例出现反流性食管炎,经对症处理均显著改善。未发生消化道出血、穿孔等严重并发症。结论PEG操作方法简便、安全,成功率高,并发症较少而轻,临床效果显著,值得临床推广应用。     

用鼻胃镜经皮胃造瘘术的护理

目的探讨应用经皮鼻胃镜下胃造瘘术的优点及护理。方法通过对2008年7月～2009年3月10例患者进行用鼻胃镜行胃造瘘术（PEG）,建立肠内营养支持及开展相应的护理。结果通过鼻胃镜行PEG及护理,患者得到了良好的营养支持。结论用鼻胃镜行PEG,与传统的胃造瘘术相比,此项操作更安全、并发症少,患者较舒适.更换瘘管简便、快捷。经皮鼻胃镜下胃造瘘术是不能张口或张口困难患者的首选管饲方法,值得临床推广应用.     

经皮内镜下胃造瘘术在上段食管癌患者中的临床应用

目的 探讨经皮内镜下胃造瘘术(percutaneous endoscopic gastrostomy,PEG)在上段食管癌患者中的临床应用.方法 回顾分析2005年1月~2010年3月在本院行PEG术的25例上段食管癌患者的临床资料.结果 所有患者PEG均获成功,术后患者营养状况明显好转.无手术相关死亡病例发生,25例患者中1例术后出现黑便,3例出现造瘘口局部少许渗血,2例出现造瘘管周围皮肤感染,经对症处理后均改善.结论 PEG技术操作简单易行、安全,创伤小,并发症少,可避免食管上段癌患者营养状态的恶化,是上段食管癌并恶性梗阻患者行肠内营养支持治疗的可供选择的一种方法.     

经皮内镜下胃造瘘术及其临床应用探讨

目的探讨经皮内镜下胃造瘘术(PEG)方法及有关临床问题。方法分析27例患者行PEG治疗的临床资料。结果27例一次置管成功。所有患者营养迅速恢复,停止静脉输液,7例恢复饮食,拔管,14例置管1年以上,5例因原发病死亡;并发1例瘘管脱落,2例PEG瘘管旁渗血,2例瘘口周围感染,无其他严重并发症。结论PEG是操作方法简便、安全、有效的胃肠道营养方法,值得临床应用。     

经皮穿刺内镜下胃造瘘术的临床应用及价值

目的探讨经皮穿刺内镜下胃造瘘术（Percutaneous Endoscopic Gastrostomy,PEG）的临床应用及价值。方法1999年9月～2008年2月间,因各种原因造成的经口进食困难引起营养不良需长期营养支持的患者116例,在本院内镜中心行PEG治疗。其中男性72例,女性44例,年龄16～94岁,平均年龄48．5岁。结果所有患者均成功完成内镜下胃造瘘术,平均耗时15min。术后跟踪随访,所有患者造瘘管置入后营养迅速恢复,停止静脉补液。造瘘管最长留置时间1．5年。116例病人中共4例发生造瘘管周围皮肤感染,6例出现反流性食管炎,经对症处理均显著改善。未发生消化道出血、穿孔等严重并发症。结论PEG技术操作简单易行、安全、并发症少,创伤小,临床效果显著,值得临床推广应用。     

经皮内镜下胃造瘘术的临床应用

目的：探讨经皮内镜下胃造瘘术（Percutaneous endoscopic gastrostomy ,PEG）的临床应用价值。方法：2005年～2007年对17例需要进行肠内营养的患者进行了PEG手术。结果：所有17例患者均成功置管，平均耗时21分钟，所有患者造瘘管置入后营养状况均得到不同程度的改善，与深静脉相比，费用明显降低，患者的生活质量得到提高。平均随访9个月，最长18个月，未发生严重并发症。术后初期1例出现造瘘口周围轻度炎症反应，1例出现造瘘口周围渗液，经积极处理均痊愈，轻微并发症发生率为11．8％。结论：PEG器材简单，操作方法简便、成功率高、患者创伤小、并发症较少、临床效果显著，是一种为患者提供肠内营养的合适选择。     

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.     

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.