合并高血压糖尿病的妇科老年患者术后处理

目的:探讨合并高血压糖尿病的老年妇女行妇科手术术后处理措施对患者恢复的影响。方法:选择合并高血压糖尿病的妇科老年患者80例,随机分成研究组40例与对照组40例,观察两组患者术后并发症的发生率和术后住院天数。结果:研究组术后并发症发生率7.5%,术后4～10 d出院,平均(5.4±1.6)d;对照组并发症发生率35%,术后5～28 d出院,平均(8.8±4.7)d。两组比较差异有统计学意义(P<0.01)。结论:对于合并高血压糖尿病的老年妇女而言,加强医生的责任心、完善术后处理,可以提高妇科手术质量,降低并发症的发生率。     

临床护理路径在经皮冠状动脉造影术的应用

目的：探讨临床护理路径应用于经皮冠状动脉造影术患者的效果，规范该类患者手术前后的医疗护理。方法：将582例经皮冠状动脉造影术患者随机分为研究组和对照组，研究组应用临床路径管理，对照组按照常规工作模式管理，比较两组患者的平均住院天数、住院费用、术后并发症及不良反应发生率。结果：研究组患者的平均住院天数、平均住院费用、术后并发症及不良反应的发生率均少于对照组P〈0．05。结论：经皮冠状动脉造影术患者实施临床护理路径管理后，可以缩短平均住院天数，降低医疗成本，减少术后并发症及不良反应。     

胸腔镜手术治疗老年患者肺大泡的护理干预

目的探讨对胸腔镜手术治疗老年患者肺大泡行护理干预后,降低其肺部并发症、住院天数及住院费用的可能性。方法降44例胸腔镜手术治疗肺大泡的老年患者随机分为对照组和试验组。对照组行常规治疗护理,试验组在常规护理基础上行护理干预。结果试验组术后并发症、住院天数、住院费用均少于对照组,组间比较差异有统计学意义（P〈0.05）。结论对胸腔镜手术治疗老年患者肺大泡行护理干预,能有效减少术后并发症、住院天数和住院费用。     

简易止血带应用于妇科开腹手术的效果分析

目的：探讨一种在基层医院妇科开腹手术中应用简单、方便、快速、有效、安全的止血方法及临床效果。方法：将2010—2011年妇科开腹192例手术患者作为研究组,采用简易止血带环扎子宫动、静脉,即时止血后,快速手术;另选择2008—2009年妇科开腹手术189例患者作为对照组,采用常规宫体注射缩宫素20U或垂体后叶素6U止血。比较两组术中出血量、手术时间、肛门排气时间、术后体温、抗生素应用时间、住院天数、住院费用。结果：研究组术中出血量、手术时间明显减少,两组比较差异均有统计学意义（P〈O．01）;研究组肛门排气时间、术后体温异常、抗生素应用时间、住院天数、住院费用亦减少,差异均有统计学意义（P〈O．05）。结论：基层医院妇科开腹手术采用简易止血带环扎子宫动、静脉,即时止血后手术,能明显缩短手术时间,减少术中出血量,降低术后并发症发生,具有创伤小、恢复快、经济、安全、有效等优点。     

妇科老年妇女围手术期处理

回顾性分析216例60岁以上的老年妇科患者，并以同期中年妇女（40～59岁）200例为对照，分析对照两组患者术前、术中及术后并发症的发生及处理。探讨老年妇科患者的围手术期经验，提高老年妇女手术治疗水平。结果：老年妇女术前69．9％合并心血管疾病和糖尿病等疾病，明显高于对照组（P〈0．05）。术中、术后并发症和中年妇女组无明显差异。提示：只要充分术前准备积极控制并发症，选择适当术式及麻醉方式，术中、术后严格监护，大多数老年患者能安全地度过围手术期。     

120例老年妇女围手术期处理的临床分析

目的探讨60岁以上老年妇女进行妇科手术的可行性。方法采用回顾性分析2004年3月-2009年3月60岁以上120例老年妇科患者围手术期的资料。结果资料显示老年妇女易合并高血压、糖尿病,老年妇科手术疾病中,子宫脱垂占35．0％,恶性肿瘤占31．7％,良性肿瘤占33．3％,术后可出现泌尿系感染、切口裂开、肺部感染等并发症。结论只要术前准备充分,选择合适的麻醉、手术方式,术中、术后加强监护,老年妇科患者可安全度过围手术期。     

快速康复外科理念联合腹腔镜治疗结直肠癌患者价值探讨

目的探讨快速康复外科(FTS)理念联合腹腔镜治疗结直肠癌手术的有效性和安全性。方法将择期行结直肠癌手术120例随机分成4组:传统的开腹手术对照组(Ⅰ组,28例),FTS理念开腹手术组(Ⅱ组,30例),单纯腹腔镜手术组(Ⅲ组,32例),FTS理念联合腹腔镜手术组(Ⅳ组,30例)。分析研究4组患者手术时间、静脉输液时间、手术切口长度、术中出血量、首次通气时间、术后住院天数和住院费用等指标。结果Ⅳ组和Ⅲ组与Ⅰ组和Ⅱ组相比较手术时间明显延长,术中出血量明显减少,手术切口明显减小,各项差异均有统计学意义(P0.05)。Ⅳ组和Ⅱ组与Ⅰ组比较术后肠功能恢复时间和住院时间都明显缩短,各项差异均有统计学意义(P0.05)。Ⅳ组与Ⅱ组相比较术后肠功能恢复时间、静脉输液时间和住院天数差异均无统计学意义(P0.05)。Ⅳ组与Ⅲ组相比较术后静脉输液时间,半流质饮食时间提前,住院天数明显缩短,差异均有统计学意义(P0.05)。结论 FTS理念联合腹腔镜治疗结直肠癌,术后肠功能恢复快,住院时间短;与FTS理念开腹手术相比,具有术中出血量少、切口小的优点,但手术时间长。     

腹腔镜胃穿孔修补术治疗胃穿孔的疗效观察

目的探讨腹腔镜胃穿孔修补术治疗胃穿孔的效果。方法 84例胃穿孔手术患者随机分为研究组与对照组,每组42例。研究组采用腹腔镜胃穿孔修补术治疗,对照组采用开腹胃穿孔修补术治疗。比较两组患者手术相关指标、手术前后胃肠道症状评分、手术前后胃蛋白酶(PGⅠ、PGⅡ)及胃肠激素(GAS、VIP)水平、术后并发症发生情况。结果研究组术中出血量、术后肛门排气时间、术后住院时间及术后并发症发生率均低于或短于对照组(均P 0. 05);两组术后肠鸣音、腹胀痛、胃肠反应评分均低于术前,且研究组术后各项评分均低于对照组(均P 0. 05);两组术后PGⅠ、PGⅡ、GAS、VIP水平均高于术前,且研究组术后PGⅠ、PGⅡ、GAS、VIP水平均高于对照组(均P 0. 05)。结论采用腹腔镜胃穿孔修补术治疗胃穿孔,可以减小患者手术创伤,利于术后恢复,改善患者症状及胃肠激素水平,降低术后并发症。     

加速康复外科在子宫肌瘤剔除术病人围手术期护理中的应用研究

目的探讨加速康复外科(ERAS)在子宫肌瘤剔除术病人围手术期护理中的应用效果。方法随机抽选于2017年12月至2018年12月我院妇科收治的70例子宫肌瘤患者,均已接受腹腔镜下子宫肌瘤剔除术。依照入组单双号随机分为两组,对照组(n=35)应用常规护理,研究组(n=35)应用加速康复外科护理措施进行护理。评价及对比两组的术后疼痛程度、手术指标(排气时长、住院天数、术后并发症发生)。结果研究组的疼痛程度低于对照组(P0.05);与对照组比较,研究组的排气时长、住院天数均明显缩短,差异均有统计学意义(P0.05)。结论临床对子宫肌瘤患者行腹腔镜下子宫肌瘤剔除术后应用加速康复外科护理,可有效减轻疼痛症状,促进术后排气,且住院时间缩短。     

老年妇科病人手术安全性的探讨

随着老年过程的出现 ,多种组织器官出现衰老和退化 ,给麻醉和手术都带来极大的危险性。由于手术技巧和监护水平的完善 ,越来越多的老年妇女接受了手术治疗 ,而且接受手术的年龄逐渐增大。如何使老年妇女安全度过围手术期已是目前我们面临的一个新课题。本文对我院近 2年收治的 5 3例老年妇科病人围手术期资料进行分析 ,现报告如下。1　临床资料1.1　我院自 2 0 0 0年 1月至 2 0 0 1年 8月妇科共收治住院手术病人 12 4 9例 ,其中 6 0岁以上 5 3例 (4.2 %)。 5 3例病人中 6 0～ 6 9岁 4 5例 (85 %) ,70～ 79岁 7例 (13%) ,87岁 1例。1.2　部分…     

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.