52例先心病患儿EEG和BAEP检测的临床分析

目的　通过小儿先心病 (CHD)脑电图 (EEG)、脑干听觉诱发电位 (BAEP)的变化 ,评价CHD对患儿脑功能、脑干发育的影响。方法　分析了 5 2例儿童CHDEEG、BAEP的变化。结果　CHD小儿EEG异常率为 4 2 .3% ,其中非紫绀组为 2 6 .3% ,紫绀组为 85 .7% ,两组间差异显著 (P <0 .0 1)。BAEP异常率 6 3.5 % ,非紫绀组为 5 2 .6 % ,紫绀组为 92 .9% ,两组间差异非常显著 (P <0 .0 1)。Ⅴ波潜伏期 (PL)、Ⅰ～Ⅴ波峰间潜伏期 (IPL)紫绀组较健康儿显著延长 (P <0 .0 5 ,P <0 .0 1,)。结论CHD可损害脑功能并延迟脑干发育 ,早期干预可能是必要的。BAEP较EEG检测似乎更能敏感地提供脑受损的信息     

先天性心脏病患儿短声诱发听性脑干反应的探讨

目的：探讨先天性心脏病（先心病）对患儿脑干发育的影响。方法：探讨先心病患儿听性脑干反应（ABR）,并以正常儿为对照组。结果：年龄＜12月,青紫型先心病（CCHD）,患儿Ⅰ波潜伏期（LP）正常,Ⅰ～Ⅴ波峰期潜伏期（IPL）较正常儿显著延长,非青紫型先天病（NCCHD）患儿Ⅰ波LP、Ⅰ～Ⅴ波LPL均显著延长;4－6岁者NCCHD和CCHD无反复缺氧发作者LP和Ⅰ～Ⅴ波LPL与正常儿无差异,CCHD反复缺氧发作者Ⅰ～Ⅴ波LPL较正常儿显著延长,异常率2．3％。结论：先心病不延迟婴儿期脑干发育,缺氧发作可损害脑干功能,对缺氧发作者应尽早进行干预。     

脑干听觉诱发电位、脑电图结果与急性脑干梗死患者吞咽功能障碍及预后的关系

目的探讨脑干听觉诱发电位(BAEP)、脑电图(EEG)检查结果与急性脑干梗死患者并发吞咽功能障碍、预后的关系。方法选取我院2016年1月至2018年2月收治的40例急性脑干梗死患者(病例组)、40例健康对象作为对照组,两组研究对象均接受BAEP、EEG检查,统计分析病例组BAEP、EEG检查异常与正常患者的吞咽困难发生程度、90天内预后情况。结果病例组患者的BAEP、EEG异常率均显著的高于对照组,差异有统计学意义(P<0. 05); BAEP正常的脑干梗死患者预后情况优于BAEP异常的患者、吞咽困难发生程度较BAEP异常轻,差异有统计学意义(P<0. 05);EEG正常的脑干梗死患者预后情况优于EEG异常的患者、吞咽困难发生程度较EEG异常轻,差异有统计学意义(P <0. 05);预后良好的患者的Ⅰ波、Ⅲ波、Ⅴ波潜伏期、Ⅰ～Ⅲ波及Ⅲ～Ⅴ波间潜伏期均显著的低于预后不良组,差异有统计学意义(P<0. 05)。结论急性脑干梗死患者BAEP、EEG检查发生异常的患者预后较差、吞咽困难程度较为严重。     

血清未结合胆红素水平对足月新生儿脑干听觉诱发电位的影响

目的　探讨血清未结合胆红素 (UB)水平与足月新生儿脑干听觉诱发电位 (BAEP)各波及波间潜伏期长短的关系。方法　 138例黄疸足月新生儿按血清UB水平分为 4组 :A组 (UB <171 0 μmol/L) 31例 ,B组 (UB171 0～ 2 5 6 5 μmol/L) 4 0例 ,C组 (UB 2 5 6 5～ 342 0 μmol/L) 35例 ,D组 (UB≥ 342 0 μmol/L) 32例。比较各组新生儿BAEP的Ⅰ ,Ⅲ ,Ⅴ波潜伏期 (PL)及波间潜伏期 (IPL)的大小。并分析高UB新生儿 (C组与D组 )治疗后血清UB降至 85 5 μmol/L 以下时BAEP值的变化。结果　A ,B ,C ,D各组随着血清UB水平的增高 ,患儿BAEPⅢ、Ⅴ波潜伏期 ,Ⅰ～Ⅲ ,Ⅲ～Ⅴ ,Ⅰ～Ⅴ波间潜伏期明显延长 (P <0 0 5 ) ;高UB(C组和D组 )患儿治疗后 ,血清UB水平显著降低 ,患儿BAEP值Ⅲ、Ⅴ波潜伏期 ,Ⅰ～Ⅲ ,Ⅲ～Ⅴ ,Ⅰ～Ⅴ波间潜伏期较治疗前明显缩短 (P <0 0 1)。D组中 3例治疗前BAEP各波未分化者 ,经治疗血清总胆红素及UB水平降至 5 0 μmol/L 以下后 ,BAEP值仍无明显改变。结论　足月新生儿血清UB水平与其BAEP间存在一定相关性。血清UB越高 ,对BAEP的影响一般也越大。及时有效的干预使血清UB水平迅速降低 ,可使大多数患儿的BAEP得到改善 ,但也有部分高胆红素血症患儿在短期内BAEP无明显改善 ,需密切追踪随访 ,采取适     

不同病期儿童结核性脑膜炎脑干听觉诱发电位的分析

目的 探讨脑干听觉诱发电位(brainstem auditory evoked potential,BAEP)在儿童结核性脑膜炎(简称结脑)不同病期中的应用价值.方法 对84例结核性脑膜炎患儿做BAEP检测.结脑患儿分为早期组26例,中期组30例,晚期组28例,24例年龄性别匹配的正常儿童作为对照组,比较各组BAEP异常率,比较各组BAEPⅠ、Ⅲ、Ⅴ波潜伏期(peak latency,PL)和Ⅰ～Ⅲ、Ⅲ～Ⅴ、Ⅰ～Ⅴ波峰间期(interpeak latency, IPL).结果 BAEP总异常率为56%(47/84),早期、中期和晚期结脑组BAEP异常率分别为34.6%、53.3%和78.6%,晚期结脑组BAEP的异常率明显升高,分别与早期和中期结脑组比较,差异均有统计学意义(P<0.05);早期和中期结脑组BAEP异常率比较,差异无统计学意义(P>0.05).晚期结脑组Ⅰ、Ⅲ、Ⅴ波的PL和Ⅲ～Ⅴ、Ⅰ～Ⅴ波的IPL均较对照组延长,差异有统计学意义(P<0.05); 晚期结脑组Ⅲ、Ⅴ波PL和Ⅲ～Ⅴ、Ⅰ～Ⅴ波IPL均较早期结脑组延长,差异有统计学意义(P<0.05);晚期结脑组Ⅲ波PL较中期结脑组延长,差异有统计学意义(P<0.05);中期结脑组Ⅰ波PL较对照组延长,差异有统计学意义(P<0.05);中期结脑组Ⅲ、Ⅴ波PL和Ⅲ～Ⅴ、Ⅰ～Ⅴ波IPL与对照组比较,差异均无统计学意义(P>0.05);早期结脑组各波PL和IPL与对照组比较,差异均无统计学意义(P>0.05).BAEP异常多为轻度,表现为Ⅲ、Ⅴ波PL和Ⅲ～Ⅴ、Ⅰ～Ⅴ的IPL延长,或波形分化不清.结论 结脑患儿BAEP异常率高,多表现为中枢性脑干听路损害,BAEP异常与结脑分期有关,BAEP可作为判断结脑患儿病情严重程度的监测指标.     

心脏停跳与不停跳心内直视手术患者围手术期EEG变化的比较

目的　观察浅低温体外循环 (CPB)心脏不停跳与中浅低温体外循环心脏停跳心内直视手术患者 ,手术前后的脑电图(EEG)变化 ,探讨心脏不停跳技术对脑功能的影响。方法　选择接受择期心内直视手术患者 5 2例 ,分为A组 (n1 =2 6 ) ,在中浅低温体外循环心脏停跳下施行开心手术 ;B组 (n2 =2 6 ) ,在浅低温体外循环心脏不停跳下施行手术。两组患者术前进行脑电图检查 ,无脑电图明显异常者 ,术后 7d复查EEG ,比较分析两组术后EEG检查结果。结果　两组患者术后 1周EEG的异常率A组6 5 .4 % ,B组 6 9.2 % ,较术前明显变差 (P <0 .0 1 ) ;但两组间差异不显著 (P >0 .0 5 ) ;接受开心手术的先心病患者手术后EEG的异常率较风心病患者术后EEG的异常率高 (P <0 .0 5 )。结论　采用本院改进的心脏不停跳心内直视手术方法与常规心脏停跳心内直视手术相比没有增加对脑组织的损伤程度 ;开心手术对小儿先天性心脏病患者脑组织的影响较成人风湿性心脏病患者重     

神经电生理技术在新生儿高胆红素血症中的应用

目的 对高胆红素血症的新生儿进行脑电图(EEG)及脑干听觉诱发电位(BAEP)检测,评估高胆红素血症对脑功能的影响.方法 对96例高胆红素血症新生儿入院后进行脑电图(EEG)及脑干听觉诱发电位(BAEP)测定.结果 高胆红素血症患儿中EEG异常率48.96%,主要表现为:弥漫性低电压、背景活动紊乱、爆发性抑制、癫痫样放电;BAEP异常率80.2%,表现为:波形分化不清或缺失,各波潜伏期(PL)及波间潜伏期(IPL)的延长.结论 EEG与BAEP均可反映脑功能异常改变,为临床诊断提供有价值的客观依据,而BAEP 检查敏感性高, 影响因素小,结果准确可靠;BAEP、EEG可作为早期判断新生儿高胆红素血症病情的一种有效、方便的检查手段.     

经颅多谱勒和脑电图对儿童偏头痛的诊断价值

目的　探讨经颅多谱勒 (TCD)与脑电图 (EEG)对儿童偏头痛的诊断价值。方法　对 5 4例临床诊断为偏头痛患儿和45例对照组分别进行TCD与EEG检测 ,并进行对比分析。结果　 5 4例偏头痛患儿TCD异常 3 8例 ,异常率为 70 .3 7%。同龄对照组 45例 ,异常 3例 ,异常率为 6.67%。两组比较有显著性差异 (P <0 .0 5 )。病例组EEG异常 2 0例占 3 7.0 4% ,对照组EEG结果全部都在正常范围内。两组比较有显著性差异 (P <0 .0 5 )。结论　采用TCD与EEG相结合对儿童偏头痛的诊断和选择用药具有重大价值。     

87例婴幼儿脑瘫脑干听觉诱发电位的分析

目的探讨脑干听觉诱发电位(BAEP)在婴幼儿脑瘫中的诊断价值。方法检测87例婴幼儿脑瘫的BAEP,测量Ⅰ、Ⅲ、Ⅴ波的潜伏期(peaklatency,PL)和Ⅰ～Ⅲ、Ⅲ～Ⅴ、Ⅰ～Ⅴ波的峰间期(interpeaklatency,IPL);34例年龄性别匹配的健康婴幼儿作为对照;脑瘫患儿分为BAEP正常组和异常组,比较两组性别、年龄、头颅CT异常情况和脑瘫程度。结果脑瘫组Ⅰ、Ⅲ、Ⅴ波的PL和Ⅰ～Ⅲ、Ⅲ～Ⅴ、Ⅰ～Ⅴ波的IPL均较对照组明显延长,差异有统计学意义(P<0.05);BAEP的异常率为66.7%,多为中枢性听路损害,表现Ⅲ、Ⅴ波PL延长;脑瘫患儿BAEP异常组与BAEP正常组比较,两组的性别、年龄差异均无统计学意义(P>0.05),BAEP异常组头颅CT异常例数和中重度脑瘫例数高于BAEP正常组,差异有统计学意义(P<0.05)。结论婴幼儿脑瘫的BAEP异常率高,主要是中枢听觉传导功能障碍,提示BAEP可反映脑瘫儿脑功能损害。     

脑电图、脑干听觉诱发电位、视觉诱发电位在小儿脑性瘫痪早期诊断中的对比分析

目的探讨脑电图（EEG）、脑干听觉诱发电位（BAEP）、视觉诱发电位（VEP）在小儿脑性瘫痪早期诊断中各自的作用及其相互关系。方法对75例小儿早期脑性瘫痪的EEG、BAEP、VEP检测结果进行回顾性分析。结果 EEG异常率为73.33%,BAEP异常率为81.33%,VEP异常率为30.67%,EEG异常率和BAEP异常率与VEP异常率比较,差异有高度统计学意义（P〈0.01）,EEG异常率与BAEP异常率比较,差异无统计学意义（P〉0.05）;EEG异常率与小儿脑性瘫痪（CP）类型有关;BAEP异常率与高危因素有关。结论脑性瘫痪早期应用EEG、BAEP、VEP检查,对脑性瘫痪早期诊断有一定的参考价值,他们之间能起到互补的作用,对临床综合分析更有意义。     

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.