早期宫内孕误诊为异位妊娠9例分析

目的 分析早期宫内孕误诊为异位妊娠的的原因及避免误诊的主要方法。方法 对1998年12月至2002年12月间本院收治的9例早期宫内孕误诊为异位妊娠患者的临床资料进行分析总结。结果 9例患者停经时间34～56天，均有不同程度的腹痛，伴不规则阴道流血7例、移动性浊音2例。宫颈举痛5例，子宫正常大小2例、稍大6例，附件增厚或包块6例。血阻HCG(278～1260)mIU／ml，尿HCG均阳性。B超检查8例均未见典型宫内孕囊，而附件区探及不均质回声包块7例，盆腔少量积液4例、中等量积液2例。预后：1例B超复查发现为宫内孕而予保胎治疗；5例行MTX杀胚治疗，后经B超复查为宫内孕；2例行急诊剖腹探查，发现为卵巢黄体破裂出血，术后行人工流产和自然流产各1例；1例因要求绝育而行手术治疗，术中未发现妊娠物，术后行诊刮，病理确诊为宫内孕。结论 对于停经时间短、症状不典型而疑为异位妊娠的患者，在病情允许的情况下，应行HCG、B超及孕酮的动态观察，提高诊断的准确性，降低误诊率。     

宫颈妊娠16例分析和诊治体会

目的：探讨宫颈妊娠的诊断及治疗方法。方法：收治宫颈妊娠患者16例,回顾性分析临床资料。结果：6例宫颈妊娠患者被误诊为宫内早孕或先兆流产,行药物流产或人工流产术中大量出血致出血性休克;10例患者经阴道超声检查明确诊断。16例患者中14例行子宫动脉栓塞（UAE）后均有效地控制阴道出血并减少了术中出血,余2例确诊患者拒绝栓塞而全身使用甲氨蝶呤（MTX）治疗,其中1例保守治疗成功,1例失败。结论：阴道超声是诊断宫颈妊娠简单可靠的方法。UAE可以有效控制宫颈妊娠出血,其结合手术或药物治疗是宫颈妊娠出血的有效治疗方法,而单纯MTX治疗的安全性及有效性有待进一步观察。     

剖宫产术后疤痕妊娠的临床研究

目的:探讨子宫下段剖宫产疤痕妊娠的早期诊断的相关因素。方法:回顾性分析我院收治的剖宫产疤痕妊娠的28例患者的临床资料。结果:3例误诊为先兆流产,4例误诊为稽留流产,2例漏诊,其中3例行人工流产术/清宫术,术中阴道出血>200 ml,再次B超检查诊断为剖宫产疤痕妊娠;3例清宫术后阴道少量不规则出血复诊,B超检查诊断为剖宫产疤痕妊娠,2例行中孕引产出胎后行清宫术,术中阴道活动性出血>200 ml,再次B超检查诊断为剖宫产疤痕妊娠。结论:阴道彩色多普勒超声检查能较准确及时地在妊娠早期作出子宫下段疤痕妊娠的初步诊断。     

宫颈妊娠4例临床分析

本文就我院1995年1月-12月间收治的5例宫颈妊娠分析报告如下。 1临床资料 例1：36岁，吸宫史2次，剖宫史1次。停经49天，阴道出血2天。血hCG 3761U／L。B超检查：宫颈沙漏状。入院诊断：宫颈妊娠。处理：甲氨蝶呤（MTX）20mg宫颈注射，连用5天后B超下行清宫术。治疗后痊愈。     

子宫下段剖宫产疤痕妊娠的早期诊断的临床研究

目的 探讨子宫下段剖宫产疤痕妊娠的早期诊断的相关因素.方法 回顾性分析2002年1月至2009年12月广东省医学院附属厚街医院收治的剖宫产疤痕妊娠的30例患者的临床资料.结果 早期临床表现无特异性,容易误诊漏诊.3例误诊为先兆流产,4例误诊为稽留流产,2例漏诊,其中5例行人流术/清宫术,术中阴道出血大于200ml,再次8超检查诊断为剖宫产疤痕妊娠;3例清宫术后阴道少量不规则出血复诊,B超检查诊断为剖宫产疤痕妊娠,4例行中孕引产出胎后行清宫术,术中阴道活动性出血大子200ml,再次B超检查诊断为剖宫产疤痕妊娠.结论 阴道彩色多普勒超声检查能较准确及时地在妊娠早期作出子宫下段疤痕妊娠的初步诊断.     

11例早期宫内妊娠误诊体会

目的：分析早期宫内妊娠误诊为异位妊娠的危害及原因,探寻诊治与预防方法。方法：选择我院2011年1月至2013年10月收治的11例早期宫内妊娠误诊为异位妊娠患者的临床资料进行回顾分析。结果：11例均有停经史,部分病人有阴道出血史及轻度腹痛,血或尿妊娠试验均呈阳性,B超提示部分病人有宫旁包块,异位妊娠待排,1周后复查均诊断为宫内妊娠。结论：对于停经时间较短或在6周内、以及受个体差异影响,形成早期宫内妊娠症状不典型的病例,不要轻易地作出异位妊娠的诊断,可在病情允许的情况下,结合病史,行血β－HCG、B超、诊刮等多种辅助手段进行综合判断复查。临床实践表明,多者联合综合检测的准确性达98．5％。     

宫内妊娠物少量残留的药物治疗

目的:探讨宫内妊娠物少量残留的药物治疗效果.方法:采用药物刮宫治疗宫内妊娠物少量残留患者52例,采用口服乙烯雌酚2mg/日,共7天,患者于服用乙烯雌酚第5天起,加服安宫黄体酮,10mg/次,3次/日,共3天,同时进行常规应用抗生素3～5天预防或控制感染.治疗结束后每个月随访1次,连续3个月,询问症状和不适,必要时B超检查.结果:52例患者治愈50例,B超检查宫内无组织残留,阴道流血低于月经量,出血时间7～8天,治愈率96 15%.有2例患者因阴道流血量多,经B超检查发现仍有残留,行清宫术,好转出院.经过治疗后连续3个月的回访,治愈的50例患者均月经正常,复查B超无异常发现,2例清宫术患者,B超复查无异常发现,月经规则,经量正常.结论:药物刮宫治疗宫内妊娠物少量残留效果显著,痛苦小.     

B超在药物流产后阴道出血时间延长中的应用

目的探讨B超在药物流产后阴道出血时间延长中的临床应用和意义。方法对89例药物流产后阴道出血时间延长者分别行B超检查，根据B超诊断的不同，临床分别给予清宫术或药物治疗。结果根据B超诊断，对52例患者立即行清宫术，均清出残留物，B超诊断与宫内清出物符合率为100％；对另外37例患者给予药物治疗，其中31例患者有效，其余6例患者用药后疗效不佳而行诊刮术后见效，B超诊断符合率为83．78％。结论B超检查可较准确地诊断宫腔内有无残留物可能，避免临床盲目诊治患者，对减少药流后阴道出血时间延长及药流后并发症的发生有较高的应用价值。     

剖宫产术后子宫疤痕妊娠15例临床分析

目的:探讨剖宫产术后子宫疤痕妊娠(CSP)的临床特点,提高对子宫疤痕处妊娠的诊治水平。方法:回顾性分析2011年11月~2014年12月在我院收治的子宫疤痕妊娠15例患者的临床资料。结果:15例孕早期均行超声检查。其中5例确诊,10例被误诊。确诊5例中,有2例B超示妊娠囊小于3 cm,直接行经阴道子宫疤痕妊娠物清除术+修补术;3例B超示妊娠囊大于3 cm,行双侧子宫动脉栓塞+甲氨蝶呤灌注+米非司酮+清宫术治疗。误诊10例中有9例行人工流产术而阴道大量出血,其中1例行急诊开腹子宫疤痕妊娠物清除术+修补术,1例因子宫穿孔急诊手术中确诊为子宫疤痕妊娠破裂行次全子宫切除术,6例行介入栓塞+甲氨蝶呤灌注+米非司酮+清宫治疗,1例入院后阴道出血少予甲氨蝶呤宫颈注射保守治疗;另1例早孕时误诊,因中孕时子宫破裂手术确诊为子宫疤痕处妊娠葡萄胎行妊娠物清除术+疤痕修补术。结论:子宫疤痕妊娠误诊率高,有剖宫产史的患者再次怀孕时应及时行阴道彩超检查,早期确诊,根据患者病情及医院技术水平和设备条件选择合适治疗方法。     

子宫疤痕妊娠34例临床诊治分析

目的探讨剖宫产术后子宫疤痕妊娠的诊疗方法。方法回顾性分析我院2006年7月—2009年3月收治34例子宫疤痕妊娠的诊治过程。结果 34例病例孕早期行阴道彩超检查31例确诊,3例误诊,确诊31例中3例B超有胎心搏动直接行开腹子宫疤痕妊娠物清除术+修补术,26例行氨甲蝶呤+米非司酮保守治疗成功,2例行介入栓塞+氨甲蝶呤+清宫术,3例误诊为宫内早孕行人工流产术中阴道大量出血急诊入院,2例行急诊子宫疤痕妊娠物清除术+修补术,1例子宫破裂手术中确诊为子宫疤痕妊娠行次全子宫切除术。结论有剖宫产史的患者再次怀孕时应及时行阴道彩超检查,一旦确诊为子宫疤痕妊娠根据病情需要选择药物保守治疗或手术治疗,如人流术中大出血应考虑是否为子宫疤痕妊娠给予积极治疗。     

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.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

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.