C-反应蛋白在普外科手术患者风险评估中的临床意义

目的 研究C-反应蛋白水平变化在普外科手术患者风险评估中的意义。方法 对63例手术患者入院后24h和术后第1天,分别测定C-反应蛋白水平,并应用POSSUM评分系统进行评分,记录并发症发生情况,将患者分为并发症组和非并发症组：结果并发症组与非并发症组入院后CRP值与入院后POSSUM分值均呈正相关（r=0．431,P=0．011;r=0．403,P=0．030）,并发症组入院后CRP值与术后第1天POSSUM分值呈正相关（r=0．494,P=0．003）,非并发症组入院后CRP值与术后第1天POSSUM分值呈正相关（r=0．395,P=0．034）。两组入院后CRP值与术后第1天CRP值差异均有统计学意义（t=-5．249,P=0．000;t=-6．456,P=0．000）。两组术后第1天CRP值与术后第1天POSSUM分值均不相关（r=0．065,P=0．713;r=0．285,P=0．134）。两组之间入院后及术后第1天CRP值差异均无统计学意义（t=-1．478,P=0．145;f=-0．975,P=0．333）：结论 入院后24h的CRP值作为普外科手术患者风险评估的一个指标,有一定的临床意义。     

SIRS病人急诊手术的术中护理

目的探讨急诊手术术后与全身炎症反应综合征(SIRS)的关系及护理方法.方法将60例急诊手术,病例60例,平均年龄39±18岁,有胆囊炎、胆石症肠梗阻、肠坏死、急性化脓性阑尾穿孔、伴腹膜炎行阑尾切除、腹腔引流,多发性骨折切开复位内固定术,观察手术时间、麻醉时间、术中失血量和住院时间,分析不同手术方式与患者术后SIRS发生率的关系.结果术中及早应用抗菌及激素,护理的高效、准确、使病人安全度过手术,术后迅速恢复,及时控制了SIRS,使SIRS没有造成机体更进一步的损伤.结论 SIRS病人急诊手术,需要手术医师、麻醉医师及手术室护士通力协作,因此,拥有一批训练有素的手术室护士,对于医生及病人来说都是非常必要的, SIRS可以作为评价手术创伤程度的客观指标.     

全身炎症反应综合征评分在预测急腹症患者预后中的临床意义

目的 了解全身炎症反应综合征(systemic inflammatory response syndrome,SIRS)评分与急腹症患者病情严重度、术后并发症发生情况及病死率的关系,进一步观察SIRS评分对预测急腹症患者预后的价值.方法 193例患者分别予以SIRS评分、急性生理学及慢性健康状况评价系统Ⅱ(acute physiology and chronic health evaluation Ⅱ,APACHEⅡ)评分及术后并发症统计,并行相关的统计学分析.结果 SIRS评分≥2分组,APACHEⅡ评分增高显著,与SIRS评分=0/1分组比较差异有统计学意义(P<0.05).并发症发生组患者SIRS评分显著增高(P<0.05).入院第1、3天APACHEⅡ评分与SIRS评分明显正相关(P<0.01).SIRS评分=0/1/2分组患者无1例死亡;SIRS＞2分时,死亡例数逐渐增高(1例),以SIRS评分为4时最高(2例).结论 SIRS评分与病情严重度密切相关,尤其SIRS评分≥2分与病情及并发症发生关系更为密切.支持SIRS评分是一个简单、独立、有价值的预后评分标准.     

胃癌开腹手术治疗后的并发症探讨分析

目的:探讨胃癌开腹手术治疗后的并发症发生的危险因素。方法:选择胃癌患者40例,都采用开腹手术治疗,同时进行相关病历资料的调查。结果:术后1个月内发生并发症8例,发生率为20.0%,单因素结果显示淋巴结清扫范围、TNM分期、年龄、术中失血量是导致术后并发症发生的主要危险因素(P<0.05)。结论:胃癌开腹手术治疗后的并发症发病率比较多,多与患者机体状况有关,需要对患者进行必要的术前干预。     

直接前侧微创入路全髋关节置换术临床应用研究

目的探讨直接前侧微创入路全髋关节置换术(THA)的临床应用效果。方法回顾性分析53例行直接前侧微创入路THA患者的临床资料,观察患者并发症发生情况,采用Harris评分评价患者的髋关节功能;通过骨盆正位X线片观察患者的假体位置及假体松动等情况。结果本组病例的平均手术时间为(114.3±38.9)min,平均术中失血量为(496.1±322.4)mL。术前Harris髋关节评分平均为38.9±11.9,术后12个月为93.2±14.6,术后Harris髋关节评分显著高于术前(t=-2.689,P=0.008)。臼杯前倾角平均为18.0°±7.6°,外展角平均为46.1°±8.5°。体质量指数与术中失血量及臼杯前倾角之间无显著相关性(r=0.102,P=0.089;r=0.112,P=0.075),但与手术时间(r=0.178,P=0.036)及臼杯外展角(r=0.154,P=0.028)呈弱正相关关系;手术时间随着手术例数的增加有减少趋势。术中发生手术切口周围神经损伤2例(3.8%),股骨近端骨折2例(3.8%);术后发生深静脉血栓形成3例(5.6%),髋关节脱位3例(5.6%);并发症发生率为20.8%。结论直接前侧微创入路THA创伤小,手术时间短,患者术后恢复快,有利于保留髋关节周围肌群正常张力,维持髋关节稳定。采用直接前侧微创入路THA,应熟练掌握手术技术,避免并发症的发生,以保证获得良好的手术效果。     

四物汤对高龄股骨转子间骨折围手术期隐性失血的影响

【目的】观察四物汤对高龄股骨转子间骨折患者围手术期隐性失血状况的影响,为临床应用中医药干预高龄股骨转子间骨折围手术期隐性失血提供参考。【方法】按患者术后是否口服中药四物汤,将36例高龄股骨转子间骨折手术患者分为治疗组20例和对照组16例。对照组给予常规西医治疗,包括抗感染、对症支持治疗和饮食指导等;治疗组在对照组常规西医治疗基础上,给予中药四物汤治疗。观察2组患者治疗前后血红蛋白（Hb）、红细胞比容（Hct）和隐性失血量的变化情况。【结果】治疗后,治疗组Hb含量较治疗前显著升高,隐性失血量较治疗前显著减少（P<0．05）;而对照组治疗前后Hb含量及隐性失血量均无显著改善（P>0．05）;治疗组对Hb含量及隐性失血量的改善作用均显著优于对照组（P<0．05）。【结论】四物汤能提高高龄股骨转子间骨折患者Hb和Hct水平,在一定程度上改善患者围手术期隐性失血状况。     

2种肝血流阻断法在肝癌切除术中的比较

目的比较2种肝血流阻断法在肝癌切除术中的作用及对术后恢复的影响。方法将46例行肝切除术的肝癌病例随机分为半肝血流阻断组(hemihepatic vascular control,HVC法,n=24)和第一肝门阻断组(Pringle's法,n=22),比较2组病例术中失血量、手术持续时间、术后并发症和术后肝功能恢复。结果2组病例术中失血量和手术持续时间差异均无显著性(P>0.05),HVC组术后3d和7d的血清谷丙转氨酶(alanine aminotransferase,ALT)明显低于Pringle's组(P<0.05),HVC组并发症发生率明显低于Pringle's组(P<0.05)。结论2种肝血流阻断法均能有效控制术中出血,半肝血流阻断法更安全,对肝功能恢复的不良影响更小。     

肝移植术中BALF成分和TNF-α、IL-1β、IL-8水平的变化及与术后急性肺损伤的关系

【目的】观察肝移植术(OLT)中肺泡灌洗液(BALF)的组分和TNF-α、IL-1β、IL-8水平的变化,并探讨它们与术后急性肺损伤(ALI)的关系。【方法】29例患者接受肝移植手术。于麻醉后(T1)及新肝期2h(T2)抽取BALF及动脉血,分析BALF内细胞成分,测定BALF总磷脂含量和总蛋白水平及血浆的蛋白质含量并计算肺通透性;检测BALF及血清TNF-α、IL-1β、IL-8水平,观察术后患者发生ALI的情况,并据此将患者分为ALI组(A组)与非ALI组(N组)。【结果】29例患者中9例(31%)术后发生ALI。A组T1时BALF内巨噬细胞比例低于N组(P<0.05),T2时BALF总蛋白、肺通透性高于N组(P<0.05)。与T1相比,A组BALF总蛋白、肺通透性及总磷脂在T2高于术前值(P<0.05)。A组T2血清及BALF中TNF-α水平和BALF内IL-1β的浓度均高于T1(P<0.05),并高于N组(P<0.05);IL-8浓度变化两组间无差异。T1的BALF内巨噬细胞比例(r=-0.427,P=0.032)、T2的肺通透性(r=0.414,P=0.038)、血清TNF-α(r=0.394,P=0.035)、BALF内TNF-α(r=0.349,P=0.044)、IL-1β(r=0.332,P=0.036)水平与术后ALI的发生有一定相关性。【结论】术中肺泡灌洗液成分和细胞因子水平分析显示新肝期2h会出现变化,ALI组患者更加显著,在肝移植术中麻醉管理应注意肺的保护和减轻炎症反应,可能有利于减少术后ALI的发生。     

手术创伤动员血管内皮祖细胞入血与移植瘤生长的关系

目的 研究手术创伤动员荷瘤裸鼠血管内皮祖细胞(EPC)入血与实体瘤生长的关系.方法 将42只荷瘤裸鼠随机分为非手术1 d组、单纯麻醉组、手术创伤组(术后24 h、48 h、72 h、30 d组)及非手术30 d组,每组6只.单纯麻醉组24 h后取血及获取移植瘤组织,手术创伤组分别在术后24 h、48 h、72 h、30 d取血及获取移植瘤组织.流式细胞仪检测各组外周血EPC百分比;ELISA检测血清血管内皮生长因子(VEGF)水平;免疫组织化学法检测移植瘤组织VEGF表达及微血管密度(MVD).结果 术后24 h、48 h、72 h组EPC百分比与非手术1 d组比较,差异均有统计学意义(P<0.05);术后24 h组、48 h组、72 h组、单纯麻醉组VEGF水平与非手术1 d组比较,差异有统计学意义(P<0.05);各组MVD差异无统计学意义(P>0.05).Pearson相关性分析显示,血清VEGF水平与外周血EPC百分比呈正相关(r=0.695 6,P<0.01),外周血EPC百分比与MVD无相关性(r=0.221 4,P>0.05),血清VEGF水平与MVD也无相关性(r=0.224 9,P>0.05).结论 手术创伤对移植瘤生长无明显促进作用.     

高龄患者开胸手术的危险因素及围术期处理

【目的】探讨老年患者开胸手术的危险因素和围术期处理。【方法】回顾性分析我院近6年在全麻下开胸手术的70岁以上老年人33例的临床经验。【结果】术后出现并发症12例(36.36%)、早期死亡2例(6.06%);衰老性合并症是围术期并发症及早期死亡的危险因素(P<0.05)。【结论】高龄并非开胸手术的禁忌证,严把手术适应症、经过积极的术前准备、合理的设计手术切除范围、适时使用电视胸腔镜、胸壁侧切口微创操作等综合治疗后,可使大部分患者安全度过围术期。     

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.     

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.