肺结核合并多脏器功能衰竭危险因素分析

目的 探讨肺结核并发多脏器功能衰竭(MOF)的原因。方法 回顾性总结2422例肺结核并发多脏器功能衰竭的发生率及病死率。结果 97例患者发生肺结核并发多脏器功能衰竭，发生MOF中90．72％为复治肺结核。以呼吸道感染为诱因者占100％，所有病例出现呼吸衰竭，95％出现心衰，肺性脑病占60％。结论 重症肺结核易导致多脏器功能衰竭，病死率随受损器官数目的增多而增高，呼吸道感染是肺结核并发MOF的诱因。     

重症肺结核并发多脏器功能衰竭危险因素分析

目的：探讨重症肺结核并发多脏器功能衰竭（MOF）的危险因素，方法：回顾性总结761例肺结核并发多脏器功能衰竭的发生率与病死率，并对重症肺结核发生多脏器功能衰竭（MOF）的原因进行单因素和多因素Logistic回归分析，结果：肺结核并发症MOF，病死率达53．8％，单因素分析显示患者年龄大，并发症多，长期缺氧，低蛋白血症等与重症肺结核并发脏器功能衰有关；多因素分析显示重症肺结核并发症器功能衰竭的危险因素是合并感染或其它疾病。结论：合并感染或其它疾病是结核并发多脏器功能衰竭的危险因素，而低氧血症，高龄和低蛋白血症也在肺结核并发多脏器功能衰竭的过程中起重要作用。     

流行性出血热合并脏器功能衰竭100例临床分析

对１００例流行性出血热合并脏器功能衰竭病人的临床资料进行分析，重型病人５８例，危重型病４２例；其中合并１个脏器衰竭者３１例，２个脏器衰竭者２例，３个脏器衰竭者１０例，４个脏器衰竭者３０例，５个脏器以上衰竭者２７例。结果表明，治愈６８例，病死３２例，病死率３２％；且多脏器（５个以上）衰竭者病死率明显增高（７７．７８％），与其他脏衰组比较有显著差异（Ｐ＜０．００１）。初始多脏衰的病死率为８２．３５％，亦明显高于其他初始脏衰组（Ｐ＜０．００１）。对流行性出血热合并脏器功能衰竭的治疗进行初步探讨。     

慢性肺心病急性发作期合并多脏器功能损害分析

对１４９例慢性肺原性心脏病并发多脏器功能损害患者的病因进行分析,合并肾功能损害９３例、肝功能损害５９例、应激性溃疡６１例、肺性脑病４４例。死亡６０例,病死率４０．２７％。病死率最高的是并发应激性溃疡（５７．３６％）。２个脏器受损病人７５例,死亡１６例（２１．３３％）;３个脏器受损者４５人,死亡２１人（４６．６７％）;４个脏器受损者２４人,死亡１９人（７９．１７％）;５个脏器受损者５人,死亡４人（８０％）。     

慢性肺心病急性发作期合并多脏器功能损害分析

对１４９例慢性肺原性心脏病并发多脏器功能损害患者的病因进行了分析,合并肾功能损害９３例、肝功能损害５９ 例、应激性溃疡６１例、肺性脑病４４例。死亡６０例,病死率４０．２７％。病死率最高的是并发应激性溃疡（５７．３６％）。２个脏 器受损病人 ７５例,死亡 １６例（２１．３３％）;３个脏器受损者 ４５人,死亡２１人（４６．６７％）;４个脏器受损者 ２４人,死亡 １９人 （７．１７％）;５个脏器受损者５人,死亡４人（８０％）。     

老年人慢性肺心病并多器官衰竭32例临床分析

通过对１０４例老年人慢性肺心病进行分析，其中并发多器官衰竭３２例（３０．８％），３２例中，死亡２０例，病死率为６２．５％，二个器官衰竭的病死率为１１．１％，三个器官衰竭的病死率为８７．５％，４个呈４个以上器官衰竭的病死率为１００．０％，提示对老年人慢性肺心病应注意的防治多器官衰竭，方可降低病死率。     

慢性肺心病并发多器官衰竭（附70例报告）

１９８６～１９９２年我院共收治急性发作期慢性肺心病１９６例，其中因严重肺部感染发生多器官衰竭（ＭＯＦ）者７０例（３５．７％），平均受损脏器２．５个，死亡２６例，总病死率为３７．１％。其中２和３个脏器受损者的病死率分别为２０．１％和４４．４％，而４和５个脏器受损者则均死亡。血气分析显示ｐＨ和ＰａＯ２值与受损脏器数目呈负相关，而ＰａＣＯ２值与受损脏器数目呈正相关。本文讨论了肺心病因肺部感染并发ＭＯＦ的发病机理，并提出防治的措施。     

肺心病合并上消化道大出血13例临床分析

通过对１３例肺心病并上消化道大出血病例分析表明：患者多是慢性肺心病呼吸衰竭病人，其病史长、年龄大、并发症多，且有多脏器功能损害、心肺功能衰竭，并发上消化道大出血是本病的危险因素之一，其发生率为２．６６％，病死率为６９．２３％，占同期肺心病死亡人数的１５．５％（９／５８），提出早期诊断和治疗是降低合并上消化道出血病死率的关键。     

慢性肺心病并多脏器功能损害41例综合分析

目的：为了提高慢性肺心病并多脏器功能损害的认识，综合分析肺心病并多脏器功能损害患者。结果１３５例肺心病并多脏器功能损害４１例（３０．４％）死亡２０例，病死率４８．８％，并发肾脏损害２２例，肺性脑病１３例，肝脏损害１０例，应激性溃疡６例。其中应激性溃疡所致上消化道出血６例全部死亡，肝脏受损１０例中死亡６例（６０％）肺性脑病１３例中死亡７例（５３．８％）肾脏受损发生率最高，死亡７例（３１．９％）除肺（     

高血压性脑出血合并多器官功能衰竭的护理（附154例死因分析）

分析１５４例高血压脑出血病人的死亡原因，结果提示：急性期患者直接死亡原因为海马回疝（５０％），小脑扁桃体疝（２９．２％），其次为肺感染（２６．６％），促进患者死亡的重要原因为多脏器功能衰竭（ＭＯＦ）（３１．８％）。早期对高血压脑出血病人进行各器官功能监护。减少ＭＯＦ的发生率是降低病死率的有效措施。     

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.     

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.     

Electro-Acupuncture Combined with the Trigger Point Needle-Embedding for Treatment of Primary Trigeminal Neuralgia in 31 Cases

In recent years, the author of this essay has applied electro-acupuncture combined with the trigger point needle-embedding for treatment of primary trigeminal neuralgia in 31 cases, yielding satis- factory results as reported in the following.     

Investigation of Matrix Metalloproteinase -1, 2 and tissue inhibitor of matrix metalloproteinases-1 in Endometriosis

Objective： To explore the role of matrix metalloproteinase-1,2 （MMP-1, MMP-2） and tissue inhibitor of matrix metalloproteinases-1 （TIMP-1） in endometriosis. Methods： The eutopic and ectopic endometria from 40 subjects suffering from endometriosis and regular.endometria from 40 subjects （excluding endometriosis） were collected and examined by in situ hybridization technology and western blot assay. Results： Both expressions of MMP-1 and -2 were stronger in ectopic endometrium and eutopic endometrium than in normal endometrium. On the contrary, the expression of TIMP-1 in ectopic endometrium and eutopic endometrium was lower. The differences were significant （P 〈 0.01 ）. Moreover, there was no relationship among the expressions of MMP-1, 2 and TIMP-1 in ectopic endometrium. Conclusion： The expressions of MMP-1, 2 and TIMP-1 lose balance and lack of periodic changes in ectopic endometrium , which explains the biological invasive behavior of endometriosis. It was suggested-that regulating the balance between the MMPs and TIMP-1 should be an ideal therapeutic target to endometriosis.     

Shi Da-zhuo (史大卓) —An outstanding cardiologist of integrative medicine

Prof. SHI Da-zhuo, Ph.D., male, was born on March 20, 1960. Prof. SHI entered the Ph.D. program in 1990 at the China Academy of Chinese Medical Sciences under the supervision of Prof. CHEN Ke-ji, majoring in the treatment of cardiovascular diseases. After receiving his Ph.D. degree in 1993, Prof. SHI started working at the Cardiovascular Center in Xiyuan Hospital affiliated to China Academy of Chinese Medical sciences.     

Persist in and Carry Forward the Integrative Medical Research——Speech at the 6th National General Congress of Chinese Association of Integrative Medicine by Academician CHEN Zhu,Minister of Ministry of Health

The 6th National General Congress of Chinese Association of Integrative Medicine （CALM） was convened at 19-20, April 2008 in Beijing. Academician CHEN Zhu, the minister of Ministry of Health indicated at the congress that the integration of Chinese and Western medicine is very well in keeping with the situation of our country and the general rule of development in medical science; and as a good integration of Chinese medicine and Western medicine, it is mutually beneficial and advantageous to both of them. Seeing the creativity shown in integrative medical investigation in theoretic and methodological sides, we should and must persist in and develop it.