低温等离子射频消融术治疗阻塞性睡眠呼吸暂停低通气综合征

目的探讨低温等离子射频消融术治疗阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的疗效。方法对73例OSAHS患者给予低温等离子射频消融术治疗,比较术前与术后6个月患者睡眠呼吸暂停低通气指数(AHI)、呼吸暂停总时间、鼾声指数、动脉血氧饱和度(SaO2)和Epwonh嗜睡程度评分。结果与治疗前比较,治疗后6个月患者AHI、呼吸暂停总时间、鼾声指数及Epwonh嗜睡程度评分明显减少(P<0.05),SaO2显著升高(P<0.05)。73例中显效43例(58.9%),有效25例(34.3%),无效5例(6.8%),总有效率为93.2%。结论低温等离子射频消融术治疗OSAHS效果好,副作用较少。     

低温等离子射频消融术治疗阻塞性睡眠呼吸暂停低通气综合征

目的:探讨低温等离子射频消融术治疗阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)的临床疗效。方法:选择77例轻、中、重度OSAHS的患者,根据阻塞部位的分型应用低温等离子射频消融术治疗。结果:术后6个月随访,手术后睡眠呼吸暂停低通气指数、最低血氧饱和度均较术前显著改善。26例轻度患者总有效率为100.00%,29例中度患者总有效率为96.55%,22例重度患者总有效率为95.45%,差异有统计学意义(P<0.01)。结论:低温等离子射频消融治疗OSAHS疗效确切,为轻中度OSAHS患者首选外科治疗方法,是重度OSAHS患者补充治疗的有效方法。     

腭咽成形术联合低温等离子射频消融术治疗OSAHS的临床疗效观察

目的:探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)行腭咽成形术联合低温等离子射频消融术的术后并发症及远期疗效.方法:采用腭咽成形术联合低温等离子射频消融术治疗主要以腭咽部平面阻塞为主的OSAHS患者36例.结果:36例患者术后打鼾症状及白天嗜睡明显减轻及消失,睡眠呼吸暂停次数明显减少,术后6个月行多导睡眠呼吸监测(SPG),其中治愈5例,显效21例,有效8例,无效2例.总有效率94.4%.结论:OSAHS目前治疗方法有多种,传统腭咽成形术术后并发症较多,腭咽成形术联合低温等离子射频消融术是一种切实有效,减少并发症的方法.     

等离子射频治疗阻塞性睡眠呼吸暂停低通气综合征疗效分析

目的:探讨等离子射频消融术治疗阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)的疗效。方法:采用等离子射频消融术治疗OSAHS患者38例,并回顾分析其临床资料及疗效。结果:手术时间为8~15 min,术中平均出血2~5 ml;术后6个月显效56%,有效41%,无效3%,总有效率97%;术后12个月显效53%,有效38%,无效9%,总有效率91%;术前与术后6个月、12个月的最长呼吸暂停时间、最长低通气时间、AHI、SaO2差异有统计学意义(P<0.05);术后6个月、12个月的最长呼吸暂停时间、最长低通气时间等差异无统计学意义。结论:等离子射频消融术由于操作简便、安全性高,是重度OSAHS患者补充治疗的主要有效方法。     

低温等离子射频消融治疗睡眠呼吸暂停低通气综合征

目的探讨低温等离子射频消融术治疗阻塞性呼吸暂停低通气综合征（OSAHS）的疗效及安全性。方法选择45例轻、中度OSAHS的患者,根据阻塞部位的不同应用低温等离子射频打孔刀进行治疗。结果术后6个月随访,45例患者中治愈6例,显效22例,有效12例,无效3例,失访2例,总有效率88.88%。结论应用低温等离子射频消融术治疗OSAHS安全可行,值得推广。     

持续气道正压通气治疗阻塞性睡眠呼吸暂停低通气综合征的疗效观察

目的:评价持续气道正压通气(CPAP)治疗阻塞性睡眠呼吸暂停低通气综合征(OSAHS)疗效。方法:经多导睡眠图(PSG)确诊,符合治疗条件的OSAHS患者,用CPAP治疗,对比治疗4周前后PSG结果,并观察临床症状变化。结果:30例OSAHS患者经CPAP治疗睡眠呼吸暂停低通气指数(AHI)由(37± 20)次／h降至(10±7)次／h,平均暂停时间由(20±7)s降至(13±10)s,最低血氧饱和度(SaO2),由(74± 12)％提高到(85±10)％,鼾声指数由(301±100)次／h降至(105±108)次／h,统计学上差异有非常显著性意义(P值均<0．01)。且日间困倦缓解,治疗客观有效率86．6％。结论:CPAP作为内科治疗OSAHS的一种手段,安全且效果肯定。     

热塑成型口腔矫治器治疗阻塞型睡眠呼吸暂停低通气综合征

目的:评价热塑成型口腔矫治器治疗阻塞型睡眠呼吸暂停低通气综合征(OSAHS)的效果。方法:4 5例经多导睡眠图(PSG)确诊的并符合治疗条件的OSAHS患者,用由加热变性的高分子塑料注塑成型的口腔矫治器治疗,对比治疗4周前后PSG结果,并询问主观症状变化。结果:矫治器治疗的客观有效率为82 .2 % ,呼吸暂停及低通气指数由(37.6±2 2 .3)次/ h降至(11.4±9.1)次/ h,平均暂停时间由(2 2 .1±8.2 ) s降至(15 .3±10 .5 ) s,最低血氧饱和度(Sa O2 )由(71.7±10 .6 ) %提高到(83.2±8.9) % ,鼾声指数由(30 4 .4±10 5 .2 )次/ h降至(10 8.3±112 .6 )次/ h,P<0 .0 1。白天困倦缓解。初用时上下颌肌肉有酸痛感,多数患者在3d～7d后适应。结论:热塑成型口腔矫治器可以作为内科的一个治疗手段提供给OSAHS患者,效果肯定,而且制作简便,患者痛苦小。     

等离子低温扁桃体消融术治疗阻塞性睡眠呼吸暂停综合征

目的：探讨等离子低温射频扁桃体消融术治疗阻塞性睡眠呼吸暂停低通气综合征的效果。方法：用等离子低温扁桃体消融术治疗阻塞性睡眠呼吸暂停低通气综合征(OSAHS)45例，于术前及术后12周行多导睡眠仪监测和Epworth嗜睡程度评分以确定治疗效果。结果：术后随访3-6个月，患者均取得了满意的疗效。与治疗前比较，最低血氧饱和度(LSPO2)显著提高(P＜0．05)；呼吸暂停低通气指数减低，差异有高度显著性(P＜0．01)。扁桃体缩小及鼾声评级降低程度与治疗前差异有高度显著性(P＜0．01)，Epworth嗜睡程度评分亦明显降低(P＜0．01)。结论：等离子低温扁桃体射频消融术具有较好的临床疗效，且方便、安全、微创，无不良反应，有较好的应用前景。     

射频治疗阻塞性睡眠呼吸暂停低通气综合征

阻塞性睡眠呼吸暂停低通气综合征(OSAHS)是一种可导致机体多系统并发症、严重危害患者身体健康的常见病.我科于2007 年7月～2008年12月采用低温等离子射频消融术治疗OSAHS28 例,取得较好疗效.现报告如下:     

下鼻甲低温射频消融术治疗阻塞性睡眠呼吸暂停低通气综合征36例

目的:探讨下鼻甲低温射频消融术治疗阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的临床效果。方法:对OSAHS存在下鼻甲肥大者进行下鼻甲低温射频消融术,治疗后3个月、10个月进行主观症状,下鼻甲形态大小变化、睡眠监测和气道压力滴定对照分析。结果:36例患者术前睡眠监测呼吸暂停低通气指数值41.3±12.7、最低血氧饱和度70.0±21.6%;术后3个月为18.5±8.4和87.4±13.1%;10个月为21.4±9.3和85.6±8.6%;经鼻气道压力滴定测定,术前17.1±4.2,术后3个月为8.6±3.6,术后10个月为9.8±4.2,较术前有显著差异(均P<0.05)。结论:下鼻甲低温射频消融术在OSAHS治疗中可改善症状,也可减小nCPAP治疗的压力,为进一步保守治疗创造条件,提高总的治疗效果。     

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.