试论人体器官移植中关于公平的伦理原则

人体器官移植这项高新医学技术，已成为挽救生命垂危病人的最有效的手段之一。至今，全球已累计超过50万人接受过各种人体器官移植，并且随着人体器官移植技术的日臻成熟，器官移植的成活率也大大提高。我国近年来器官移植的病人数量也大幅度增加。人体器官移植在医学上的成功毋庸置疑，然而所带来大量的社会伦理问题有待进一步探讨和解决。例如，器官移植是否尊重了供体者的权利；人体器官交易；特别是器官移植中的公平问题等一系列伦理问题，不能解决这些伦理问题，将可能造成严重的社会问题，从而阻碍人体器官移植这项事业健康顺利的发展…     

从一例亲属捐献活体器官的伦理讨论谈起

以一例年轻者向年长者亲属捐献肾移植的伦理审查个案为例,分析目前我国活体器官移植工作面临的一些问题,并探讨活体器官移植的风险与伦理审查模式。伦理审查要有一个完善的流程,不应该仅是对适应症等形式上的审查,而应将重点放在供者和患者双方的利弊权衡之上;亲属间的器官捐献也应严格遵循“无偿、非商品化”原则;医院在法律允许的范围内应充分考虑到患者和供者双方的利益,并结合预期手术效果等其他因素判断其是否应进行器官移植手术,而不应仅以患者和供者的风险概率作为依据。     

我国器官移植的现状与伦理学思考

探讨促进我国器官移植进一步加快发展的途径，通过对我国器官移植现状以及所面临问题的分析，阐述了人们的传统文化背景，思想观念及伦理道德观是影响我国器官移植发展的因素，提出改变观念、实行科学的脑死亡法，为器官移植立法是我国器官移植腾飞的根本途径。     

器官移植的社会伦理问题探讨

目的：探讨分析器官移植临床应用所引发和面临的的伦理学问题,寻求合理有效的解决方案。方法：从器官移植基本伦理原则、价值利益、法律、道德等角度,对非亲属间器官移植、亲属间器官移植、异种器官移植、特殊器官移植等方面所涉及的社会伦理学问题进行分析、对比、探讨伦理学方面的合理性和可行性。结果：倡导在器官移植领域保留和开展那些符合伦理道德、合理、合法的临床器官移植应用,摒弃不合伦理情理法理的做法,并为器官移植科研和临床应用提供一定的伦理学依据。结论：器官移植临床应用面临的伦理学问题内容广泛而复杂,临床应用一定要通过仔细全面的伦理学论证确保该移植项目在社会伦理、道德法律等方面均安全合理可行方可进行临床器官移植。     

器官移植的社会伦理问题探讨

目的探讨分析器官移植临床应用所引发和面临的的伦理学问题,寻求合理有效的解决方案.方法从器官移植基本伦理原则、价值利益、法律、道德等角度,对非亲属间器官移植、亲属间器官移植、异种器官移植、特殊器官移植等方面所涉及的社会伦理学问题进行分析、对比、探讨伦理学方面的合理性和可行性.结果倡导在器官移植领域保留和开展那些符合伦理道德、合理、合法的临床器官移植应用,摒弃不合伦理情理法理的做法,并为器官移植科研和临床应用提供一定的伦理学依据.结论器官移植临床应用面临的伦理学问题内容广泛而复杂,临床应用一定要通过仔细全面的伦理学论证确保该移植项目在社会伦理、道德法律等方面均安全合理可行方可进行临床器官移植.     

由全国首例维、汉活体肾移植谈器官移植伦理委员会工作及其困惑

结合器官移植伦理委员会对一个特殊器官移植案例的审查，试从伦理委员会的审查范围，尤其是伦理委员会的职能等有关方面，对我国器官移植伦理委员会工作中的问题和困惑进行了探讨。     

异种器官移植的发展与医学伦理学思考

异种器官移植的基础研究和技术发展已经成为当前器官移植学的新领域.本文分析了异种器官移植的现状与面临的问题,探讨了异种器官移植研究人员和临床医师面临的医学伦理问题,进一步提出了在异种器官移植过程中应该恪守的一系列伦理原则:贯彻知情同意原则;坚持人道主义和功利主义相结合的原则;确立技术和卫生标准,严格遵守医学标准,审慎地选择受体的原则;遵循对受体健康利益关心和忠诚的原则;无伤害原则和有利于人类的原则.此外,还探讨了建立健全异种器官移植的法律法规的重要性.     

器官移植面临的伦理问题及对策

器官移植引发的伦理道理问题,直接影响了该技术的应用和发展,供体严重匮乏是制约我国器官移植工作的重要因素.本文从伦理学角度,探讨了器官移植面临的伦理道德问题,提出应尽快为脑死亡立法,树立新的伦理观念,明确禁止器官商业化.另外强调,知情同意是供体器官摘取的首要伦理原则,医学原则和社会标准是受体选择的依据.     

脑机接口技术的伦理风险及应对措施

在伦理学领域,关于脑机接口技术的问题主要聚焦于身心伦理和社会伦理,包括个人隐私权、人是不是完整意义上的人、社会责任归属等,涉及的人群包括患者、医生以及患者生活的整个社会群体。除剖析了身心伦理风险、社会伦理风险外,还根据目前脑机接口的研究现状分析了未来其大规模应用后可能存在的伦理问题,主要包括身心伦理风险的知情同意权、隐私权、决定权,社会伦理风险的责任归属以及公平性问题,未来伦理风险中脑是机器的载体还是机器是脑的延续问题,并从个体、制度和机构三个层面提出了解决措施,以期对脑机接口今后发展提出治理建议。此外,通过社会调研采集并汇总相关意见,获得本土化数据。在此基础上首次引入脑机接口的未来风险,并从伦理学视角出发,以期探索未来问题的解决方案。     

中国器官捐献的发展历程与展望

器官移植是上个世纪下半叶由欧美国家引进入我国以来，已成为一种成熟的临床技术，它挽救了大量晚期器官功能衰竭病人的生命。然而器官的捐献与分配涉及诸如文化、传统、伦理、法制等深层次的社会问题。建立一个伦理的公民器官捐献体系是几代中国器官移植医生的梦想，这个梦想正在我们这一代人中得以实现，我们正在开始一个阳光下的新征程，我国移植医务人员将光明正大地登上世界移植医学的舞台，使我国移植事业能在几年内以不可争辩的伦理方式成为世界移植大国。     

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…     

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.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Dr.Zhang Ren's Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

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.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.