二次剖宫产切口缝合方法的探讨

目的：探索适合二次剖宫产切口的缝合方法。方法：将120例第2次行剖宫产的孕妇分为两组：对照组40例采用马彦彦新式剖宫产术,不缝合脏壁层腹膜。观察组80例采用改良新式剖宫产术,连续缝合子宫膀胱反折腹膜及腹膜,其中40例不缝合皮下脂肪层,10例缝合皮下脂肪层3-5针,30例间断一起缝合皮下脂肪层。结果：两组术后腹腔粘连以及愈合情况的比较差异有统计意义（ P〈0.05）。结论：改良新式剖宫产缝合腹膜恢复解剖层次,可以相应地减少腹腔粘连防止脏器损伤;而在缝合皮下脂肪层的方法中,不缝合皮下脂肪层的方法可以更好地减少皮下脂肪层缝合后的局部组织缺血坏死及残留缝线的异物反应,皮下不易出现硬结,且产妇血液处于高凝状态,切口不容易出血,有利于切口愈合。     

腹部横切口剖宫产术不缝合皮下脂肪组织的临床效果研究

目的分析腹部横切口剖宫产术不缝合皮下脂肪组织的临床效果。方法选取我院腹部横切口剖宫产术产妇100例,随机分观察组和对照组各50例。观察组关闭腹膜缝合腹直肌前鞘后,不缝合皮下脂肪层;对照组常规缝合腹膜、腹直肌前鞘、皮下脂肪层,分析2组手术情况。结果观察组切口愈合率高于对照组,手术时间、术中出血量、疼痛程度及住院时间均少于对照组（P〈0．05）,并发症发生率少于对照组（P〈0．01）。结论腹部横切口剖宫产术不缝合皮下脂肪组织效果显著,术后切口疼痛较轻,无硬结,无脂肪液化发生,具有较高的应用价值。     

腹部切口不同缝合方式对妊娠期糖尿病剖宫产产妇术后切口疼痛及愈合的影响

目的 研究腹部切口不同缝合方式对妊娠期糖尿病剖宫产产妇术后切口疼痛及愈合的影响.方法 按照随机数字表法将2018年9月至2020年1月本院收治的95例妊娠期糖尿病患者分为对照组(n=48)和观察组(n=47).对照组给予皮外缝合术,观察组给予皮内缝合术,比较两组缝合及住院时间、切口愈合情况、术后不同时间点的疼痛程度[视觉模拟评分量表(VAS)].结果 观察组甲级愈合(57.45％)高于对照组(43.75％),差异有统计学意义(P<0.05);两组缝合时间比较差异无统计学意义;观察组住院时间短于对照组,差异有统计学意义(P<0.05);术后6 h,两组VAS评分比较差异无统计学意义,术后12、24及48 h,两组VAS评分均低于术后6 h,且观察组低于对照组,差异有统计学意义(P<0.05).结论 妊娠期糖尿病剖宫产产妇的腹部切口经皮内缝合术缝合后,可缓解术后切口疼痛感,更利于术后切口愈合,缩短住院时间.     

剖宫产腹部纵切口不同缝合方式的临床分析

目的：评价剖腹产腹部纵切口不同缝合方式的临床疗效。方法选取2013年1-12月该院剖宫产手术的产妇210例,随机选取120例进行改良式缝合法作为观察组,对照组90例,采取传统缝合法进行缝合,观察并比较两组患者术后切口愈合情况。结果观察组产妇切口甲级愈合115(95.8%)例,乙级愈合5(4.2%)例,对照组甲级愈合80(83.3%)例,乙级愈合10(16.7%)例,两组患者切口愈合情况比较差异有统计学意义(P<0.05)。结论改良式缝合法用于剖宫产腹部纵切口的临床效果好,能减少对于产妇切口的异物刺激,提高了腹部切口的甲级俞合率,值得在临床上予以推广。     

不缝合腹膜式剖宫产术的临床观察

近年来剖宫产术式不断有改进 ,不缝合腹膜剖宫产术式就是其中之一。我院于 2 0 0 0年 1～ 11月对 80例产妇行不缝合腹膜式剖宫产术 ,作者就该术式的安全性及并发症作了临床观察。现报告如下。1　资料与方法1.1　临床资料　将同期在我院剖宫产分娩的 16 0名产妇随机分成观察组与对照组各 80例 ,胎膜早破大于 2 4小时者不列入本研究中。观察组孕周36 + 5 ～ 42 + 3(平均 38+ 6 )周 ,年龄 2 1～37(平均 2 5 .8)岁 ,其中 ,头位无合并症2 9例 ,臀位 8例 ,横位 1例 ,孕高征 2 0例 (包括子痫 2例 ) ,有剖宫产史 6例 ,胎盘早剥 1例 ,前置胎盘 4例 ,…     

剖宫产腹壁切口新式缝合法80例临床观察

目的观察采取剖宫产手术分娩的产妇行腹壁切口新式缝合方法的临床应用效果。方法观察组80例剖宫产分娩产妇采用腹壁切口新式缝合方法;对照组80例剖宫产分娩产妇采用传统的腹壁缝合方法。结果观察组切口缝合时间为（9．5±2．6）min;切口周围皮肤红肿反应者2例,占2．5％;切口甲级愈合79例,占98．8％;而对照组中切口缝合时间为（16．4±3．2）min;切口周围皮肤红肿反应者68例,占85％;切口甲级愈合72例,占90％。两组腹壁切口缝合方法在切口缝合时间、切口周围皮肤红肿反应、甲级愈合率方面有显著差异（P〈0．05）。结论剖宫产腹壁切口新式缝合法能显著缩短手术时间,避免切口周围红肿反应,提高切口甲级愈合率,此方法安全、有效、简便,已在临床广泛应用。     

改良式腹膜外剖宫产术临床分析

目的 :评价改良式腹膜外剖宫产术的优点。方法 :选择有剖宫产指征的孕妇 1 6 5例 ,随机分为两组 ,1 0 6例作改良式腹膜外剖宫产术 (腹膜外组 ) ,5 9例作腹膜内剖宫产术 (腹膜内组 ) ,然后观察及比较两组产妇术中 (从手术开始到胎儿娩出所用的手术时间、总手术时间、术中出血量 )和术后(胃肠功能恢复、伤口疼痛及愈合等 )情况。结果 :腹膜外组从不间断切皮至胎儿娩出时间及总手术时间与腹膜内组比较 ,差异无显著性 (P均 >0 .0 5 ) ,而两组术中出血量相比较则差异有显著性 (P <0 .0 1 ) ;腹膜外组术后病率 (发热、伤口疼痛及腹胀等 )明显少于腹膜内组 ,两组比较差异均有显著性 (P均<0 .0 1 )。结论 :改良式腹膜外剖宫产术具有切口美观、可防止腹腔粘连、感染 ,术后恢复快等优点 ,值得推广应用。     

腹式横切口剖宫产改良皮肤缝法及术后免腹带150例临床分析

目的　探讨腹式横切口剖宫产改良皮肤缝法及术后免腹带对产妇伤口的影响。方法　 2 0 0 1年 10月～ 2 0 0 3年 6月收治剖宫产产妇分为 4组 ,观察组 :剖宫产不缝脂肪层 ,皮肤皮内缝合 (需拆线 )术后免用腹带 15 0例 ;对照组Ⅰ :缝合脂肪层 ,皮肤皮内缝合 (不拆线 )术后加用腹带 15 0例 ;对照组Ⅱ :皮肤、脂肪丝线缝合 ,术后免用腹带 15 0例 ;对照组Ⅲ :皮肤、脂肪丝线缝合 ,术后加用腹带 15 0例。结果　观察组手术时间明显少于对照组Ⅰ(P <0 0 5 ) ,伤口愈合不良明显低于其他各组 (P <0 0 1) ;对照组Ⅱ伤口愈合不良亦低于其他两个对照组 (P <0 0 1) ;观察组和对照组Ⅱ术后肛门排气时间无明显差异 ,但与对照组Ⅰ和Ⅱ有显著性差异 (P <0 0 1) ,观察组和对照组Ⅰ较其他两组术后伤口疤痕小、美观。结论　剖宫产不缝脂肪层 ,皮肤皮内缝合 (需拆线 )术后免用腹带 ,具有简便、快捷、利于产妇伤口愈合、术后恢复快等优点。     

碱性成纤维细胞生长因子与剖宫产术切口裂开的愈合

目的 :观察重组碱性成纤维细胞生长因子 (bFGF)应用于剖宫产术切口裂开后愈合的效果。方法 :对 60例剖宫产术切口裂开病例随机分为观察组 3 0例 ,其中裂开 5cm以上 12例 ,5cm以下 18例 ,均行清创后用bFGF喷于创面后用宽胶布将裂口拉紧固定 ,隔天封闭固定换药并予以频谱仪理疗促进愈合。对照组 3 0例 ,其中裂开 5cm以上 12例行二期缝合术 ,5cm以下 18例行清创后用宽胶布将裂口拉紧固定 ,隔天封闭固定换药并予以频谱仪理疗促进愈合。结果 :裂口5cm以上者观察组平均愈合天数为 ( 7 6± 1 0 )天 ,对照组为 ( 7 4± 0 8)天 ,均达近似一期愈合。裂口 5cm以下者观察组平均愈合天数为 ( 6 8± 1 5 )天 ,对照组为 ( 11 2± 1 2 )天 ,均达近似一期愈合。结论 :bFGF有明显促进伤口愈合作用 ,且简单易行 ,经济实效。     

胶片引流辅助红光照射预防剖宫产术后切口脂肪液化

目的探讨切口乳胶片引流辅助术后红光照射对预防剖宫产术后切口脂肪液化的疗效。方法对株洲市第四医院妇产科2011-06～2012-01的85例有潜在脂肪液化风险的剖宫产产妇的临床资料进行回顾性对比分析。结果观察组产妇无一例出现切口脂肪液化,切口均甲级愈合;对照组产妇有6例出现切口脂肪液化。观察组与对照组的切口愈合时间分别为(6.24±2.08)d和(10.8±2.45)d,住院时间分别为(6.8±2.24)d和(13.6±3.87)d。差异均有统计学意义(P<0.05)。结论对于有潜在脂肪液化高风险的剖宫产产妇切口放置乳胶片引流条及术后辅助红光照射可预防切口脂肪液化。     

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.