彻底清创术对手外伤感染愈合的影响

目的 探讨彻底清创术对手外伤感染及愈合的影响。方法对87例手外伤病人在彻底清创前、后做细菌培养,总结细菌培养的阳性率、阴性率及伤121愈合率。结果清创术前细菌培养的阳性率、阴性率分别为95．4％、4．6％,术后分别为8．0％和92．0％。伤口Ⅰ期愈合率97．7％（85例）,Ⅱ期愈合率2．3％（2例）。经卡方检验,x^2=132．9,P〈0．01,有明显统计学差异。结论彻底清创术是降低手外伤术后感染的有效手段。     

急诊外伤缝合826例分析

目的：总结急诊外伤缝合的注意事项，为临床工作提供参考。方法：回顾性分析我院自1997．01．01～2007．12．31以来急诊科收治的826例外伤患者伤口缝合的预后情况。结果：所处理伤口89．0％甲级愈合，8．8％乙级愈合，2．2％丙级愈合。异物残留2例，占0．2％。结论：所有急诊外伤的伤口均应认真对待，严格施行清创术，一般都能甲级愈合。     

甲硝唑冲洗液在急性化脓性腹膜炎术中冲洗的疗效分析

目的 观察甲硝唑冲洗液在急性化脓性腹膜炎术中冲洗的疗效。方法 选择外科住院的急性化脓性腹膜炎患者116例，随机分为甲硝唑组和对照组，每组均为58例。分别用自制的甲硝唑冲洗液（生理盐水500ml＋0．2％甲硝唑溶液500ml＋庆大霉素24万单位）和生理盐水冲洗腹腔和手术切口。观察术后切口甲级愈合率、腹膜炎感染控制率。结果 甲硝唑组和对照组切口甲级愈合率（分别为100％、69％）、7天内腹膜炎感染控制率（分别为97％、79％）均有显著性差异（P〈0．01），说明两种治疗方法的疗效有显著性差别。结论 甲硝唑冲洗液在急性化脓性腹膜炎患者术中有显著的疗效，在临床上有应用推广价值。     

钛网与自体碎骨一期修补开放性颅骨粉碎性骨折30例的疗效观察

目的比较钛网与自体碎骨一期修补开放性颅骨粉碎性骨折的疗效。方法将60例开放性颅骨粉碎性骨折患者按随机数字表法分为两组,治疗组30例清创后对复位后不稳的骨片以钛网作支架进行一期固定修复,对照组30例采用自体颅骨碎骨片丝线打孔固定、医用胶粘合成形的方法一期修复修补颅骨缺损。对两组手术效果、术后皮下积液发生率、半年后切口感染率及术后平均切口愈合时间进行比较。结果治疗组伤口甲级愈合80．0％、乙级愈合16．7％、丙级3．3％,对照组分别为43．3％、46．7％、10．0％,治疗组伤口愈合效果优于对照组（P＜0．05）。治疗组术后皮下积液发生率10．0％,低于对照组的40．0％（P＜0．05）。治疗组切口愈合时间（6．7±0．8）d,短于对照组的（11．3±0．6）d（P＜0．05）。结论钛网作支架一期固定修复开放性颅骨粉碎性骨折效果优于一期自体颅骨成型方法。     

分层缝合与全层缝合对急诊面部软组织外伤患者疗效对比

目的对比分层缝合与全层缝合对急诊面部软组织外伤患者的临床疗效。方法选取51例急诊面部软组织外伤患者随机分成甲组（n=26）和乙（n=25）。所有患者都按常规进行清创和伤口修整，甲组实行分层缝合，乙组实行全层缝合。对比2组伤口I期愈合率以及感染、瘢痕、硬结的发生率。结果甲组伤口I期愈合率及感染、瘢痕、硬结发生率依次为96.15％、0、0、0，乙组依次为72％、16％、20％、28％，2组之间具有差异（p〈0．05）。结论对急诊面部软组织外伤患者而言，分层缝合更具微创性，比全层缝合更很效果更好。     

外科门诊56例外伤缝合的治疗体会

目的观察外科门诊外伤缝合的疗效,总结经验,为临床治疗提供参考。方法回顾性分析笔者所在医院外科门诊治疗的56例外伤患者的病例资料,均采用外伤缝合进行治疗,观察所有患者的预后。结果 56例外伤患者均一期愈合,无一例行二次手术。甲级愈合51例(91.1%),乙级愈合5例(8.9%),丙级愈合0例。5例乙级愈合患者外伤缝合后出现红肿等炎性反应,经加强换药及口服消炎药治疗后愈合。结论处理外伤时应格外注意对伤口的清洗消毒、对伤口彻底的清创、术中探查异物和术后伤口换药等,避免外伤缝合术后切口感染、愈合不良。     

63例耳廓外伤的诊治体会

本文总结63例耳廓外伤治疗体会、耳部外伤须及时彻底清创,保留残体组织,减轻缺损后疤痕畸形,综合治疗促进伤口愈合;在绿脓杆菌感染的情况下,及早使用庆大霉素溶液(庆大霉素24万U+生理盐水50ml)或局部注射妥布霉素,从而提高治愈率.     

180例口腔颌面部清创缝合术的体会

目的：探讨口腔颌面部清创缝合术的操作方法与技巧。方法：对近几年来诊治的180例口腔颌面部外伤患者施行清创缝合手术的病历资料进行回顾性分析,总结治疗经验。结果：180例患者中,162例伤口甲级愈合．占90％;13例乙级愈合,87．2％;5例伤口感染,占2．8％。结论：清创缝合术的操作方法与技巧对促进伤口愈合、减少伤口感染起着至关重要的作用。     

产后应用生理盐水与0．03％碘伏溶液冲洗会阴伤口的效果比较

目的探讨应用何种冲洗液更有利于会阴伤口的愈合及减少并发症。方法将在本院产科住院经阴道分娩的产妇300例,随机分为实验组155例与对照组145例。实验组：先用生理盐水彻底冲洗阴道壁及会阴伤口,然后行缝合术,产后5d继续用生理盐水冲洗外阴,2次／d;对照组：先用0．03％碘伏溶液彻底冲洗阴道壁及会阴伤口,然后行缝合术,产后5d继续用0．03％碘伏溶液冲洗外阴,2次／d。分别评估、比较术时术后5d内,产妇在伤口疼痛程度、感染率及愈合情况的差异。结果两组产妇伤口疼痛程度、感染率及愈合情况的差异均具有统计学意义（P〈0．01）,实验组明显优于对照组。结论应用生理盐水代替0．03％碘伏溶液冲洗会阴伤口可减轻产妇痛苦及经济负担,提高社会对助产士及医院的认可度,从而提高医院的经济效益及社会效应。     

两种不同护理方法对会阴侧切伤口愈合情况的影响

目的探讨湿性换药和红外线理疗对会阴侧切口愈合的临床应用效果及价值。方法 120例无合并症的会阴侧切产妇随机分为2组,实验组68例,对照组52例。实验组用生理盐水清洗伤口,1%碘伏棉球消毒会阴切口及周围,并以0.5%甲硝唑液纱布湿敷伤口,并用红外线理疗仪照射30min～1h,照射结束后会阴伤口敷消毒凡士林纱布,1日2次;对照组仅用生理盐水清洗伤口后用1%碘伏棉球消毒会阴切口。比较2组侧切口愈合情况。结果实验组甲级愈合60例（88.2%）,乙级愈合8例（8.8%）;对照组甲级愈合26例（50.0%）,乙级愈合12例（23.1%）,丙级愈合14例（26.9%）。2组愈合情况比较差异有统计学意义（P〈0.01）。实验组产妇切口疼痛分级评分明显优于对照组（P〈0.01）。结论勤清洁伤口、湿性换药、红外线理疗和保持伤口湿润密闭能够减轻会阴侧切伤口疼痛,促进愈合,且使用简便。     

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.