不同途径中和肝素对先天性心脏病合并肺动脉高压术后肺循环的影响

目的探讨不同途径输注鱼精蛋白对非紫绀型先天性心脏病合并肺动脉高压患者体外循环术后肺循环的影响。方法选择手术治疗非紫绀型先天性心脏病患者80例,根据不同给药途径(主动脉、中心静脉)及有无肺动脉高压分为4组,每组20例:A1组(无肺动脉高压、主动脉给药)、A2组(无肺动脉高压、中心静脉给药)、B1组(肺动脉高压、主动脉给药)、B2组(肺动脉高压、中心静脉给药)。记录术前(T0)、输注鱼精蛋白之前(T1)、输注后1min(T2)、3min(T3)、5min(T4)、10min(T5)、15min(T6)、25min(T7)各时间点肺动脉压(PAP)、肺静脉压(PVP)、中心静脉压(CVP)、气道峰压(Ppeak)、平均气道压(Pmean)等参数,并采静脉血测血清中各时间点血栓素B2(TXB2)的水平。结果输注鱼精蛋白后,经中心静脉给药A2组及B2组PAP、PVP、CVP、Ppeak、Pmean均高于经主动脉给药的A1组及B1组(P<0.05);给药后(T2~T7)4组患者血中TXB2浓度较术前(T0)均明显升高(P<0.05),经中心静脉给药的A2组及B2组较主动脉给药的A1组及B1组升高更为显著(P<0.01)。结论心脏直视术后输注鱼精蛋白经主动脉给药较中心静脉给药可明显减少TXB2的释放,可避免鱼精蛋白直接进入肺循环刺激肺血管和气管平滑肌产生强烈痉挛,对体外循环术后患者的肺循环影响较小,特别是合并有肺动脉高压的患者。     

鱼精蛋白在心肌再灌注期的低血压效应

目的　探讨鱼精蛋白在体外循环心内直视术中再灌注期的低血压效应及其机制。方法　连续选取先天性心脏病患儿 2 3名 ,分别于体外循环直视手术中 ,鱼精蛋白给予前 1min ,给予后 5min ,30min ,测定右心房血NO的含量。同时监测平均动脉压 (MAP)的变化。结果　有 7名患儿发生低血压反应 (MAP≥ 10mmHg) ,伴随NO2 -/NO3 -含量较给药前明显增高(P <0 .0 5 ) ,与正常组相比差异有显著性 (P <0 .0 1)。结论　鱼精蛋白参与心肌再灌注期低血压反应的发生 ,其机制可能与短暂性NO的大量产生有关。     

星状神经节阻滞伍配地塞米松治疗过敏性鼻炎临床观察

目的　探讨星状神经节阻滞 (SGB)伍配地塞米松治疗过敏性鼻炎的临床效果以及对穿刺部位疼痛发生状况的影响。方法　将 12 0例过敏性鼻炎经SGB治疗时伍配地塞米松 ,按地塞米松不同途径给药分组 ,即 :注射伍用 (A组 ,n=60 )、口服配伍 (B组 ,n =60 ) ,设 60例不伍用药 (C组 )为对照组 ,观察各组临床疗效及穿刺部位疼痛状况。结果　A组和B组的总有效率明显高于C组 (P均 <0 .0 5 ) ,但A组与B组比较差异无显著性 (P >0 .0 5 )。A组穿刺部位疼痛发生率及疼痛程度在 1、2周、2 0d后明显低于B组、C组 (P <0 .0 5或 0 .0 1) ,而B组与C组差异无显著性 (P >0 .0 5 )。结论　SGB治疗过敏性鼻炎伍配地塞米松疗效满意 ,可有效地减少穿刺部位疼痛的发生。     

巴曲亭对体外循环心内直视术凝血功能的影响

目的:观察体外循环心内直视术时应用巴曲亭对凝血全酶时间 (ACT)、凝血酶原时间 (PT)、纤维蛋白原 (FIB)、部分凝血活酶时间 (APTT)、凝血酶时间 (TT)及血小板 (PL T)等凝血指标的影响。 方法 :择期体外循环心内直视术患者 5 2例 ,随机分为两组 :巴曲亭组 2 7例 ,对照组 2 5例。麻醉方法为全麻。巴曲亭组停体外循环后给巴曲亭 ,给药后 15 m in给予鱼精蛋白中和肝素 (1∶ 1) ,10 min后测 ACT;对照组停体外循环后即给予鱼精蛋白中和肝素 (1∶ 1) ,10 m in后测 ACT。于术前 1d、术后 1h检测 PT、FIB、PL T、APTT、TT等凝血指标 ,记录术后第 1天出血量。 结果:两组患者给予巴曲亭前后 PL T、PT、TT及 FIB差异均无统计学意义 ,术后 1h两组 TT差异有统计学意义 (P <0 .0 5 ) ,两组 APTT在术前和术后 1h差异均无统计学意义 ,但组内手术前后差异均有统计学意义 (P <0 .0 1)。肝素化前两组 ACT差异无统计学意义 (P >0 .0 5 ) ,但按相同的比例鱼精蛋白中和后两组的 ACT相比 ,巴曲亭组明显短于对照组 (P <0 .0 1)。术后第 1天巴曲亭组出血量与对照组相比差异有统计学意义 (0 .0 1

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硝苯地平治疗红霉素静脉滴注导致腹痛的效果观察

目的　评价比较硝苯地平与山莨菪碱治疗红霉素所致腹痛的临床效果。方法　将 60例病人随机分为硝苯地平组 (A组 )及山莨菪碱组 (B组 ) ,每组各 3 0例。A组按每次 0 .5mg/kg舌下含服或口服 ,最大量不超过 10mg ;B组按每次 0 .3～ 0 .5mg/kg肌注 ,最大量不超过 10mg ,均在患者静脉滴注红霉素出现腹痛 10～ 2 0min内给药 ,分别观察两组10min、2 0min、3 0min腹痛缓解时间及治疗总有效率情况。结果　A组腹痛缓解时间为 12 .79± 3 .14min ,B组为 15 .16±3 .10min ,差异有显著性 (P <0 .0 5 ) ;A组治疗总有效率 (93 .3 3 % )显著高于B组 (73 .3 3 % ) ,P <0 .0 1;副作用发生率也明显减少 (χ2 =15 .0 17,P <0 .0 1)。结论　红霉素静脉滴注所导致的腹痛治疗中两药对比以A组为佳。     

丙泊酚辅助硬膜外麻醉下妇科腹腔镜检查的临床观察

目的　观察妇科腹腔镜检查术中丙泊酚辅助硬膜外阻滞的效果。方法　 4 0例妇科腹腔镜检查患者随机分成两组 ,每组 2 0例。麻醉完善后 ,A组先静注丙泊酚 1mg/kg ,继之以 3mg·kg-1·h-1微泵维持 ;B组静注杜冷丁 5 0mg ,氟派啶 2 .5mg。结果　两组在给药后 5minSBP、DBP、HR较麻醉前明显降低 (P <0 .0 5 ) ,在CO2 气腹后 10minSBP、DBP、HR均升高 ,B组升高较A组更显著 (P <0 .0 5 ) ;两组在给药后 5min和充气后 10min ,镇静评分较麻醉前均增加 (P <0 .0 5 ) ,A组较B组的镇静评分增加更显著 (P <0 .0 5 ) ,放气后 10min两组的镇静评分有差异 (P <0 .0 5 )。结论　丙泊酚辅助硬膜外妇科腹腔镜检查效果较杜氟合剂好     

利多卡因预处理对鱼精蛋白诱发肺血管不良反应的临床观察

目的观察利多卡因预处理对鱼精蛋白诱发肺血管不良反应的影响。方法择期体外循环下行先心病矫治术患儿51例。随机分为2组:利多卡因组(L组,n=27)和对照组(C组,n=24),L组患者于鱼精蛋白中和前1min,经肺动脉压测压管内直接静脉输注利多卡因2 mg/kg,C组给予0.9%生理盐水2 mg/kg;两组患者中和时于右颈内静脉内泵注鱼精蛋白4 mg/kg,泵注时间为5 min。观察两组患者给鱼精蛋白前1 min(T0)及给鱼精蛋白期间1、3、5、10、20 min(T1-T5)的肺动脉收缩压(PAP)、气道峰压(Paw)、心率(HR)、平均动脉压(MAP)的变化;观察两组患儿鱼精蛋白不良反应的发生率。结果与T0时刻相比,两组患儿均于T2、T3时刻PAP、Paw、MAP升高(P0.05);与C组比较,L组各时间点MAP、HR、PAP、Paw变化差异无统计学意义(P 0.05);L组无患者发生不良反应,C组有4例患者发生不良反应,伴有PAP、Paw明显上升,MAP、HR明显下降,其发生率为16.67%,两组患者鱼精蛋白反应发生率差异比较有统计学意义(χ~2=4.883,P=0.027)。结论利多卡因预处理可能减轻鱼精蛋白中和时诱发的肺血管不良反应。     

牛磺酸对哮喘豚鼠气道重塑治疗效果的初步观察

目的 :探讨牛磺酸对哮喘豚鼠气道壁厚度和转化生长因子 β1的影响。方法 :采用卵蛋白腹腔注射法复制哮喘豚鼠模型 ,分别给予生理盐水和牛磺酸治疗 ,比较治疗后小气道 (直径 <2 0 0 μm)壁厚度 (% )和气道壁中TGF - β1的含量。结果 :牛磺酸治疗组 (B组 )小气道壁厚度与哮喘组 (A组 )无显著差异 (P >0 .0 5 ) ;气道壁TGF - β1含量 (灰度值 )B组与A组差异非常显著 (P <0 .0 1)。结论 :牛磺酸能有效抑制气道壁中TGF - β1蛋白的表达 ,对气道重塑的治疗效果还需进一步观察。     

不同剂量艾司洛尔对气管拔管时心血管反应的预防作用

目的 :观察不同剂量艾司洛尔对气管拔管时心血管反应的预防作用。方法 :将 1 75例择期手术病人随机分为A(对照组 ) ,B(0 .5mg/kg组 ) ,C(1 .0mg/kg组 ) ,D(1 .5mg/kg组 )和E(2 .0mg/kg组 )五组 ,拔管前分别静注生理盐水 1 0ml,艾司洛尔 0 .5mg/kg ,1 .0mg/kg ,1 .5mg/kg ,2 .0mg/kg。记录病人给药前、拔管时、拔管后 1 ,3,5 ,1 0min时收缩压 (SBP)、舒张压 (DBP)、心率 (HR) ,并算出相应的脉率收缩压乘积 (RPP)。结果 :A组拔管时SBP ,DBP ,HR ,RPP及拔管后 1minDBP ,HR ,RPP显著高于给药前 (P <0 .0 1 ) ;B组拔管时DBP ,HR ,RPP显著高于给药前(P <0 .0 1 ) ,拔管时及拔管后 1minSBP ,HR ,RPP显著低于A组 (P <0 .0 1 ) ;C ,D ,E三组拔管时SBP ,DBP ,HR ,RPP显著低于A ,B两组 (P <0 .0 5 ) ,拔管后 1minSBP ,HR ,RPP显著低于A组 (P <0 .0 1 ) ;拔管后 3minC ,D两组SBP ,D ,E两组HR ,C ,D ,E三组RPP显著低于A组 (P <0 .0 5 ) ;D组拔管后 3～ 1 0minHR ,RPP ,E组拔管时及拔管后 1～ 1 0minHR ,RPP显著低于给药前 (P <0 .0 5 ) ,但E组有 3例用药后发生心动过缓。结论 :静注艾司洛尔 1 .5mg/kg对气管拔管时的心血管反应预防效果较好且无副作用发生     

体外循环后鱼精蛋白使用方法的临床探讨

目的　探讨体外循环(CPB)后分次小剂量拮抗体内肝素的可行性。方法　5 0例CPB直视手术病人随机分为常规剂量组(A组,n =2 5 )和分次小剂量组(B组,n =2 5 )。A组使用鱼精蛋白(PRTM)拮抗肝素的方法是1∶1.5 ;B组使用PRTM中和肝素的量为0 .8∶1,后据术野渗血或引流量情况酌情追加。观察激活凝血时间(ACT)和术后各段时间渗出量及血红蛋白丢失量。结果　①给药3 0min后两组ACT均有不同程度的延长,但差异无显著性(P >0 .0 5 ) ;②B组术后2 4h的引流量及血红蛋白丢失量明显少于A组(P <0 .0 1) ;③B组使用的PRTM量明显少于A组(P <0 .0 1)。结论　使用小剂量PRTM分次拮抗CPB后体内残存肝素,安全有效,也减少术后引流量及PRTM用量。     

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.