超声测量二尖瓣、主动脉瓣瓣环内径对风湿性心瓣膜病患者置换二尖瓣、主动脉瓣的临床意义

目的比较风湿性心瓣膜病患者瓣膜置换术前、术后的心脏形态结构及功能的变化,探讨超声测量二尖瓣、主动脉瓣瓣环内径对风湿性心瓣膜病患者置换二尖瓣、主动脉瓣的意义。方法回顾分析经心胸外科手术置换二尖瓣或主动脉瓣的45例风湿性心瓣膜病患者,比较术前及术后的超声声像图及测值改变。结果 45例患者中单纯置换金属二尖瓣14例,单纯置换金属主动脉瓣2例,单纯置换生物二尖瓣3例,单纯置换生物主动脉瓣3例,置换金属二尖瓣+主动脉瓣22例,置换生物二尖瓣+主动脉瓣1例;手术前测量二尖瓣瓣环内径为32～68mm,主动脉瓣瓣环内径为22～29mm,其中置换的二尖瓣型号为25#～29#,置换的主动脉瓣型号为19#～23#。结论术前超声测量二尖瓣、主动脉瓣瓣环内径可以为临床手术置换瓣膜的大小提供依据,超声观察及评价术前、术后患者的心脏形态结构及功能的改变具有重要的临床意义。     

重症风湿性瓣膜病合并重度三尖瓣关闭不全的临床研究

目的总结重症风湿性瓣膜病二尖瓣和主动脉瓣置换或二尖瓣置换的同时,三尖瓣同期成形或置换治疗心脏瓣膜病的手术疗效。方法2000年7月至2007年7月共收治重症瓣膜病合并重度三尖瓣关闭不全患者52例,38例行二尖瓣和主动脉瓣双瓣置换,12例行二尖瓣置换,2例行二尖瓣主动脉瓣三尖瓣联合置换,其余50例均行三尖瓣成形。结果死亡4例,手术死亡率为7.69%。随访3～18个月,无死亡病例。心功能明显改善,三尖瓣反流明显减少。I～Ⅱ级46例、Ⅲ级2例。结论对于重症风湿性瓣膜病变者,三尖瓣存在重度关闭不全或严重器质性病变时,在进行二尖瓣主动脉瓣置换的同时进行三尖瓣有效成形或置换,有利于术后右心功能的恢复,改善心功能,能明显提高远期生活质量。     

初期开展心脏瓣膜病外科治疗23例的经验和教训分析

目的：回顾性分析23例心脏瓣膜病患者的临床资料,总结初期开展瓣膜外科治疗所应汲取的经验和教训。方法全组除1例为主动脉右瓣冠脱垂外,其余22例均为风湿性心脏瓣膜病,共有二尖瓣病变19例次,主动脉瓣病变15例次,其中主动脉瓣、二尖瓣联合瓣膜病变11例;均在气管插管＋静脉复合麻醉下,经胸正中切口,常规建立体外循环。二尖瓣置换术（MVR）采用右房—房间隔入路,多数采用2-0 prolene 线连续缝合,主动脉瓣膜替换（AVR）采用主动脉根部切口,采用双头带垫间断褥式缝合,必要时可间断单针缝合。双瓣膜置换先置换二尖瓣,再置换主动脉瓣。合并三尖瓣中度以上关闭不全病例,同期行 Devega 术或置环成形术（TVP）。合并 CABG 患者先在体外循环下行桥血管远端吻合,再行瓣膜置换术,并行循环下进行桥血管近端吻合。结果术后心脏21例自动复跳,2例心外膜除颤后复跳,术后再次开胸止血 1例,房间隔切口裂开1例,呼衰及精神症状 1例,均经积极治疗痊愈出院。全组无死亡病例。术后1周复查心超均未发现瓣周漏。术后全部随访至今,随访患者心功能都有不同程度好转。结论准确掌握手术时机,充分术前准备及正确围术期处理,术中积极保护心肌和左室功能,正确处理合并症,可明显提高瓣膜置换术的成功率,降低手术并发症,提高患者生存质量。     

开展心脏人工瓣膜替换术的初步报告

心脏瓣膜疾病是常见病。我们临床观察,云南高原风湿性心脏瓣膜病的发病率似较沿海地区为高。心脏瓣膜由于病变而损坏严重者,用单纯的扩张手术或直视修补手术不能恢复或改善其功能时,就应考虑施行心脏瓣膜替换术,以心脏人工瓣膜代替病变的瓣膜,重建血液流通功能。临床上常用的心脏人工瓣膜有二种,即人工机械瓣及人工生物瓣。我科于1980年4月为2例风湿性二尖瓣病变患者,应用人工牛心包瓣替换二尖瓣获得成功,现报告如下:     

慢性风湿性心瓣膜病的护理

慢性风湿性心脏病是指风湿性心脏炎停止后，从发炎、损害、愈合过程中遗留下来的心脏病变，特别是瓣膜病变，表现为瓣膜狭窄或关闭不全，导致止波动力学改变，出现二尖瓣面容、咳嗽、呼吸困难、咳血、心悸、下肢水肿等一系列临床症状，使病人精神及日常生活、工作受到很大影响和制约，倍受折磨。临床资料那科自1992～1995年共收治26例风心瓣膜病病人；男性9例，女性17例，其中单纯二尖瓣狭窄8例，二尖瓣狭窄并关闭不全5例，主动脉瓣关闭不全3例，风心合并心衰、房颤，肺气肿7例，二尖瓣并主动脉病变3例。年龄最小的24岁，最大的59岁。治疗正…     

心脏瓣膜替换术328例治疗体会

目的：总结吉林省四平市第一人民医院近10年来所治疗的心脏瓣膜替换术的手术方法及围手术期的处理经验。方法：通过分析在吉林省四平市第一人民医院接受心脏瓣膜替换术的328例患者的临床治疗效果。结果：328例风湿性心脏病患者均接受瓣膜替换术,其中单纯二尖瓣替换术206例,二尖瓣、主动脉瓣同时替换术122例．绝大部分患者同时行三尖瓣环缩,对于以二尖瓣关闭不全为主,左心室增大,二尖瓣环扩张者多采用保留二尖瓣后叶装置的术式,手术后绝大部分患者心功能得到很大改善,生活质量明显提高。结论：单纯二尖瓣替换术的患者术后死亡率为1．0％,双瓣替换术的术后死亡率为1．5％。心脏瓣膜病患者采用瓣膜替换术已是根治的最佳方法。     

心脏瓣膜病再次手术287例临床分析

目的探讨心脏瓣膜病再次手术的原因、手术时机、术中注意要点。方法回顾分析2003年6月～2010年6月,该院287例心脏瓣膜病再次手术病例。男性102例,女性185例,年龄(45.89±11.10)岁。两次手术的时间间隔为3个月～38年(14.01±8.74)年,术前心功能(NYHA分级)Ⅱ级14例,Ⅲ级217例,Ⅳ级56例。其中二尖瓣+主动脉瓣+三尖瓣置换2例,二尖瓣+主动脉瓣置换32例,二尖瓣+三尖瓣置换12例,二尖瓣置换201例,三尖瓣置换19例,主动脉瓣置换7例,瓣周漏修补14例。结果全组早期死亡11例,病死率为3.82%,死亡原因包括术后低心排出量综合征5例,恶性心律失常2例,多脏器功能衰竭3例,术中止血困难1例。生存患者术后心功能大都恢复到Ⅰ～Ⅱ级。心脏瓣膜病再次手术原因包括:二尖瓣闭式扩张术后189例,人工瓣膜心内膜(PVE)13例,机械瓣置换术后功能障碍21例,瓣周漏31例,二尖瓣和(或)主动脉瓣置换术后其他瓣膜病变33例。结论合理选择手术时机、加强术中心肌保护是提高手术成功关键。     

彩色多普勒超声心动图对老年退行性与风湿性心瓣膜病变的评价

本文采用超声心电图对老年退行性与风湿性心瓣膜病变进行观察，根据其发病年龄、性别、发病因素及发展趋势加以探讨。1 资料与方法使用日本EUB-565彩色多普勒超声心动图，在检查的744例患者中筛选出老年退行性与风湿性心瓣膜病患者75例，其中老年退行性心瓣膜病患者53例，均有不同程度的主动脉瓣或瓣环钙化，有8例伴有二尖瓣钙化。风湿性心瓣膜病变者22例，单纯性二尖瓣病变者12例，联合瓣膜病变者10例。2 结果在75例瓣膜病变中，老年退行性心瓣膜病变者53例(占71%)，男33例，女20例，男性年龄58~86岁，平均64岁，女性年龄61~90岁，平均71…     

风湿性心脏瓣膜置换同期行心房颤动射频消融术29例围术期的护理干预

心房纤颤是风湿性心脏瓣膜病患者常见的伴发病,在接受风湿性心脏瓣膜手术的患者中79%伴有心房纤颤[1]。在瓣膜置换手术的同时进行射频消融心房纤颤是外科治疗瓣膜病合并心房纤颤的有效方法。2009年7月至2010年6月我院收治了心脏瓣膜置换同期行房颤射频消融术患者29例,经围术期切实有效护理,效果满意,现总结如下。     

心脏瓣膜再次置换术后合并大出血护理体会

风湿性心脏瓣膜病尤其是瓣膜病变严重、增厚、畸形、活动受限、心功能减退，都应考虑行瓣膜病膜置换术。如所换瓣膜老化损坏，可再次置换。笔者在北京阜外心血管病专科医院进修期间护理该类患者８例，其中合并大出血者１例，总结护理体会如下。１病例摘要患者，男，４６岁，３９ｋｇ。术后Ｈｂ１０ｇ，Ｃ／Ｔ０．７５，心功能Ⅲ级，ＢＰ９０／６０ｍｍＨｇ，因第一次所换生物瓣损害，出现二尖瓣及主动脉搏关闭不全，在全麻低温体外循环下行ＢＶＲ术，以机械瓣分别置换之，入ＩＣＵ后出血量多不止，而再次开胸手术。２护理要点做好全麻低温体…     

Efficacy of gut lavage,hemodialysis, and hemoperfusion in the therapy of paraquat or diquat intoxication

Clinical and in vitro investigations were carried out to test the efficacy of gut lavage, hemodialysis, and hemoperfusion in the treatment of poisoning with paraquat or diquat. In a patient suffering from diquat intoxication 130 times more diquat was removed by gut lavage 30 h after ingestion than was removed by complete aspiration of the gastric contents.Determination of in vitro clearances for paraquat and diquat by hemodialysis showed that, at serum concentrations of 1–2 ppm, such as are frequently encountered in poisoning in man, toxicologically relevant quantities of herbicide cannot be removed from the body. At a concentration of 20 ppm, on the other hand, hemodialysis proved to be effective, the clearance being 70 ml/min at a blood flow rate of 100 ml/min. The efficacy of hemoperfusion with coated activated charcoal was on the whole better. Especially at concentrations around 1–2 ppm, the clearance values for hemoperfusion were some 5–7 times higher than those for hemodialysis.In a patient suffering from paraquat poisoning, both hemodialysis as well as hemoperfusion were carried out. The in vitro results could be confirmed: At serum concentrations of paraquat less than 1 ppm no clearance could be obtained by hemodialysis while by hemoperfusion with activated charcoal quite high clearance values were measured and the serum level dropped down to zero.

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Zusammenfassung Klinische Untersuchungen und Laboratoriumsversuche wurden durchgeführt, um die Wirksamkeit von Darmspülung, Hämodialyse und Hämoperfusion bei Paraquat- und Deiquat-Vergiftungen zu prüfen.Bei einem Patienten wurde 30 Std nach Deiquat-Aufnahme durch Darmspülung 130mal mehr Deiquat entfernt als durch vollständige Aspiration des Mageninhaltes. In vitro-Versuche ergaben, daß bei Blutserumkonzentrationen von 1–2 ppm, die bei Vergiftungen oft gemessen werden, durch Hämodialyse keine toxikologisch relevanten Paraquat- oder Deiquat-Mengen entfernt werden können. Dagegen erwies sich die Hämodialyse bei 20 ppm und einer Blutumlaufgeschwindigkeit von 100 ml/min mit einer Clearance von 70 ml/min als wirksam. Die Hämoperfusion mit beschicheter Aktivkohle war in diesen Versuchen aber eindeutig überlegen, denn insbesondere bei Konzentrationen um 1–2 ppm waren die Clearance-Werte 5–7mal höher als bei der Hämodialyse.Die in vitro-Ergebnisse wurden bei einem Patienten mit einer Paraquat-Vergiftung bestätigt: Bei Konzentrationen unter 1 ppm war die Hämodialyse wirkungslos, während durch Hämoperfusion relativ hohe Clearance-Werte erreicht wurden, so daß der Serumspiegel rasch unter die Nachweisgrenze abfiel.

     

In vitro studies on sterically stabilized liposomes (SL) as enzyme carriers in organophosphorus (OP) antagonism

This study describes a new approach for organophosphorous (OP) antidotal treatment by encapsulating an OP hydrolyzing enzyme, OPA anhydrolase (OPAA), within sterically stabilized liposomes. The recombinant OPAA enzyme was derived from Alteromonas strain JD6. It has broad substrate specificity to a wide range of OP compounds: DFP and the nerve agents, soman and sarin. Liposomes encapsulating OPAA (SL)* were made by mechanical dispersion method. Hydrolysis of DFP by (SL)* was measured by following an increase of fluoride ion concentration using a fluoride ion selective electrode. OPAA entrapped in the carrier liposomes rapidly hydrolyze DFP, with the rate of DFP hydrolysis directly proportional to the amount of (SL)* added to the solution. Liposomal carriers containing no enzyme did not hydrolyze DFP. The reaction was linear and the rate of hydrolysis was first order in the substrate. This enzyme carrier system serves as a biodegradable protective environment for the recombinant OP-metabolizing enzyme, OPAA, resulting in prolongation of enzymatic concentration in the body. These studies suggest that the protection of OP intoxication can be strikingly enhanced by adding OPAA encapsulated within (SL)* to pralidoxime and atropine.     

Synthesis,Cytotoxicity and Antileishmanial Activity of Some N-(2-(indol-3-yl)ethyl)-7-chloroquinolin-4-amines

We report herein the condensation of 4,7-dichloroquinoline (1) with tryptamine (2) and D-tryptophan methyl ester (3) . Hydrolysis of the methyl ester adduct (5) yielded the free acid (6) . The compounds were evaluated in vitro for activity against four different species of Leishmania promastigote forms and for cytotoxic activity against Kb and Vero cells. Compound (5) showed good activity against the Leishmania species tested, while all three compounds displayed moderate activity in both Kb and Vero cells.     

Steroidal sapogenin contents in some domestic plants

In order to find out the values of the steroid resources for the future use. the compositions and contents of steroidal sapogenins from 13 domestic plants have been investigated. As a result,Dioscorea nipponica, D. quinqueloba andSmilax china were found to have large amount of diosgenin. And pennogenin inTrillium kamtschaticum andParis verticillata, yuccagenin inAllium fistulosum, hecogenin inAgave americana and neochlorogenin inSolanum nigum were appeared to be major steroidal sapogenins.     

Aquatic Insects and Trace Metals: Bioavailability,Bioaccumulation, and Toxicity

Abstract

The uptake of metals from food and water sources by insects is thought to be additive. For a given metal, the proportions taken up from water and food will depend both on the bioavailable concentration of the metal associated with each source and the mechanism and rate by which the metal enters the insect. Attempts to correlate insect trace metal concentrations with the trophic level of insects should be made with a knowledge of the feeding relationships of the individual taxa concerned. Pathways for the uptake of essential metals, such as copper and zinc, exist at the cellular level, and other nonessential metals, such as cadmium, also appear to enter via these routes. Within cells, trace metals can be bound to proteins or stored in granules. The internal distribution of metals among body tissues is very heterogeneous, and distribution patterns tend to be both metal and taxon specific. Trace metals associated with insects can be both bound on the surface of their chitinous exoskeleton and incorporated into body tissues. The quantities of trace meals accumulated by an individual reflect the net balance between the rate of metal influx from both dissolved and particulate sources and the rate of metal efflux from the organism. The toxicity of metals has been demonstrated at all levels of biological organization: cell, tissue, individual, population, and community. Much of the literature pertaining to the toxic effects of metals on aquatic insects is based on laboratory observations and, as such, it is difficult to extrapolate the data to insects in nature. The few experimental studies in nature suggest that trace metal contaminants can affect both the distribution and the abundance of aquatic insects. Insects have a largely unexploited potential as biomonitors of metal contamination in nature. A better understanding of the physico-chemical and biological mechanisms mediating trace metal bioavailability and exchange will facilitate the development of general predictive models relating trace metal concentrations in insects to those in their environment. Such models will facilitate the use of insects as contaminant biomonitors.