外科心脏再同步化治疗的超声心动图评价

目的 应用超声心动图来评价外科方法植入左室心外膜电极的心脏再同步化治疗(CRT)慢性心力衰竭的可行性和近期疗效.方法 接受外科CRT的慢性心力衰竭患者10例,用常规超声心动图及组织多普勒成像技术观察术前、术后左室收缩功能指标和心脏同步性参数的变化,并且在术中应用经食管超声心动图(TEE)指导左室心外膜电极位置的优选.结果 与术前比较,CRT术后的左室舒张末期内径(LVEDD)由(69.4±13.6) mm 降至 (60.0± 6.9 )mm(P<0.05),左室射血分数( LVEF )由(32.9±7.6)%升至(41.3±8.3) % (P<0.05 ) ,左室不同步指数12-Tp-SD由 (143.2±30.8) ms 降至(56.4±22.1)ms(P<0.05).结论 外科指导植入左室心外膜电极的CRT是安全的,有效的.传统超声心动图及组织同步显像技术能够指导左室心外膜电极放置于真正的靶位置,并评价其疗效.     

三维超声心动图测量左室心肌质量与心脏终点结局事件的相关性

目的:为评价三维超声心动图在心血管疾病中的应用前景,验证左室心肌质量对心血管事件和死亡发生的预测价值,应用三维超声心动图检测左室心肌质量,探讨左室心肌质量与心血管病患者远期预后的关系。方法:①超声测定:选择2003-10/2007-04武警医学院附属医院CCU及普通病房住院的64例患者接受左室心肌质量指数、静息左室射血分数测定和NYHA心脏功能分级的评估,仪器采用彩色多普勒超声诊断仪,型号为GE vivid-7。②分组及随访:根据左室肥厚标准和各参数平均数分为2组,左室心肌质量指数男性<131g/m2或女性<100g/m2为Ⅰ组,男性≥131g/m2或女性≥100g/m2为Ⅱ组,连续随访54个月,观察终点为心源性死亡。结果:61例进入结果分析。随访期末发现左室心肌质量指数与远期死亡有着显著的相关性(r=0.592,P=0.000);静息左室射血分数和NYHA心脏功能分级与死亡没有相关性(P>0.05);左室肥厚的Ⅱ组死亡例数多于Ⅰ组(P<0.01),两组的静息左室射血分数和NYHA心脏功能分级比较差异不显著(P>0.05);左室心肌质量指数高于平均数的Ⅱ组与Ⅰ组死亡相对危险比为2.56(95%CI),差异有统计学意义(P=0.020),但是静息左室射血分数和NYHA心脏功能分级之间死亡相对危险比没有统计学意义(P>0.05)。结论:①左室心肌质量与心血管病患者远期预后关系密切,可用于预测心源性死亡的发生情况。②三维超声心动图测定左室心肌质量及功能参数方便准确,可用于心功能定量评估。     

实时三维超声心动图评价正常人左室射血分数的初步研究

目的　探讨实时三维超声心动图评价正常人左室射血分数的可行性和价值。方法　应用实时三维超声心动图与常规M型超声心动图测量 2 4例正常志愿者的左室射血分数 ,比较两种测量方法一致性和相关性。结果　所有志愿者均可获得满意实时三维与M型超声图像 ;两种方法所得测值之间差异无显著性 (P >0 .0 5 ) ,并具有良好相关性 (P <0 .0 0 1)。结论　实时三维超声心动图评价正常人左室射血分数是准确和可性行的     

心脏直视手术中顽固室性心律失常处理经验总结

顽固室性心律失常是心脏直视手术中、术后的严重并发症 ,其抢救水平直接关系到病人的生存率和手术成败 ,我们总结了我院 1989年 6月～ 2 0 0 1年 12月心脏直视术中发生顽固室性心律失常 2 0例成功的处理经验 ,报告如下。1　资料与方法1 1　一般资料　本组病人 2 0例 ,年龄 5～ 5 0岁 ,男 12例 ,女8例。二尖瓣膜置换术 8例 ,双瓣膜置换 8例 ,法乐氏四联症(Ｆ4 )矫正术 2例 ,室缺修补术 1例 ,房缺修补术 1例。术前心脏超声心动图检查 :左室容积 (2 0 0± 80 )ｍＬ ,左室射血分数值(40± 16 ) %。术前心房纤颤 14例 ,频发室性早搏 3例。心胸比 …     

心脏瓣膜疾病患者术后出现心排血量减少的高危因素分析

目的:分析心脏瓣膜疾病患者术后出现心排血量减少的高危因素,以提高预后,改善心功能。方法:经诊断、纳入与排除后选取我院2018年1月-2019年1月收治的心脏瓣膜疾病手术患者120例,所有患者接受心脏瓣置换术,根据患者具体情况选择具体手术方法,术后密切观察患者生命体征,并给予相应得(的)辅助治疗。术前6个月患者接受飞利浦超声诊断检查,测量患者左室射血分数、左室舒张模内径、左心房内径、心排血量及术后心排血量,记录患者手术时间、体外循环转机时间、主动脉阻断时间、置换膜瓣数量。并分析心脏瓣膜疾病患者术后出现心排血量减少单因素与多因素。结果:120例患者中有24例心排血量减少,发生率20.00%,未减少96例(80%)。单因素分析结果显示,年龄、性别、术前左室舒张末内径、术前心胸比与术后排血量减少无关(P0.05),术前心功能分级、体外循环转机时间、置换膜瓣数量、术前左室输血分数、术中主动脉阻断时间、术前左室射血分数是排血量减少的单因素(P0.05)。术前心功能分级、体外循环转机时间、术前左室输血分数、术中主动脉阻断时间、术前左室射血分数是排血量减少的独立危险因素(P0.05),置换膜瓣与其无关。结论:重视脏瓣置换术前患者的术前心功能分级、体外循环转机时间、术前左室输血分数、术中主动脉阻断时间,选择合适的手术方式能有效预防心排血量减少,有利于提高预后。     

同种异位心脏移植的超声心动图研究

目的 研究异位心脏移植的超声心动图特点,评价心功能及早期排异反应.方法 对5例接受异位心脏移植的患者,应用超声心动图分别进行术前、术中、术后及随访观测.观察原位受体心脏(受体)和异位供体心脏(供体)的吻合关系及房室大小、左室射血分数(LVEF)、室壁运动、瓣膜功能、肺动脉压变化、胸腔积液及心包积液情况.结果 5例均为冠心病晚期患者,心功能Ⅲ～Ⅳ级,左室射血分数平均(24.4±4.1)%.所有患者均有室壁瘤,并接受冠状动脉旁路移植术.部分患者接受二尖瓣成形、室壁瘤切除及干细胞移植.供体均置于右侧胸腔.4例为左心辅助,1例为全心辅助.超声评价术前受体的心功能减低,均发现异常室壁运动及室壁瘤.术中经食管超声能够评价复跳后即刻心功能、吻合口、瓣膜以及心脏排气的情况.超声显示术后供体和受体心功能均逐渐恢复;在术后随访6个月至1年中,受体心功能较术前不同程度提高.主要的排异反应为少量的胸腔及心包积液.结论 异位心脏移植超声心动图具有鲜明的特征性,在术前受体评价、术中监测及术后随访中都具有重要的临床价值.     

磁共振心脏成像与超声心动图评价左室收缩功能

目的评价磁共振心脏成像(CMRI)与超声心动图对左室收缩功能的诊断价值.方法对75例临床怀疑心脏疾病的患者进行心脏MRI与超声心动图检查,测量左室射血分数(LVEF),其中27例结果与左室造影相对照.结果 75例心脏MRI所测EF值(%)＝42.31±19.70,超声心动图所测EF值(%)＝48.79±17.10;27例行左室造影病例中,心脏MRI所测EF值(%)＝35.64±13.36,超声心动图所测EF值(%)＝39.95±12.72,左室造影所测EF值(%)＝36.65±14.27.对同一病例,心脏MRI所测EF值较超声心动图偏低(-6.48±12.34,t＝-4.544, P<0.001).27例患者心脏MRI与超声心动图结果均与左室造影结果无统计学差异:心脏MRI( r＝0.839,P＜0.001),超声心动图( r＝0.761,P＜0.001).结论对左室收缩功能的评价,心脏MRI与超声心动图均具重要的临床应用价值( r＝0.784,P＜0.001),心脏MRI一般比超声心动图所测LVEF数值偏小,差值≤10%.     

实时心肌造影超声心动图评价心肌梗死患者血运重建术后左室重构

目的探讨实时心肌造影超声心动图评价心肌梗死患者血运重建术后左室重构的价值。方法20例准备行血运重建术心肌梗死患者，于术前1～5d行常规超声心动图和实时心肌造影超声心动图检查，并于术后3个月再行常规超声心动图检查。室壁运动分析采用18节段分析法，心肌造影灌注分析：按照心肌灌注记分指数（MPSI）分成2组：MPSI≤1．5为心肌灌注良好组；MPSI〉1．5为心肌灌注较差组。分别将：①两组术前左室射血分数（LVEF）、左室收缩末容积（LVESV）、左室舒张末容积（LVEDV）与术后3个月比较；②两组术前的LVEF、LVESV、LVEDV，术后3个月的LVEF、LVESV、LVEDV各自比较；③两组患者手术前后左室射血分数差值（ALVEF）、收缩末容积差值（ALVESV）、舒张末容积差值（△LVEDV）进行比较；④对ALVEF、△LVESV、△LVEDV与MPSI分别做相关性分析。结果MPSI〉1．5组患者手术后3个月的LVEF较MPSI≤1．5组明显减低，LVEDV较MPSI≤1．5组明显增大，MPSI〉1．5组和MPSI≤1．5组患者的ALVEF、ALVEDV存在差别，差异有统计学意义（P〈0．05）；MPSI与ALVEF呈负相关，与△LVESV、△LVEDV呈正相关（P〈0．05）。结论术前MPSI〉1．5组较MPSI≤1．5组发生左室重构的可能性大，实时心肌超影超声心动图能较好的评估心肌梗死患者血运重建术后左室重构情况。     

老年冠心病患者非心脏手术围术期心血管事件危险因素筛选与分析

目的:筛选并分析老年冠心病患者非心脏手术围术期心血管事件的危险因素.方法:行择期手术的老年冠心病非心脏手术患者223例,记录术中、术后心血管事件(恶性心律失常、心肌缺血、不稳定性心绞痛、心肌梗死、高血压),根据有无发生心血管事件分为不良事件组和无不良事件组,并进行单因素分析及多因素非条件Logistic回归分析.结果:不良事件组中术前有ST段压低≥0.05 mV、不稳定型心绞痛、高血压、年龄>70岁、吸烟、糖尿病、射血分数≤50%、心功能Ⅲ级、心肌梗死、心律失常、血红蛋白<120 g/L、纤维蛋白原增高的患者心血管事件发生率均高于无不良事件组,以上危险因素均与不良事件发生呈正相关性(P<0.05).结论:术前心律失常、糖尿病、心肌梗死、不稳定型心绞痛、纤维蛋白原增高、射血分数≤50%、血红蛋白<120 g/L及ST段压低≥0.05 mV是老年冠心病患者非心脏手术围术期心血管事件的主要危险因素.     

超声心动图分析肺移植术后心脏结构及功能的变化

目的 应用超声心动图检查肺移植术后早期心脏结构与功能的变化,探讨其对肺移植术后早期心脏结构与心功能变化的诊断价值.方法 回顾分析45例肺移植患者术前术后的超声心动图资料,对比术前与术后早期心脏结构与功能的超声检查结果,有明显差别的定性资料再应用Pearson直线相关分析判断其与肺动脉收缩压降低之间的关系.结果 与术前相比,术后平均肺动脉收缩压明显降低[(62.3±27.2)mm Hg对(36.20±7.8)mm Hg,P＜0.01],右室内径明显缩小,左房内径、左室舒张末期内径明显扩大,每搏输出量明显增加[(43.85±14.78)ml对(58.68±13.85)ml],左室射血分数明显下降[(69.31±7.50)％对(62.82±8.12)％],上述差异均具有统计学意义(P＜0.05).Pearson直线相关分析显示肺移植术后肺动脉收缩压降低程度越大,术后左房内径、左室舒张末内径增加幅度越大,左室射血分数降低幅度越大(P＜0.05).结论 肺移植术后早期右心结构正常化,右心功能改善,左心扩大,心搏出量增加,但左心室收缩功能有所降低,这些变化与肺动脉收缩压的快速降低有关.超声心动图监测肺移植术后早期心功能变化有一定的应用价值.     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Clinical Trial Updates and Hotline Sessions presented at the European Society of Cardiology Congress 2007

This article provides information and commentaries on trials which were presented at the Hotline and Clinical Trial Update Sessions at the European Society of Cardiology Congress 2007 in Vienna. The key presentations were performed by leading experts in the field with relevant positions in the trials or registries. It is important to note that unpublished reports should be considered as preliminary data, as the analysis may change in the final publications. The comprehensive summaries have been generated from the oral presentation and the webcasts of the European Society of Cardiology and should provide the readers with the most comprehensive information of relevant publications.     

Balance and Boundaries in Grief Counseling: An Intervention Framework for Volunteer Training

Volunteers or paraprofessional counselors are commonly used to provide supportive care to the bereaved. These counselors generally are trained in basic listening skills, providing a generic, nonspecific approach to intervention that remains to be proven effective. The present paper outlines a framework that provides paraprofessionals with a broader model for intervention with the bereaved. Attention to boundaries as a helper and balance in the grief recovery are central to the model. Interventions are described that provide the paraprofessional counselor with more options for tailoring their counseling strategy to the individual. These include techniques that are presumed to be more specific to the enhancement of grief recovery.     

A new method for the simultaneous analysis of unmodified and modified urinary nucleosides and nucleobases by high performance liquid chromatography

Details are given of a new, rapid and simple pre-fractionation method and an isocratic high performance liquid chromatography system suitable for parallel analysis of nucleosides and nucleobases from urine and other biological fluids. The quantitative recovery and excellent reproducibility of the method is demonstrated by analysis of representative standard RNA catabolites. The advantage of this new method for application to biological samples is discussed.     

Adsorption of Charged Non-albumin Bound Drugs by Amorphous Silica

We investigated the in vitro drug adsorption of PQ 10150 sodium silicate gel (AIS, Santa Clara, CA) with particle size of 230 um and surface area of 400 nr/g. We observed 99% to 88% adsorption of gentamicin; a mean 91 % of disopyramide; a mean 89% of quinidine at low concentration, falling to 75% at higher concentration. Insulin was 88% adsorbed at low concentrations but less so (65%) at higher concentrations. We observed a mean 83 % adsorption of procainamide, a mean 84% of N-acetyl procainamide, 74% oflidocaine, 73% of amitriptyline; and 44% of desipramine. We found an average 14% reduction of total digoxin concentration when serum containing digoxin (2 to 33 ng/mL) was exposed to sodium silicate, while the reduction in free digoxin concentration was 16%. Five percent ethosuximide was also removed. The adsorption of theophylline, phenobarbital, acetaminophen, phenytoin, ethylene glycol, methotrexate, salicylate, thiocyanate and diazepam was minimal and not significant. We conclude that significant amounts of charged, non-albumin bound drugs can be removed by PQ 10150 sodium silicate gel.