瞬时波强技术评价2型糖尿病早期左心室功能的临床研究

目的应用瞬时波强技术(WI)检测2型糖尿病早期患者的左心室功能变化,探讨其临床应用价值。方法选择左室射血分数(EF)≥50%的单纯2型糖尿病组(T2DM)21例和糖尿病合并高血压病组(T2DM+EH)25例,正常对照组25例,均行常规超声心动图和颈动脉WI检测,对比分析3组受试者各项指标的差异。结果 T2DM组与对照组比较:收缩晚期瞬时减速度波强(W2)明显增高(P<0.01),收缩早期瞬时加速度波强(W1)增高(P<0.05),W1顶点到W2顶点的时间(W1～W2)明显缩短(P<0.01)。T2DM+EH组与对照组比较:W1明显增高(P<0.01),W2增高(P<0.05)。T2DM+EH组与T2DM组比较:W1增高(P<0.05),W2呈降低趋势,但差异无统计学意义(P>0.05)。结论瞬时波强技术可以无创检出糖尿病早期患者左心室功能损害,具有重要的临床应用价值。     

颈动脉瞬时波强在评价冠心病患者心功能中的作用

目的探讨颈动脉瞬时波强评价心功能的临床价值。方法选2009年1-9月解放军总医院心内科住院的冠心病心功能不全患者51例,其中男性34例,女性17例,年龄(66±10)岁。常规行超声心动图及瞬时波强(wave in-tensity,WI)检测,记录左室射血分数(left ventricular ejection fraction,LVEF)、左室舒张末内径(left ventricular diastojic di-mension,LVDd)、左室舒张末容积(end diastolic volume,EDV)、左室收缩末容积(end systolic volume,ESV)、左房内径(leftatril dimension,LAd)、颈动脉瞬时加速度波强(accelerating wave intensity,W1)、颈动脉瞬时减速度波强(decelerating waveintensity,W2);超声检查完毕即刻测量6 min步行距离(6 minutes walking distance,6MWD);之后在2 h内行冠状动脉造影,造影显示每位患者至少有1处病变狭窄≥50%,其中47例导管测量左室压力,记录左室最大压力变化(LV+dp/dtmax);分析51例患者上述超声指标与6MWD之间的相关性。结果线性回归分析显示W1、LVEF、LVDd、EDV、ESV、LV+dp/dtmax与6MWD均显示明显相关(r分别为0.687、0.591、-0.552、-0.450、-0.513、0.693,P<0.01);其中W1对6MWD影响程度最大(标准回归系数Beta依次为W1 0.789、ESV 0.701、LVEF 0.567、LV+dp/dtmax 0.540、EDV 0.485、LVDd 0.067)。结论作为更加简便的评价心功能的方法,WI可能较传统的超声指标具有更加准确的临床价值。     

瞬时波强技术评价甲状腺机能亢进患者左心室功能的临床观察

目的观察瞬时波强(wave intensity,WI)技术评价甲亢患者左心室功能的价值。方法获取46例甲亢患者(甲亢组)及35例健康对照者(正常对照组)一般资料、常规超声心动图资料、WI参数,并比较两组间各指标有无统计学差异。结果甲亢组心率、收缩压高于正常对照组,舒张压低于正常对照组;甲亢组左室舒张末期内径(LVIDd)、左室舒张末期室间隔厚度(IVSd)、左室舒张末期容积(LVEDV)、左室收缩末期容积(LVESV)、每搏量(SV)、左室射血分数(LVEF)与正常对照组相比无明显差异,两组间其他参数均有明显差异;甲亢组瞬时加速度波强(W1)、第一峰到第二峰的时间间期(W1-W2)明显高于对照组,瞬时减速度波强(W2)、心电图的R波顶点到第一峰W1的时间间期(R-W1)明显低于对照组。结论 WI技术作为一项通过动脉内血流动力学反映心脏功能的新指标,可快捷、客观、无创、有效地评价甲亢患者左心室功能。     

慢性肾病患者颈动脉超声瞬时波强参数与血清生化指标的变化

目的探讨慢性肾病(CKD)患者颈动脉超声瞬时波强参数对与血清生化指标的变化。方法选择40例CKD患者(肾病组)及40例健康对照组,采用彩色多普勒超声检测两组颈总动脉内-中膜厚度(IMT)及颈动脉超声瞬时波强参数;检测血生化指标;对两组检查结果进行统计分析。结果两组颈总动脉IMT厚度比较差异无统计学意义(P>0.05);肾病组血清肌酐(Cr)、β2微球蛋白(β2-MG)、胱抑素C(Cy C)含量均高于对照组(P<0.05)。肾病组瞬时加速度波强(W1)、瞬时减速度波强(W2)、负向波面积(NA)、弹性系数(EP)、僵硬参数(β)、单点脉搏波传导速度(PWVβ)、WI单点脉搏波传导速度(PWV-WI)均明显高于对照组(P<0.05);两组心电图R波至W1波峰时间(R-1st)、W1至W2波峰时间(1st-2nd)、顺应性(AC)、管径增大指数(AI)比较,差异无统计学意义(P>0.05)。血清Cr、β2-MG、Cys-C、IP水平与W2、NA、β、EP、PWVβ、PWV-WI均呈正相关(P<0.05)。结论 CKD患者颈动脉瞬时波强参数和血清生化指标的改变均早于血管形态学改变。     

主动脉球囊反搏对再灌注不良的急性前壁心肌梗死患者血浆脑钠素和心功能的影响

目的评价主动脉球囊反搏(IABP)对急性前壁ST段抬高(再灌注不良)心肌梗死患者治疗的有效性和安全性及对血浆脑钠素(BNP)、左室舒张末期直径(LVEDD)、左室射血分数(LVEF)值的影响。方法再灌注不良心肌梗死患者40例,在最优药物治疗基础上按是否应用IABP分为A组(IABP植入组,20例)、B组(对照组,20例)。免疫化学发光法测患者入院后1、7、90 d血浆BNP浓度,超声心动图测入院后1、7d以及90d LVEDD、LVEF值。结果入院后1 d两组BNP和LVEDD、LVEF值差异均无统计学意义(P>0.05)。入院后7 d、90 d A组BNP低于B组,差异均有统计学意义〔(692±153)pg/ml vs.(805±151)pg/ml,P<0.05;(587±191)pg/ml vs.(722±174)pg/ml,P<0.05〕。入院后7d A组、B组LVEDD值和LVEF值差异均无统计学意义(P>0.05)。入院后90 d,A组LVEDD值明显低于B组,差异有统计学意义〔(55±2)mm vs.(58±3)mm,P<0.05〕,LVEF值差异无统计学意义(P>0.05)。结论在最优药物治疗基础上,IABP能进一步降低再灌注不良的急性前壁ST段抬高心肌梗死患者BNP值,改善心功能指标。     

瞬时波强技术在早期评估老年原发性高血压血流动力学改变中的应用

目的：探讨瞬时波强（WI）技术在早期无创性评价心脏功能和动脉硬化中的应用价值。方法：依BP水平将老年原发性高血压患者（108例）分为I~III级高血压组和单纯收缩期高血压组,另选正常BP者（30名）为对照组,均行超声心动图及颈动脉WI检查。结果：与对照组比,高血压各组瞬时加速度波强（W1）、瞬时减速度波强（W2）及负向波面积（NA）升高（P〈0.05）,高血压各组间左室短轴缩短率、左室射血分数、W1及W2差异无统计学意义。高血压组NA与颈总动脉收缩期峰速度（PSV）（r=0.423,P〈0.05）正相关,而对照组NA与PSV相关性无统计学意义。结论：WI技术在早期评价老年原发性高血压动脉硬化及血流动力学方面较常规超声检查更敏感,可为原发性高血压动脉硬化提供一种新的快速无创的检测方法。     

冠心病左室应变及扭转与临床心功能分级的相关性

目的 应用超声斑点追踪技术(STI)检测冠心病(CAD)患者左室应变及扭转参数,并与纽约心功能分级积分(NYHA-P)进行比较分析,探讨STI定量评估CAD心功能分级的价值.方法 随机对70例CAD患者按NYHA-P分为纽约心功能分级正常或接近正常组(40例)及心功能分级异常组(30例),并选择正常对照组(30例),比较受检者NY-HA-P、左室射血分数(LVEF)、左室心肌整体径向应变(GRS)、纵向应变(GLS)、左室心肌收缩期心肌扭转角度(TA).结果 CAD组与对照组比较:LVEF、GLS、GRS、TA减低(P<0.05);心功能正常组与异常组比较:LVEF、GLS、GRS、TA减低(P<0.05);正常组GLS、GRS、TA与LVEF无相关性,与NYHA-P相关;异常组GLS、GRS、TA与LVEF及NYHA-P呈相关性;以GLS-14.65℅截断点判定患者NYHA-P积分高于4.5分的灵敏度为87.30℅、特异度为75℅,Yuedden指数最高为0.653.结论 2D-STI技术检测心肌应变及扭转评价CAD左心室局部功能具有独特的优越性,局部应变及扭转参数与左室射血分数不一定相关,但与临床心功能分级相关,应变及扭转评价临床心功能较左室射血分数敏感,可以定量评价CAD患者实际临床心功能状态.     

核素心室造影及左室腔-心肌比值检测心梗后心功能

观察了37例心梗患者和28例正常对照组的~(99m)TC-MIBI首次通过法左室造影(FPRNA)检测左室射血分数(LVEF)及心肌断层显像加作短轴面左室腔-心肌比值(C/W),旨在了解一次注药进行两种分析对于缺血性心肌病变的心肌灌注和心功能变化的临床实用价值,并结合超声心动图(UCG)的LVEF和左室内径对比观察.结果示:(1)心梗组的FPRNA的LVEF,C/W均显著低于对照组LVEF,C/W(p<0.05～0.01).(2)心梗组中FPRNA的LVEF与UCG的IVEF相关显著(r=0.62,P<0.01),与左室内径呈负相关(r=-0.63,P<0.01).与梗塞节段数是显著负相关(r=-0.79,P<0.001).(3)心梗组中C/W与FPRNA的LVEF呈显著正相关(r=0.69,P<0.001);与左室内径呈显著负相关(r=-0.51,P<0.05);与患者梗塞节段的数量呈显著负相关(r=-0.76,P<0.001).(4)C/W对于心功能不全的检出敏感性92%,特异性50%,准确性75%.     

不同类型心力衰竭患者肺部超声参数变化及与LVEF、NT-proBNP的相关性分析

目的探讨不同类型心力衰竭(HF)患者肺部超声参数变化,并分析左室射血分数(LVEF)、血浆氨基末端B型利钠肽前体(NT-proBNP)与其相关性。方法采用病例对照组研究方式,按照LVEF分为射血分数下降型心衰(HFREF组,44例)和射血分数保留型心衰(HFPEF组,45例),患者均进行床旁肺部超声检查,比较两组肺超声指标变化,分析肺超声指标B线(彗星尾征)与患者LVEF及NT-proBNP指标的相关性。结果HFREF组的B线条数为(31.6±12.5)条,高于HFPEF组的(26.4±11.7)条,LVEF则低于HFPEF组,差异均具有统计学意义(P<0.05);HFREF组的NT-proBNP为(5.64±1.63)pg/mL,高于HFPEF组的(2.33±1.27)pg/mL,差异具有统计学意义(P<0.05);B线条数与患者的LVEF、NT-proBNP水平均呈正相关,差异均具有统计学意义(P<0.05)。结论不同类型心衰患者的肺超声影像图中B线数多于HFPEF患者,且与机体的LVEF、NT-proBNP水平有良好的相关性。     

肱动脉波强度对复杂先天性心脏病患者左心收缩功能评估的临床应用

目的探讨外周动脉瞬时波强度在左心室几何形态异常或大动脉连接异常的复杂先天性心脏病心功能评估方面的临床应用价值.方法应用以回声跟踪技术为基础的波强度(wave intensity,W)I技术对27例单心室患儿和30例健康受检者的肱动脉进行检查,测量其瞬时波强度曲线,并自动获得W1峰(瞬时加速度波强)等参数,进行对比分析;并对右室双出口18例(其中室间隔缺损靠近主动脉的12例),完全性大动脉转位6例,矫正型大动脉转位8例共32例大动脉连接关系异常的患者进行W1的测量评估.结果单心室等复杂先天性心脏病患儿W1峰较对照组显著减低(P<0.01),W1与心室Max(dP/d)t呈显著正相关(r=0.874,P<0.01).大动脉连接关系异常的受检者W1均较健康对照组减低,差异有统计学意义(P<0.05),右室双出口中室间隔缺损靠近主动脉的患者W1峰值较右室双出口中主动脉远离室间隔的患者稍高.结论 WI可作为评价心室收缩功能的新方法,对于由于左心室几何形态异常及大动脉连接异常的复杂先天性心脏病患者左心室功能,WI技术也能对其进行较为准确的评估;能够在心脏病外科手术治疗术前、术中及术后提供真实准确的评价.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

Dr.Zhang Ren''''s Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

Luo Lingjie''''s Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.     

Survey and practice of reporting quality of randomized controlled clinical trials on traditional Chinese medicine

Evidence obtained from randomized controlled trials （RCTs） has been generally accepted as the gold standard in the evaluation of clinical effectiveness. Readers need to understand the trial design, implementation, results, analysis and interpretation, so as to fully Jnderstand the results of RCTs. Thus, the investigators of RCTs have to report these items in a complete, accurate and clear manner. Since 1998, we have conducted several evaluations on the reporting quality of RCTs published in Chinese journals on traditional Chinese medicine （TCM） and results have shown that there is an urgent need for higher quality RCTs on TCM.     

TCM Treatment of Ankylosing Spondylitis by Tonifying the Kidney and Strengthening the Governor Vessel

Ankylosing spondylitis is a chronic and progressive disorder with inflammation mainly involving the central axis joints. It mainly affects the cervical spine and the lumbosacral area, with the pathogenesis closely related to the kidney and the Governor Vessel (GV). TCM holds that the syndrome is deficiency in origin and excess in superficiality, which is due to insufficiency of the kidney, deficiency of GV, and blocking of the channels with the invasion of exogenous evil, leading to poor circulation of qi and blood and malnutrition of the bones, muscles and joints. The TCM method of tonifying the kidney and strengthening GV to regulate circulation of qi and blood and check the arthralgia pain should be adopted, with the Kidney-Tonifying and GV Strengthening Decoction (益肾强督汤) prescribed.     

IMPROVING P-gp EXPRESSION IN HUMAN MONONUCLEAR CELLS IN VITRO TRANSFECTED BY MULTIDRUG RESISTANCE-1 mRNA

CHEMOTHERAPY playsa greatrolein the treat- ment of malignanttumors,especiallyingynecolo- gicalones.But inanticancerchemotherapy,leuko-cytopeniaisfrequentlytheprimarydose-limitingsideeffect factor.Moreover,cancersarefrequentlychemoresistantbe-causeof overexpressionof P-glycoprotein(P-gp), which isencodedby multidrugresistancegene (MDR1 ) and detectableinup to50% ofhuman cancersand renderscellsresistancetoanticancerdrugs.The safetyand potentialtherapeuticbenefitof mdr1 gene transferredto h…