小儿先天性心脏病合并重度肺动脉高压诊断性治疗的临床研究

目的:探讨诊断性治疗在小儿先天性心脏病(CHD)合并重度肺动脉高压(PH)中的临床价值。方法:选择确诊的CHD合并重度PH患儿31例,强心、利尿基础上,采用西地那非或波生坦治疗8~24周,行右心导管检查后,全麻下行根治术,术中搁置漂浮导管对术中和术后患儿肺动脉压(PAP)进行监测。术后残余PH患儿继续靶向药物治疗,并于术后随访24个月。结果:经靶向药物治疗,患儿平均血氧饱和度(SpO2)均>95%;术前右心导管检查结果为:MPAP 46~92(75.11±12.98)mmHg;肺血管阻力指数(PVRI)4.62~15.33(10.18±3.07)Wood/unit·m~2;肺循环血液流量/体循环血液流量(Qp/Qs)1.29~2.96(1.85±0.38);30例患儿急性肺血管扩张实验结果为阳性,1例阴性。术后随访中患儿无死亡病例。结论:诊断性药物靶向治疗结合慢性肺血管扩张实验,可为处于临界点的CHD合并重度PH患儿提供根治机会,且靶向药物治疗对术后残余PH患儿继续治疗具有一定疗效。     

单向活瓣补片矫治先天性心脏病合并重度肺动脉高压伴双向分流的疗效评价

目的:评价单向活瓣补片矫治先心病(CHD)合并重度肺动脉高压(PH)伴双向分流的效果及预后。方法:65例CHD+PH患者,采用单向活瓣技术修补畸形。观察术后疗效并随访。结果:术后24h内死亡3例,1周内死亡1例。随访3~120个月,远期死亡3例;术后肺动脉收缩压Pp[65.2±5.1mmHg]较术前Pp[80.3±7.6mmHg]明显降低(P<0.05),术后动脉血气PO2[71.4±3.8mmHg]较术前PO2[58.2±4.6mmHg]明显升高(P<0.05);术后心功能及6min步行实验(6MWT)较术前明显改善。结论 :应用单向活瓣补片技术治疗先心病合并重度肺动脉高压伴双向分流可获得较为满意的疗效。     

6个月以下小婴儿室间隔缺损合并重度肺动脉高压的围术期处理

目的总结6个月以下小婴儿室间隔缺损(VSD)合并重度肺动脉高压(PH)围术期处理的经验。方法2004年3月~2005年10月,我院收治6个月以下VSD合并重度PH患儿20例,体重4.5~7.5kg,年龄2~5.5个月,全组均在体外循环下心内直视手术。结果肺部感染11例,1例气胸,心律失常4例,多器官功能不全2例,死亡2例。结论小婴儿VSD合并重度肺动脉高压术后肺部并发症最常见,合理有效的治疗可获得满意的疗效。     

成人先天性心脏病合并重度肺动脉高压的心内直视手术治疗经验探讨

目的 总结成人先天性心脏病合并重度肺动脉高压患者在体外循环下心内直视手术的处理经验,探讨此类患者手术指征、手术时机,以提高手术效果。方法 回顾性分析2016年1月至2021年12月在安徽医科大学第一附属医院心脏大血管外科行体外循环下心内直视手术治疗的62例18岁及以上先天性心脏病合并重度肺动脉高压患者相关资料,归纳患者术前、术后及随访(通过门诊及电话随访2～40月)时的肺动脉压力、心脏大小、心功能等指标,统计患者死亡和严重并发症情况,同时按照手术入路不同分组(微创手术组、常规手术组),比较两种手术治疗效果的差异。结果 患者术前、术后及随访时的肺动脉压力、左房大小、左室舒张末期直径与射血分数比较,差异均无统计学意义(P＞0.05)。62例患者术后早期死亡4例,死亡率6.5%;肺部感染22例(35.5%),低心排综合征4例(6.5%),低氧血症4例(6.5%),肺动脉高压危象1例(1.6%)。随访期间,失访7例,无随访死亡病例,患者肺动脉压力控制满意,心功能均为Ⅱ级及以上,手术效果良好。微创手术与常规手术治疗效果比较,差异均无统计学意义(P>0.05)。结论 成人先天性心脏病合并重度肺动脉高压患者的心内直视手术治疗的效果满意,微创手术与常规手术治疗效果一致。     

成人重度肺动脉狭窄的手术治疗

目的 总结成人重度肺动脉狭窄手术围术期的治疗经验.方法 11例成人肺动脉狭窄患者接受手术治疗,均行补片右室流出道拓宽,同时矫治合并其他心内畸形.结果 1例因术后静脉血栓导致肺栓塞死亡,另1例因右心功能不全死亡;余9例顺利痊愈出院.结论 手术仍然是治疗成人重度肺动脉狭窄的最有效手段,术后出现的右心功能不全和(或)肺栓塞是影响预后的危险因素.     

风湿性心脏病合并重度肺动脉高压的手术治疗

目的 总结风湿性心脏病合并重度肺动脉高压的手术治疗经验.方法 回顾性分析32例行人工瓣膜置换术的风湿性心脏病合并重度肺动脉高压患者的临床资料,包括术前检查及术前、术中、术后处理方法.结果 无住院死亡病例,术后主要并发症有心律失常、继发性出血、低心排综合征和肾功能衰竭,无肺动脉高压危象发生.术后7～10 d检测肺动脉压力较术前显著降低[(41.9±8.9)mmHg/vs (85.1±13.8)mmHg](P<0.01).19例患者随访6～18个月,无远期死亡病例.结论 掌握手术适应证、充分的术前准备、正确的围术期处理、减少心肌及肺损伤是提高手术治疗风湿性心脏病合并重度肺动脉高压成功率的关键.     

风湿性心脏病合并重度肺动脉高压的手术治疗

目的 总结风湿性心脏病合并重度肺动脉高压的手术治疗经验.方法 回顾性分析32例行人工瓣膜置换术的风湿性心脏病合并重度肺动脉高压患者的临床资料,包括术前检查及术前、术中、术后处理方法.结果 无住院死亡病例,术后主要并发症有心律失常、继发性出血、低心排综合征和肾功能衰竭,无肺动脉高压危象发生.术后7～10 d检测肺动脉压力较术前显著降低[(41.9±8.9)mmHg/vs (85.1±13.8)mmHg](P<0.01).19例患者随访6～18个月,无远期死亡病例.结论 掌握手术适应证、充分的术前准备、正确的围术期处理、减少心肌及肺损伤是提高手术治疗风湿性心脏病合并重度肺动脉高压成功率的关键.     

一期大动脉调转术的主要问题及对策

目的 总结一期大动脉调转术(ASO)治疗完全性大动脉转位(TGA)存在的主要问题并探讨其应对策略.方法 对 2006 年 5 月至 2007 年 8 月收治的 14 例患儿实施一期大动脉调转手术.患儿平均年龄(2.6±0.8)个月(0.5～14 个月);平均体重(3.85±1.30)kg(3～9 kg).室间隔完整 TGA(TGA/IVS)12 例,均合并房间隔缺损(ASD),同时合并动脉导管未闭(PDA)11 例;TGA 合并室间隔缺损(TGA/VSD)2 例,均同时合并 PDA 和 ASD.11 例合并中度肺动脉高压,3 例合并重度肺动脉高压,术前均使用前列腺素 E1(PGE1).手术在全麻、中低温、低流量体外循环下完成.在主动脉、肺动脉瓣上方横断,将左右冠状动脉开口移栽至肺动脉近端.经肺动脉分叉下方,吻合肺动脉近端和升主动脉远端.用自体心包修复主动脉近端缺失部分,并在新主动脉开放后吻合主动脉近端和肺动脉远端.结果 3 例 TGA/IVS患儿术后肺部感染,2 例(分别为 13 个月、3 个月)患儿分别于术后 10 h及12 h 突发室颤死亡.未发生与冠状动脉移植相关并发症.术前肺动脉高压患儿,特别是重度肺动脉高压,术后肺动脉压力均明显下降.12 例术后顺利恢复出院.随诊 3～12 个月,全部患儿心功能恢复良好,无远期并发症和死亡.结论 一期大动脉调转手术对于 TGA 有较好早期治疗效果.针对术中主要问题作出适当的手术应对措施,可以获得满意治疗效果.     

先天性心脏病合并重度肺动脉高压术前应用前列腺素E1的临床观察

目的总结先天性心脏病(CHD)合并重度肺动脉高压(PH)术前应用前列腺素E1的治疗效果.方法对28例CHD合并PH患者采用前列腺素E1(PGE1)进行术前治疗,用量为15～20μg/kg·min-1,每天6～8 h,连续用药10～14 d.测定用药前后其肺动脉平均压、周围动脉氧分压、血氧饱和度及心率、血压的变化.结果PGE1明显改善CHD合并重度PH病人的血液动力学指标.结论先天性心脏病合并肺动脉高压,术前应用PGE1治疗,可提高手术安全性.     

单向活瓣补片在先天性心脏病合并重度肺动脉高压患者外科治疗中的应用

目的探讨单向活瓣补片在先天性心脏病合并重度肺动脉高压患者外科治疗中的临床应用价值。方法选择47例成人先天性心脏病合并重度肺动脉高压病例,采用单向活瓣补片进行心脏间隔缺损修补,麻醉行深静脉穿刺过程中放置Swan-Ganz漂浮导管监测手术前后肺动脉压（PAP）、肺血管阻力（PVR）、心排量（CO）,另抽取外周动脉血检测动脉氧分压（PaO2）等项指标;手术前后行心脏彩超检查了解心脏间隔缺损状况及肺动脉压、间隔分流变化情况,同时检测PAP变化。结果采用单向活瓣补片修补技术,患者术后早期PAP、PVR即较术前明显减低（P〈0.05）,PaO2、CO增加,随访4~20个月,PAP进一步减低,心功能明显改善。全组除1例因术后低心排死亡外,其余均无肺动脉高压危象或心力衰竭发生。随访中发现2例术后PH持续存在,单向活瓣持续右向左分流,其余44例心脏彩超提示术后1~6个月活瓣关闭（平均3.6个月）、分流消失,PH自术前的（76.81±13.33）mmHg降至（37.23±9.46）mmHg（P〈0.01）。结论应用单向活瓣补片修补技术能显著降低先天性心脏病合并重度肺动脉高压病例的手术风险。     

Acupuncture Treatment of Vomiting

CASE HISTORY A female patient, 46 years old, head of the foreign affairs department of a certain university in Beijing, paid her first visit on October 9, 2006, with the chief complaint of vomiting for one month. She got vomiting after meals in early September. Before that, she had discomfortable sensation in the stomach due to angry with others, but she didn't pay much attention. Later, it developed into vomiting after eating. After the vomiting, the discomfort would be relieved, but with slight hypodynamia. She was once diagnosed as having 'neurogenic vomiting'. Having taken some western and Chinese drugs, the above symptoms were a little bit improved, but she would have nausea upon eating and with regurgitation. Because of the fear for vomiting, she did not dare to have food intake, with body weight reduction of 6 kilos in one month.     

Qiu Baoguo''''s Experience in Treating Consumptive Syndromes after Radio-Chemotherapies

Radiotherapy and chemotherapy are the important modern medical therapies for malignant tumors,yet they can also bring about serious local and systemic toxic side reactions so to decrease the patient;'s life quality,manifested by a series of consumptive symptoms.Having engaged in the combined work of Chinese and western medicine for nearly 50 years,the research fellow Qiu Baoguo in Henan Provincial Academy of TCM has developed his unique views on the TCM study of consumptive syndromes.The author of this essay had once the fortune tO follow Dr.Qiu in clinic,and specially would like to introduce in the following Dr.Qiu's experience in treating consumptive syndromes after radio-chemotherapies for patients with malignant tumor.     

Insomnia Due to Deficiency of Both the Heart and Spleen Treated by Acupuncture-Moxibustion and Chinese Tuina

OBJECTIVE: To observe therapeutic effects of the comprehensive therapy of acupuncture-moxibustion and Chinese Tuina for treatment of insomnia due to deficiency of both the heart and spleen. METHODS: 92 cases were divided randomly into the treatment group (treated by acupuncture-moxibustion and Chinese Tuina) and the control group (treated by acupuncture-moxibustion). RESULTS: The therapeutic effect of the treatment group was obviously superior to that of the control group (the CHI2 test showed P < 0.01). CONCLUSIONS: The comprehensive therapy of acupuncture-moxibustion and Chinese Tuina can give marked therapeutic effects for treatment of insomnia due to deficiency of both the heart and spleen.     

Analysis of CK-19,PDX-1,Nestin,Ngn3 in different donor islet purity in rats

Objective: To investigate if there are the CK-19, PDX-1, Nestin, Ngn3 positive cells in the donor islets of different purity in rats. Methods: Thirty male adult SD rats were randomly divided into 3 groups. Islets were isolated using digestion by ductal injection of collagenase. Group Ⅰ (n=10): Separating cell preparations were not purified, Group Ⅱ(n=10): Islet sediment was purified with 25% Ficoll400 ,Group Ⅲ (n=10): Islet sediment was purified with 25% and 11% Ficoll-400. The levels of protein of CK-19, PDX-1, Nestin and Ngn3 were detected by immunohistochemistry and the mRNA of CK-19, PDX-1, Nestin, Ngn3 was amplified by RT-PCR. Results: After two different purification methods applied, three islet preparations of different purities were obtained. The difference of islet purity was significant among various groups (P＜0.05). Compared with group Ⅱ and group Ⅲ,the protein and mRNA of CK-19, PDX-1, Nestin,Ngn3 were both higher in group Ⅰ; group Ⅲ was poorly expressed. Conclusions: The three different islet purity donor islet have different CK-19, PDX-1, Nestin, Ngn3 positive cells within them, indicating that there are some islet stem cells in the purified donor islet.     

A preliminary screening study on the associated proteins in human psoriasis vulgaris by serum proteomics technologies

Objective：To investigate the optimum screening conditions of associated proteins in human psoriasis vulgaris by serum proteomics technique, and to screen the different expression proteins related with psoriasis vulgaris. Methods：Serum samples of peripheral blood were collected from newly diagnosed psoriasis vulgaris patients in the clinic, and 20 matched healthy persons. Serum albumin IgG was removed by filtering with ProteoExtract Albumin/IgG. After comparative proteomics analysis the different protein spots were identified using 2-DE and MS. Results ：Electrophoresis figures with high resolution and reproducibility were obtained. Three different expression proteins were found only in the serum from psoriasis vulgaris patients, while nine other different proteins expressing from healthy volunteers. Conclusion：The protein expression was different in the serum between the psoriasis vulgaris patients and healthy volunteers. It was hoped that we could find the biomarkers related to psoriasis vulgaris by using proteomics.     

A CASE OF HUGE GASTRIC DISOPYROBEZOAR

PYTOBEZOARS are common bezoars in gastrontestinal tract, commonly seen in stomach and mall intestine,1but huge disopyrobezoars are     

Acupuncture Treatment of Chest Bi Syndrome

CASE HISTORY A male,a retired officer of 61 years old,paid his first visit on May 12,2006.The patient stated that 2 weeks before he suddenly got paroxysmal precordial choking pain,with irregular attacks.Each attack would last several seconds to several minutes.The attack was accompanied with heavy oppressed sensation in the precordial region,palpitation,lassitude,and in severe cases,sweating,which was once diagnosed by a hospital as'coronary heart disease'.Recalling the case history,the patient said that several days before he got angry with others because of some affairs in work,and he was not so used to the life pattern since he had just retired from his busy working post.At usual times,he was quick tempered and peevish.In recent days,he had poor appetite,and loose stool.     

Instructions to Contributors

The English edition of Chinese Journal of Integrative Medicine is edited and published by the Chinese Journal of Integrated Traditional and Western Medicine Press.Original scientific papers of advanced clinical and experimental medicine in the field of complementary/alternative medicine or integrative medicine are expected.