定量组织速度成像用于左室舒张功能的评价

目的 应用定量组织速度成像（QTVI）测定二尖瓣环运动速度评价高血压病患者左室舒张功能。方法 应用定量组织速度成像测定30例正常人和60例高血压病患者的二尖瓣环舒张早期峰值速度（Ve）、左房收缩期峰值速度（Va），计算Ve／Va比值；并用脉冲多普勒测定二尖瓣口舒张早期峰值血流速度E峰、舒张晚期峰值血流速度A峰，计算E／A值。结果 正常组舒张早期峰值速度（E）〉左房收缩期峰值速度（A），E／A〉1；二尖瓣环舒张早期峰值速度（Ve）〉左房收缩期峰值速度（Va），Ve／Va〉1，高血压病人组二尖瓣口血流频谱及二尖瓣环运动组织速度成像测值差异有显著性，高血压组中二尖瓣环运动速度Ve／Va与二尖瓣血流频谱V／A差异无显著性。但在检出病例中QTVI明显优于血流频谱。结论 应用定量组织速度成像测定二尖瓣口运动速度能较准确估计高血压病患者左室舒张功能。     

彩超对二尖瓣舒张期血流速度与室壁组织运动速度测定左室舒张功能的对比观察

目的 对比观察二尖瓣舒张期血流速度与室壁组织运动速度(TVI)对左室舒张功能测定的临床意义.方法 使用彩色多普勒超声诊断仪对1315例患者的二尖瓣舒张期血流速度与室壁组织运动速度(TVI)进行检测,二种方法均取心尖四腔心切面,二尖瓣舒张期血流速度的测量:将取样容积置于二尖瓣瓣尖部附近的左室腔内,测量E峰、A峰最大血流速度;室壁组织运动速度的测量:将取样容积置于左室侧壁二尖瓣环处,测量舒张早期e波峰值及舒张晚期a波峰值组织运动最大速度.结果 彩色多普勒超声对二尖瓣舒张期血流速度与室壁组织运动速度对比分析,表明二者对左室舒张功能的评定均有意义.但在心室负荷过重、心率快、心房纤颤、二尖瓣中、重度反流等情况下,采用二尖瓣舒张期血流频谱测定左心室功能受到限制,而室壁组织运动速度不受上述因素的影响,评价左室舒张功能更具优势.结论 二尖瓣舒张期血流速度与室壁组织运动速度评价左室舒张功能比较:室壁组织运动速度较二尖瓣舒张期血流速度对左心室舒张功能的测定更具敏感性.二者结合应用可提高对左心室舒张功能评价的准确性.     

组织多普勒成像技术测量E／e＇评估尿毒症患者左室舒张功能

目的：利用组织多普勒技术测量尿毒症患者二尖瓣E／e＇来评价尿毒症患者的左室舒张功能。方法：选取左室射血分数正常的尿毒症患者52例（观察组）及健康成人37例（对照组）作为研究对象,利用组织多普勒分别测量二尖瓣口血流频谱舒张早期E峰峰值流速,舒张晚期A峰峰值流速及二尖瓣口运动频谱舒张早期峰值速度e＇及舒张晚期峰值速度 a＇,然后比较两组之间E／A、e＇／a＇的变化,并利用E／e＇来评价左室舒张功能的变化。结果：尿毒症患者（观察组）52例E 峰峰值流速及e峰峰值运动速度较正常对照组均有不同程度的降低,E／A、e＇／a＇减低,E／e＇较正常对照组明显升高,其差异具有统计学意义（ P ＜0．05）。结论：组织多普勒成像技术测量E／e＇是评估尿毒症患者左室舒张功能的一个较好指标,较传统的左室舒张功能测量方法更精确,重复性好。     

高血压病左心室肥厚QTd检测

目的探讨高血压病患者左室肥厚和舒张功能受损时的QT离散度（QTd）变化。方法74例高血压病患者，用多导联同步心电图测量并计算出QTd，超声心动图测量E／A比值和等容舒张时间（IRTms），计算左室重量（LVM）和左室重量指数（LVMI），作相关分析。结果左室肥厚（LVH）组46例的QTd显著高于非LVH组，P＜0．001。LVH组均有不同程度的E峰下降、A峰增大、E／A比值减少及IRT延长。QTd与A、IRT呈正相关（r＝058、0．60），与E呈负相关（r＝0．55）。结论QTd增大与左室肥厚及舒张功能相关。     

多普勒组织成像技术对高血压患者左室舒张功能临床评价

目的采用多普勒组织成像技术(DTI)检测二尖瓣环舒张期运动速度,评价高血压患者左室舒张功能的临床价值。方法将82例原发性高血压患者分为两组:心肌不增厚组(non-LVH)35例,心肌增厚组(LVH)47例;另设对照组(健康人)101例。①在二尖瓣环后间隔和左侧壁位点,用DTI法分别检测高血压患者及健康人舒张早期e1、e2,舒张晚期a1、a2峰值,同时计算e/a比值。②在二尖瓣口用血流脉冲多普勒法(PWD)测舒张期血流E峰、A峰、E/A比值。③取右上肺静脉(PV)频谱,测收缩期血流速度(PVS)、舒张期血流速度(PVD)、S/D比值及心房收缩期逆向血流速度(PvaV)及时间(PvaT),并进行对照分析。结果①高血压患者non-LVH组、LVH组二尖瓣环DTI参数e1、e2、e1/a1、e2/a2均明显低于对照组(P<0.01)。②non-LVH、LVH组二尖瓣口血流参数E、E/A明显低于对照组(P<0.05,P<0.01),而A明显高于对照组(P<0.05)。non-LVH组、LVH组DTI与PWD参数相关性分析表明:e1/a1、e2/a2与E/A比值呈正相关,相关性良好(r=0.65,r=0.76;r=0.56,r=0.64;均P<0.01)。③non-LVH组、LVH组PV参数S/D比值明显高于正常组(P<0.05,P<0.01)。LVH组PvaV、PvaT,明显大于正常组及non-LVH组(均P<0.01)。结论DTI二尖瓣环运动速度能客观反映左室舒张功能受损。DTI结合肺静脉血流参数,可提高综合分析高血压病左室舒张功能的准确性。     

组织多普勒成像技术评价高血压患者左室舒张功能

目的:探讨采用组织多普勒成像技术(DTI)检测二尖瓣环舒张期运动速度,评价高血压患者左室舒张功能的临床价值.方法:将82例原发性高血压患者分为两组:心肌不增厚组(non-LVH)35例,心肌增厚组(LVH)47例;另设对照组(健康人)82例.①采用DTI分别测量舒张早期e1、e2峰,舒张晚期a1、a2峰,同时计算e/a比值;②二尖瓣口下血流频谱测E峰、A峰、E/A比值;③取右上肺静脉(PV)频谱测肺静脉收缩期血流速度PVS,舒张期血流速度PVD,S/D比值及心房收缩期逆向血流速度(PvaV)及时间(PvaT).结果:①高血压患者non-LVH组、LVH组二尖瓣环DTI参数e1、e2 、e1/a1、e2/a2均明显低于对照组(P<0.01,P<0.05).②non-LVH、LVH组二尖瓣口血流参数E、E/A明显低于对组(P<0.01,P<0.05),而A明显高于对照组(P<0.01,P<0.05).non-LVH组、LVH组DTI与PWD参数相关性分析表明:e1/a1、e2/a2与E/A比值呈正相关(r=0.65,r=0.76,r=0.56,r=0.64,P<0.01).③non-LVH组、LVH组PV参数S/D比值明显高于对照组(P<0.01,P<0.05).LVH组PvaV、PvaT明显大于对照组及non-LVH组(P<0.01).结论:DTI二尖瓣环运动速度能客观反映左室舒张功能受损情况;DTI结合肺静脉血流参数,可提高综合分析高血压左室舒张功能的准确性.     

多普勒组织成像技术对高血压患者左室舒张功能的研究

目的:探讨多普勒组织成像(Doppler Tissue Imaging,DTI)技术评价高血压病(EH)患者左室舒张功能的价值,以寻求早期获得高血压左室舒张功能可靠而客观的方法。方法:36例正常人和27例EH患者(伴心肌肥厚者15例和不伴心肌肥厚者12例),用DTI法分别检测正常人及EH患者二尖瓣环室间隔侧及侧壁侧舒张早期运动速度(Ea)、舒张晚期运动速度(Aa)及Ea/Aa,并用二尖瓣血流多普勒法检测舒张期血流速度E、A及E/A以作比较。结果:正常人Ea、Aa、Ea/Aa与年龄相关,EH患者相关性降低;高血压组Ea、Ea,/Aa较正常人减低有显著性意义(P<0.01),且心室肥厚(LVH)组比非肥厚(non-LVH)组降低更明显。EH患者二尖瓣血流频谱E、E/A虽降低,但左室肥厚组与非肥厚组无明显差异(P>0.05)。结论:DTI法能简便准确地定量EH患者二尖瓣环舒张期运动速度的改变,从而准确判断舒张功能受损程度,此法优于二尖瓣血流频谱法。     

高血压左室肥厚与左室舒张功能减低的关系

目的：观察高血压引起左室肥厚与左室舒张功能的关系。方法：对正常对照组56例及高血压组98例应用超声心动图检测,分别测定左室内径（LAD）、舒张末左室内径（LVDd）、舒张期室间隔厚度及左室壁厚度（PWT）,计算左室肌重、左室肌重指数（LVMI）。分别测定LVH组、NLVH组二尖瓣下血流E峰及A峰,并计算A／E比值,判定为左室舒张功能。结果：高血压组较正常对照组的LVST、PWT及LVMI均有不同程度的升高,98例高血压组病人中有48例LVH,占49．0％,其中34例二尖瓣下血流A／E〉1判定为左室舒张功能减退,占70．8％;而NVLH50例,二尖瓣下血流A／E〉1仅10例,占20．0％,差异有显著性（P〈0．05）。说明左室肥厚可使左室舒张功能减低。     

多普勒组织成像技术对高血压患者左室功能的评价

目的:了解采用多普勒组织成像技术(TDI)检测二尖瓣环运动速度对评价高血压患者左室功能的临床价值。方法:根据左室质量指数(LVMI)将78例高血压患者分为左室肥厚组(n=32)和左室非肥厚组(n=46),另设正常对照组(n=31),分别行常规超声心动图检查测量左室射血分数(EF),二尖瓣口舒张早期与舒张晚期血流峰值之比(E/A)。在TDI模式下获得二尖瓣环运动频谱,测量收缩期峰值速度(Vs)舒张早期峰值速度(Ve),舒张晚期峰值速度(Va),并计算Ve/Va比值。结果:(1)高血压组与正常对照组EF值均正常,高血压病左室肥厚组(LVH)Vs低于左室非肥厚组(NLVH)及对照组,高血压组E/A、Ve、Ve/Va均低于对照组,且肥厚组低于非肥厚组,高血压组E/A低于对照组、Va高于对照组,P均<0.05;(2)二尖瓣环Ve/Va、Ve、Va与二尖瓣口血流E/A比值有关,其中以Ve/Va与E/A的相关性最好。结论:TDI技术测定二尖瓣环运动速度能客观反映左室功能,结合多普勒超声可提高综合分析高血压病左室舒缩功能的准确性。     

超声应变率对不同构型高血压患者左心室舒张功能的评价

目的应用应变-应变率探讨不同左心室构型的原发性高血压患者左心室长轴方向应变-应变率在舒张期的变化。方法采用M型、二维超声测量不同构型高血压患者左心室室壁厚度、左室舒张末期内径,并计算左心室质量指数（LVMI）、相对室壁厚度（RWT）,根据LVMI和RwT将高血压分为正常左室构型（B）;向心性重构（C）,向心性肥厚（D）和离心性肥厚（E）四组,每组均取20例,正常对照组20例（A）,测量二尖瓣血流频谱E、A及左室平均应变率e、a。结果舒张期高血压各组应变率6减低、a增高,e／a比值减小,在各组间差异存在统计学意义（P〈O．05）;且E／A与e／a结论一致。结论应变一应变率成像为临床提供了一个敏感、简便、可靠的评价原发性高血压患者左室舒张功能的指标。     

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.     

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…     

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.     

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.     

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.     

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.     

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.