人脐带间充质干细胞治疗失代偿性肝硬化患者的初步研究

目的评价人脐带间充质干细胞(UC-MSCs)治疗失代偿性肝硬化的安全性及临床疗效。方法采用平行对照、单盲法将26例失代偿性肝硬化患者进行分组,其中20例为治疗组,接受UC-MSCs外周静脉回输治疗;6例为对照组,给予0.9%NaCl溶液回输,两组均同时行综合内科治疗。测定回输后不同时间点治疗组与对照组白蛋白(Alb)、下腹腹水及终末期肝病模型(MELD)评分的变化。结果 UC-MSCs回输后,除个别患者体温有自限性升高外,无其他不良反应。接受UC-MSCs回输48周后,Alb较治疗前显著升高、腹水较治疗前显著减少(P<0.05);随访末,两组腹水情况比较,差异有统计学意义(P<0.05),但MELD评分差异无统计学意义(P>0.05)。结论人UC-MSCs治疗失代偿性肝硬化患者安全性好,能减轻患者的临床症状,减少腹水形成。     

以肺不张为表现生长三年的腺样囊性癌一例并文献复习

腺样囊性癌为低度恶性肿瘤,病史相对较长,淋巴转移率低,血行转移慢,早期手术治疗预后较好。分析2011年10月我院收治的1例腺样囊性癌的临床资料及诊治经过,并结合相关文献进行复习,旨在提高对肺的腺样囊性癌临床及影像学特点的认识。     

植入起搏器的阵发性心房颤动患者导管消融术后临床分析

目的 对导管消融治疗阵发性心房颤动(房颤)合并窦房结功能障碍植入永久起搏器治疗的患者进行分析,比较传统心电图记录判断房颤复发率与起搏器程控记录模式转换事件判断房颤复发率有无差别.方法 所有患者因阵发性房颤接受导管消融治疗,因合并病态窦房结综合征于导管消融前后植入双腔起搏器治疗.消融术后3个月随访开始记录房颤发作情况.分别通过传统记录方式(心电图、24 h动态心电图)和起搏器程控记录(模式转换事件)判断房颤复发情况.结果 共40例(男28例)患者纳入研究,平均年龄(46.00±9.37)岁,左心室射血分数0.52 ～0.73 (0.61±0.03),左心房内径31.00 ～38.00(34.00±6.56)mm,随访4.5～42.0(25.0±8.2)个月.随访结束时,38例患者维持窦性心律.根据临床症状、心电图、24 h动态心电图诊断房颤复发10例(25％);根据起搏器程控记录房颤复发16例(40％).结论 合并病态窦房结综合征的阵发性房颤患者,需要植入永久起搏器.导管消融术后根据心电图和起搏器腔内电图判断房颤的复发率有无差别.     

血清可替宁水平与冠心病的关系

目的研究血清可替宁水平与冠心病的关系,探讨其在冠心病中的临床应用价值。方法按冠状动脉造影结果将149例研究对象分为冠心病组(97例)和非冠心病对照组(52例),进行病例对照研究,同位素稀释串联质谱法(isotope dilution tandem mass spectrometry,ID-LC/MS/MS)测定血清可替宁浓度,分析可替宁与冠心病及其他危险因素的关系。结果 149例行冠状动脉造影患者血清可替宁浓度呈偏态和尖态分布(偏度2.90,峰度7.96),吸烟者的可替宁浓度为12.64(0.91～99.61)μg/L,显著高于非吸烟者[0.22(0.12～0.51)μg/L,P<0.001]。高可替宁水平组(>10.00μg/L)患冠心病的风险显著高于低可替宁水平组(<1.00μg/L)(OR=2.94,95%CI:1.11～7.78,P<0.05);且随着血清可替宁水平的升高,OR值增大呈量效关系(均为P<0.05)。多因素Logistic回归分析显示,糖尿病、血脂异常及可替宁为最显著的危险因素(均为P<0.05)。血清可替宁与吸烟(r=0.656,P<0.001)和白细胞计数(WBC,r=0.257,P=0.010)呈显著正相关,与HDL-C(r=-0.184,P=0.025)和HDL2-C(r=-0.217,P=0.008)呈显著负相关。结论血清可替宁水平能够有效地反映吸烟的暴露水平,其水平升高能够增加患冠心病的危险。     

P2X_1受体在急性冠状动脉综合征中的表达

目的观察P2X1受体在急性冠状动脉综合征(ACS)患者血小板中的表达及激活P2X1受体后血小板钙离子浓度的变化,探讨P2X1受体在ACS发生时对血小板功能的调节作用。方法选取70例ACS患者为研究对象,其中急性心肌梗死(AMI)患者30例,不稳定型心绞痛(UA)患者40例,同期入院的健康受试者20例为对照组。应用反转录-聚合酶链反应(RT-PCR)和实时荧光定量PCR方法,观察P2X1受体和血小板膜糖蛋白Ⅱb/Ⅲa(GPⅡb/Ⅲa)受体在对照组和ACS组血小板中的表达情况。以α,β-me ATP(3μmol/L)激活血小板,Fluo-3 AM Ester为标记物在荧光分光光度计下观察血小板钙离子水平变化。结果对照组及ACS组的血小板中均有P2X1受体、GPⅡb/Ⅲa受体的表达,且在ACS组的表达较对照组高(1.62±0.69比0.88±0.04,1.58±0.11比0.85±0.06,P<0.05);ACS组患者钙离子基线水平高于对照组[(418.96±31.85)nmol/L比(307.20±23.37)nmol/L,P<0.05]。结论 P2X1受体在ACS的发生发展过程中起重要作用。     

经导管注入利福平灭菌粉末(维夫欣)治疗支气管结核疗效观察

目的探讨经导管注入利福平治疗支气管结核合并感染的临床疗效。方法 84例支气管结核合并感染患者分为治疗组44例,对照组40例,治疗组经导管注入利福平与对照组进行比较,观察两组患者临床症状改善、痰菌阴转、镜下改变情况。结果治疗组患者临床症状改善较对照组快,治疗1、2、3月末时治疗组痰菌阴转率为47.7%、90.9%、97.7%,治疗组总有效率为81.8%、90.9%、97.7%,均高于对照组的37.5%、70%、82.5%,57.5%、72.5%、80%。结论经支气管镜行导管内注入利福平治疗支气管结核合并感染安全有效且无明显不良反应发生。     

帕瑞昔布钠超前镇痛对胸腔镜肺大疱切除术后疼痛的影响

目的 观察帕瑞昔布钠(特耐)超前镇痛对胸腔镜肺大疱切除术后疼痛的影响.方法 选择双腔气管插管全麻下择期行肺大疱切除术患者60例,随机均分为观察组和对照组.两组患者麻醉诱导用药与麻醉维持用药均相同,观察组术前15 min静注特耐40 mg,对照组静注生理盐水2 ml.术后15 min、1 h、2 h、4 h、8 h、12 h采用视觉模拟评分法(VAS)评估两组患者疼痛程度;同时观察患者术后呼吸抑制、皮肤瘙痒、恶心呕吐、头晕等不良反应发生情况.结果 与对照组比较,观察组术后各时点VAS评分明显降低(P<0.05);观察组2例(6.6%)发生不良反应,对照组3例(10.0%)发生不良反应,两组比较,差异无统计学意义(P>0.05).结论 帕瑞昔布钠超前应用于胸腔镜肺大疱切除术后镇痛效果确切,不良反应无明显增多,有利于患者术后恢复.     

APACHEⅢ评分及氧合指数对老年重症肺炎预后影响的分析

目的 探讨APACHEⅢ评分与氧合指数对老年重症肺炎预后的影响.方法 56例患者,根据出院是否存活,分为存活组与死亡组,测定动脉血气,计算氧合指数,进行APACHEⅢ评分,分析APACHEⅢ评分与氧合指数对预后的影响.结果 存活组APACHEⅢ评分及氧合指数与死亡组比较,均有显著差异(P＜0.05),死亡组APACHEⅢ评分随住院延长而增高,氧合指数随住院延长而降低,存活组与之相反.氧合指数与APACHEⅢ评分负相关(r=-0.7542,P＜0.01).结论 APACHEⅢ评分与氧合指数有助判断病情危重程度,观察两者变化,对判断预后有一定的作用.     

Identification of the slow conduction zone in a macroreentry circuit of verapamil-sensitive idiopathic left ventricular tachycardia using electroanatomic mapping

Identification of the Slow Conduction Zone in a Macroreentry. Background: Although idiopathic left ventricular tachycardia (ILVT) has been shown to possess a slow conduction zone (SCZ), the details of the electrophysiological and anatomic aspects are still not well understood. Objective: We hypothesized that the SCZ can be identified using a 3‐dimensional electroanatomic (EA) mapping system. Methods : Ten patients with ILVT were mapped using a 3‐dimensional electroanatomic (EA) mapping system. After a 3‐dimensional endocardial geometry of the left ventricular was created, the conduction system with left Purkinje potential (PP) and the SCZ with diastolic potential (DP) in LV were mapped during sinus rhythm (SR) and ventricular tachycardia (VT) and were tagged as special landmarks in the geometry. The electrophysiological and anatomic aspects of it were investigated. Results: EA mapping during SR and VT was successfully performed in 7 patients, during VT in 3 patients. The SCZ with DPs located at the inferoposterior septum was found in 7 patients during SR and all patients during VT. The length of the SCZ was 25.2 ± 2.3 mm with conduction velocity 0.08 ± 0.01 m/s. No differences in these parameters were found between patients during SR and VT (P > 0.05). An area with PP was found within the posterior septum. A crossover junction area with DP and PP was found in 7 patients during SR and VT. This area with DP and PP during SR coincided or were in proximity to such area during VT and radiofrequency ablation targeting the site within the area abolished VT in all patients. Conclusion: The ILVT substrate within the junction area of the SCZ and the posterior fascicular can be identified and can be used to guide the ablation of ILVT. (J Cardiovasc Electrophysiol, Vol. 23, pp. 840‐845, August 2012)     

Cardiac Resynchronization Therapy: Do Women Benefit More Than Men?

Gender and Resynchronization Therapy. Introduction: Women are underrepresented in cardiac resynchronization therapy (CRT) trials. Whether there is a gender difference in the benefit derived from CRT has not been well studied. Methods: This study included 728 consecutive CRT recipients at our institution who met guidelines for placement of a CRT device. Clinical characteristics and echocardiographic parameters were collected at baseline and after CRT; Kaplan–Meier survival analysis was performed using a national death and location database. The effects and outcome of CRT were compared between women and men. Results: Of 728 patients, 166 were female (22.8%). Female patients were younger than male patients (66.0 ± 11.9 years vs 69.4 ± 10.9 years; P < 0.001) and more often had nonischemic cardiomyopathy (68% vs 36%; P < 0.001). Both female and male patients had significantly improved clinical and echocardiographic parameters after CRT. The magnitude of improvement was similar in women and men, except that improvement in New York Heart Association (NYHA) class was greater in women than in men (–0.79 ± 0.78 vs –0.56 ± 0.85; P = 0.009). Although women were at lower risk of death than men after CRT (hazard ratio, 0.51; 95% confidence interval, 0.35–0.75; P < 0.001, unadjusted), multivariate analysis indicated gender was not, but age at CRT placement, cardiomyopathy cause, NYHA class, and lead location were independent predictors of survival. Conclusion: Female CRT recipients seem to achieve greater survival benefit than male recipients. However, this benefit is majorly driven by nonischemic cardiomyopathy and other clinical factors. (J Cardiovasc Electrophysiol, Vol. 23, pp. 172‐178, February 2012)