正常人收缩期左侧房室平面位移的超声心动图检测

目的：利用超声心动图检测正常人左侧房室平面位移幅度。方法：被检对象为１４４ 例正常人,男７２ 例,女７２ 例。按不同年龄分为６ 组,分别为：Ⅰ组（ｎ＝ ２４ ,３～６ 岁）;Ⅱ组（ｎ＝２４ ,７～１４ 岁） ;Ⅲ组（ｎ＝２４,１５～１９ 岁） ;Ⅳ组（ｎ＝ ２４,２０～３９ 岁）;Ⅴ组（ｎ＝２４ ,４０ ～５９ 岁） 及Ⅵ组（ｎ＝ ２４ ,≥６０ 岁）。结果：①左心收缩期房室平面位移测值在Ⅰ组～Ⅴ组之间无显著性差异（ Ｐ＞０－０５）,而Ⅵ组测值较Ⅰ组～Ⅴ组的测值均低（ Ｐ＜ ０－０５）;②左心收缩期房室平面位移测值不受心率、血压、体表面积及性别的影响。结论：①左侧房室平面位移测值受年龄因素影响;②制定正常左侧房室平面位移测值可以不考虑心率、血压、体表面积及性别的影响     

Three-dimensional imaging of mitral and tricuspid annuli for total artificial heart implantation

The establishment of a method to clarify the three-dimensional interrelations among the mitral annulus, tricuspid annulus, ascending aorta, and main pulmonary artery, which constitute the interface between the human and total artificial heart (TAH), is essential to the design of the TAH. In a previous study based on transverse magnetic resonance (MR) images of a live human heart, reconstructed images of mitral and tricuspid annuli were found to be deformed. The present study of cadaver and beating hearts revealed that the optimal conditions for atrioventricular annular reconstruction of a beating heart with electrocardiogram-gated MR imaging include use of four-chamber imaging, 5 mm slice thickness, and a slice interval ranging from 5 to 7 mm. Under these conditions, the mitral and tricuspid annuli of 3 beating hearts were reconstructed successfully. It was recognized that during the systolic phase the mitral and tricuspid annuli move anteriorly, leftward and downward, and that in late systole the right lateral margin of the tricuspid annulus is close to the sternum.     

经椎板间隙入路显微内窥镜手术治疗腰椎间盘突出症

目的：探讨经椎板间隙入路显微内窥镜手术治疗腰椎间盘突出症的手术适应证，手术存在问题及解决方法。方法：用METRX治疗腰椎间盘突出症l16例，详细介绍手术过程、操作技巧、手术适应证和术中注意问题。结果；平均随访15．1个月，按Nakal疗效评定分级属优90例，良22例，可2例，差2例，优良率96．6％。结论：严格掌握手术适应证、准确定位、娴熟操作技巧、彻底止血、术后有计划的康复训练是手术成功的关键。     

"脊柱九针疗法"治疗腰椎间盘突出症40例

目的　观察采用“脊柱九针疗法”治疗腰椎间盘突出症的疗效。方法与结果　选择 4 0例经 CT检查确诊为腰椎间盘突出症 ,并有典型临床症状的患者作为研究对象 ,选用突出椎间盘的相应椎体及上下两个节段椎体棘突下和“夹脊穴”为主进针点 ,针刺治疗腰椎间盘突出症 ,总有效率为 10 0 %。结论　“脊柱九针疗法”较常规针刺取穴方法具有针对性强 ,针感强 ,疗效明显之特点 ,且取穴简便 ,操作简单安全。     

Diagnostic and Perinatal Management of Fetal Extrasystole

Fifty fetuses referred to the Polish Mother's Memorial Hospital for fetal echocardiography between January 1, 1991 and June 1, 1995 were evaluated. The mean fetal gestational age at the time of diagnosis of arrhythmia was 34.1 weeks, and the mean gestational age at the time of delivery was 38.7 weeks. Checkup echocardiographic examinations were performed every 10–14 days, for a mean 2.4 studies per fetus. In most cases (48/50, 96%), premature atrial contractions were present during the first echocardiography examination. The fetal heart study was normal in 30 cases; in 7 (14%) there was tricuspid valve regurgitation, in 7 (14%) an atrial septal aneurysm, in 4 congenital heart defects, in 1 myocardial hypertrophy, and in 1 disproportion in the four-chamber view. Of the 50 fetuses, 43 underwent regular echocardiographic monitoring alone; in 7 cases, based on the presence of additional echocardiographic findings, pharmacotherapy was applied (digoxin, verapamil, or both). Three neonates died after delivery owing to malformations in two cases (one critical aortic stenosis, one spina bifida plus hygroma colli) and due to myocarditis in one case. In six of seven newborns treated in utero, myocarditis was diagnosed after birth (including the one with neonatal demise). Most of the newborns were in good condition after birth, their mean Apgar score being 8.6 and the mean birth weight 3259 g. We concluded that most extrasystoles represent an isolated anomaly, not affecting the fetal condition. Their presence should not influence the obstetric care and may require only echocardiographic monitoring. In most of our cases the premature contractions subsided after birth, although sometimes they preceded fetal supraventricular tachycardia or appeared after congenital myocarditis.     

Morphology of Tricuspid Valve in Pulmonary Atresia with Intact Ventricular Septum

Pulmonary atresia with intact ventricular septum (PAIVS) is a rare congenital cardiac anomaly that has been classified into two types: one is a more frequent type having dysplasia of tricuspid valve (TV) with a small annulus, underdeveloped right ventricle (RV) with a hypoplastic cavity and a hypertrophic wall; the other type has severe dysplasia of TV and dilatation of RV, right atrium (RA), and right atrioventricular junction with thinning of the RV wall. We performed a morphologic study on 11 autopsied hearts with PAIVS, giving particular emphasis to the variation of morphology of the TV. We could classify these hearts into 3 groups according to the degree of right ventricular development. In the first group of 7 cases (type I), the RVs were underdeveloped. Thick leaflets, restricted valve apparatus with short chordae, and small annuli were characteristics of the TV. In the second group of 3 cases (type II), the RVs showed marked enlargement of the cavity and thinning of the wall. The TV showed redundant, dysplastic, sail-like anterior leaflets, and the downward displacement of septal leaflet and/or posterior leaflet, which are the findings frequently observed in Ebstein's malformation. The RVs were dilated and with partially unguarded tricuspid orifice. The septal leaflet of the TV was dysplastic and, in two cases, the septal leaflet showed chordal structure at the upper surface facing the RA, which is a peculiar finding that has not been described in the literature. The remaining case was a heart with a moderately developed RV (type III). The TV showed mildly dysplastic appearance and we classify this as a separate type, because we could expect the best surgical results in this type. This type had optimal size of RV and the mildest degree of dysplasia of TV. In PAIVS, the morphology of TV correlates well with the type of the right ventricular development.     

The Histology of the Lung in Neonates with Tricuspid Valve Disease and Gross Cardiomegaly Due to Severe Regurgitation

Lung autopsies from four neonates with Ebstein's anomaly or tricuspid valve dysplasia and gross cardiomegaly were examined. The mean cardiothoracic ratio was 92 ± 0.5%. The degrees of pulmonary hypoplasia and pulmonary artery muscularization were assessed and were compared with those in lungs from four controls and four patients with diaphragmatic hernias. Lung and body weight ratios and radial alveolar counts, which reflect pulmonary hypoplasia and immaturity, were significantly decreased only in patients with diaphragmatic hernia. The thickness of the medial muscle layer in small pulmonary arteries was greater in patients with diaphragmatic hernia; however, in patients with tricuspid valve disease, it was relatively small. Abnormal vascular muscle extension was seen only in patients with diaphragmatic hernia. In the cases of tricuspid valve disease, although cardiomegaly and lung compression were severe, lung hypoplasia and immaturity were not, and neither abnormal medial thickening nor extension were found. Our results suggest that, at least in full-term infants with tricuspid valve disease, surgical relief of lung compression may improve respiratory function, even if the cardiomegaly is severe.     

新生儿巨结肠术前多功能洗肠机的设计和研制

提出一种新型的新生儿多功能洗肠机的设计思想,并详细介绍机器的结构及各组成部分的功能.临床应用在一定程度上减轻了临床医护人员的劳动强度,同时缩短了先天性新生儿巨结肠患者术前灌肠的准备时间,并减少了患儿的并发症,具有一定的应用价值.     

麻醉对腰椎间盘突出症手术病人T淋巴细胞亚群的影响

目的研究不同麻醉方法对围手术期腰椎间盘突出症病人细胞免疫功能的影响。方法应用流式细胞仪,对58例采用局麻和硬膜外麻醉方法接受腰椎间盘髓核摘除术病人术前、术后第1天以及术后第3天的T淋巴细胞亚群进行测定及比较分析。结果术后第1天,采用两种不同麻醉方法的手术病人CD4 亚群数量下降,CD4 /CD8 比值下降(t=2.220~3.450,P<0.05);术后第3天恢复到术前水平;两组病人在同一时段的CD4 、CD8 水平差别无统计学意义(P>0.05)。结论两种麻醉方法都能获得满意的手术效果,对手术病人的细胞免疫功能影响没有差别。