造影剂到达腹主动脉的峰值大小与患者因素的关系

目的探讨造影剂到达腹主动脉的峰值大小与患者因素之间的关系。方法108例患者以2.5ml/s注射欧乃派克(300mgI/ml)20ml,12s后采用testbolus技术在腹腔干水平同层动态扫描腹主动脉,用dynamic evaluation软件测得腹主动脉的峰值大小,采用单因素回归分析和多因素逐步回归分析法研究患者的性别、年龄、身高、体重、心率、血压、注射位点、达峰时间及是否有心脏病、糖尿病、或化疗史对造影剂到达腹主动脉峰值大小是否有影响及影响程度。结果造影剂到达腹主动脉峰值大小,在男性平均比女性低;其随年龄、身高、体重、达峰时间的增加而逐渐降低,注射位点在手背静脉其值平均比在肘部静脉低;其不受心率、血压、是否有心脏病、糖尿病或化疗史的影响。参考公式:峰值大小(HU)=383.8400-身高(cm)×1.0909-体重(kg)×0.6760 注射位点×16.7878-达峰时间(s)×1.6882。结论可根据患者的性别、年龄、身高、体重、注射位点和达峰时间来适当调整患者CT血管成像时造影剂用量。     

婴儿主动脉缩窄合并心内畸形的一期矫治

目的总结婴儿主动脉缩窄（CoA）合并心内畸形一期矫治的手术方法和临床经验。方法2001年1月至2006年1月，对28例CoA合并心内畸形患者行一期手术矫治。CoA为导管前型18例，邻近或正对导管处10例；伴主动脉弓发育不良6例，动脉导管未闭22例。合并的心内畸形包括：室间隔缺损16例、室间隔缺损＋房间隔缺损5例、完全性房室间隔缺损3例，完全型大动脉错位伴室间隔缺损（D—TGA／VSD）2例，右心室双出口2例。采用左胸后外侧联合胸骨正中切口（双切口）径路手术12例，胸骨正中切口径路（单一切口）手术16例。采用缩窄段切除端端吻合术20例，Gore—Tex补片扩大成形术4例，左锁骨下动脉翻转扩大成形术4例。结果全组无手术死亡，术后呼吸机辅助呼吸时间7h～13d，住ICU时间3～18d。因术后心脏扩大延迟48～72h关胸4例，术后发生急性肾功能衰竭行腹膜透析3例，吸入一氧化氮（NO）治疗重度肺动脉高压3例。术后下肢收缩压高于上肢10～20mmHg18例（64．3％），收缩压上、下肢相差不大8例（28．6％），上肢分别高于下肢15mmHg和20mmHg2例（7．1％）。所有患者均得到随访，随访时间3～50个月，1例D—TGA／VSD患者因重度三尖瓣反流、肺部严重感染和呼吸功能衰竭于术后3个月死亡；其余27例患者恢复顺利。心脏超声心动图提示：1例采用端端吻合法、1例采用Gore～Tex补片扩大成形术的患者在CoA纠治处仍存在压差，分别为25mmHg、28mmHg，均未再次手术。结论一期手术矫治CoA合并心内畸形可以缩短疗程，有利于患者术后心、肺功能的恢复，避免二次手术的痛苦，降低治疗费用。可采用单一胸骨正中切口或胸骨正中联合左胸后外侧切口完成手术。     

腹主动脉球囊阻断技术在骶骨肿瘤切除中的临床评价

[目的]探讨应用腹主动脉球囊阻断技术在行骶骨肿瘤切除术中的临床应用价值。[方法]对36例骶骨肿瘤患者切除过程中应用腹主动脉球囊阻断技术(腹主动脉球囊阻断组),复习既往32例骶骨肿瘤应用传统的术前血管栓塞技术切除肿瘤患者(对照组)的临床资料,比较2组手术时间、出血量、并发症发生率、平均住院时间、术后恢复时间及复发率。[结果]腹主动脉球囊阻断组手术时间为(149.19±73.81)min,术中出血量为(826.67±509.11)ml,有2例骶神经损伤,平均住院时间(26.05±7.08)d,术后恢复时间(34.61±8,22)d,半年复发率5.5%,1年复发率11%,2年复发率16%;对照组手术时间为(221.33±45.19)min,出血量为(1652±706.99)ml,有3例骶神经损伤,4例出现局部皮肤缺血性疼痛,1例出现性功能障碍。平均住院时间(37.93±7.63)d,术后恢复时间(46.03±9.67)d,半年复发率18%,1年复发率31%,2年复发率40.6%。两者比较有显著性差异(P<0.05)。[结论]在骶骨肿瘤过程中,采用腹主动脉球囊阻断技术,可以缩短手术时间,减少出血量及并发症,缩短住院天数,术后恢复快,降低了复发率。是一项具有实用价值的临床技术。     

短期化疗对兔腹主动脉顺应性的影响

目的 比较短期化疗前后兔腹主动脉顺应性的变化，了解化疗药物对血管力学特性的影响。方法将15只新西兰兔随机等分为5组，其中4组接受1周期化疗（卡铂100mg／m^2，第1、3、5天；异环磷酰胺1500mg／m^2，第1、3、5天；足叶乙贰100mg／m^2，第l～3天），另1组为对照组。分别测量各组兔腹主动脉比顺应性（化疗组分为化疗后第2、7、14、21天进行观察）。结果短期化疗前后兔腹主动脉顺应性显著变化，化疗后第14天下降最明显，而第21天则基本恢复。结论短期化疗能够降低兔腹主动脉比顺应性，降低的程度与化疗后时间相关，并具有可逆行性。     

The Use of Stent Grafts for the Treatment of Aneurysms and Dissections of the Thoracic Aorta: A Single Centre Experience

OBJECTIVE: To review the results of stent graft treatment for diseases of the thoracic aorta. DESIGN: A retrospective study of the results of thoracic stent graft procedures in a single centre. METHODS: The results of 30 procedures performed in 24 patients were analysed. Eleven patients had aneurysmal dilatation of the descending thoracic aorta (>5.5 cm), nine patients had complicated type B dissection, three had penetrating ulcers and one had a traumatic pseudoaneurysm. Imaging follow-up consisted of CT scans performed at one, three, six and 12 months following the procedure and annually thereafter. RESULTS: One technical failure occurred due to a ruptured external iliac artery. There were no other immediate failures. The primary technical success rate was 83%. The 30-day procedural and patient mortality rates were 7 and 8%, respectively. No neurological complications occurred. Seven patients had the subclavian artery covered without complications. Secondary intervention was required in 21%. During the follow-up period (mean 11 months, range 1-48 months.) there were five deaths, two of which were related to stent graft infection. CONCLUSION: Thoracic stent grafts offer a realistic alternative to surgery.     

Smooth muscle of rabbit isolated aorta contains the NK-2 tachykinin receptor

Summary Neurokinin A, neurokinin B and substance P caused concentration-related contractions of rabbit isolated aorta with pD₂ values of 8.1, 6.9 and 6.0, respectively. [D-Pro², D-Trp^7,9]-substance P, a competitive tachykinin antagonist, had pA₂ values of 5.3 against neurokinin A, 5.1 against neurokinin B and 5.2 against substance P indicating that tachykinin receptors mediated responses to the agonists. [pGIu⁵,MePhe⁸,-McGly⁹]-substance P 5–11 (DiMe-C7), senktide and septide did not contract the aorta. It is concluded that of the known tachykinin receptors smooth muscle of the rabbit isolated aorta contains only the NK-2 type. Send offprint requests to J. W. Constantine at the above address     

氧化胆固醇对动脉毒性作用的研究

将Wistar大鼠随机分成氧化胆固醇组(Och)、纯胆固醇组(Pch)和对照组,分别用氧化胆固醇混合物(250mg/kg bw/d)、纯胆固醇(250mg/kg bw/d)以及悬浮固醇用的明胶液体给大鼠灌胃,连续二天。于第二次灌胃后18小时,从大鼠尾静脉注射伊文思兰溶液,并于注射后2小时处死;取出主动脉用荧光显微分光光度术测定主动脉内膜的通透性。此外,另一部分动物在第二次灌胃后24小时处死,取出主动脉作扫描电镜的内膜观察。结果表明,Och大鼠主动脉内膜的通透性显著高于Pch组与对照组大鼠(P<0.01),而Pch组大鼠主动脉内膜的通透性和对照组无显著差异(P>0.05)。     

Morphometric analysis of the great vessels in early fetal life

Pathological examination of the heart and great vessels wasperformed in 61 specimens obtained after surgical terminationof pregnancy for psychosocial indications at 9–18 weeksof gestation. The aorta and pulmonary trunk were identifiedand external diameters were measured at the level of, and distalto the aortic valve and pulmonary valve, the level of the aorticisthmus and thoracic aorta, and the proximal and distal ductusarteriosus. All eight vessel diameters increased linearly withgestational age and the ratio of the diameter of the aorticisthmus to that of the aortic valve or the distal ductus arteriosusalso increased with gestation. Early pregnancy is characterizedby rapid growth of the fetal head and this may well be the consequenceof a preferential distribution of left ventricular output infavour of the head due to relative narrowing of the aortic isthmusat this gestation.     

Velocity profiles in the ascending aorta in pigs: Axial development and influence of changes in left ventricular contraction pattern

Summary Earlier studies using hot-film anemometry in pigs have revealed skewed tangentially rotating velocity profiles in the ascending aorta during systole. The reason for this phenomenon has been postulated to be caused by the left ventricular contraction pattern. Therefore, the aim of this study was to investigate the influence of the left ventricular contraction pattern on the velocity fields in the ascending aorta of pigs. We used a 10 MHz perivascular pulsed Doppler ultrasound system to measure point blood velocities at two axial locations over the entire cross sectional area in the ascending aorta of 90 kg pigs. The axial component of the velocity profiles was visualized dynamically by computerized 3-dimensional animation techniques. Changing left ventricular contraction patterns were accomplished by reversible occlusion of either the left anterior descending or right posterior descending coronary artery. The axial development of the systolic rotating and skewed velocity profiles in the ascending aorta was described. The appearance of the systolic velocity profiles were virtually unaffected by changes in left ventricular contraction pattern.This study was kindly supported by The Danish Heart Foundation, Civilingeniør Frode Nyegaard og Hustru's Fond and NOVO's Forskningsfond     

Presynaptic action of adrenaline on adrenoceptors modulating stimulation-evoked 3H-noradrenaline release from rabbit isolated aorta

Summary The purpose of this investigation was to study the effect of adrenaline on presynaptic adrenoceptors by recording the release of ³H-noradrenaline evoked by electrical-field stimulation. Adrenaline (10^–10–³ × 10^–9 mol/l) had no effect on the ³H-overflow evoked by stimulation of aorta preloaded with ³H-noradrenaline. At 10^–8 and 3 × 10^–8 mol/l, the ³H-overflow was decreased by up to 47%. The maximum decrease was more marked in the presence of either cocaine (3 × 10^–5 mol/l) plus corticosterone (4 × 10^–5 mol/l), cocaine (3.3 × 10^–6 mol/l) plus normetanephrine (4 × 10^–5 mol/l), or desipramine (10^–6 mol/l) plus normetanephrine (10^–5 mol/l). The relationship between adrenaline-induced decrease and stimulation-frequency was dependent on the experimental design: either the decrease was the same at all frequencies (1–16 Hz) or it was more marked, the lower the frequency (1 > 3 > 8 Hz). Phentolamine and rauwolscine (both 10^–6 mol/l) antagonized the inhibitory effect of adrenaline (10 ^{– 8}–10^–6 mol/l). Phenoxybenzamine (10^–6 mol/l), prevented the inhibitory effect. No enhancing effect of adrenaline (10^–9–10^–6 mol/l) was observed in the presence of these three -adrenoceptor antagonists. Our results suggest that adrenaline activates inhibitory ₂-adrenoceptors, but not facilitatory -adrenoceptors on postganglionic sympathetic nerve terminals in rabbit aorta. Send offprint requests to J. Abrahamsen at the above address