35例窦缓者食道调搏电生理测定报告

本文报告35例不明原因窦缓者的食道调搏电生理检查结果,着重对反映窦房结功能的心脏固有心率。窦房结恢复时间、校正窦房结恢复时间、窦房传导时间进行分析,并揭示了其相关性。     

正心泰对急性心肌梗死患者左心室功能及心室晚电位的影响

目的 :探讨正心泰治疗急性心肌梗死 (AMI)的电生理机制。方法 :将 5 9例 AMI患者按随机法分为观察组及对照组 ,分别接受常规西药加正心泰及单纯西药治疗 ,以超声心动图及晚电位检测仪检查治疗后患者的左心室功能和心室晚电位 (VL P)各项指标变化。结果 :治疗后观察组左心功能各项指标均明显优于对照组(P均 <0 .0 5 ) ;观察组的 VL P阴性率 (2 6 % )明显低于对照组 (18% ,χ2 =4 .71,P<0 .0 5 ) ,VL P各指标也明显好于对照组 (P<0 .0 5或 P<0 .0 1)。结论 :正心泰可改善 AMI患者左心室功能 ,并降低心室晚电位阳性率。     

定量组织速度成像评价模拟失重人体心肌纵向收缩运动

目的应用定量组织速度成像(QTVI)了解中长期微重力对健康人左室心肌纵向收缩运动的影响,探讨QTVI技术评价模拟失重环境下心肌运动的应用价值。方法16名健康青年男性志愿者,采取-6°头低位连续卧床21d,分别于卧前、卧中第10、20d行心脏超声检查,应用QTVI获取心尖四腔、两腔和左室长轴观图像存储后脱机测量,同步观察左室壁各段心肌纵向收缩速度峰值(Vs),进行统计学分析。结果-6°头低位卧床第10、20d分别与卧前Vs比较:第10d左室前、后壁的基底段、中间段及前间隔各节段增高,而下壁和后间隔近心尖段减低,第20d下壁和后间隔近心尖段继续减低,而后壁、前间隔近心尖段仍高于卧前,差异均具有统计学意义。结论QTVI能够反映微重力环境左室心肌局部收缩运动情况,Vs值有助于进一步了解模拟失重、失重环境下左室心肌收缩运动的变化过程。     

三镜同期手术扩大一期缝合术应用范围238例报告

目的 总结运用腹腔镜、胆道镜、十二指肠镜（三镜）同期手术治疗胆囊结石、胆总管结石和乳头狭窄,及扩大一期缝合术应用范围的经验.方法 腹腔镜下行 LC、胆总管切开、胆道镜取石、液电碎石,经腹胆道镜钳道插入输尿管导管或斑马导丝至十二指肠腔,经口十二指肠镜行乳头切开术,一期缝合胆总管切口.结果 扩大一期缝合术应用范围 238 例,术中成功切除胆囊和取净胆总管结石238 例（ 100.0% ）.236 例（ 99.2% ）乳头狭窄切开成功,直接施行一期缝合术,2 例（ 0.8% ）乳头狭窄切开失败者改为 T 管引流术.术后发生轻症胰腺炎 4 例（ 1.7% ）;发生胆漏 7 例（ 2.9% ）,经腹腔引流管引流治愈;无肠穿孔、胆管穿孔、大出血、重症胰腺炎等并发症,无死亡.结论 选择适宜的患者,采用三镜同期手术扩大一期缝合术应用范围是可行、有效和安全的.     

三维超声仿真心腔内窥镜技术诊断房间隔缺损的实验研究

目的 探讨三维超声虚拟现实技术实现仿真心腔内窥镜观测房间隔缺损（ASD）的可行性。方法建立10个新鲜离体猪心ASD模型，经超声水槽用HP Sonos 5500超声系统采集三维超声图像，用移动立方体算法进行表面重建及可视化，建立心内三维超声仿真心腔内窥镜系统；同时将该系统的ASD面积、最大径和最小径测值与实测值进行比较。结果10例离体心ASD均成功获得虚拟显示。三维超声虚拟现实技术能够模拟心内视角显示缺损的形态、部位及邻近上腔静脉、下腔静脉间的关系，且与实际观察结果一致。测量三维重建并虚拟显示后的ASD面积、最大径和最小径，测得数据与实测值高度相关（r〉0．95，P〈0．01）。结论三维超声仿真心腔内窥镜技术为小儿先天性心脏病三维超声诊断提供了一种新方法。     

四维超声心动图显示房间隔缺损的临床研究

为了观察房间隔缺损解剖病变的立体结构关系，对１５例正常人和１８例房间隔缺损患者的房间隔及其心内血流分流信号进行了四维（动态三维）超声心动图重建。结果表明：四维超声心动图能直观逼真地展现房间隔解剖结构的立体特征，对其毗邻结构上、下腔静脉、三尖瓣、主动脉等及相互间的解剖关系也能清晰显示。从右房或左房侧面对房间隔进行观察，正常房间隔结构完整；房缺时，见房间隔上有缺孔，其形状、大小、数目、与毗邻解剖结构的关系显示清晰并可观察实时活动。对血流分流信号进行四维重建，可显示分流束的立体形态及动态变化。部分病例术中修补后重建见房间隔完整。研究表明四维超声心动图能观察房间隔缺损解剖病变的立体形态及动态变化，较两维超声心动图能更准确地区分缺损类型、测量缺损大小。并能协助制定治疗方案及评价疗效     

Effects of Procainamide on the Excitable Gap Composition in Common Human Atrial Flutter

The composition of the excitable gap (EG) in common atrial flutter (AFI) was determined before and during infusion of procainamide (PA) in 9 patients (6 men and 3 women; age 70 ± 7 years). The EG was determined by introducing a premature stimulus after every 20th AFI complex detected using a quadripolar electrode catheter placed just above the tricuspid valve. Diastole was scanned in 2- to 4-ms decrements to the atrial effective refractory period (ERP). The relationship between the coupling interval and the return cycle length (CL) determined a reset-response curve (RRC), which described the EG. PA (15 mg/kg) was administered during AFl over 30 minutes and RRC was repeated at maximum AFI CL. PA prolonged AF1 CL from 227 ± 29 to 296 ± 62 ms (P < 0.01) but did not terminate AFI. ERP during AFl prolonged from 169 ± 24 to 219 ± 41 ms (P < 0.01). Control EG was 57 ± 16 ms or 25%± 6% of AFl CL and on PA EG was 77 ± 30 ms (P = 0.01), which was still 26%± 7% of the CL. Without drug, RRC was mixed in eight cases demonstrating an EG composed of fully excitable tissue (10 ± 4 ms or 19%± 10% of the EG) and partially refractory tissue (48 ± 18 ms), PA did not change the duration of the fully excitable region (13 ± 10 ms or 19%± 15% of EG). Peak PA plasma concentration was 47 ± 20 μmol/L. PA prolonged AFI CL, ERP, and EG duration but did not change the proportion of AFI CL occupied by the EG. The persistence of fully excitable tissue at the head of the wavefront in the presence of PA may largely explain its inefficacy in the acute termination of common AFl.     

左无名静脉右心耳旁路移植术治疗复杂前上纵隔肿瘤效果分析

目的:总结复杂前上纵隔肿瘤的手术治疗经验,评价左无名静脉-右心耳旁路移植术的疗效。方法:回顾性分析8例骑跨于上腔静脉及左右无名静脉的前上纵隔肿瘤患者的资料。其中B2与B3混合型胸腺瘤1例,B2型胸腺瘤2例,纵隔神经内分泌癌(类癌)2例,胸腺鳞癌3例。术中均行人工血管左无名静脉-右心耳旁路移植术,并完整切除原发肿瘤和受累及部分上腔静脉、左右无名静脉。结果:8例患者均顺利出院,无围手术期严重并发症,1例术后9个月骨转移死亡。结论:对于治疗无远处转移的侵犯上腔静脉和左右无名静脉并引起上腔静脉综合征的纵隔肿瘤,左无名静脉-右心耳旁路人工血管移植术可以提高切除率,缓解临床症状,进而延长此类患者的生存期。     

Transthoracic versus transesophageal cardioversion of atrial fibrillation under light sedation: a prospective randomized trial

BACKGROUND: Electrical cardioversion (ECV) of atrial fibrillation (AF) is limited by a 5-10% failure rate and by the expense arising from a perceived need for general anesthesia. A transesophageal approach using light sedation has been proposed as a means of augmenting the success rate and avoiding the need for general anesthesia. We hypothesized that the high rate of success and the lower energy requirement associated with biphasic cardioversion might eliminate any advantage of the transesophageal approach. METHODS: We randomly assigned 60 patients attending for ECV of persistent AF to a transesophageal or a transthoracic approach. Sedation of moderate depth was achieved with intravenous midazolam. The dose of midazolam was titrated in the same manner in both groups. RESULTS: Sinus rhythm was restored in 29/30 patients (97%) in each group using a similar number of shocks for both groups (1.3 +/- 0.6 transesophageal vs 1.4 +/- 0.7 transthoracic, P = NS) with a similar procedure duration (14.1 +/- 8.2 minutes vs 13.8 +/- 7.5 minutes, P = NS). Both groups received similar doses of midazolam (4.2 +/- 2.7 mg vs 4.4 +/- 2.8 mg, P = NS) and both reported a similar discomfort score in (0.9 +/- 1.3 vs 1.1 +/- 1.8, P = NS). No complication occurred in either group. CONCLUSION: AF may be cardioverted safely and effectively by either a transthoracic or a transesophageal approach. The use of sedation of moderate depth renders cardioversion by either approach acceptable. As transesophageal ECV shows no clear advantage, transthoracic cardioversion should remain the approach of first choice.     

Role of different negative pressure values in the process of infected wounds treated by vacuum‐assisted closure: an experimental study

Vacuum‐assisted closure (VAC) device is widely used to treat infected wounds in clinical work. Although the effect of VAC with different negative pressure values is well established, whether different negative pressures could result in varying modulation of wound relative cytokines was not clear. We hypothesise that instead of the highest negative pressure value the suitable value for VAC is the one which is the most effective on regulating wound relative cytokines. Infected wounds created on pigs' back were used to investigate the effects of varying negative pressure values of VAC devices. Wounds were treated with VAC of different negative pressure values or moist gauze, which was set as control. The VAC foam, semiocclusive dresses and moist gauze were changed on days 3, 5, 7 and 9 after wounds were created. When changing dressings, tissues from wounds were harvested for bacteria count and histology examination including Masson's trichrome stain and immunohistochemistry for microvessels. Western blot was carried out to test the expression of vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF). Results showed that on days 3 and 5 the number of bacteria in wounds treated by VAC with 75, 150, 225 and 300 mmHg was significantly decreased compared with that in wounds treated by gauze and 0 mmHg pressure value. However, there was no difference in wounds treated with negative pressure values of 75 , 150, 225 and 300 mmHg at any time spot. Immunohistochemistry showed that more microvessels were generated in wounds treated by VAC using 75 and 150 mmHg negative pressure comparing with that using 225 and 300 mmHg on days 3 and 5. However this difference vanished on days 7 and 9. Morphological evaluation by Masson's trichrome staining showed increased collagen deposition in VAC of 75 and 150 mmHg compared with that in VAC of 225 and 300 mmHg. Western blot showed that the expression of VEGF and bFGF significantly increased when the wounds treated with 75 and 150 mmHg negative pressure values compared with the wounds treated with 225 and 300 mmHg on day 5. Treatment using VAC with different negative pressure values more than 75 mmHg has similar efficiency on reducing bacteria in the infected wound. VAC with negative pressure values of 75 and 150 mmHg promote wound healing more quickly than other pressure values. Moreover, comparing with vigorous negative pressure, relatively moderate pressures contribute to wound healing via accelerated granulation growth, increased angiogenic factor production and improved collagen fibre deposition. Further study of this model may show other molecular mechanisms.