Stress doppler echocardiography in connective tissue disease patients without overt pulmonary arterial hypertension

Background Pulmonary arterial hypertension(PAH) is a common complication of connective tissue disease(CTD) and confers a worse prognosis. Stress doppler echocardiography(SDE) can detect early pulmonary vasculopathy and assess right heart function in patients with pulmonary arterial hypertension. In this study, the SDE was applied to analyze the degree of pulmonary vascular lesion and the function of right heart in CTD patients without overt PAH. Methods CTD patients without overt PAH were divided into exercised-induced pulmonary hypertension(EIPH) group and non-EIPH group depending on whether tricuspid regurgitation(TR) exceeded 3.1 m/s during exercise and assessed by echocardiography at rest and during exercise. The data of right ventricular function and the slope of the incremental of the mean pulmonary artery pressure and cardiac output(ΔmPAP/ΔCO) were analyzed. Results Forty-seven CTD patients without overt PAH(35 female, mean age 40.3±12.0 years) were enrolled and divided into EIPH group(n=21) and non-EIPH group(n=26). Patients with systemic sclerosis(SSc) were more likely to have EIPH(47.6% vs. 28.6%, P0.05) than those with systemic lupus erythematosus(SLE). Patients in EIPH group had a higher value of ΔmPAP/ΔCO than that of the non-EIPH group(4.5±3.1 vs. 2.2±1.3, P0.05). SSc was more prevalent in CTD patients and the symptoms of dyspnea occurred more often in EIPH group(52.4%), indicating a pressure-flow mismatch induced by exercise. However, the cardiac function demonstrated by left ventricular ejection fraction(LVEF), tricuspid annular plane systolic excursion(TAPSE),DTI-Derived S'-wave velocity(S') and right ventricular fractional area change(RVFAC), as well as functional reserve reflected by the changes of TAPSE, S', RVFAC before and after exercise, did not differ significantly between the two groups. Conclusions Although right ventricular(RV) reserve function does not change much before and after exercise, patients in EIPH group have a higher value of ΔmPAP/ΔCO than that of the non-EIPH group and more likely to have symptoms during exercise. Thus, to assess the potential for pulmonary vascular disease, echocardiography should be performed at rest and during exercise.[S Chin J Cardiol 2019;20(1):31-36]     

115例先天缺陷产前诊断分析

产前诊断又称宫内诊断，就是在出生前对胎儿的健康情况做出诊断，是近代医学遗传学与临床医学相结合而发展起来的一门科学。医疗保健机构对胎儿进行先天性缺陷和遗传性疾病的诊断及相应的筛查，是《母婴保健法》赋予的职责，是优生优育，提高出生人口素质的必要手段：     

婚前医学检查情况分析

目的探讨婚前医学检查（简称婚检）者的健康现状及对优生优育的影响。方法对2009年9月至2010年9月在我所自愿婚检青年的资料进行回顾性分析,其中男婚检3379人,女婚检3435人。结果疾病检出率男性为50.22%,女性为36.39%,其中男性以生殖系统疾病为主,乙肝三系及肝功能异常在男女双方所占比例较高,分别是男的占20.75%,女的占8.82%。性病也占有一定的比例,并有逐年增加的趋势。结论婚检青年的健康状况不容乐观,且会影响优生优育,婚前医学检查工作仍有重要意义。     

655例高危妊娠临床分析

目的:探讨剖宫产率居高不下的主要影响因素,为降低剖宫产率提供依据。方法:对2004年1月￣2006年1月在全区城镇住院分娩的病例采用回顾性分析。结果:孕期高危筛选377例,筛选率34.1%;产时高危506例,发生率45.8%;孕期高危合并产时高危228例,发生率20.6%;孕期未筛选的产时高危278例,发生率25.2%。其中剖宫产477例,剖宫产率43.2%;产钳57例,发生率5.2%。结论:从孕期开始筛选高危妊娠,严格把握剖宫产手术指征,可降低剖宫产率。     

胃肠外抗凝治疗对接受经皮冠状动脉介入术的非ST段抬高型急性冠状动脉综合征患者预后的影响

2018年12月JAMA Intern Med刊出了由广东省人民医院陈纪言、谭宁和何鹏程教授牵头的研究"胃肠外抗凝治疗对接受经皮冠状动脉(冠脉)介入(PCI)术的非ST段抬高型急性冠脉综合征患者(NSTE-ACS)预后的影响"[Chen JY,He PC,Liu YH,et al.Association of parenteral anticoagulation therapy with outcomes in Chinese patients undergoing percutaneous coronary intervention for non-ST-segment elevation acute coronary syndrome.JAMA Intern Med,2019,179(2):186-194.]。该研究基于多中心回顾性观察,纳入接受PCI治疗的NSTE-ACS患者,探讨术前胃肠外抗凝治疗对预后的影响,对目前指南推荐的NSTE-ACS患者常规胃肠外抗凝的治疗策略提出质疑。     

无痛人工流产术的临床研究

目的:提高计划生育手术质量,减轻受术者的痛苦。方法:将600例自愿要求无痛人工流产术的孕妇分成2组,一组用异丙酚静脉麻醉,另一组用仕泰栓于手术前30min塞肛,另选择200例孕妇对照。结果:异丙酚静脉麻醉用于门诊无痛人流术,完全无痛有效率达100%,无人工流产综合征发生。结论:无痛人流技术的使用,解除了广大受术者的痛苦,值得在临床推广应用。     

300例不孕患者的病因及治疗结果分析

目的提高妇女的自我保健能力,降低不孕症的发生率。方法对在我院诊治的300对不孕夫妇的不孕原因及治疗结果进行分析。结果女方原因258例,男方原因20例,不明原因22例。其中女方排卵障碍99例,(33.00%),生殖器炎症127例(42.33%),子宫发育不良及宫口狭窄32例(16.67%),男方精液原因20例(6.67%),原因不明22例(7.33%)。结论分析不孕原因,进行对症治疗,可降低不孕症的发生率,提高妊娠率。     

2005-2009年台州市路桥区妇女病普查分析及应对措施

目的：为了提高台州市路桥区妇女的健康水平和生活质量。方法：按统一制定的普查项目填写,由临床妇科医师按照妇科病检查常规,程序性进行宫颈涂片及细胞学检查,子宫B超,超红外冷强光透乳检查。结果：妇科疾病患病率较高,宫颈癌及癌前病变患病率呈逐年上升趋势,且呈年轻化趋势。乳腺疾病患病率较高。结论：通过妇女病普查普治,达到减少或消灭某些妇科病的目的,以便及早发现宫颈癌。     

消结安胶囊治疗乳腺增生的疗效观察

目的：观察消结安胶囊治疗乳腺增生的临床疗效。方法：2009年10月~2010年10月在我所妇科门诊确诊的乳腺增生患者270例,将270例确诊为乳腺增生的患者随机分成两组,每组135人,A组采用乳癖消片,每日3次,每次6片;B组采用消结安胶囊,每日3次,每次2片。结果：治疗后20天随访,两组的总有效率分别为A组76.30%,B组为94.81%。B组的总有效率高于A组,差异有统计学意义（P〈0.01）。结论：消结安胶囊能缓解乳房胀痛,缩小肿块,消结安胶囊治疗乳腺增生疗效显著,特别对乳腺小叶增生肝郁气滞型乳房疼痛的症状改善显著。