运动与红细胞免疫

红细胞有多种免疫功能，如清除免疫复合物、识别和储存抗原、促进吞噬细胞的吞噬作用等。运动影响着红细胞的免疫功能，红细胞携带氧的能力与运动员体质密切相关，而影响红细胞携带能力的不同运动量也影响着红细胞的天然免疫功能。红细胞免疫功能又在机体的防御，维持生理平衡和运动能力等方面起重要作用。     

Percutaneous balloon angioplasty of coarctation of the aorta in children: 12 -year follow-up results

Objective To evaluate the efficiency of percutaneous balloon angioplasty of coarctation o f the aorta in children and discuss its risk factors that can lead to poor long -term results.Methods From September 1987 to August 1999, 24 patients underwent 27 balloon angioplasty procedures for native or recurrent coarctation of the aorta at our institution . There were 19 patients with discrete (membranous) coarctation, 4 patients wit h long-segment and aortic arch hypoplasia, and 1 patient with postoperative recu rr ence. The balloon diameter was chosen not to exceed the diameter of the aorta p roximal to the stenotic site (11.06±2.80 mm vs 11.78±3.18 mm), with th e chosen diameter two to four times that of the stenotic segment (2.57±0.68 t imes). The patients have been followed up for half to twelve years (mean 6.2 ±2.8 years). Satisfactory result was defined as a reduction in the pressure g radient across the site of coarctation to ≤20 mm Hg. Results The systolic pressure gradient across the coarctation site decreased from 48. 17±14.68 mm Hg to 14.96±13.12 mm Hg (P<0.01) and the diameter of the coarctation site increased from 4.66±2.43 mm to 8.80±3.32 mm (P<0. 01). Immediate satisfactory results were obtained in 19 patients (79%). Of the 5 patients with unsatisfactory results, 4 had aortic arch hypoplasia and 1 had membranous coarctation. Of the 19 patients with satisfactory results, 18 patie nts had membranous coarctation and 1 patient had recurrent postoperative coarcta tion. No aneurysm and other complications had occurred in any patients at the follow-ups. Conclusion Percutaneous balloon angioplasty is an effective treatment alternative to surger y in most patients with recurrent postoperative or native membranous coarctation of the aorta. It should not be recommended for the coarctation of aortic arch hypoplasia.     

评价儿科高级生命支持培训课程的有效性和必要性

为提高儿科医护人员心肺复苏的成功率 ,我们自1999年起举办了由美国心脏学会 (AmericanHeartAssociation,AHA)和美国儿科学会(AmericanAcademyofPediatrics,AAP)推荐的《PediatricAdvancedLifeSupport》(PALS ,儿科高级生命支持 )培训课程。本文探讨在儿科医护人员中开设此培训班的有效性和必要性 ,旨在全国范围推广 ,以提高我国小儿心肺停止复苏及创伤、危重病的抢救成功率。材料与方法2001年1～12月本院先后举办了5期《PALS》培训班 ,每期2天共16学时。培训教材是AHA和AAP推荐的《PediatricAdvancedLifeSupport》1997年版本…     

先天性心脏病重度肺动脉高压性质的综合评价

目的探讨先天性心脏病（简称先心病）合并重度肺动脉高压患儿器质性肺动脉高压（简称肺高压）的诊断标准。方法３７例经手术治疗后早期肺动脉压力降至正常的患儿作为动力性肺高压组；７例经手术治疗后仍持续性肺动脉高压及６例临床诊断为器质性肺高压而未予手术的共１３例患儿作为器质性肺高压组，对比两组心导管检查血液动力学指标。结果两组肺血管阻力、肺小动脉楔压、肺循环血流量与体循环血流量之比（Ｑｐ／Ｑｓ）及降主动脉血氧饱和度（ＳａＯ２）差异均有显著意义，如按年龄大于２岁、肺动脉阻力＞７２ｋＰａ·ｓ－１·Ｌ－１（９Ｗｏｏｄ单位）、肺小动脉楔压≤１．６ｋＰａ（１２ｍｍＨｇ）、Ｑｐ／Ｑｓ＜２和动脉血氧饱和度＜０．９０作为临床诊断器质性肺高压的指标，则本组动力性肺高压组仅有５．４％的患儿符合上述指标３项或３项以上，而器质性肺高压组所有病例均符合上述指标３项或３项以上。结论先心病合并重度肺动脉高压存在上述５项指标中３项或３项以上，高度提示患儿存在器质性肺动脉高压     

二尖瓣畸形的超声心动图诊断及评估(附23例分析)

目的 探讨超声心动图对二尖瓣畸形的诊断价值及其在临床评估中的作用.方法 应用超声心动图检查23例二尖瓣畸形患者并与随访结果对照.结果 23例二尖瓣畸形患者超声诊断:二尖瓣闭锁3例,双口二尖瓣2例,二尖瓣发育不良腱索短小1例,乳头肌发育不良降落伞样二尖瓣1例,二尖瓣裂缺16例.结论 二尖瓣畸形患者病情严重程度与其解剖发育及是否合并心内畸形有关,超声心动图对二尖瓣、腱索及乳头肌畸形的形态、位置及瓣口的梗阻、返流等血流动力学变化的诊断准确可靠,并可成为指导二尖瓣畸形的临床治疗、评价预后的有效手段.     

超声心动图对胎儿心脏房室瓣返流的诊断意义(附33例报告)

随着产前诊断技术的进步及超声仪器精度的提高,超声心动图已成为产前胎儿心脏异常诊断的有效方法。我院运用超声心动图检查经常规产科超声筛选及临床高危的382例胎儿心脏,共检出房室瓣返流33例,报道如下。1资料与方法1.1一般资料:2003年8月至2008年1月我院经常规产科超声筛选及     

QUANTIFICATION OF RIGHT VENTRICULAR FUNCTION IN ATRIAL SEPTAL DEFECT USING ULTRASOUNDBASED STRAIN RATE IMAGING

Objective To study the validation of ultrasound-based strain rate imaging in the quantitative assessment of right ventricular （RV） function in atrial septal defect （ASD）. Methods Tissue Doppler images （TDI） of RV longitudinal and short axes were recorded from the apical 4-chamber view and the subcostal short-axis view in 18 normal controls, 28 children with ASD and 14 children after Amplazter closure of ASD respectively. Peak systolic velocities （ V）, peak systolic strain rates （SR）, peak systolic strains （S） at the basal segment, middle segment of RV lateral wall and the basal septum from the longitudinal axis, the middle segment of RV free waU from the short axis were quantitatively measured using QLAB^TM tissue velocity quantification software system respectively. Peak dp/ dt from the RV isovolumic contraction determined during the right cardiac catheterization in 28 ASD patients was used as the gold standard of RV contractility. Peak systolic indices were compared against max dp/dt by linear correlation, Results Peak systolic indices at the basal and middle segments of RV lateral wall from the longitudiual axis increased significantly in 28 ASD patients. Peak systolic indices at the basal septum also increased in patient group, but not significantly. Significant decreases in peak systolic indices at the basal and middle segments of RV lateral wall were observed after the Amplatzer closure in 14 ASD patients. There was no significant difference at the middle segment of RV free wall from the short axis between patient group and normal control. A strong correlation was found between max dp/dt and peak systolic indices at the basal and middle segments of RV lateral wal l （ P 〈 0. 05 ）. Conclusion Ultrasound-based strain rate imaging can assess quantitatively RVfunction in CHD. Peak systolic strains determined at the basal and middle segments of RV lateral wall are strong noninvasive indices of RV contractility.     

主—肺动脉间隔缺损6例报告

主一肺动脉间隔缺损,又称主一肺动脉窗(Aortopulmonary Window,简称APW),是少见的先天性心血管畸形之一,因早期出现肺动脉高压及心力衰竭,临床表现类似于大分流量的室间隔缺损(VSD)或动脉导管未闭(PDA)而易引起误诊及延误手术治疗。本文报告6例APW的临床表现及诊断、治疗经过,以冀提高本病的早期诊断率。     

超声心动图诊断法洛四联症的临床价值评估

目的评价超声心动图诊断法洛四联症（TOF）的准确性、可靠性和效益,探讨法洛四联症无创伤性术前诊断方法及手术指征。方法以手术后诊断为金标准,评价234例TOF患儿的二维超声心动图（2-DE）诊断及心导管诊断结果。结果对于TOF的诊断,2-DE诊断灵敏度97.9%,特异度99.8%,符合率99.6%;心导管诊断灵敏度99.5%,特异度100%,符合率99.9%;两者的差异无统计学意义。在TOF合并心血管畸形的诊断中,2-DE诊断CA横跨ROVT、侧支血管、PDA的灵敏度、特异度、符合率与手术后诊断存在明显差异。结论2-DE可替代心导管造影检查用于TOF的诊断。如果术前2-DE检查发现冠状动脉显示不清或怀疑走行异常、存在侧支血管、PDA与侧支血管难以鉴别及肺动脉分支发育不良时,需进一步行心导管造影检查。     

二期Fontan术术前HGB、HCT和SpO2与肺血管阻力的相关性

目的 分析二期Fontan术术前肺血管阻力(PVR)与血红蛋白浓度(HGB)、红细胞比容(HCT)及经皮氧饱和度(SpO2)的关系,建立无创评价PVR的方法.方法 选择35例准备施行二期Fontan手术的患儿,测定静脉血HGB、HCT和安静时不吸氧状态下的SpO2,同时行心导管检查,测定和计算PVR.分别将HGB、HCT和SpO2作为自变量,PVR作为因变量,进行直线相关分析,并分别计算HGB、HCT和SpO2与PVR的直线回归方程.结果 35例患儿术前HGB和HCT与SpO2均呈显著的负相关(r=-0.685,P＜0.01;r=-0.634,P＜0.01);HGB、HCT和SpO2与PVR也存在显著的相关性(r=0.562,P＜0.01;r=0.579,P＜0.01;r=-0.392,P＜0.05).HGB、HCT和Sp02与PVR的直线回归方程分别为y=0.268x-2.093,y=0.108x-2.976和y=11.951-0.117x.结论 二期Fontan术术前HGB、HCT和SpO2与PVR均高度相关,可根据计算的直线回归方程,由术前测得的HGB、HCT和SpO2值计算PVR估计值,用以评价肺血管阻力.