老年人消化性溃疡并上消化道出血误诊26例分析

将我院 1999- 0 1～ 2 0 0 3- 0 4收治的老年人消化性溃疡并出血误诊 2 6例分析如下。1　临床资料本组男 2 1例 ,女 5例 ,年龄 6 0～ 80岁 ,平均 6 5 .17岁。上腹轻微不适者 12例 ,胸骨后疼痛者 5例 ,吞咽时咽部阻塞感 6例 ,头晕、胸闷、乏力 3例。有明确溃疡病史者 19例 ,病史时间 0 .5～ 5 0 a,平均 12 .7a;有明显合并症者 2 3例 ,其中冠心病 8例 ,高血压病 12例 ,肺气肿、肺心病 8例 ,糖尿病 4例 ,胆道系统疾病 5例 ,风湿性关节炎 2例 ,无明显合并症者 3例。入院时心电图检查 8例有明显缺血表现 ,其中 2例伴房性早搏 ;6例血红蛋白为 9～ …     

慢性肺原性心脏病并发多器官衰竭38例分析

慢性肺原性心脏病并发多器官衰竭（ＭＯＦ）均为呼吸道感染所致，３８例中９例出现感染性休克。治疗措施除抗感染等综合治疗外，常规静脉滴注复方丹参注射液；对有上消化道出血、急性肾功能衰竭者采用大黄通腑泄浊、祛瘀止血。治疗结果：３８例中死亡２４例，病死率６３．１６％。作者结合文献复习，认为ＭＯＦ发病机制主要是：除微生物及其毒素直接损害细胞外，还有内源性介质引起炎症反应、氧自由基损害、花生四烯酸衍生物对细胞的     

超声造影与彩色多普勒超声对肝实质性肿块诊断价值

目的比较彩色多普勒超声和实时超声造影在肝实质性肿块中的诊断价值。方法应用彩色多普勒超声及超声造影技术对常规二维超声难以定性的29例患者共33个肝实质性肿块进行检查,结果与手术及病理结果相对照。结果33个肿块中原发性肝细胞性肝癌24个,肝血管瘤3个,肝脏局灶性结节增生3个,局限性脂肪肝2个,肝孤立性坏死结节1个。彩色多普勒超声在肿块内部或肿块周边能检测到动脉血流频谱者共19例21个肿块;超声造影除一例肝孤立性坏死结节外,其余32个病灶均在不同时相出现不同程度强化现象。如以动脉相呈高回声而门脉相及延迟相呈低回声为恶性肿块的诊断标准,则超声造影对肝癌诊断的准确性为92%;如以肿块内部检测到动脉样血流频谱为诊断恶性肿块的诊断标准,则彩色多普勒超声诊断肝癌的准确性为75%,二者差别有显著性(P<0.05)。结论实时超声造影显著提高肝实质性肿块诊断的准确性,对肝脏实质性肿块良、恶性的诊断及鉴别诊断具有重要价值。     

用你一生读经典

2010年2月底,温总理第一次和网民互动时,说了一段话让人印象深刻,"读书不仅给人力量,而且给人安全感和幸福感。"温总理说,我很希望有一天看见地铁里面人人都捧着一本书。从前我们一直说读书给人知识、给人力量,如今,总理站在更高的高度告诉我们读书还能让人感到安全和幸福。     

慢性阻塞性肺疾病患者SIRT1表达与氧化应激的相关性研究

目的检测慢性阻塞性肺疾病(简称慢阻肺)患者外周血单个核细胞(PBMC)中沉默信息调节因子2相关酶1(SIRT-1)蛋白表达和血清丙二醛(MDA)和超氧化物歧化酶(SOD)水平,探讨SIRT-1和氧化应激的相关性。方法选择慢阻肺患者30例,分为慢阻肺低风险组和慢阻肺高风险组,每组各15例,并与20名健康非吸烟者(对照组)做比较。采用Western blot法检测3组研究对象PBMC中SIRT-1蛋白表达,同时测定血清MDA、SOD水平,分析SIRT-1蛋白表达和氧化应激相关性。结果与对照组相比,慢阻肺组患者PBMC中SIRT1蛋白表达显著降低;与慢阻肺低风险组相比,慢阻肺高风险组SIRT1蛋白表达进一步降低(P均0.05);慢阻肺血清MDA升高,SOD降低,在慢阻肺高风险组尤为明显(P均0.05);Pearson直线相关法分析SIRT-1蛋白表达水平与血清MDA呈显著负相关(r=-0.687,P0.05),与SOD呈正相关(r=0.471,P0.05)。结论慢阻肺患者PBMC中SIRT1蛋白表达显著降低,与氧化应激密切相关,提示SIRT1在慢阻肺发病过程中具有重要作用。     

肺动脉闭锁的基因研究进展北大核心CSCD

先天性心脏病是儿童最常见的先天性畸形之一,是导致患儿死亡的一个重要原因。肺动脉闭锁(pulmonary atresia, PA)是其中较为罕见的类型,并发症多,治愈率低,预后差。须从发病原因、手术治疗、术后护理、疾病预后等方面进行综合评估。先天性心脏病的发生与基因突变、环境恶化等众多不利因素密切相关,为该病的预防和治疗带来了极大的挑战。本文将从PA的病因入手,针对其遗传学方面的可能病因进行阐述。     

乐活眼看乐活乡

阳朔是慵懒的,丽江是柔软的,婺源是粗朴的……不同的人用不同的眼光解读所到之处.中国乐活第一人沈立博士眼中的束河古镇是乐活的.那里的雪山、房屋、菜地、水池、鲜花告诉他:在这里,人和自然是和谐相处的、其乐融融的.     

单肺Fontan手术1例

病儿 男,4岁.全身发绀4年余.查体:发育正常,营养中等,心率110次/min,血压98/65 mmHg(1 mm Hg=0.133kPa),SpO20.68,双肺未闻及于湿罗音.     

非糖尿病脑梗死急性期肺部感染患者血糖水平变化分析

急性脑梗死发生率、致残率、病死率均高,是危害中老年身体健康的常见病、多发病,尤其是并发肺部感染可使病情加重,是导致患者死亡的最常见原因之一[1]。新近有研究发现非糖尿病脑梗死患者血糖水平与脑梗死面积、部位及预后有关[2]。但与脑梗死常常并发的肺部感染的关系未作提示。对此,笔者拟对脑梗死急性期并发肺部感染患者血糖水平变化作一分析,以探讨脑梗死急性期血糖水平变化与肺部感染的关系。     

体外循环下小儿肌部室间隔缺损的镶嵌治疗

目的 探讨镶嵌模式(hybrid procedure)治疗小儿肌部室间隔缺损(Mvsd)的手术方法及临床应用.方法 2006年1月至2010年6月,在体外循环心内直视手术下采用手术及封堵相结合的镶嵌技术矫治小儿Mvsd 45例,其中男20例,女25例;年龄52天～12岁;体重3～32 kg.7例为单个Mvsd,38例为多发性VSD.同时合并大血管错位(D-TGA)1例、法洛四联症(TOF)2例、肺动脉狭窄(PS)3例、动脉导管未闭(PDA)6例、房间隔缺损(ASD)6例、主动脉缩窄1例.均在心脏停跳后直视下将导引钢丝经三尖瓣孔自心脏右室面穿过VSD至左室面,直视下置入导引器,然后送入封堵器,完成Mvsd封堵.多发性VSD 38例,予自体心包片修补膜周部等较大的VSD,心内其他畸形同期完成矫治.结果 42例置入单枚封堵器(直径4～10 mm)、3例置入双枚封堵器(直径4～7 mm).手术经过顺利,术前左室射血分数(EF)均在正常范围,术后1天小于8月龄组EF均值低于正常,大于8月龄组EF正常,两者差异有统计学意义.术后常规每天给予5 mg/kg肠溶阿司匹林3～6个月.术后随访超声检查示封堵器位置无偏移,无残余分流,无二尖瓣、主动脉瓣反流、Ⅲ度传导阻滞及新发心律失常等.术后因重症感染放弃治疗1例,无远期死亡病例.结论 体外循环下镶嵌技术治疗小儿 Mvsd明显降低了围手术期并发症及病死率,简化了手术过程,降低了手术风险,是一种安全、有效的方法.

Abstract：

Objective To summarize the technique and clinical experience of hybrid procedure under cardiopulmonary bypass (CPB) in children with muscular ventricular septal defect (mVSD). Methods From January 2006 to June 2010, 45 cases of mVSD underwent hybrid procedure with CPB. mVSDs were closed with devices under direct vision in 45 cases. Of them, there were 20 males and 25 females. They ranged from 52 days to 12 years [mean (2.05 ±2.48) year] in age and from 3 to 30 kg [(11.93 ±7.70)kg] in body weight. Preoperatively, most of children were highly susceptible to respiratory tract infections. The hybrid approach was used in all patients with CPB under the guidance of transesophageal echocardiography (TEE). The diameter of mVSDs ranged from 2 to 7 mm under TEE. Of 45 cases, 40 patients had increased rates of pulmonary blood flow. 29 patients had left axis deviation and 12 cases had sinus arrhythmia on electrocardiography (ECG). 19 had other congenital heart lesions, including transposition of great arteries in 1 case, tetralogy of Fallot in 2, pulmonary artery stenosis in 3, patent ductus arteriosus in 6, atrial septal defects in 6) and aorta coactation in 1. The quantity of VSDs were from 1 to 7 (single, in 7; two, in 24 case; three, in 8 case; four, in 5 case and seven, in lease. 37 patients were combined with pulmonary hypertension in our cohort. 38 patients with another large VSD and 19 with other congenital heart lesions were required surgical repair at sometime. Results The hybrid procedures were undertaken in all 45 cases of this cohort. All cases were successful and no deaths occurred during operation. A total of 48 devices were implanted in 45 patients, including single devices in 42 cases (device size ranged from 4 to 10 mm) and two devices in 3 cases (device size ranged from 4 -7 mm). The average time on CPB was (58.28 ±20.70) min , while aortic crossclamp time was(34. 94 ± 14.75) min. In addition, the time on mechanical ventilation postoperatively ranged from 2 hours to 6 days. Compared to the older children, 20 infante aged less than 8 monhad a significant difference in cardiac function in the early postoperative period. One infant was given up treatment because of serious infection. Anather cases recovered with the use of supportive treatment, such as using vasoactive agents, digoxin, inhaling nitric oxide, diuresis, and so on. The enteric-coated aspirin was given at dose of 5 mg ? kg -1. day -1 for a period of 3 to 6 months as usual postoperatively. All patients attended follow-up at 1 week, 1 month, 3 months, 6 months, 1 year and 2 years post-procedure. No major complications were encountered during this period. All cases were no instance of migration of any of the devices, residual shunt, aortic regurgitation, atrioventricular valve dysfunction, Ⅲo atrial-ventricular conduction block, new arrhythmia, and so on. There are no death in long-term follow-up. Conclusion Hybrid procedure is safe and effective for the closure of congenital heart defects in children.