血浆NT—pro-BNP和左房内径对房颤导管射频消融术后复发的评估价值

目的：探讨术前血浆NT-pro-BNP和术前超声心动图左房内径对环肺静脉消融术治疗房颤术后复发的相关性,以提高房颤射频消融手术的成功率。方法70例行环肺静脉消融术的房颤患者,在术前检测血浆NT-pro-BNP,经胸超声心动图测量左房内径,经食道超声心动图了解有无左房内血栓形成。15例有左房内血栓形成者未行环肺静脉消融术,余下55例均成功行环肺静脉消融术。术后随诊,每月复查心电图,动态心电图了解有无房颤的复发。3月后仍有房颤发生则认为手术失败。成功组39例、失败组16例。结果69%患者NT-pro-BNP高于正常范围。消融失败组NT-pro-BNP明显高于成功组,失败组左房内径明显大于成功组。结论对于NT-pro-BNP明显增高且左房内径又明显增大者行环肺静脉消融术治疗房颤则复发的可能性明显增加,可将术前NT-pro-BNP及左房内径作为房颤术前筛选患者的参考指标。     

缬沙坦对房颤射频消融术后左房容积结构与功能的影响

目的检测经三维标测房颤射频消融术患者在服用缬沙坦后的临床各项指标,探讨房颤射频消融术后服用缬沙坦降低左房内径减少房颤复发的趋势。方法将40例成功经房颤射频消融术的患者随机分为观察组和对照组,每组各20例,对照组只服用原有治疗基础病药物,观察组应继续口服治疗基础疾病的药物,同时加用缬沙坦80mg,每日1次。观察两组患者在术后1个月、3个月、6个月、9个月心脏超声左房内径的变化、12导联心电图、HOLTER及房颤的复发情况。结果房颤射频消融术后,2组患者的左房内径较术前有一定程度减少,但是两组间在术后1个月、3个月、6个月无明显差异(P>0.05),而在术后9个月差异有显著性(P<0.05),同时对照组和观察组相比,房颤的复发率差异无显著性,但是有趋向于显著性的趋势。结论应用缬沙坦可以减少房颤射频消融术后左房内径、有减少房颤复发趋势。     

导管射频消融术对房颤患者左心房结构的影响

目的评价导管射频消融术对心房颤动(AF,房颤)患者左心房结构的影响。方法 43例房颤患者接受治疗,其中阵发性房颤32例,持续性房颤11例。8例行肺静脉电隔离术,35例行Carto指导下环肺静脉前庭隔离术,消融终点均为双侧肺静脉完全电隔离。应用超声心动图测定其消融术前1~3 d和术后1、3个月静息时窦性心律下左心房内径,分析消融术前、后左心房结构的变化。结果 43例房颤患者均成功施行环肺静脉左房线性消融术,随访时间(6±2)月,最短3个月,最长14个月,治愈率93.02%。左房内径消融术后1个月较术前无明显改变[(35.74±5.77)mm vs(35.69±6.25)mm,P>0.05],随访3个月时左房内径较术前显著减小[(31.99±3.66)mm vs(35.69±6.25)mm,P<0.01]。结论房颤患者于术后3个月时左房结构可逆重构。     

不同左房内径对外科射频消融治疗房颤效果的影响

目的探讨术前不同左房内径对外科射频消融治疗房颤效果的影响。方法选取因心脏瓣膜病合并房颤在郑州大学人民医院接受手术治疗的患者100例,所有患者行瓣膜手术同时行房颤射频消融术,根据左房内径大小不同将患者分为两组,A组66例左房内径<60 mm,B组34例左房内径≥60 mm。通过收集18导联心电图分别对比术后即刻、出院时、术后3个月、术后6个月、术后1 a的窦性心律恢复情况。结果两组患者术后即刻、出院时、术后3个月、术后6个月和术后1 a窦性心律恢复率差异均有统计学意义(P<0.05),术后半年及术后1 a A组的窦性心律恢复率分别为90.74%、90.32%,B组的窦性心律恢复率分别为63.64%、59.37%。结论左房内径大小≥60 mm是影响房颤射频消融术后恢复窦性心律的负性因素。     

左房线性消融治疗阵发性心房颤动患者术后的左房功能心超评价

目的动态观察阵发性心房颤动(房颤)患者射频消融术前及消融后不同时段左房结构和功能的变化,探讨射频消融术对左房功能的影响及其临床意义。方法: 28例阵发性房颤患者接受左房线性消融 肺静脉电隔离术,其中男18例,女10例,平均年龄(61．3±8．8)岁(46- 75岁),术前房颤持续时间(4．5±3．3)年(0．5- 13年),14例无基础心脏病,12例有高血压,2例有冠心病。分别于术前、术后1周内、1、6及12个月以上时应用心脏超声观察左房结构和功能随时间变化的过程。观察左房前后径、左右径和上下径的变化,测量左房最大容积、最小容积和心房收缩前容积,计算左房主动射血分数(LAAEF),脉冲多普勒测量二尖辦E波、A波峰速度(VE、VA)和速度时间积分(E-VTI、A-VTI),计算左房充盈分数(AFF)和左房射血力(AEF)。结果①28例患者术后平均随访(10．5±4．7)个月(3-19个月),随访终点时20例无复发,8例复发:术后3个月时,10例患者因始终无AF发作而停抗心律失常药;6个月时,10例患者仍需口服抗心律失常药物,AF发作较术前减少70％,其中6例为普罗帕酮,4例服用胺碘酮;另有8例患者服药过程中房颤发作仍频繁,其中5例合用胺碘酮和美托洛尔,1例合用普罗帕酮和美托洛尔,2例单纯用美托洛尔控制心室率。②术后消融成功者左房内径和容积逐渐缩小,而复发者无明显变化;1周内消融组患者左房大小均未见明显变化,之后因临床转归的不同,各自呈现不同的变化趋势:消融成功组左房逐渐变小,6和12个月时左房前后径和左右径与术前比较差异有统计学意义(P<0．05),左房上下径的P值为0．05,12个月时左房最大容积和最小容积较术前明显减小(P<0．05);而复发组左房内径和容积均无明显变化。③左房收缩功能因消融而部分丧失,VA和A-VTI在术后1周内进一步减小,术后逐渐恢复,消融成功者1个月时逐渐好转,至术后12个月较术前有明显增加(P<0．05);LAAEF、AFF和AEF同样在术后1周内降低,以后随时间的推移逐渐恢复;但复发者至随访末期仍低于术前水平。结论左房线性消融是治疗阵发性房颤的有效方法,消融成功者可一定程度逆转左房结构重构,复发者无明显变化;成功组左房收缩功能在术后1周内降低,但长期转归佳,而复发者左房收缩功能仍低于术前。     

心房颤动射频消融患者血浆脑钠肽水平的变化及临床价值

目的探讨无器质性心脏病的心房颤动(简称房颤)患者,导管射频消融(RFCA)前、后氨基末端脑钠肽前体(NT-proBNP)的变化规律性,以及对房颤RFCA术后6个月内复发的预测价值。方法对105例无器质性心脏病心功能正常的房颤患者,根据房颤发作类型不同分为两组:阵发性房颤组(64例)和持续性房颤组(41例)。分别检测两组术前24h、术后3d及术后3个月时NT-proBNP的水平,以及超声心动图检测左心房内径等参数。比较两组患者间消融前、后NT-proBNP水平的变化,以及NT-proBNP是否与术后6个月内房颤复发有相关性。结果术前持续性房颤组患者NT-proBNP水平较阵发性房颤组患者高[(842.09±197.31)pg/mL vs.(658.35±202.45)pg/mL,P=0.040]。阵发性房颤组患者术后3dNT-proBNP水平较术前、术后3个月有下降,但差异无统计学意义(P=0.060)。持续性房颤组患者,术后3dNT-proBNP水平较术前和术后3个月显著降低(P=0.040),术后3个月与术前基线相比有降低,但差异无统计学意义(P=0.420)。随访6个月阵发性房颤组有15例(23.44%)出现复发,持续性房颤组有12例(29.27%)出现复发,两组中房颤复发患者基线NT-proBNP水平均高于未发生房颤复发患者。进一步多因素分析显示,术前NT-proBNP水平(P=0.048)以及左心房内径(P=0.049)是房颤复发的独立预测因素。结论无器质性心脏病心功能正常的房颤患者,房颤射频消融术后3dNT-proBNP水平呈下降趋势,以持续性房颤患者最为显著,术前较高的基线NT-proBNP水平及左心房内径可作为预测房颤射频消融术后6个月内复发的指标。     

替米沙坦联合螺内酯预防阵发性心房颤动射频消融术后早期复发的疗效

目的:探讨替米沙坦联合螺内酯预防阵发性心房颤动射频消融术后早期复发的临床疗效。方法:选择本院96例行射频消融术的阵发性心房颤动患者,随机分为观察组和对照组,每组各48例。观察组给予替米沙坦联合螺内酯治疗,对照组给予华法林及胺碘酮治疗。结果:观察组复发率为6.25%,对照组为22.92%,两组比较差异有统计学意义(P0.05)。观察组术后1个月hs CRP高于对照组,术后3个月观察组NT-pro BNP低于对照组,两组比较差异均有统计学意义(P0.05)。结论:替米沙坦联合螺内酯预防阵发性心房颤动射频消融术后,可减少房颤早期复发。     

射频消融术对阵发性房颤患者左房结构和收缩功能的影响

目的 应用超声心动图观察阵发性心房颤动(PAF)患者射频前后左房结构和收缩功能的变化.方法 52例PAF患者行射频消融术,分别于术前及术后1 d、6个月时应用超声心动图测定左房内径(LAD)、左房面积(LAA)和左房容积(LAV),记录二尖瓣血流频谱A峰流速(VA)、左房射血力(LAF),同时使用组织多普勒记录二尖瓣前...     

心房颤动射频消融术前后左房压力测量的意义

目的探索左房压力测量在心房颤动(简称"房颤")射频消融术中应用的价值,尤其在合并心功能不全的房颤患者消融中的意义。方法入选39例导管消融的房颤患者,年龄(64.4±12.6)岁。阵发性房颤24例,持续性、永久性房颤15例。心功能NYHAⅠ级17例,Ⅱ级18例,Ⅲ级4例。左室射血分数51%～77%。分别测量消融术前、术后即刻左房压力。结果患者术后左房压力(28.8±10.6)cmH2O,较术前左房压力[(24.5±6.6)cmH2O]明显升高(P=0.000);心功能Ⅲ级组手术前后的变化值[(7.2±4.3)cmH2O]显著高于Ⅰ级组[(5.5±2.0)cmH2O]和Ⅱ级组[(4.3±3.2)cmH2O](P<0.05);术后左房压力与手术时间、放电时间的相关系数分别为0.799(P=0.010)、0.765(P=0.046);消融术前后左房压变化值与手术时间、放电时间的相关系数分别为0.914(P=0.001)、0.834(P=0.009)。术后出现心力衰竭症状或肺部啰音的患者,术后左房压力以及左房压力变化值均明显高于无症状者和无啰音者(P<0.05)。结论房颤合并心功能不全患者进行射频消融术时,左房压力可成为术中监测的重要临床内容,不仅方法简单实用,更可以提高术中的安全性。     

最大P波宽度及P波离散度对阵发性房颤环肺静脉隔离术后复发的预测作用

目的探讨最大P波宽度(Pmax)及P波离散度(Pd)对阵发性心房颤动(房颤)环肺静脉隔离术后复发的预测作用(circumferential pulmonary vein ablation,CPVA)。方法 69名因阵发性房颤接受环肺静脉隔离术的患者,在术前和术后窦性心律时分别测定记录Pmax和Pd,并对患者进行随访,了解其复发情况。结果随访8～36个月,共有16名患者房颤复发,复发组和无复发组在年龄、性别、病程、基础疾病、左房内径(LA)、左室舒张末期内径(LVed)、射血分数(EF)上差异均无统计学意义;两组术前及术后Pmanx、Pd差异均无统计学意义,但术前和术后Pmax及Pd在复发组均有高于无复发组的趋势。复发组术后Pmax小于术前(P<0.05),而无复发组术后Pmax、Pd及复发组Pd均有小于术前的趋势。结论 Pmax及Pd对预测阵发性房颤消融术后复发的作用尚不能确定,但左房内消融可能影响了折返激动的形成。仍需大规模临床试验进一步评价体表心电图对预测房颤消融术后复发的价值,从而筛选复发高风险患者,予以干预措施,减少CPVA术后房颤复发。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.