病例193:反复肺栓塞1例

正2018年第6期(截稿日期2018年5月1日)患者,女,48岁,既往体健,因"突发胸闷、呼吸困难4h"于2015年6月入成都中医药大学附属医院(我院)胸痛中心;急诊科快速床旁检验示心肌酶及心肌损伤标志物阴性,D-二聚体10(参考值0.5)mg/L;动脉血气分析示pH 7.084,二氧化碳分压(PCO2)41.5mm Hg(1mm Hg=0.133kPa),氧分压(PO2)63.5mm Hg,     

延长呼气法和曲线拟合法在老年慢性阻塞性肺疾病呼吸衰竭患者呼出气二氧化碳图中的应用

Objective To find noninvasive estimation of partial pressure of carbon dioxide in artery (PaCO2) by measuring the end-tidal CO2 partial pressure (PETCO2) in elderly patients with respiratory failure with chronic obstructive pulmonary disease (COPD). Methods All the 30 acutely exacerbated COPD subjects received routine clinical treatment including bronchodilators,mucolytics, glucocorticosteroid, antibiotics and oxygen therapy for 5-7 days, and part of them received noninvasive positive-pressure ventilation (NIPPV) treatment concurrently. They were both tested by eupnea method and prolonged expiratory method before and after treatment. Results Before treatment, PET CO2 (Q) (end-tidal CO2 pressure with eupnea, (50.72±8.93) mm Hg wassignificantly lower than PaCO2 (F=38.73, P＜0.01 ). Yet, PETCO2(P) (end-tidal CO2 pressure with prolong expiration) was (70.35±8.91) mm Hg and PaCO2 was (71.25±9.08) mm Hg. There was no significant difference between PETCO2 (P) and PaCO2 (P＞0.05). The similar results were found after treatment. By linear regression analysis, PetCO2(P) was remarkably positive correlated with PaCO2 before and after treatment (r=0.96 and 0.97, respectively, P＜0.01). According to TABG,PCO2(C) which was calculated by the average expiratory time of fitting curve was (71.78±9.04)mm Hg. And there was no significant difference between PCO2 (C) and PaCO2 (P＞0.05);Thesimilar results were founcl after treatment. By linear regression analysis, PCO2 (C) was remarkably positively correlated with PaCO2 (r=0.97 and 0.98, respectively, P＜0.01) before and after treatment. Conclusions In COPD patients with type Ⅱ respiratory failure, conventional PETCO2 (Q) is significantly lower than PaCO2. Yet, PETCO2 (P) could exactly estimate PaCO2 and is appropriate to its dynamic monitoring. And PCO2 (C) which is calculated by mode Boltzmann on eupnea curve also obtain similar results.     

延长呼气法和曲线拟合法在老年慢性阻塞性肺疾病呼吸衰竭患者呼出气二氧化碳图中的应用

Objective To find noninvasive estimation of partial pressure of carbon dioxide in artery (PaCO2) by measuring the end-tidal CO2 partial pressure (PETCO2) in elderly patients with respiratory failure with chronic obstructive pulmonary disease (COPD). Methods All the 30 acutely exacerbated COPD subjects received routine clinical treatment including bronchodilators,mucolytics, glucocorticosteroid, antibiotics and oxygen therapy for 5-7 days, and part of them received noninvasive positive-pressure ventilation (NIPPV) treatment concurrently. They were both tested by eupnea method and prolonged expiratory method before and after treatment. Results Before treatment, PET CO2 (Q) (end-tidal CO2 pressure with eupnea, (50.72±8.93) mm Hg wassignificantly lower than PaCO2 (F=38.73, P＜0.01 ). Yet, PETCO2(P) (end-tidal CO2 pressure with prolong expiration) was (70.35±8.91) mm Hg and PaCO2 was (71.25±9.08) mm Hg. There was no significant difference between PETCO2 (P) and PaCO2 (P＞0.05). The similar results were found after treatment. By linear regression analysis, PetCO2(P) was remarkably positive correlated with PaCO2 before and after treatment (r=0.96 and 0.97, respectively, P＜0.01). According to TABG,PCO2(C) which was calculated by the average expiratory time of fitting curve was (71.78±9.04)mm Hg. And there was no significant difference between PCO2 (C) and PaCO2 (P＞0.05);Thesimilar results were founcl after treatment. By linear regression analysis, PCO2 (C) was remarkably positively correlated with PaCO2 (r=0.97 and 0.98, respectively, P＜0.01) before and after treatment. Conclusions In COPD patients with type Ⅱ respiratory failure, conventional PETCO2 (Q) is significantly lower than PaCO2. Yet, PETCO2 (P) could exactly estimate PaCO2 and is appropriate to its dynamic monitoring. And PCO2 (C) which is calculated by mode Boltzmann on eupnea curve also obtain similar results.     

The clinical efficiency and safety of bisorpolol hydrochlorothiazide in patients with mild to moderate essential hypertension

Objective To investigate the efficacy and safety of bisorpolol/hydroehlorothiazide (Lodoz) in patients with mild and moderate essential hypertension. Methods After 2 weeks of placebo run-in period, 90 hypertensive patients with sitting diastolic blood pressure (DBP) between 95 and 109 mm Hg(1 mm Hg =0. 133 kPa) and systolic blood pressure (SBP) below 180 mm Hg were treated by Lodoz(2. 5 mg/6. 25 mg/day) for 4 weeks.     

Association of blood pressure classification in young adults using the 2017 ACC/AHA guideline with subsequent all-cause mortality

Background Little is known regarding the association of changes in blood pressure level with risk of allcause and cardiovascular disease(CVD) mortality in young adults. Methods This cohort study from the 1999-2006 National Health and Nutrition Examination Survey(NHANES) consisted of 9977 adults aged from 18 to 40 years by following up until the date of death or December 31, 2015. Participants were categorized by blood pressure readings using the blood pressure classification of the 2017 American College of Cardiology/American Heart Association(ACC/AHA) High Blood Pressure Clinical Practice Guidelines: normal(systolic, 120 mm Hg;diastolic, 80 mm Hg), elevated(systolic, 120-129 mm Hg; diastolic, 80 mm Hg), and hypertension(systolic,≥130 mm Hg; diastolic,≥80 mm Hg). Multivariable Cox proportional hazard models yielded adjusted hazard ratios(HRs) and 95% confidence intervals(CIs) of CVD and all-cause mortality. Results A total of 8356 participants(median age, 26.63 ± 7.01, 3758 women [44.97%]), of whom 265(3.17%) all-cause and 10(0.12%)CVD mortality were observed during a median follow-up duration of 152.96 ± 30.45 months. All-cause mortality incidence rates for normal blood pressure, elevated blood pressure, and hypertension were 172(2.91%), 43(3.52%), and 50(4.10%), respectively. With the normal blood pressure group being a reference, from elevated blood pressure to hypertension group, adjusted HRs for all-cause mortality were 1.24(95% CI, 0.63-2.42) and1.52(95% CI, 0.83-2.80)(P=0.162) after adjustment for potential confounders. Conclusions Among young adults, those with elevated blood pressure and hypertension, compared with those with normal blood pressure before the age of 40, as defined by the blood pressure classification in the 2017 ACC/AHA guidelines, are not significantly associated with increased risk of subsequent all-cause mortality.[S Chin J Cardiol 2019;20(4):201-210]     

Increased inspiratory esophagogastric junction pressure in systemic sclerosis:An add-on to antireflux barrier

AIM:To investigate crural diaphragm(CD)function in systemic sclerosis(SSc)using high-resolution manometryand standardized inspiratory maneuvers.METHODS:Eight SSc volunteers(average age,40.1years;one male)and 13 controls(average age,32.2years;six males)participated in the study.A highresolution manometry/impedance system measured the esophagus and esophagogastric junction(EGJ)pressure profile during swallows and two respiratory maneuvers:sinus arrhythmia maneuver(SAM;the average of six EGJ peak pressures during 5-s deep inhalations)and threshold maneuver(TM;the EGJ peak pressures during forced inhalation under 12 and 24 cm H2O loads).Inspiratory diaphragm lowering(IDL)was taken as the displacement of the EGJ high-pressure zone during the SAM.RESULTS:SSc patients had lower mean lower esophageal sphincter pressure than controls during normal breathing(19.7±2.8 mm Hg vs 32.2±2.7 mm Hg,P=0.007).Sinus arrhythmia maneuver pressure was higher in SSc patients than in controls(142.6±9.4 mm Hg vs 104.6±13.8 mm Hg,P=0.019).Sinus arrhythmia maneuver pressure normalized to IDL was also higher in SSc patients than in controls(83.8±13.4 mm Hg vs37.5±6.9 mm Hg,P=0.005).Threshold maneuver pressures normalized to IDL were also greater in SSc patients than in controls(TM 12 cm H2O:85.1±16.4mm Hg vs 43.9±6.3 mm Hg,P=0.039;TM 24 cm H2O:85.2±16.4 mm Hg vs 46.2±6.6 mm Hg,P=0.065).Inspiratory diaphragm lowering in SSc patients was less than in controls(2.1±0.3 cm vs 3±0.2 cm,P=0.011).CONCLUSION:SSc patients had increased inspiratory EGJ pressure.This is an add-on to EGJ pressure and indicates that the antireflux barrier can be trained.     

缬沙坦/氨氯地平复方片剂对单药控制不良的轻中度高血压患者的疗效观察

Objective To evaluate the efficacy and safety of a once daily valsartan/amlodipine 80/ 5 mg combination tablet in Chinese mild to moderate hypertensive patients without adequate blood pressure control by monotherapy. Methods Two muhicenter, randomized, double-blind, doubledummy, active-controlled, parallel group trials were conducted. After a washout period (no medication) of 1-4 weeks, patients with Mean Sitting Diastolic Blood Pressure (MSDBP) ≥95 nun Hg (1 mm Hg = 0.133 kPa) and < 110 mm Hg received a monotherapy of either Amlodipine 5 mg (in study 1) or valsartan 80 mg (in study 2) for 4 weeks. Patients with MSDBP ≥90 mm Hg and < 110 mm Hg at the end of the monotherapy period were randomized to receive valsartan/amlodipine 80/5 mg treatment, or continue with the monotherapy. Results In study 1, compared with amlodipine 5 nag, valsartan/amlodipine 80/5 nag once daily further reduced mean sitting systolic blood pressure (MSSBP)/MSDBP 4.4/3 mm Hg (P <0.0001). In study 2, compared with valsartan 80 mg, valsartan/amlodipine 80/5 mg once daily further reduced MSSBP/MSDBP 6.4/4.2 mm Hg (P<0.0001). The blood pressure (BP) control rates (BP < 140/90 mm Hg) of combination treatment group were 71.0% and 71.2% respectively, and significantly higher than the monotherapy groups in both trials. Incidence of adverse events was comparable in monotherapy and combination therapy groups. Conclusion Our results showed that valsartan/amlodipine 80/5 mg was superior to amlodipine 5 mg or valsartan 80 mg done in lowering blood pressure and BP control in patients with mild to moderate hypertension not adequately controlled with tanlodipine 5 mg or valsartan 80 mg monotherapy. No new or unexpected safety issues were identified with valsartan/amlodipine combination therapy compared with monotherapy.     

骨形态发生蛋白2型受体基因在肺动脉高压发病机制中的研究进展

<正>肺动脉高压(pulmonary arterial hypertension,PAH)是一种罕见的以肺末梢小动脉进行性重构、肺动脉内压力异常升高为特征的临床疾病~([1])。PAH诊断标准为静息状态下右心漂浮导管(right-heart catheterization,RHC)测定平均肺动脉压(mean pressure of pulmonary artery,mPAP)≥25mm Hg(1mm Hg=0.133kPa),肺毛细血管楔压(pulmonary capillary wedge pressure,PCWP)≤15 mm Hg,肺血管阻力     

高血压前期需要重新定义吗?

<正>2003年,美国高血压预防、检测、评估和治疗全国联合委员会第7次报告(the seventh report of the joint national committee on prevention,detection,evaluation,and treatment of high blood pressure,JNC7)提出了"高血压前期(prehypertension,PHT)"的概念,指的是收缩压120~139或舒张压80~89mm Hg(1 mm Hg=0.133kPa)的状态。1999WHO/国际高血压学会(International Society Hyper-     

Cardiac catheterization and comprehensive clinical evaluation after bidirectional Glenn shunt surgery in 60 patients with complex congenital heart disease

Background The bidirectional Glenn shunt surgery is a palliative procedure for patients with complex congenital heart disease(CHD) who are not suitable for biventricular repair in early life. There is limited evidence of successful strategies for long-term hemodynamic stabilization. Furthermore, there have been no data on optimal hemodynamics that could be used as a reference for patients' follow-on management. Methods Sixty CHD patients, 44 male and 16 female, with bidirectional Glenn shunt surgery and cardiac catheterization were enrolled at our hospital between January 2014 and December 2016. Pre-and post Glenn shunt percutaneous oxygen saturation(SpO_2), 6-minute walk test(6 MWT), superior vena cava pressure(SVCP), pulmonary arterial pressure(PAP), pulmonary capillary wedge pressure(PCWP), pulmonary vascular resistance(PVR), small pulmonary vascular resistance(s PVR) were measured. Pre-and post-total cavopulmonary connection(TCPC) SpO_2, and in-hospital complications were monitored. The optimal hemodynamic cutoff values for TCPC patient selection were estimated by receive operating characteristic(ROC) curve analysis. Results SpO_2 was significantly increased by bidirectional Glenn shunt surgery(75.42 ± 9.62% to 86.98 ± 7.63%, P 0.001) from 82.70 ± 5.99% to 95.00 ±4.07% in the 47 patients with TCPC. Forty-two patients completed the 6 MWT with a mean distance of 362.7 ±75.0 m and a SpO_2 decrease from 81.80 ± 7.84% to 67.59 ± 1.82%(P 0.001). The △SpO_2 and 6-minute walk distance(6 MWD) in the 32 who underwent TCPC and ten of them did not reach statistical significance(17.22 ±13.82% vs. 13.87 ± 8.74%, P = 0.08 and 358.88 ± 78.97 m vs. 374.80 ± 62.55 m, P = 0.564]. After cardiac catheterization, 47 patients were selected for TCPC. The right pulmonary artery systolic pressure(s RPAP), mean right pulmonary artery pressure(m RPAP), mean left pulmonary artery pressure(m LPAP), PVR, and s PVR were significantly lower in the TCPC group than in the non-TCPC group. The differences in superior vena cava systolic blood pressure(s SVCP), mean superior vena cava pressure(m SVCP), and left pulmonary artery systolic pressure(s LPAP) were not significant. The optimal cutoff values for TCPC were s SVCP ≤ 20 mm Hg(P = 0.025),s RPAP ≤ 22 mm Hg(P = 0.0001, mRPAP ≤ 13 mm Hg(P =0.003), s LPAP ≤ 27 mm Hg(P =0.03), m LPAP ≤ 11 mm Hg(P = 0.01), PVR ≤ 4.3 Wood U/m~2(P 0.0001) and were significantly associated with TCPC selection,except for m SVCP ≤ 19 mm Hg(P = 0.06) and s PVR ≤ 2.0 wood U/m~2(P = 0.0531). One patient died because of low cardiac output after TCPC. In-hospital mortality was 2.1%. Conclusion The SpO_2 can be significantly improved after bidirectional Glenn shunt and TCPC surgery. The 6 MWT is an index of activity tolerance prior toTCPC. Hemodynamic values of s SVCP ≤ 20 mm Hg, s RPAP ≤ 22 mm Hg, m RPAP ≤ 13 mm Hg, s LPAP ≤ 27 mm Hg, m LPAP ≤ 11 mm Hg, and PVR ≤ 4.3 Wood U/m~2 can help identify post Glenn-shunt patients indicated for TCPC.     

Effect of home blood pressure telemonitoring with self-care support on uncontrolled systolic hypertension in diabetics

Lowering blood pressure reduces cardiovascular risk, yet hypertension is poorly controlled in diabetic patients. In a pilot study we demonstrated that a home blood pressure telemonitoring system, which provided self-care messages on the smartphone of hypertensive diabetic patients immediately after each reading, improved blood pressure control. Messages were based on care paths defined by running averages of transmitted readings. The present study tests the system’s effectiveness in a randomized, controlled trial in diabetic patients with uncontrolled systolic hypertension. Of 244 subjects screened for eligibility, 110 (45%) were randomly allocated to the intervention (n = 55) or control (n = 55) group, and 105 (95.5%) completed the 1-year outcome visit. In the intention-to-treat analysis, mean daytime ambulatory systolic blood pressure, the primary end point, decreased significantly only in the intervention group by 9.1 ± 15.6 mm Hg (SD; P < 0.0001), and the mean between-group difference was 7.1 ± 2.3 mm Hg (SE; P<0.005). Furthermore, 51% of intervention subjects achieved the guideline recommended target of <130/80 mm Hg compared with 31% of control subjects (P < 0.05). These improvements were obtained without the use of more or different antihypertensive medications or additional clinic visits to physicians. Providing self-care support did not affect anxiety but worsened depression on the Hospital Anxiety and Depression Scale (baseline, 4.1±3.76; exit, 5.2±4.30; P = 0.014). This study demonstrated that home blood pressure telemonitoring combined with automated self-care support reduced the blood pressure of diabetic patients with uncontrolled systolic hypertension and improved hypertension control. Home blood pressure monitoring alone had no effect on blood pressure. Promoting patient self-care may have negative psychological effects.     

踝间血压差研究进展

正踝间血压差(踝间差,the difference of interankle systolic blood pressure)是双下肢踝部收缩压的差值。据统计发现,社区人群中踝间差≥10 mm Hg(1mm Hg=0.133kPa)的检出率为18.5%~([1]),而在脑卒中患者中踝间差≥7mm Hg的检出率为59.6%~([2])。近年来,有越来越多的研究显示踝间差增大是多种疾     

肥厚型梗阻性心肌病经皮经腔间隔心肌消融术与室间隔心肌切除术疗效比较

目的应用超声心动图比较肥厚型梗阻性心肌病患者经皮经腔间隔心肌消融术与室间隔心肌切除术的疗效。方法分别于经皮经腔间隔心肌消融术及室间隔心肌切除术前、后测量肥厚型梗阻性心肌病患者左室流出道压差,比较术前及术后压差。结果肥厚型梗阻性心肌病患者在进行经皮经腔间隔心肌消融术与室间隔心肌切除术后,左室流出道压差均较术前明显减低。经皮经腔间隔心肌消融术肥厚型心肌病患者术前左室流出道压差(99±19)mm Hg(1 mm Hg=0.133 kPa),术后降至(36±20) mm Hg(P<0.05)。进行室间隔心肌切除术肥厚型心肌病患者术前左室流出道压差(117±32) mm Hg,术后降至(28±17) mm Hg(P<0.05)。经皮经腔间隔心肌消融术与室间隔心肌切除术患者术后左室流出道压差差异无统计学意义[(36±20)mm Hg比(28±17)mm Hg]。结论经皮经腔间隔心肌消融术可以明显减低肥厚型梗阻性心肌病患者左室流出道压差,且与室间隔心肌切除术疗效相似。     

真分叉病变术中并发冠状动脉穿孔一例

1临床资料患者男,72岁,因"突发心前区疼痛、憋喘12 h余"入院。查体:血压134/74 mm Hg(1 mm Hg=0.133 k Pa),心率70次/min,双下肺可闻及湿性啰音,余无其他阳性体征。心电图示:Ⅰ、a VL、V3~V6导联T波倒置。超敏肌钙蛋白2.65μg/L(正常值<0.11μg/L)。诊断:冠心病,急性心肌     

Catheter ablation for atrial fibrillation in a subset of patients with concomitant hypertension

AIM:To study patients with atrial fibrillation and hypertension who had successful catheter ablation for changes in blood pressure 1 year later.METHODS:A retrospective study was performed on patients who had catheter ablation for atrial fibrillation(AF) and hypertension(HTN) which included local autonomic ganglionated plexi denervation and pulmonary veins isolation.Of the records of 119 patients,followup data was found in order to determine the presence of sinus rhythm and data on systolic(SBP) and diastolic blood pressure at 2 wk,3 mo,6 mo and 1 year after the ablation procedure.Transthoracic echocardiograms were taken at the time of the catheter procedure to determine left atrial dimensions(LADs) and left ventricular size.RESULTS:There was no significant difference in the preablation mean blood pressures between the two groups(P = 0.08).After 1 year 33 of the 60 with AF and HTN were in sinus rhythm,of whom 12 had normal LADs,≤ 4 cm Group 1,and 21 had enlarged left atria(LADs 4 cm,Group 2).For Group 1,at 1 year of follow up,there was a significant difference in the SBP(119.2 ± 13 mm Hg) compared to pre-ablation(142.6 ± 13.7 mm Hg,P = 0.001).For Group 2,there was no significant difference in the SBP,pre-ablation(130.3 ± 17.5 mm Hg) and at 1 year of follow up(130.4 ± 13.4 mm Hg,P = 0.75).All patients were on similar anti-hypertensive medications.There was a trend for a greater left ventricular size in Group 2 compared to Group 1.CONCLUSION:We suggest that Group 1 had HTN due to sympathetic hyperactivity,neurogenic HTN;whereas HTN in Group 2 was based on arterial vasoconstriction.     

Age-related impairment of esophagogastric junction relaxation and bolus flow time

AIM To investigate the functional effects of abnormal esophagogastric(EGJ) measurements in asymptomatic healthy volunteers over eighty years of age. METHODS Data from 30 young controls(11 M, mean age 37 ± 11 years) and 15 aged subjects(9 M, 85 ± 4 years) were compared for novel metrics of EGJ-function: EGJcontractile integral(EGJ-CI), "total" EGJ-CI and bolus flow time(BFT). Data were acquired using a 3.2 mm, 25 pressure(1 cm spacing) and 12 impedance segment(2 cm) solid-state catheter(Unisensor and MMS SolarGI system) across the EGJ. Five swallows each of 5 m L liquid(L) and viscous(V) bolus were analyzed. Mean values were compared using Student's t test for normally distributed data or Mann Whitney U-test when non-normally distributed. A P value 0.05 was considered significant.RESULTS EGJ-CI at rest was similar for older subjects compared to controls. "Total" EGJ-CI, measured during liquid swallowing, was increased in older individuals when compared to young controls(O 39 ± 7 mm Hg.cm vs C 18 ± 3 mm Hg.cm; P = 0.006). For both liquid and viscous bolus consistencies, IRP4 was increased(L: 11.9 ± 2.3 mm Hg vs 5.9 ± 1.0 mm Hg, P = 0.019 and V: 14.3 ± 2.4 mm Hg vs 7.3 ± 0.8 mm Hg; P = 0.02) and BFT was reduced(L: 1.7 ± 0.3 s vs 3.8 ± 0.2 s and V: 1.9 ± 0.3 s vs 3.8 ± 0.2 s; P 0.001 for both) in older subjects, when compared to young. A matrix of bolus flow and presence above the EGJ indicated reductions in bolus flow at the EGJ occurred due to both impaired bolus transport through the esophageal body(i.e., the bolus never reached the EGJ) and increased flow resistance at the EGJ(i.e., the bolus retained just above the EGJ).CONCLUSION Bolus flow through the EGJ is reduced in asymptomatic older individuals. Both ineffective esophageal bolus transport and increased EGJ resistance contribute to impaired bolus flow.     

室间隔缺损和动脉导管未闭合并中重度肺动脉高压的分期复合治疗

目的 评价经导管介入封堵加择期外科手术的分期复合治疗应用于室间隔缺损和动脉导管未闭合并中重度肺动脉高压患者的安全性及有效性.方法 自2004年7月至2009年7月,对22例室间隔缺损和动脉导管未闭合并中重度肺动脉高压患者进行了先经导管介入封堵动脉导管未闭,随后择期行开胸室间隔缺损修补术的分期复合治疗.术后进行随访,观察心律改变、残余分流、封堵器形态、有无瓣膜反流及主动脉狭窄等情况,测量肺动脉压变化,评价治疗效果.结果 经导管介入封堵治疗后,患者肺动脉收缩压由(76.2±25.8)mm Hg(1 mm Hg=0.133 kPa)降至(55.4±20.6)mm Hg(P=0.005),肺动脉平均压由(53.5±23.5)mm Hg降至(36.2±17.8)mm Hg(P=0.049),全肺动脉阻力由(8.2±4.9)wood单位降至(6.9±4.3)wood单位(P=0.037),肺循环血流量与体循环血流量的比值(Qp/Qs)由2.8±2.3升至3.4±1.7(P=0.045).外科手术后,肺动脉收缩压由(64.5±22.3)mm Hg降至(43.1±18.9)mm Hg(P=0.001),肺动脉平均压由(40.2±18.7)mm Hg降至(29.5±15.8)mm Hg(P=0.040).随访中所有患者均未出现右心衰竭和死亡.结论 室间隔缺损和动脉导管未闭合并中重度肺动脉高压的经导管介入封堵加择期外科手术的分期复合治疗安全、有效.

Abstract：

Objective To evaluate the safety and efficacy of staged hybrid approach in treating ventricular septal defect (VSD) patients combined with patent ductus arteriosus (PDA) and pulmonary artery hypertension (PAH). Methods From July 2004 to July 2009, 22 VSD patients with PDA and PAH were enrolled and received staged hybrid approach treatment( transcatheter PDA occlusion and elective open surgery for VSD several lays after PDA occlusion). All patients were followed up to examine rhythm change,residual shunt, shape of occlude, possible valve regurgitation, and aortic stenosis by echocardiography. Results After transcatheter PDA occlusion, pulmonary arterial systolic pressure decreased from (76. 2 ± 25. 8 ) mm Hg ( 1 mm Hg = 0. 133 kPa) to ( 55.4 ± 20. 6 ) mm Hg ( P = 0. 005 ),mean pulmonary artery pressure decreased from ( 53.5 ± 23.5 ) mm Hg to ( 36. 2 ± 17. 8 ) mm Hg ( P=0. 049), total pulmonary resistance decreased from (8. 2 ±4.9)wood units to (6.9 ±4. 3)wood units (P =0. 037), and pulmonary-to-systemic flow ratio (Qp/Qs) increased from 2. 8 ± 2. 3 to 3.4 ± 1.7 ( P = 0. 045 )post transcatheter interventional PDA occlusion. After VSD repair, pulmonary arterial systolic pressure decreased from (64. 5 ± 22. 3 ) mm Hg to (43. 1 ± 18. 9) mm Hg ( P = 0. 001 ) and mean pulmonary artery pressure decreased from (40. 2 ± 18. 7 ) mm Hg to (29. 5 ± 15. 8) mm Hg ( P = 0. 040). There was no death or right heart failure during the follow-up. Conclusion Staged hybrid approach is an effective and safe strategy for treating VSD patients with PDA and PAH.     

盐酸卡替洛尔滴眼液降眼压疗效观察

目的 观察β-受体阻滞剂盐酸卡替洛尔滴眼液对患者24 h眼压的影响.方法 选取30例既往无抗青光眼药物使用史的患者,测量患者用药前24 h眼压(时间点为2:00 AM、6:00 AM、10:00 AM、2:00 PM、6:00 PM、10:00 PM).测量后给予患者盐酸卡替洛尔滴眼液点眼治疗,每天7:00 AM及7:00 PM各1次,每次1～2滴.观察患者用药15 d后的24 h眼压,并进行对比分析.结果 用药前患者24 h内6个检测点平均眼压分别为(19.77±2.51、19.52±2.34、20.38±2.71、20.07±3.65、19.97±4.10、19.97±4.31) mm Hg(1 mm Hg=0.133 kPa),用药后患者平均眼压分别为(17.12±2.38、17.42±2.60、18.18±2.36、18.02±3.77、17.72±3.17、17.35±3.40)mm Hg,用药前后患者平均眼压差异有统计学意义(t=11.68,P=0.000).其中用药前后日间平均眼压下降幅度为(2.46±2.05)mm Hg,夜间平均眼压下降幅度为(2.17±1.88) mm Hg,两者差异无统计学意义.结论 盐酸卡替洛尔滴眼液可有效降低患者眼压,其24 h降眼压幅度是稳定的.

Abstract：

Objective To investigate the effect of carteolol hydrochloride eye drops on 24-hour variation of intraocular pressure (IOP). Methods The 30 patients who had never used any anti-glaucoma eye drops were chosen, and their 24-hour variation of IOP (at 2:00 AM, 6:00 AM, 10:00 AM, 2:00 PM, 6:00 PM, 10:00 PM) were measured. Then carteolol hydrochloride eye drops were used twice a day (7:00 AM and 7:00 PM), 1-2 drops each time. Fifteen days later, their 24-h IOP was measured again and the data were analyzed. Results The average IOP at six monitoring points before treatment were (19.77±2.51) mm Hg, (19.52±2.34) mm Hg, (20.38±2.71) mm Hg, (20.07±3.65) mm Hg, (19.97±4.10) mm Hg and (19.97±4.31) mm Hg, the corresponding data after 15 days of treatment were (17.12±2.38) mm Hg, (17.42±2.60) mm Hg, (18.18±2.36) mm Hg, (18.02±3.77) mm Hg, (17.72±3.17) mm Hg and (17.35±3.40) mm Hg (t=11.68, P=0.000). The difference before and after treatment was (2.46±2.05) mm Hg during day and (2.17±1.88) mm Hg during night, and no significant difference was found between them. Conclusions Carteolol hydrochloride eye drops could significantly reduce the IOP, the decreased extent of 24-h IOP is stable.     

表现为急性心肌梗死的嗜铬细胞瘤一例

正1临床资料患者,男性,65岁,主因"反复胸痛2年,再发加重2h"入院。近2年来胸痛发作时伴有血压升高,可达200/120mm Hg(1 mm Hg=0.133 k Pa),平时血压正常。入院前2 h,胸痛再发,持续不缓解,伴全身大汗。入院查体:躁动不安,全身大汗,呼吸急促,血压210/125 mm Hg,双肺底可闻及少许湿啰音,心率98次/min,律齐,未闻及杂音。心电图示V1~6 ST段明显压低,T波高尖。发病2 h心肌标志物正常。     

计算机视觉食管曲张静脉压力检测技术的初步研究

Objective To evaluate the clinical reliability and feasibility of computerized endoscopic balloon manometry in vitro and in vivo, in measurement of pressure of esophageal varices. Methods Computerized endoscopic balloon manometry was used to measure the pressure of variceal model with different diameter (3 mm, 6 mm and 8 mm) and intraluminal pressures (ranging from 8 to 36 mm Hg), and the findings were compared with actual pressures. The technique was also applied in 23 patients with liver cirrhosis and esophageal varices, and its correlation with hepatic venous pressure gradient and other factors related with varices bleeding. Results The study in vitro showed that the measured intraluminal pressure was correlated significantly with the actual value ( r ≥ 0. 993, P ＜ 0. 001 ) without obvious measurement bias(95% CI = -0.13 cm H2O to 0. 33 cm H2O). The measurement in 23 patients were success with little variation coefficient (r≥0. 998) between repeated procedures. Regression analysis showed a good correlation between variceal pressure and hepatic venous pressure gradient (r=0. 858, P ＜ 0. 001 ). A higher variceal pressure was strongly associated with presence of previous bleeding episodes, vascular diameter and presence of red color signs, but did not correlate with the parameter of Child-Pugh classification ( t = 0. 31, P =0. 76). Conclusion Computerized endoscopic balloon manometry is reliable and feasible to examine esophageal variceal pressure, and is very likely to be a valuable clinical index for variceal bleeding.