射频消融或冷冻消融两种方法对左心房扩大房颤患者的治疗效果比较

目的 对比射频消融或冷冻消融两种方法在左房扩大的房颤患者中是否存在治疗效果差异。方法 选取自2016年12月至2022年5月期间前来福建省莆田市第一医院心血管内科房颤中心就诊并行导管消融术的左心房扩大（left atrial volume index,LAVI）>34ml/m2的房颤患者作为研究对象,共106例。根据术式,分成射频组（n=54）和冷冻组（n=52）,比较两组术后房颤复发的情况。结果 本研究中位随访时间为12个月,无死亡病例,失访率为3.8%,房颤消融后总体复发率为36.8%。两组临床基线情况及术后并发症差异无统计学意义（P>0.05）;射频组的手术用时较长（P<0.001）、X-射线时间短、曝光量更少（P<0.05）;生存分析结果显示,两组患者无房颤/房扑/房速生存率比较,差异无统计学意义（P>0.05）。结论 对于左房扩大的房颤患者,两种术式临床效果相近。冷冻消融手术用时较短,而射频消融时医患所承受的X射线时间及曝光剂量更低,应根据实际情况选择合适的消融方法。     

以环肺静脉消融为基础分步消融治疗心房颤动

目的探讨在三维标测系统指导下，以环肺静脉消融为基础，分步消融治疗心房颤动（房颤）的可行性和有效性。方法对12例药物治疗无效的阵发性房颤（10例）和持续性房颤（2例）患者，以三步消融方法进行消融：环肺静脉前庭消融、节段性肺静脉消融和碎裂电位 (CFAEs) 消融。以每个阶段房颤不再被诱发作为消融终点,或完成三个阶段。结果消融结束时，10例阵发性房颤不再被诱发，其中第1阶段7例，第2阶段2例，第3阶段1例。2例持续性房颤在完成所有3个阶段后仍持续发作，最后经体外电转复。3例于术后2d内短暂复发，继续随访后未再房颤复发，1例房颤并典型心房扑动（房扑）患者术后复发房扑，无房颤复发。所有患者经(10±4)个月随访后，均无房颤复发，无左房房性心律失常出现。手术无并发症发生。手术中放电时间(38±11)min, X线透视时间(37±11)min，操作时间(3.0±0.5)h。结论 以房颤不再被诱发为手术终点、以环肺静脉消融为基础的分步消融治疗房颤策略是安全可行的。对于阵发性房颤采用环肺静脉消融术式即有良好效果，而对单纯环肺静脉消融不成功者结合节段性肺静脉消融及碎裂电位消融可进一步提高成功率。     

导管消融治疗心房颤动的有效性与安全性研究

目的探讨经导管消融治疗心房颤动的有效性和安全性。方法对32例阵发性房颤,4例持续性房颤患者进行导管消融治疗。其中,3例患者采用环状冷冻导管消融(cryoablation)隔离肺静脉;33例患者采用Lasso导管及三维电解剖标测(CARTO)指导的环肺静脉前庭线性消融。结果成功率:冷冻消融组为33.33%;CARTO组为90.9%。手术时间:CARTO组较冷冻消融组,手术时间延长,CARTO组手术时间为(325±79)min;冷冻消融(205±72)min,P<0.05。X线曝光时间:CARTO组较冷冻消融组,曝光时间缩短,CARTO组(43±16)min;冷冻消融为(55±18)min,P<0.05。并发症:冷冻消融无并发症;CARTO组出现2例心脏压塞;另有1例患者术后第2d出现脑栓塞,经药物治疗后,肢体障碍完全恢复。结论经导管冷冻消融及CARTO指导下,环肺静脉前庭线性消融治疗房颤的方法均安全有效。三维电解剖标测(CARTO)指导下的环肺静脉前庭线性消融术效果更好。     

三维电磁标测系统（Carto）标测和指导射频消融复杂房性心律失常

目的：评价Carto系统电解剖标测和指导射频消融治疗复杂房性心律失常的应用价值。方法：选择各种复杂房性快速心律失常患者共10例，其中右房峡部依赖性房扑3例，先心房缺修补术后瘢痕性房扑1例，房室结双径路1例，房颤5例（阵发性房颤4例，持续性房颤1例）。房扑及房室结双径路在心动过速或冠状静脉窦起搏时应用Carto系统标测，从其电解剖传导图中判断心律失常起源和发生机制，并指导射频消融。房颤患者术前行64排CT检查，重建出的左房三维图像，在Carto—Merge指导下与心脏的电解剖结构精确融合，在三维融合图上环肺静脉12＇周消融，实现肺静脉与左房电隔离。结果：10例全部消融成功。房扑及房室结双径路操作时间（120±52）分钟，曝光时间为（13±11）分钟，房颤操作时间（185±51）分钟，曝光时间（31±9）分钟，术中2例患者为房颤心律，其中1例消融过程中恢复窦性心律。随访时间〉1个月，1例房颤患者术后发生非典型房扑，15天后转为窦律，另1例房颤患者术后第二天发生房颤，1小时后转为窦律，1例房颤患者发生心包填塞并发症。结论：Carto系统可安全有效应用于各种复杂房性快速心律失常的标测和消融，减少X线曝光时间。它将心内电图与三维解剖结构联系起来，判断不同心律失常机制及起源部位，对指导消融有较大价值。利用其定位记忆功能，可避免损伤传导系统及进行补充放电．减少并发症和复发率，在Carto-Merge指导下能更精确的实现肺静脉与左房电隔离。     

射频消融节律控制治疗心力衰竭合并心房颤动的疗效观察

【摘要】目的：观察射频消融节律控制治疗心力衰竭（简称心衰）合并心房颤动（简称房颤）的临床疗效。方法：随机双盲法将70例心衰合并房颤患者分为两组各35例，对照组采取药物室率控制、抗凝治疗，观察组则行射频消融节律控制治疗，比较两组临床疗效、治疗前后心功能变化及不良心脑血管事件发生率。结果：观察组总有效率91.4%，显著高于对照组的71.4%，P＜0.05。两组治疗后LVEF[（51.4±13.4）VS（44.2±15.8）]%、LAD[（38.7±7.9）VS（57.0±10.2）]mm比较，差异显著（P＜0.05）。随访6个月，观察组脑梗死发生率、房颤复发率分别为0.0%、8.6%，显著低于对照组的17.1%、37.1%（P＜0.05）。结论：射频消融节律控制治疗心衰合并房颤效果明显优于室率控制方案，能明显改善患者心功能，降低不良心脑血管事件发生率。     

老年房颤患者导管射频消融疗效及复发相关因素分析

目的：研究老年房颤患者导管射频消融的疗效及复发相关因素。方法：收集2013年1月—2016年12月于南京医科大学第一附属医院行房颤导管射频消融,且年龄≥60岁患者的临床资料,分析手术疗效、安全性及复发的相关因素。结果：共入组482例患者,年龄（66.5±4.7）岁。其中,男297例（61.6%）,女185例（38.4%）,阵发性房颤239例（49.6%）,持续性房颤243例（50.4%）。围术期共4例穿刺局部并发症,无严重并发症发生。随访（20.4±5.6）个月,共104例（21.6%）患者房颤复发。房颤复发组与未复发组在左心房大小、糖尿病、心衰、房颤患者卒中风险评估评分（CHA2DS2?VASc）积分等因素存在显著差异（P < 0.05）,两组年龄、性别、高血压病等因素无显著差异。结论：导管射频消融治疗老年房颤患者安全有效,左心房增大、合并糖尿病、心衰等可能与复发相关。     

超声消融治疗局灶性房颤临床研究

目的 :探讨在肺静脉造影和标测电位指导下 ,以超声球囊导管消融肺静脉口治疗局灶性房颤的近远期疗效。方法 :采用肺静脉超声消融。结果 :9例患者共确定 2 4条靶肺静脉 ,即左、右上肺静脉各 9条 ,左下肺静脉 6条。消融 (4 3± 1 5 )次 ,实际温度 (5 7 2± 3 6 )℃ ,每次消融时间 (96 8± 12 5 )s ,每例平均消融 (378 6± 4 1 3)s ,肺静脉电位振幅降低 80 %以上。消融中 9例患者均有胸痛 ,7例需静脉注射吗啡缓解 ,无并发症。房颤于术后(4 8 3± 11 7)h复发 ,均开始服用抗心律失常药物。随访 (11 8± 7 5 )月 ,房颤发作从术前每周 (5 7± 3 9)次减少到 (3 4± 2 3)次。结论 :①以房早消失、肺静脉电位振幅降低和实际消融温度不能作为即刻疗效终点 ,②晚期肺静脉口重构效应能减少局灶性房颤的远期发作 ,③超声球囊导管消融靶肺静脉后房颤的近期复发不能代表远期疗效。     

射频消融电隔离肺静脉治疗阵发性房颤10例临床分析

目的 :观察射频消融电隔离肺静脉治疗阵发性房颤的临床疗效。方法 :阵发性房颤 10例 ,环状电极指示下对肺静脉行射频消融电隔离术。结果 :10例患者共消融了 2 8根肺静脉 ,其中在房颤心律下消融 2 5根。 2 8根肺静脉中 2 3根达到消融终点。总操作时间和 X线透视时间分别为 12 8± 2 1min和 3 7± 8min。平均随访时间为 4.5± 3 .3个月。无房颤发作者 7例 ,房颤发作明显减少 1例 ,总有效率达 80 %。结论 :射频消融电隔离肺静脉治疗阵发性房颤具有较好的临床疗效。     

射频消融治疗频发室性早搏对左室功能及其结构的影响

目的 探讨射频消融治疗频发室性早搏（室早）对左室功能及其结构的影响。 方法 收集2006年1月至2010年12月成功行射频消融治疗的频发室早病例56例,同期随访未予射频消融治疗的频发室早病例42例。比较不同处理前、后室早数、超声心动图LVEF、LVEDD、LVESD、IVSd、LVPWd各参数的变化。 结果 ①与非消融组比较,消融组射频消融治疗后,室早总数明显减少（17813±1542个/24h）vs（125±113个/24h）,P<0.01;超声心动图[LVEDD（48.9±3.8）vs（44.1±4.0）,P<0.05;LVESD（30.1±4.2）vs（27±3.7）,P<0.05;IVSd（8.5±0.8）vs（7.5±0.8）,P<0.05;LVPWd（8.5±0.9）vs（7.5±0.8）,P<0.05]各项参数差异有显著性;LVEF[（0.64±0.08）vs (0.72±0.06),P<0.05]显著提高。②与术前比较,射频消融治疗后,室早总数由术前的（23662±12559个/24h）减少为（125±113个/24h）,P<0.01,患者胸闷、心悸症状缓解,超声心动图[LVEDD（50.6±5.4）vs（44.1±4.0）,P<0.05;LVESD（32.1±5.3）vs（27±3.7）,P<0.05;IVSd（8.8±1.1）vs（7.5±0.8）,P<0.05;LVPWd（8.7±1.1）vs（7.5±0.8）,P<0.05]各项参数明显缩小;LVEF[（0.64±0.09）vs (0.72±0.06),P<0.05]显著提高。 结论 射频消融可有效改善频发室早引起的心脏结构重构和功能减退,缓解患者不适症状。     

单中心球囊冷冻消融术后房性快速性心律失常的电生理标测和再消融治疗

目的 对阵发性心房颤动(简称房颤)患者行球囊冷冻消融后复发房性快速性心律失常的电生理机制进行初步探讨.方法 连续入选阵发性房颤行球囊冷冻消融后复发房性快速性心律失常、并行再次消融的患者.术中使用三维电解剖标测系统,先对左心房进行电压标测,判断各支肺静脉及肺静脉前庭是否仍有电传导,若有,则行射频消融,完成肺静脉及肺静脉前...     

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.