右胸前外侧小切口心脏跳动下矫治先天性心脏缺损

目的　评价右胸前外侧小切口心脏跳动下的心内直视矫治手术的应用价值。方法　 1999年 11月～ 2 0 0 3年 1月采用右胸前外侧小切口路径 ,在心脏跳动下行 2 4例房间隔缺损修补术 ,部分型心内膜垫缺损矫正术 16例作为对照组。其中男 14例 ,女 2 6例 ,年龄 3～ 4 0岁。结果　手术顺利 ,所有患者随访 2～ 2 0月 ,均健在 ,无术后并发症。房间隔缺损修补术患者体外循环 (32 5 0± 18 5 0 )min ,术后呼吸机辅助呼吸 (2 0 0± 1 2 0 )h ;对照组患者体外循环 (6 8 5 0±17 5 0 )min ,术后呼吸机辅助呼吸 (4 2 0± 1 10 )h。结论　右胸前外侧小切口心脏跳动下矫治先天性心脏缺损的心内直视手术是可行、有效、安全的技术     

经右外侧小切口矫治先天性心脏畸形102例体会

目的:探讨经右外侧小切口剖胸体外循环矫治先天性心脏畸形的经验.方法:1996年6月至2002年1月共完成经胸右外侧第4肋间小切口进胸,体外循环下先天性心脏畸形矫治术102例.开展手术的病种包括房间隔缺损40例(合并三尖瓣关闭不全2例,完全肺动脉畸形引流入右心房1例,肺动脉狭窄3例),室间隔缺损53例(合并二尖瓣关闭不全2例,三尖瓣关闭不全9例,右室流出道狭窄3例,肺动脉狭窄1例),心内膜垫缺损4例,法乐四联症4例,动脉导管未闭手术后残余分流合并主动脉下狭窄1例.体外循环时间平均60.7分±33.2分(15分-168分),心肌阻断时间31.9分±24.3分(3分-117分),手术后住院天数6.3天±8.6天(4天-15天).结果:全组患者无手术死亡.结论:经由胸右外侧小切口矫治先天性心脏畸形手术具有创伤小、出血少、斑痕隐蔽、不破坏胸廓的骨性连续性,防止手术发生鸡胸,美观效果好于胸部正中切口等优点.     

右胸前外侧小切口心脏不停跳房间隔缺损修补术

目的 总结右胸前外侧小切口心脏不停跳下房间隔缺损修补术的治疗经验。方法 手术在常温深度血液稀释体外循环下施行,沿右侧第5肋间切开皮肤,经第3或第4肋间入胸,距右膈神经前2.0cm纵向切开心包,主动脉及上、下腔静脉插管常规建立体外循环时间为(36.0±14.4)min。心脏跳动下切开右心房,直接缝合和自体心包片或涤纶片修补缺损。结果 57例患者均痊愈出院。术后气管插管呼吸机辅助时间(6.3±2.8)h,监护时间(35.3±16.4)h,术后住院(7.5±1.2)d。术后胸腔引流量(250.8±175.3)mL。54例(94.7％)未输库血。术后随访3个月～4年,心功能较术前改善。结论 采用右胸前外侧小切口心脏不停跳技术修补房间隔缺损,微创美观,安全可靠,手术操作简单,库血用量小,疗效满意。房间隔缺损及合并部分型肺静脉畸形引流患者的手术治疗均可采用此技术。     

经右胸前外侧小切口治疗先天性心脏病157例

经右胸前外侧小切口 ,常规体外循环和插管技术 ,完成先天性心脏病 (先心病 )矫治术 15 7例 ,现将手术经验及治疗结果总结分析如下。1　临床资料1.1　一般资料　先心病患者 15 7例 ,其中男 72例 ,女 85例 ;年龄 2 .5～ 4 6 .0岁 , x±s(11.9± 6 .6 )岁 ;体重 11～ 71kg , x±s(30 .2± 14 .3)kg。房间隔缺损 82例 ,室间隔缺损70例 ,室间隔缺损并房间隔缺损 5例。胸部X线片示 :心脏增大 ,肺血增多 ,心胸比例 x±s(0 .5 5± 0 .0 7)。彩色多普勒明确房间隔缺损或室间隔缺损诊断 ,肺动脉压中度增高 2 0例 ,部分型肺静脉畸形引流 6例 ,干下型…     

经右胸外侧小切口心内手术45例分析

目的总结经右胸外侧小切口心内手术的经验。方法对比分析2002年5月—2006年3月经右胸外侧小切口体外循环心内直视手术45例(右胸外侧小切口组)与同期常规正中切口78例(胸正中切口组)病历资料及手术效果。结果二组患者手术顺利,无重大并发症及手术死亡;主动脉阻断时间、手术时间、体外循环时间、辅助呼吸时间等与同期正中切口组差异均无统计学意义(P>0.05);平均胸腔引流量(230.0±58.3)ml vs(310.0±110.0)ml,术后平均住院天数(7.4±0.62)d vs(9.3±0.91)d,右胸外侧小切口组均显著低于胸正中切口组(P<0.05)。结论右胸外侧小切口可安全有效地用于某些先天性心脏病矫治手术;此手术切口符合微创手术的要求,隐蔽、出血少、缩短患者住院时间,减轻患者的精神及骨性创伤。     

右胸外侧小切口剖胸矫治先天性心脏病12例

[目的 ]介绍在体外循环下经右胸外侧小切口剖胸行心内直视手术的体会 .[方法 ]经右胸外侧第 4肋间进胸 ,矫治先天性心脏畸形 12例 ,其中修补房间隔缺损 2例 ,室间隔缺损 5例 ,法洛氏四联征 4例 ,部分心内膜垫缺损 1例 .[结果 ]全组无手术死亡病例 ,1例法洛氏四联征病例在术后出现低心排综合症 ,3例出现部分右束支传导阻滞 ,1例在房间隔缺损术后拔胸腔引流管时出现气胸 ,再次做胸腔闭式引流 .[结论 ]经右胸外侧小切口手术法可替代正中剖胸矫治先天性心脏畸形手术法 ,它具有损伤小、恢复快、不破坏胸廓连续性及防止术后鸡胸等优点 ,属于微创外科手术 ,值得推广 .     

右外侧小切口体外循环下心脏不停跳心内直视手术

目的　探讨右外侧小切口体外循环下心脏不停跳心内直视手术的方法。方法　经右外侧小切口在体外循环心脏不停跳下进行心脏直视手术 16例。结果　全组平均切口长度 ( 8 2 6± 1 6 7)cm ,体外循环时间 ( 38 2 6± 16 38)min ,术后呼吸机辅助时间 ( 8 93± 3 2 4)h ,胸腔引流量 ( 14 8 2 3± 5 5 6 2 )ml ,术后住院时间 ( 8 5 1± 2 4 5 )d。术后恢复良好 ,无栓塞、心律失常及脑部并发症。结论　右外侧小切口心脏不停跳行心内直视手术创伤小 ,恢复快 ,简便安全 ,美容效果好     

局限性低位部分胸骨劈开心内直视手术的解剖学基础与临床应用研究

目的 :探索美观、损伤小的局限性低位部分胸骨劈开小切口开胸技术在心内直视手术中的解剖学基础和临床应用价值。方法 :应用局限性低位部分胸骨劈开小切口行心内直视手术 14例 ,观测皮肤切口、胸骨纵切口、显露主动脉、肺动脉、右心及左心范围。病种包括 :房间隔缺损 (ASD) 5例、室间隔缺损 (VSD) 4例、房缺合并室缺 (A +V) 2例、肺动脉狭窄 (PS) 1例、风湿性心脏病二尖瓣狭窄并关闭不全 2例。其中房缺 (ASD) 5例、室缺 (VSD) 3例、房缺合并室缺 (A +V) 1例、肺动脉狭窄 (PS) 1例均在浅低温心脏不停跳心内直视下完成手术 ,室缺 (VSD) 1例、房缺合并室缺 (A +V) 1例、风湿性心脏病二尖瓣置换术 2例则在低温心脏停跳下顺利完成手术。结果 :全组无手术死亡 ,均顺利地完成了手术治疗 ,术中及术后均无合并症发生 ,术后无明显疼痛。皮肤切口长度 9.5± 3.5cm ,胸骨纵切口长度 10 .8± 3.6cm ,皮肤切口 /胸骨长度系数为 0 .72± 0 .15 ,显露主动脉 2 .7± 0 .7cm ,显露肺动脉 1.3±0 .5cm。术中心脏停跳者心肌阻断 8～ 72min ,平均 2 3.6min ,体外循环时间 2 7～ 10 8min ,平均 4 8.5min。术后胸液引流量 6 0～ 35 0ml,平均 14 0± 5 0ml,术后住院 6～ 14d ,平均 8.5d。全组切口均甲级愈合 ,无胸骨畸形 ,胸锁关     

体外循环微创心内直视手术38例

1　临床资料　 2 0 0 0 0 1 / 2 0 0 3 0 9体外循环 (CPB)下共施行右胸小切口微创心脏手术 38(男 2 6 ,女 1 2 )例 ,年龄 6～ 35岁 ,体质量 1 5～ 73kg .先天性心脏病房间隔缺损修补术 2 3例 ,先天性心脏病室间隔缺损修补术 1 5例 .患者均行常规静吸复合全身麻醉并行气管插管机械通气 .平卧位、右胸垫高 30～4 0°,右前胸切口 ,第四肋间进胸 ,悬吊心包 ,游离上下腔静脉 ,肝素化 3mg/kg后 ,游离主动脉并在主动脉根部作荷包缝合 ,插特定制作的长形带硬质导芯的主动脉供血管 ,于右心耳部作荷包 ,并切开心耳插上腔静脉引流管 ,于右房壁作荷包…     

右胸前外侧小切口房室间隔缺损修补术

自 1 997年 1 0月至 1 999年 1 0月 ,我们采用右胸前外侧小切口 ,在体外循环下行先天性房、室间隔缺损修补术 2 1例 ,效果良好。现报告如下 :1　临床资料本组 2 1例中男 5例 ,女 1 6例。年龄 5～2 5岁 ,平均 1 0岁。术前均经彩超、心电图、胸片检查 ,定位诊断明确。其中房间隔缺损1 5例 ,室间隔缺损 6例。2　手术方法气管插管全身麻醉 ,病人仰卧位 ,右背部垫高 45度 ,右上肢屈肘悬吊于手术台头架上。自右乳头下 4～ 5ｃｍ至右腋中线作弧形切口 ,女性沿右乳房下缘作弧形切口 ,切口长8～ 1 2ｃｍ ,切开部分胸大肌和前锯肌 ,经右第4肋间进入胸…     

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.     

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.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.