血管内超声成像在冠状动脉内支架植入术中的应用评价

目的探讨血管内超声成像(IVUS)在冠状动脉内支架植入术中的作用。方法用IVUS对44例行冠状动脉内支架植入治疗的患者进行评价,测量支架扩张前、扩张后和高压球囊再次扩张后的最小管腔直径、最小管腔面积、总截面积、斑块面积和面积狭窄率,观察扩张后支架是否贴壁、支架扩张是否充分及支架长度是否足够。结果在首次扩张后,仅有4处病变的IVUS结果符合理想的支架植入标准,40处病变未达到理想标准中有35处进行了高压球囊再次扩张,支架内的最小管腔面积由首次扩张后的(7·3±1·7)mm2增加至最终的(9·2±1·5)mm2(P<0·001);扩张术后最小管腔直径、最小管腔面积、总截面积增加,斑块面积缩小,面积狭窄率降低,差异有统计学意义。最终有22处病变(50%)达到IVUS支架植入理想标准。结论IVUS能指导支架的植入和实时评价手术的效果;对于首次扩张后造影结果满意但IVUS结果不理想的病变,在IVUS指导下的更高压力(14~16atm)扩张可使50%的病变进一步得到改善。     

药物支架和切割球囊在药物洗脱支架植入术后再狭窄中治疗效果比较

目的比较药物支架再植入和切割球囊2种方法,在药物洗脱支架植入术后再狭窄病人中的治疗效果。方法回顾分析124例药物洗脱支架内再狭窄病人,经切割球囊或药物支架再次植入治疗即刻和术后随访结果。并于治疗时及术后(6.0±1.4)个月行冠脉造影检查。结果 2组病人的年龄、性别、既往病史及介入治疗前支架内再狭窄情况比较,差异无统计学意义(P>0.05)。介入治疗即刻切割球囊组与药物支架组:最小管腔直径[(2.54±0.45)mm vs(2.67±0.48)mm]及直径狭窄率(23.5%±10.3%vs 21.8%±9.4%)比较,差异无统计学意义(P>0.05)。术后6个月药物支架组的最小管腔直径(1.86±0.63)mm明显高于切割球囊组(1.34±0.71)mm(P<0.01),且直径狭窄率显著低于切割球囊组(39.2%vs 47.8%,P<0.05)。药物支架组复发再狭窄和晚期管腔丢失量均低于切割球囊组[4.1%vs 9.8%,(0.52±0.48)mm vs(0.74±0.53)mm],差异有统计学意义(P<0.01)。结论药物支架再植入相比于切割球囊治疗药物洗脱支架术后再狭窄,6个月后支架内再狭窄率低于切割球囊组。     

药物洗脱支架内再狭窄的介入治疗

目的评价药物洗脱支架(DES)内再狭窄患者中根据再狭窄模式选择介入治疗的远期预后。方法选择2006年6月—2009年12月因DES内再狭窄于上海交通大学附属胸科医院行再次介入治疗的冠状动脉性心脏病患者,根据再狭窄部位及类型选择介入治疗方案。对于累及DES节段的再狭窄者行再次植入DES术;对于狭窄部位局限于DES内的Ⅰ型病变者行高压球囊扩张术;对于狭窄部位局限于DES内的Ⅱ～Ⅳ型病变者先行球囊扩张,再根据扩张后的结果由术者决定是否再次植入DES。所有患者均前瞻性随访主要心血管不良事件(MACE),包括死亡、靶病变重建(TLR)和心肌梗死(MI)。结果共88例行介入治疗,其中42例行单纯球囊血管成形(POBA)术(POBA组),46例行再次植入DES(DES组)。两组间各靶病变部位及各种原植入DES的涂层药物类型构成比的差异均无统计学意义(P值均>0.05),两组间再狭窄病变部位及类型构成比的差异均有统计学意义(P值均<0.05)。POBA组、DES组的支架内再狭窄(ISR)的发生率分别为(72.5±11.9)%、(76.2±9.1)%,两组间的差异无统计学意义(P>0.05)。平均随访时间为(2.2±1.0)年,两组间MACE、TLR、MI的发生率及病死率的差异均无统计学意义(P值均>0.05)。结论根据DES内再狭窄部位及类型选择介入治疗方案是有效的。对于局灶型ISR可行POBA术,而对于非局灶型或节段内ISR病变则需要再次植入DES。     

血管内超声、切割球囊和非顺应性球囊在支架内再狭窄中的应用

目的应用血管内超声(IVUS)探讨支架内再狭窄的机制，研究切割球囊及非顺应性高压球囊治疗支架内再狭窄的近远期疗效。方法48例患者，56支病变冠脉，64处病变，血管内超声检测显示内膜增生为主者48处予切割球囊扩张，显示为原支架扩张不充分伴内膜增生者16处予非顺应性高压球囊扩张，术后平均5.3月行冠脉造影随访。结果血管内超声显示内膜增生为支架内再狭窄的主要因素的患者(66.7％)采用切割球囊扩张，扩张前后支架内增生内膜的面积缩小(P＜0.05)，支架截面积变化不大(P＞0.05)；血管内超声显示原支架扩张不充分伴内膜增生的患者则予非顺应性高压球囊扩张，扩张前后支架截面积增加(P＜0.05)；同时支架内增生内膜面积减小(P＜0.05)。冠脉造影随访，切割球囊组和非顺应性球囊组再次支架内狭窄发生率分别为28.6％、29.7％(P＞0.05)。结论结合应用血管内超声，切割球囊和非顺应性球囊可以在支架内再狭窄的治疗中取得更佳疗效，值得推广应用。     

冠状动脉内支架植入术的护理体会

冠状动脉内支架植入术是目前治疗冠心病的一种主要方法 ,是扩张冠状动脉内径 ,解除其狭窄 ,改善其对心肌血液供应的一种非外科手术方法 ,常与冠状动脉内球囊成形术(ＰＴＣＡ)同时进行。这是因为ＰＴＣＡ术后易出现残余狭窄或管腔发生明显弹性回缩 ,而植入支架后可防止并发症 ,获得最大的管腔直径 ,根本杜绝狭窄 ,降低再狭窄率。我院 2 0 0 0年1～ 11月共行植入术 3例 ,由于采取了积极的护理措施 ,预防了术后并发症的发生 ,取得了良好的疗效。1　资料及方法1.1　临床资料　 2 0 0 0年我院共行支架植入术 3例 ,均为男性 ,且冠状动脉均为单支病…     

Percutaneous intervention for in-stent restenosis after drug-eluting stent implantation

目的 评价药物洗脱支架(DES)内再狭窄患者中根据再狭窄模式选择介入治疗的远期预后.方法 选择2006年6月-2009年12月因DES内再狭窄于上海交通大学附属胸科医院行再次介入治疗的冠状动脉性心脏病患者,根据再狭窄部位及类型选择介入治疗方案.对于累及DES节段的再狭窄者行再次植入DES术;对于狭窄部位局限于DES内的I型病变者行高压球囊扩张术;对于狭窄部位局限于DES内的Ⅱ～Ⅳ型病变者先行球囊扩张,再根据扩张后的结果由术者决定是否再次植入DES.所有患者均前瞻性随访主要心血管不良事件( MACE),包括死亡、靶病变重建(TLR)和心肌梗死(MI).结果 共88例行介入治疗,其中42例行单纯球囊血管成形(POBA)术(POBA组),46例行再次植入DES( DES组).两组间各靶病变部位及各种原植入DES的涂层药物类型构成比的差异均无统计学意义(P值均＞0.05),两组间再狭窄病变部位及类型构成比的差异均有统计学意义(P值均＜0.05).POBA组、DES组的支架内再狭窄(ISR)的发生率分别为(72.5±11.9)％、(76.2±9.1)％,两组间的差异无统计学意义(P＞0.05).平均随访时间为(2.2±1.0)年,两组间MACE、TLR、MI的发生率及病死率的差异均无统计学意义(P值均＞0.05).结论 根据DES内再狭窄部位及类型选择介入治疗方案是有效的.对于局灶型ISR可行POBA术,而对于非局灶型或节段内ISR病变则需要再次植入DES.     

非顺应球囊后扩张对置入药物洗脱支架预后的影响

目的评估使用非顺应性球囊后扩张对经置入药物洗脱支架冠状动脉粥样硬化性心脏病(以下简称冠心病)患者的疗效。方法回顾性分析2011年1月至2011年5月共356例行药物洗脱支架植入且使用非顺应性球囊后扩张的患者,采用倾向性评分抽取同期356例行药物洗脱支架植入术而未后扩张的患者与之1∶1匹配。结果 2组在年龄、性别、临床表现、主要危险因素及冠状动脉病变特征方面比较,差异无统计学意义(P>0.05),具有可比性。平均随访时间18个月,后扩张组主要不良心血管事件(major adverse cardiac events,MACE)明显低于未后扩张组(10.1%vs 15.7%,P=0.020),主要是靶血管重建(6.2%vs10.7%,P=0.010)、支架内血栓(1.1%vs 3.7%,P=0.030)发生率比较,差异有统计学意义(P<0.05),而心肌梗死(3.9%vs4.6%,P=0.700)、死亡(1.1%vs 1.7%,P=0.760)比较,差异没有统计学意义。结论冠心病患者置入药物洗脱支架后使用非顺应性球囊后扩张安全,可改善患者的临床预后。     

未预扩张直接冠状动脉内支架植入术的临床应用

为观察直接冠状动脉内支架植入术的可行性和临床效果 ,对 2 3例冠心病患者行未预扩张直接冠状动脉内支架植入术 ,同期与按传统方法预先用球囊扩张后再植入支架的 2 4例冠心病患者进行对比 ,观察其即刻和远期效果。结果显示 :两组病例的手术即刻成功率均为 10 0 % ,而未预扩张组的不良心脏事件 (心绞痛、心肌梗塞、心性死亡 )的发生率较预扩张组低。提示对恰当选择的冠状动脉病变直接植入支架具有较高的即刻成功率和较理想的远期效果     

血管内超声评价冠状动脉支架植入对斑块的影响

目的 探讨应用血管内超声评价冠状动脉直接支架植入术(STENT)与球囊扩张后经皮刺冠状动脉腔内成形(PTCA)+支架植入术前后粥样斑块体积的变化及差别.方法 42例经冠状动脉造影诊断为冠状动脉粥样硬化性心脏病患者,分别采用STENT与球囊扩张后PTCA+支架植入术.同一患者不同病变可采用不同手术方法.采用血管内超声测量术前、术后粥样斑块体积,比较术前、术后粥样斑块体积变化及2组粥样斑块体积变化的差异.结果 2组术后粥样斑块体积较术前减少.STENT组粥样斑块体积减少(1.08±0.46)mm3;球囊扩张后PTCA+支架植入组粥样斑块体积减少(1.67±0.62)mm3.STENT组粥样斑块体积减少值较球囊扩张后PTCA+支架植入组为低.结论 STENT减少了球囊扩张次数,可减少粥样斑块的破碎及脱落,粥样斑块体积减少值较球囊扩张后PTCA+支架植入组更小.     

髂股静脉成形术治疗下肢深静脉血栓的临床研究

目的观察髂股静脉成形术对治疗下肢深静脉血栓的疗效。方法选择2013年5月至2014年5月来我院诊治的80例下肢深静脉血栓患者,分为对照组和观察组各40例。所有患者均先行导管溶栓治疗,对照组采用管腔内球囊扩张成形术,观察组采用球囊扩张联合支架植入术。术后对病人进行随访,观察近期疗效。结果两组分别进行介入治疗1个月后、3个月及治疗6个月后,球囊扩张组与球囊扩张联合支架植入组在下肢症状改善情况方面无统计学意义(P0.05);而在治疗12个月后,球囊扩张联合支架植入组疗效优于球囊扩张组(P0.05)。结论球囊扩张加支架植入比单纯球囊扩张治疗效果显著,能除患者痛苦,恢复患肢功能与提高生活质量。     

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.