实时三维超声心动图容积-时间曲线测定冠心病患者左室峰值排空率的价值

目的探讨实时三维超声心动图（TR-3DE）容积-时间曲线（VTC）测定冠心病患者左室峰值排空率（PER）的应用价值。方法应用TR-3DE的左室VTC测量34例冠心病患者和34例正常人的PER,并进行比较;分析冠心病患者左室PER与射血分数（EF）的相关性。结果冠心病患者的PER明显小于正常对照组（P〈O．001）．与EF呈显著正相关（r=0．875）。结论TR-3DE VTC可以准确测量左室PER。能反映冠心病患者左室整体收缩功能状况。     

C反应蛋白与高血压左室重构关系的临床探讨

目的：探讨原发性高血压（EH）患者左室重构与C反应蛋白（CRP）的关系及影响其水平的临床指标。方法：所有研究对象114例包括EH组81例和健康对照组33例。EH组行彩色多普勒超声心动图检查,根据左室重量指数（LVMI）将EH患者分为增高组和正常组两组,分别测定两组的血清C反应蛋白（CRP）、总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL—C）、高密度脂蛋白胆固醇（HDL—C）、尿素氮（BUN）、肌酐（CR）、尿酸（UA）及血钾（K^＋）水平。结果：高血压组与健康对照组血清CRP水平之间差异显著（P〈0．05）;LVMI增高组与LVMI正常组血清C反应蛋白水平之间差异显著（P〈0．05）,前者显著增高,且随着LVMI的增加,C反应蛋白呈上升趋势。C反应蛋白与TG、CR、室间隔厚度、左室后壁厚度、左室舒张末期内径呈正相关,与EF呈负相关（P〈0．05）。结论：（1）血清CRP浓度与EH相关,提示炎症反应可能参与了EH的发生;（2）CRP是EH患者合并左室重构的独立预测指标,它在左室重构的发生发展中可能起了一定作用。     

超声心动图对2型糖尿病左心室功能的评价

目的应用超声心动图检测糖尿病患者左室舒张功能的改变,为早期诊断、治疗及预防糖尿病心肌病变提供依据。方法54例血压正常的Ⅱ型糖尿病患者,依据尿白蛋白量〉15ml／min诊断为糖尿病微血管病变。实验分为3组。A组：32例,糖尿病无微血管病变;B组：22例,糖尿病合并微血管病变;C组：20名,健康人对照。所有糖尿病患者均进行超声心动图检查,测定左室收缩功能、舒张功能及左室心肌重量指数（LVMI）。所有指标与对照组进行比较。结果各组收缩功能指标差异无显著性意义（P〉0．05）。糖尿病组的LVMI较对照组增高（P〈0．05）。两组糖尿病均有不同程度的舒张功能减低,表现为舒张早期血流速度减低;二尖瓣的VE／VA,组织多普勒的e／a和左室流入道彩色多普勒血流传播速度（LVFP）均降低;等容舒张时间（IVRT）延长（P〈0．05）。结论超声心动图可以检测到无微血管病变的Ⅱ型糖尿病患者的左室舒张功能改变。     

青年男性完全习服高原环境后的左心超声心动图变化

目的观察青年男性完全习服高原环境后的左心超声心动图的变化。方法实验分为平原组（海拔1400m）和高原组（移居海拔3900～4700m高原1年以上）,利用超声诊断仪对两组人员进行常规超声心脏检测,测量指标包括左室舒张末内径（LVEDD）、左室收缩末内径（LVESD）、左室缩短率（LVFS）、每搏输出量（SV）、搏动指数（EF）、每分输出量（CO）,比较移居高原习服人群左心超声心动图参数的变化。结果高原组LVEDD、LVESD、SV非常显著低于平原组（P〈0．01）,而LVFS、EF值非常显著高于平原组（P〈0．01）。结论移居高原可使左室容量轻微减小,每搏输出量减少,每分输出量增加。     

小心脏综合征的超声心动图诊断标准

对254名临床上无器质性心脏病的招飞体检申请者进行超声心动图研究，以建立小心脏综合征的超声心动图诊断标准。按标准方法，用ALOKASSD－260超声诊断仪检查。测量计算左室舒张末期内径（EDD）、舒张末期容积（EDV）、心肌质量（LVM）、心搏量（SV）、短轴缩短率（FS）和射血分数（EF），以x－2s的方法确定左室功能各参数的下限，分别为4.1cm（EDD）、60．91ml（EDV）、110．9g（LVM）、32．2ml（SV）、0．26（FS）和0．52（EF）。EDD、EDV、LVM有一项以上达不到上述下限者，属于小心脏。小心脏合并左室功能下降者诊断为小心脏综合征，建议后者招飞体检不合格。     

曲美他嗪治疗高原性心脏病伴心力衰竭患者的疗效观察

目的探讨盐酸曲美他嗪治疗高原性心脏病伴心力衰竭患者的疗效。方法选择2006年6月～2010年7月在我院心内科住院的HAHD患者82例,随机分为治疗组42例,对照组40例。两组均给予利尿剂、血管紧张素转换酶抑制剂、13阻滞剂、地高辛等药物治疗。治疗组再加用盐酸曲美他嗪20mgtid。治疗前和治疗3月后行6分钟步行试验,采用超声心动图评估左室舒张末期内径（LVED）和左室射血分数（LVEF）。结果治疗3个月后治疗组6分钟步行距离较对照组显著增加（P〈0．05）,治疗组LVED较对照组显著降低（P〈0．05）,而治疗组LVEF较对照组显著提高（P〈0．05）。结论加用盐酸曲美他嗪可显著改善HAHD患者的心功能。     

Tei指数评价原发性高血压患者左心室舒张功能的价值

目的探讨心肌做功指数（Tei指数）评价原发性高血压患者左心室舒张功能的价值。方法原发性高血压患者94例分为非左室肥厚组52例，左室肥厚组42例，正常对照组30例。全部行彩色多普勒超声心动图检查测量各组左室射血分数（LVEF）、二尖瓣血流频谱舒张早期和舒张晚期血流峰值之比（E／A）和左室Tei指数。结果各组LVEF均大于〉50％，各组组间差异无统计学意义；高血压各组无论有无左室肥厚，二尖瓣E／A比值较对照组明显减小（P〈0．05）、左室Tei指数较对照组显著增大（P〈0．05）。结论高血压病早期左室结构尚未出现改变时已经有左室舒张功能的减低，左室肥厚进一步加重了左室舒张功能障碍。左心室Tei指数增加对于高血压病左室收缩功能尚未发生改变时，及早发现左室舒张功能障碍有一定意义。     

高血压患者左心房结构和功能的研究

目的：探讨高血压对左心房结构和功能的影响。方法：根据JNC7高血压诊断标准及左室质量指数,将患者分为高血压左室肥厚组、高血压非左室肥厚组。对照组为同期健康体检者。采用超声心动图测定左房容积及相关功能指标。结果：高血压非左室肥厚组、左室肥厚组与对照组间LVMI、Tei、E／A、LAD、LAVmax、LARV均有显著性差异（P〈0．01—0．05）;左室肥厚组和非左室肥厚组间LVMI、Tei、LAVmin有显著性差异（P〈0．05）。结论：左房重构发生在左室肥厚之前。随着高血压病情进展,左房功能渐失代偿。左房做功增加和结构改变均可反映左室舒张功能的异常。     

超声心动图自动心肌运动定量与三维定量分析评估左室收缩功能应用价值比较

目的探讨实时三维超声心动图在老年非瓣膜性心房颤动(房颤)患者左右心室结构和功能评价中的价值。方法选取青海省心脑血管病专科医院自2016年3月至2017年12月收治的老年非瓣膜性房颤患者105例为研究对象,设为A组,另选取同期100例窦性心律老年患者作为B组。两组均采用二维超声心动图、频谱多普勒、组织多普勒(TDI)和实时三维超声心动图检查,比较两组左右心室相关指标的差异。结果二维超声、频谱多普勒和TDI结果中,A组左室射血分数、右心室面积变化分数和三尖瓣环位移显著低于B组,两组比较,差异有统计学意义(P <0. 05); A组右室舒张末期内径、三尖瓣环舒张早期前向血流峰值速度/血流峰值速度、二尖瓣口舒张早期前向血流峰值速度/血流峰值速度显著高于B组,两组比较,差异有统计学意义(P <0. 05)。实时三维超声结果中,A组左室舒张末期容积、左室收缩末期容积、右室舒张末期容积和右室收缩末期容积显著高于B组,两组比较,差异有统计学意义(P <0. 05); A组LVEF和右室射血分数显著低于B组,两组比较,差异有统计学意义(P <0. 05)。结论实时三维超声心动图可简便、快速、准确地评估老年非瓣膜性房颤患者左右心室结构和功能。     

高血压患者左房扩大意义与心房纤颤的相关性研究

目的：观察原发性高血压（EH）患者左心房内径变化的临床意义及其与心房纤颤（房颤）发生的关系。方法：360例EH患者应用彩色多普勒超声心动图仪及三导心电图仪，动态心电图仪，测定患者左房内径（LAD）、左室舒张末内径（LVDd）、左室后壁厚度（LVPWT）、室间隔厚度（IVST）、射血分数（EF）值、E／A比值及房颤的检出。结果：EH组LAD较正常对照组显著增加。高血压伴左室肥厚（LVH）者LAD较高血压无LVH及对照者显著增加（P〈0．05），LAD与EF值呈显著负相关（P〈0．05）。EH患者伴左房扩大者中62．2％发生心房纤颤，EH伴心房纤颤患者中左房扩大者占97．53％。结论：EH患者LAD较正常者增加，35．0％EH患者伴有左房（LA）扩大。LA扩大与EH伴LVH及心功能减退有关，LA扩大与心房纤颤的发生有关。LA扩大可能是EH病情进展、心功能减退及心房纤颤发生的危险标志。     

Dealing with cancer--conversations with radiotherapy patients

Thirty in-patients treated by radiotherapy were questioned in qualitative interviews about the information they had received from the physicians and their way to deal with the disease and the physicians. Furthermore 18 persons out of this group were accompanied continuously. The confidential relationships between the patients and the author of the study brought about spontaneous conversations showing some new aspects of the way to experience disease and therapy. Despite a poor prognosis and an initially insufficient information, the patients formulated their questions openly. Generally they desired a clearer communication. They criticized above all the lack of information and attention from the physicians. A need for confidence, frankness, and the conveyance of a justified hope was expressed. The physician's stress and resulting lack of time was complained of. During the time of accompanying which lasted several weeks, it became evident that information means a way to deal with the disease to which the patient can make his individual contribution. The majority of questions as well as emotional reactions as fear or depression came from those patients who seemed to be quiet persons.     

Radiochemotherapy with temozolomide for patients with glioblastoma

Background

The objective of this retrospective analysis was to assess long-term outcome and prognostic factors of unselected patients treated for glioblastoma (GB) at a single center with surgery, standard radiotherapy (RT), and concomitant temozolomide (TMZ). From 1999?C2005, the institutional protocol included surgery and RT with TMZ. From 2005 on, adjuvant TMZ was routinely added.

Patients and Methods

Between April 1999 and September 2009, 181 patients with GB were treated with RT (60 Gy in 30 fractions) and concomitant TMZ (75 mg/m²/day throughout RT). Biopsy only had been performed in 53 patients (29.3%), 128 patients (70.7%) had undergone resection, which was complete based on postoperative MRI in 51 patients (28.2%). Adjuvant TMZ was applied in 67 of 181 patients (37%).

Results

Median overall survival (OS) and progression-free survival (PFS) were 15.0 (95% CI, 13.1?C16.8) and 7.2 months (95% CI, 5.9?C8.5), respectively. After complete resection, partial/subtotal resection and biopsy, median OS was 23.20, 14.75, and 7.89 months (p < 0.001), respectively. In multivariate Cox proportional hazards regression models, extent of resection (p < 0.0001), Karnofsky??s performance score (p < 0.0001) and adjuvant TMZ (p = 0.001) were significant independent prognostic factors for OS. RT with concomitant TMZ was well tolerated in the majority of patients and could be completed as scheduled in 146 patients (80.7%), while 11 patients (6.1%) discontinued RT. Another 35 patients (19.3%) interrupted concomitant chemotherapy.

Conclusion

RT with concomitant TMZ is a feasible regimen with acceptable toxicity in routine practice. Our data are compatible with a beneficial effect of adjuvant TMZ on OS and PFS.     

湿润烧伤膏与手术联合治疗褥疮的护理

目的 :减少溃疡期褥疮的术前准备时间 ,缩短褥疮的总病程。方法 :将 1996年 5月至 2 0 0 2年 5月收住院的 4 2例溃疡期褥疮病人按随机原则分为 2组 ,2 1例术前用湿润烧伤膏纱换药处理 ,为A组 (试验组 ) ;2 1例用庆大霉素紫草油纱布换药处理 ,为B组 (对照组 )。 2组病例的年龄、性别、发病原因、病灶部位、病灶范围等经统计学处理 ,无显著性差别 ,有可比性。两组病人均换药至创面新鲜行皮瓣转移手术 ;比较两组平均术前换药时间 ,及换药 +手术的总住院日。术前术后两组患者均运用护理程序施行整体护理。结果 :A组术前平均换药时间为 8 4 9± 2 2 3天 ,B组为 15 6 0± 6 70天 ;A组平均治愈时间为 2 0 5 0± 4 81天 ,B组为 35 31± 7 70天。结论 :湿润烧伤膏换药与庆大霉素紫草油纱布换药比较 ,前者可明显缩短褥疮手术的术前准备时间及病人的总住院天数。     

Bronchogenic carcinoma: staging with MR compared with staging with CT and surgery

Thirty-three patients suspected of having bronchogenic carcinoma were studied prospectively using magnetic resonance (MR). In this group, 30 underwent examination with computed tomography (CT), 15 underwent thoracotomy, six had mediastinal biopsy procedures performed, and eight underwent bronchoscopy. MR studies, which included transaxial spin-echo imaging (TR, 0.5 and 2.0 sec; TE, 28 and 56 msec) of all patients and sagittal or coronal imaging of 18, were performed without knowledge of CT findings, using only plain radiographs as a guide. CT and MR studies were interpreted separately. CT and MR provided comparable information regarding the presence and size of mediastinal lymph nodes. MR better discriminated mediastinal nodes from vascular structures. However, in two of 11 patients who had multiple mediastinal lymph nodes that were normal in size at CT examination and surgery, MR suggested a confluent abnormal mass, probably because of its poorer spatial resolution. MR was superior to CT in showing enlarged hilar lymph nodes, but CT was better for demonstrating bronchial abnormalities. In three of four patients who had a proved hilar mass with distal obstructive pneumonia, MR (TR, 2.0 sec) helped distinguish between the mass and collapsed lung.     

多虑平、雷尼替丁治疗消化性溃疡81例临床观察

1995年 1月～ 1 998年 2月 ,我们采用多虑平、雷尼替丁治疗消化性溃疡 (ＰＵ) ,并与雷尼替丁为对照组进行治疗观察 ,疗效满意 ,现总结报告如下。1　临床资料1 1　一般资料　本组 81例ＰＵ均因上腹痛、返酸、腹胀及食欲不振等症状 ,经胃镜诊断为溃疡活动期患者。病程 2个月～ 5ａ,平均 1 7ａ。伴有焦虑、抑郁及夜眠欠佳等症者59例。随机分为 2组 :治疗组 4 1例 ,男 3 8例 ,女 3例 ;年龄 1 8～ 3 6岁 ,平均 2 4岁。其中胃溃疡 1 1例 ,十二指肠球部溃疡 3 0例。对照组 4 0例 ,男 3 7例 ,女 3例 ;年龄 1 9～ 3 5岁 ,平均 2 4 5岁 ;胃溃疡 1 2…     

臭氧治疗船员下肢损伤89例

2006年10月至2007年4月,我科采用引进的德国赫尔曼Medozon型臭氧发生装置系统产生的臭氧治疗船员下肢损伤89例,疗效满意.现报告如下.     

Tumor Burden Assessment with Positron Emission Tomography with

Objective: In patients with advanced cancer, total tumor burden affects the likelihood of tumor response and has important implications for prognosis. The aim of this study was to select the optimum 2-[F-18]fluoro-2-deoxy-D-glucose-positron emission tomography (FDG PET) tumor uptake parameter to accurately measure tumor burden in advanced metastatic renal cell cancer, in comparison with volumes measured with computed tomography (CT), as a reference test.Materials and Methods: Six patients with metastatic renal cell carcinoma measurable on CT were studied. CT and FDG PET scans were carried out on all patients within 4 weeks prior to their entry into a phase I-II radioimmunotherapy trial. CT-based evaluation of disease extent (tumor volume) and 4 PET-based measurements (standardized uptake value[SUVmax], SUVav, volume, and total lesion glycolysis [TLG]) were performed independently by a radiologist (VN) and a nuclear medicine physician (TA). The degree of correlation between conventional (CT) extent of disease and parameters describing tumor concentration of FDG was then determined.Results: Fifty-seven CT-measurable metastatic lesions in lung, abdomen, and scalp were evaluated in 6 patients. There was a high correlation between CT and FDG PET volume estimates for lesions greater than 5 cm(3) in size. However, a PET-derived parameter that embodies both FDG uptake and lesion size, the TLG, correlated better with CT-derived tumor volume than did FDG PET volume alone.Conclusion: Using CT volume as a gold standard, the optimal PET-based estimate of total tumor burden in patients with metastatic renal cancer is the sum over all lesions of the total lesion glycolysis.