冠心病患者冠状动脉内支架置入术的临床应用

目的 :评价冠心病患者冠状动脉内支架置入术的临床疗效。方法 :分析 2年来冠状动脉内支架置入术 94例资料。结果 :94例患者 131支冠状动脉的 15 1处病变共置入支架 112枚 ,手术和临床成功率分别为 99.1%和 97.8%。术前病变平均狭窄为 (92 .8± 4.9) % ,术后残余狭窄为 (5 .4± 8.1) %。因球囊扩张后不理想占 43.7% (4 9枚 ) ,PTCA并发夹层、急性闭塞或濒临闭塞占 2 5 .9% (2 9枚 ) ,选择性置入支架占 30 .4% (34枚 )。严重并发症 2例 (2 .1% )。结论 :冠心病患者冠状动脉内支架置入术成功率高 ,疗效好 ,并发症少。     

老年冠状动脉支架置入术的临床体会

目的 :初步评估老年冠心病患者的冠状动脉造影及支架置入术的临床特点。　方法 :将我院 182例年龄≥6 0岁的老年患者的冠状动脉造影狭窄分布和置入支架的分布情况进行统计 ,并与文献资料进行对照分析。　结果 :182例患者中 10 7例有单支、双支、3支或合并左主干病变 ,造影的阳性率为 5 8.8%。其中单支病变 4 1例 ,占38.32 % ,双支病变 32例 ,占 2 9.91% ,3支病变 2 1例 ,占 19.6 3% ,左主干 (LM )病变 13例 ,占 12 .14 %。造影结果显示 ,血管狭窄共计 199支 35 1处 ,其中LM 13支 13处 ,前降支 (LAD) 83支 14 4处 ,旋支 (LCX) 4 4支 87处 ,右冠状动脉 (RCA) 5 9支 10 7处。 199支狭窄血管共置入支架 12 2枚 ,扩张后置入支架的相关动脉为LAD 5 6例 6 0枚 ,LCX2 1例 2 4枚 ,RCA 30例 38枚。同一血管置入 2枚支架的有 10例患者。 12 2枚支架中 ,Coroflex支架 93枚 ,占 76 .2 3% ,Helistent支架 11枚 ,占 9.0 2 % ,AVE支架 17枚 ,占 13.92 % ,Bestent支架 1枚 ,占 0 .82 %。所有支架的直径范围为 2 .0～ 4 .0mm ,其中直径 2 .0mm 2枚 ,2 .5mm 2 3枚 ,3.0mm 4 9枚 ,3.5mm 2 9枚 ,4 .0mm 13枚 ;长度范围为 8～ 30mm ,其中≤ 10mm 2 1枚 ,10～ 15mm 4 3枚 ,16～ 2 0mm 37枚 ,2 1～ 2 5mm 13枚 ,>2 5mm 2枚。　结     

冠状动脉造影定量分析对冠状动脉内支架置入术即刻疗效的评价

目的 :采用冠状动脉造影定量分析法评价冠状动脉性心脏病 (简称冠心病 )患者冠状动脉内支架置入术的即刻临床效果。　方法 :在 10 0例冠心病患者的靶病变处置入 14 7枚人工支架 ,通过冠状动脉造影定量分析法分析冠状动脉内支架置入前、后靶病变血管内径和横截面积的变化。　结果 :支架置入后靶病变处血管内径和横截面积的即刻增益分别为 1.4 4～ 3.74 (2 .4 7± 0 .4 9)mm、2 .6 2～ 12 .18(6 .4 7± 1.87)mm2 ,直径和面积残余狭窄率分别为 - 11.2 8%～ 14 .17% (3.5 0± 0 .0 4 ) %、- 2 1.2 8%～ 2 6 .3% (6 .6 2± 6 .74 ) % ,患者的症状得到改善。　结论 :冠状动脉造影计算机定量分析冠状动脉内支架置入前、后即刻疗效是一种可靠而简易的方法。     

经皮冠状动脉腔内支架置入术治疗冠心病

目的:评估冠状动脉内支架置入术的效果。方法:回顾性分析1996年2月～2000年2月我院接受冠状动脉内支架置入术的120例病人的治疗效果。结果:在183处病变共置入支架125只。在未经介入性治疗的病变置入支架(De novo stenting)101只,PTCA结果不理想(suboptimal)置入支架19只,2例PTCA并发夹层,濒临闭塞时紧急置入支架(Bail-out stenting)2只,在再狭窄病变置入支架3只。置入支架平均直径3.00±0.69mm,平均长度18.15±10.26mm。手术即刻成功率98.4％,主要并发症率为1.6％((2例AMI)。结论:冠脉内支架置入术是治疗冠心病的一种安全有效的介入性治疗技术,其成功率高,并发症少。     

经皮冠状动脉腔内成形术及支架置入46例临床体会

1目的　探讨经皮冠状动脉腔内成形术 ( PTCA)及支架置入 ( ICS)术的临床效果与体会。 2方法　选择 46例冠心病患者 ,其中 32例先预扩张后放支架 ,14例未扩张而直接置入支架 ;3结果　 46例中共扩张 72处病变 ,置入支架 6 7个 ,支架置入前血管狭窄程度为 ( 89.6± 6 .7) % ,支架置入后血管腔残余狭窄为 ( 0 .45± 1.7) % ( P<0 .0 0 1) ,支架长度为 ( 14 .6± 4.8) mm,直径 ( 3.0± 0 .4) mm,成功率为 10 0 % ,无任何并发症 ,随访率 96 .2 % ,2 6例接受造影 ,未见再狭窄形成 ;4结论　 PTCA及支架置入是治疗冠心病最为有效和最可靠的方法 ,其成功率达 98%以上 ,安全可靠 ,基本上无并发症 ,特别是对某些轻度钙化或无钙化者可直接置入支架 ,既节省时间 ,又省钱 ,并可减少 X线曝光时间。     

经皮冠状动脉腔内成形术治疗支架内再狭窄

目的　评价用经皮冠状动脉腔内成形术 (PTCA)治疗支架内再狭窄临床疗效。方法　 2 1例患者(2 4个支架 )于冠状动脉内支架术后平均 (7.3± 5 .3)个月发生支架内再狭窄 (支架节段管腔内径减小≥ 5 0 % ) ,各例均有心绞痛症状。以标准方法行PTCA治疗。结果　 2 4个支架中 ,完全阻塞 6个 ,不完全阻塞 18个。PT CA总成功率为 95 .8% ,冠状动脉最小内径由术前 (0 .5 9± 0 .46 )mm增至术后 (2 .2 9± 0 .33)mm(P <0 .0 0 1) ;狭窄程度由术前 (79± 15 ) %降至术后 (17± 4) % (P <0 .0 0 1) ,术中无严重并发症。随访 (4.6± 3.1)个月 ,16例心绞痛明显减轻或消失。结论　用PTCA治疗冠状动脉内支架术后再狭窄安全、有效。     

PTCA及支架术治疗82例冠心病患者的临床分析

目的 :回顾分析 88例次经皮腔内冠状动脉成形术 (PTCA)及支架置入术 (支架术 )治疗冠心病的临床疗效。方法 :对 82例冠心病患者共行 88例次 PTCA或加支架术 ,其中心绞痛患者 5 0例 ,心肌梗死 3 1例 ,无症状性心肌缺血 1例 ;临床心功能 (2 .8± 0 .6)级 (除外急性心肌梗死急诊手术者 ) ;处理病变血管 10 8处 ,共置入支架 95枚 ,其中 L M2枚 ,L AD42枚 ,LCX2 0枚 ,RCA3 1枚。结果 :PTCA成功率 93 .5 % ,PTCA成功后 ,拟行支架术者均能完成支架术 ,心绞痛缓解率 98% ,临床心功能 (1.5± 0 .5 )级 ,较术前明显改善 (P <0 .0 5 ) ;支架术并发症小于 4.5 % ,多为穿刺局部并发症。结论 :PTCA加支架术治疗严重心肌缺血患者疗效确切 ,并发症少 ,值得临床进一步推广应用     

磁化支架防治犬PTCA术后冠状动脉再狭窄

目的　探讨磁化支架对 (PTCA,Percutaneoustranslum inal coronary angioplasty)术后冠状动脉再狭窄的防治作用 .方法　 2 0只健康杂种犬 ,超大球囊反复扩张损伤靶血管 (前降支或旋支中段 )制备 PTCA术后冠状动脉狭窄模型 (大于 5 0 % )后随机分成对照组和实验组各 10只 ,对照组靶血管置入普通 Palmaz支架 ,实验组靶血管置入磁化 Palmaz支架 .手术前、后不用抗血小板药和抗凝药 ,术后 6 mo冠状动脉造影并处死犬 ,切取靶血管 3cm进行组织病理学检查 .结果　冠状动脉造影示冠状动脉再狭窄率对照组 30 % ,实验组 0 ;组织病理学检查靶血管平均内膜厚度 [对照组 (2 .98±0 .5 6 ) m m,实验组 (1.13± 0 .4 1) mm ]有显著差异 ,P<0 .0 5 .结论　磁化支架对犬 PTCA术后冠状动脉再狭窄有显著的防治作用 .     

经皮冠状动脉腔内成形术及支架置入144例临床体会

目的　探讨经皮冠状动脉腔内成形术 (PTCA )及支架置入 (ICS)术的临床效果。方法　选择 14 4例冠心病患者 ,其中 14 0例先预扩张后放支架 ,4例未经球囊预扩张 ,直接置入支架。结果　 14 4例中共扩张 2 2 3处病变 ,置入支架2 2 3个 ,支架置入前血管狭窄程度为 (89.6± 6.7) % ,支架置入后血管腔无残余狭窄 ,成功率为 10 0 % ,96例术后 3～ 6个月冠脉造影复查 ,90例 (共置入 13 6个支架 )未见再狭窄形成 ,6例 (共置入 12个支架 )有 8处出现再狭窄。结论　PTCA及支架置入是治疗冠心病最为有效和最可靠的方法 ,并发症少 ,特别是对某些轻度钙化或无钙化者可直接置入支架 ,可减少X线曝光时间。     

冠状动脉内超声检查在支架内再狭窄研究中的临床应用

目的 :比较常规冠脉造影、冠脉造影计算机定量分析和冠脉内超声 ,探讨冠脉内超声在支架内再狭窄研究中的应用。方法 :对 4 1例病人的 4 5处病变置入支架治疗 ,术前、术后采用冠脉造影和冠脉内超声系列检查。结果 :术前、术后即刻以及术后 3个月、6个月冠脉造影病变狭窄程度分别是 87.4± 11.3% ,8± 9.2 % ,4 9.8±10 .7%和 5 7.2± 12 .3% ;QCA示狭窄程度分别为 6 1.4± 16 .0 % ,3.3± 13.3% ,2 4 .8± 2 0 .6 %和 2 8.9±18.8% ,两种方法得出的结果有显著性差异。冠脉内超声示术后即刻以及术后 3个月、6个月的支架横断面积从 8.2 5± 1.83mm2到 95 8± 2 .5 9mm2 (P <0 .0 0 1)和 10 .4 6± 2 .6 9mm2 (P <0 .0 1) ,支架横断面积进行性扩大 ,前后比较在统计学上有显著性差异。结论 :ICUS是研究支架内再狭窄的一个最直接、客观的方法 ,安全、易操作。     

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.