先天性心脏病外科进展

先天性心脏病的发生率在新生儿中高达6.7‰,每年我国约有15～20万名先天性心脏病出现.随着心脏外科的发展,该病外科可治性高、疗效好.如果对这些患儿不加处理,其中1/3患者因病情危重将在6个月～1岁内夭折.因此,未成熟儿、新生儿、婴幼儿期危重先天性心脏病外科治疗仍成为21世纪心脏外科的挑战.除了外科操作技术的发展外,各学科密切配合是心脏外科迅速发展的重要前提.心内科对该病的病理解剖和血流动力学资料的结合已成为诊断统一体;心内外科镶嵌治疗成为婴幼儿心脏外科手术成功的重要保证;体外循环设备技术的发展,使新生儿、婴幼儿患者对体外循环耐受性提高,保证外科医师有足够时间进行精细手术操作;麻醉、监护设备和技术的创新,提高了患者对手术应激的耐受性,降低了不必要的机体能量消耗,加快了康复,提高手术的生存率;ECMO或VAD已成为复杂先天性心脏病围术期心肺支持的重要手段;合成和生物材料的更新,提高了复杂先天性心脏病的可治率,延长了植入材料的寿命;未成熟心肌、肺、脑、肾等重要脏器的保护和胎儿心脏外科是当今先天性心脏病外科发展的热点.     

婴幼儿先天性心脏病的外科治疗

随着对婴幼儿先天性心脏病(先心病)的病理解剖和生理特点认识的不断提高及婴幼儿体外循环(CPB)技术不断完善,近年来,婴幼儿心脏外科发展迅速,心脏直视手术的死亡率逐年下降.     

先天性心脏病婴幼儿体外循环术后体温的护理

先天性心脏病(简称先心病)婴幼儿体外循环(CPB)术后为高危儿，近年来随着心脏外科、麻醉、体外循环和重症监护的发展，使先心病婴幼儿心脏外科手术死亡率大大降低，手术成功率逐年增加。但是由于先心病婴幼儿患者特殊的生理特征，使70％的患儿CPB术后易发生体温失衡，影响心脏功能和机体代谢，严重的可以危及生命。     

婴幼儿先天性心脏病手术18例分析

随着近几年对婴幼儿心脏疾病认识、诊断、婴幼儿体外循环（Extracorporeal circulation,ECC）技术、手术技术、围术期管理技术的提高,许多大型医院的心脏外科开展了婴幼儿先天性心脏病（Congenital heart disease,CHD）手术。     

婴幼儿先心病外科治疗——附64例分析

婴幼儿先心病外科治疗附６４例分析孙国成蔡振杰万明明耿斌王余平（第四军医大学唐都医院心脏外科西安７１００３８）关键词先天性心脏病婴幼儿外科手术中图号Ｒ６５４．２婴幼儿先天性心脏病是一种较为常见的疾患，其发病率为新生儿的６．２‰．国内对婴幼儿先心病的诊治...     

心脏手术病人的心理护理体会

心脏外科手术指的是心脏本身病变的外科矫正术,我科收治的心外科手术患者主要包括先天性心脏病和慢性风湿性心脏瓣膜病、冠心病三大类,先天性心脏病需施行心脏畸形或异常通路矫治术,风湿性心脏瓣膜病需施行人工心脏瓣膜置换术,冠心病需要施行冠状动脉搭桥手术。不论是哪一类手术,都要在开胸条件下进行,而且大多要在体外循环的支持下于心腔内操作。因此,心脏外科手术具有手术创伤大、技术操作复杂、手术风险大、费用较高的特点,此外,心脏手术是此类患者赖以生存的唯一治疗措施,患者对手术的成功抱有极高的期望。因此,患者及其亲属往往处于焦…     

67例10kg以下婴幼儿先天性心脏病外科治疗

目的：提高婴幼儿先天性心脏病手术疗效。方法：总结６７例１０ｋｇ以下先天性心脏病体外循环下心内直视手术的经验。结果：左向右分流常见先天性心脏病５０例，右向左分流或双向分流的复杂先心病１７例，术后死亡３例。结论：婴幼儿先心病应尽早手术治疗为宜，中低温体外循环下尤为适合；术后强调持续保温、镇静、呼吸道通畅，防止术后并发症的发生。     

婴幼儿深低温停循环心脏直视手术的麻醉

随着心脏外科的发展,婴幼儿心脏直视手术日益增多,这标志着诊断检查技术、麻醉、体外循环、外科等各方面水平的提高。国内一些单位已开展婴幼儿及新生儿心脏直视手术。手术病种有房室间隔缺损,也有四联症、右室     

心脏手术病人的心理护理体会

心脏外科手术指的是心脏本身病变的外科矫正术，我科收治的心外科手术患者主要包括先天性心脏病和慢性风湿性心脏瓣膜病、冠心病三大类，先天性心脏病需施行心脏畸形或异常通路矫治术，风湿性心脏瓣膜病需施行人工心脏瓣膜置换术，冠心病需要施行冠状动脉搭桥手术。不论是哪—类手术，都要在开胸条件下进行，而且大多要在体外循环的支持下于心腔内操作。     

1例14天新生儿心脏手术围术期的监护

先天性心脏病是先天性畸形中常见的一种，由于胎儿的心脏在母体发育有缺陷或部分停顿所造成，近年来随着心肌保护、外科技术及围术期监护技术的提高，越来越多的复杂先天性心脏病患儿获得了在新生儿期手术治疗的机会，由于新生儿在经历体外循环及手术创伤后常常并有内环境孔及主要器官的功能障碍，术后监护是及时发现这些异常，并给予适时的干预，帮助新生儿尽快康复。我科于2003年12月成功救治1例在全麻低温体外循环下行肺动脉瓣切开成形术新生儿，此例手术属广西地区首例新生儿心脏直视手术。本文将监护体会总结如下。     

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.