血液透析患者并发肺动脉高压与左心室功能的关系

目的探讨维持性血液透析（MHD）患者并发肺动脉高压（PAH）对左心室结构及功能的影响。方法选取2005年1月至2010年12月在天津市第四中心医院肾内科进行维持性血液透析的尿毒症患者146例,以是否合并PAH将所有患者分为PAH组（n=44）和无PAH的对照组（n=102）,对其临床资料、实验室指标及超声心动图特点进行回顾性分析。结果与对照组相比,PAH组左心房内径、左心室舒张期内径、右心房内径、右心室前后径、肺动脉前后径显著增加,PAH组与对照组分别为：左心房内径（43.79±6.03）mm vs（37.60±4.73）mm（P〈0.01）;左心室舒张期内径（55.21±6.16）mmvs（47.87±5.12）mm（P〈0.01）;右心房内径（37.91±5.07）mmvs（31.55±6.34）mm（P〈0.01）;右心室前后径（18.32±3.91）mmvs（16.00±2.40）mm（P〈0.01）;肺动脉前后径（24.91±3.61）mmvs（22.57±2.62）mm（P〈0.01）。PAH组与对照组比较,左心室射血分数（LVEF）、左心室舒张早期流速峰值（E峰）、左心室舒张早期流速峰值与舒张晚期流速峰值（A峰）比值（E/A）显著降低,LVEF（48.03±11.05）%vs（61.24±8.72）%（P〈0.01）;E峰值[72.00（43.00）]cm/s vs[101.50（67.75）]cm/s（P〈0.05）;E/A[0.75（0.27）]vs[1.26（2.06）]（P〈0.05）。且肺动脉压值与E/A呈负相关（r=-0.441,P〈0.05）。结论MHD患者并发PAH可引起左心室结构改变及收缩、舒张功能障碍,随着肺动脉收缩压升高,左心舒张功能障碍加重。     

血小板活化与慢性阻塞性肺疾病肺动脉高压的关系

目的:研究血小板活化与慢性阻塞性肺疾病(COPD)肺动脉高压的关系。方法:COPD患者40例,按超声心动图测定的肺动脉压的结果分为COPD肺动脉高压组(A组)20例,COPD肺动脉压正常组(B组)20例。同时选取健康对照者(C组)20例。采用流式细胞仪三色荧光标记法检测3组微量全血血小板活化特异性分子标志物GPⅡb/Ⅲa复合物(PAC-1)、P选择素(CD62P)在血小板表面的阳性表达的百分率。结果:3组的PAC-1阳性表达率分别是(10.95±4.54)%、(4.84±1.70)%、(3.95±0.39)%,A组显著高于B组(P<0.05),B组显著高于C组(P<0.05)。3组的CD62P阳性表达率分别是(12.91±4.32)%、(6.55±2.48)%、(3.69±0.77)%,A组显著高于B组(P<0.05),B组显著高于C组(P<0.05)。相关分析显示,在A组,血小板PAC-1阳性表达率与肺动脉压呈正相关关系(r=0.75,P<0.05),同时血小板CD62P阳性表达率与肺动脉压也呈正相关关系(r=0.79,P<0.05)。结论:血小板活化与COPD肺动脉高压具有十分密切的关系。     

先天性心脏病合并肺动脉高压患儿手术前后的呼吸道管理

总结46例先天性心脏病合并肺动脉高压患儿术前和术后的呼吸道管理。术前做好呼吸道管理,对患儿的家长进行健康宣教,术后预防呼吸机相关性肺炎,做好肺动脉高压危象的预防和护理。所有患儿顺利恢复。     

肺动脉高压模型大鼠循环内皮祖细胞与血浆一氧化氮水平相关性的实验研究

目的 探讨肺动脉高压(PH)模型大鼠循环内皮祖细胞(EPC)水平的变化及其与血浆一氧化氮(NO)浓度的关系.方法 利用野百合碱诱导大鼠发生肺动脉高压,使用流式细胞仪对其外周血CD45 阴性、CD34/Flk-1 双阳性的单个核细胞计数,以表示循环EPC,采用Greiss 法对其血浆NO 浓度进行检测.利用简单线性回归分析二者之间的关系.同时,对体外培养条件下循环EPC 的产量,CD34、Flk-1 的表达情况进行检测.结果 PH 模型组循环EPC 水平明显低于对照组[(0.016 ±0.007)% vs.(0.031 ±0.011)%,t ＝3.144,P ＜0.01].血浆NO 浓度亦显著下降[(19.66 ±2.78)μmol/L vs.(54.31 ±3.81)μmol/L,t ＝20.784,P ＜0.01].二者之间呈正相关(r ＝0.792,P ＜0.05).在体外培养条件下,PH 模型组EPC 的数量以及CD34、Flk-1 的表达亦较对照组明显下调.结论 PH 的发生可能与血浆NO 浓度降低导致循环EPC 水平下调有关.     

先心病合并肺动脉高压诊断治疗的新进展

先天性心脏病（Congenital heart disease, CHD）并肺动脉高压（pulmonary hypertension,PH）其自然进程为长期的左向右分流,肺血流持续血容量增加所导致的肺血管收缩和血管壁重构、肺血管内皮细胞损伤和功能失调、肺动脉微血栓形成等,最终进展为艾森曼格综合征,直至死亡.其为动脉型肺动脉高压中的一种重要类型,这些认知已经影响了目前临床上对肺动脉高压的治疗,     

低氧性肺动脉高压与血浆5-羟色胺、血栓素水平的相关性

目的:探讨低氧性肺动脉高压患者肺动脉压与血浆5-羟色胺(5-HT)、血栓素(TXA2)之间的相关性,以期进一步分析低氧性肺动脉高压的发病机制。方法:用超声心动图测定15例明确诊断为慢性肺源性心脏病患者的肺动脉收缩压,并按肺动脉收缩压力的高低分为轻度肺动脉高压组8例及中重度肺动脉高压组7例;同期用酶联免疫分析法测定患者血浆5-HT及TXA2水平。结果:轻度肺动脉高压组的血浆5-HT及TXA2水平明显低于中重度肺动脉高压组(P<0.01);血浆5-HT及TXA2水平与肺动脉压的变化呈明显相关性(r1=0.765,P1<0.05;r2=0.689,P2<0.05)。结论:低氧性肺动脉高压随着血浆5-HT及TXA2水平增高而加重。血浆5-HT和TXA2可能参与了低氧性肺动高压的发病机制。     

超声Tei指数联合三尖瓣环收缩期位移评价肺动脉高压患儿右心室功能

目的探讨超声Tei指数联合三尖瓣环收缩期位移评价肺动脉高压患儿右心室功能的价值。方法 55例肺动脉高压患儿按肺动脉收缩压程度分为肺动脉高压轻度、中度和重度3组,选取同期门诊体检健康儿童25例作对照组,应用超声心动图分别测量各组右心室Tei指数和三尖瓣环收缩期位移。比较各组间差异,并应用相关分析肺动脉高压患儿三尖瓣环收缩期位移与肺动脉收缩压的关系。结果肺动脉高压中度组右心室Tei指数(0.60±0.09)、重度组右心室Tei指数(0.78±0.11)均明显高于正常对照组(0.37±0.08),重度组右心室Tei指数大于中度组,差异均具有统计学意义(P<0.05),轻度组(0.48±0.06)和正常对照组间差异无统计学意义(P>0.05)。肺动脉高压中度组右心室游离壁[(16.4±4.3)mm]、室间隔三尖瓣环收缩期位移[(8.3±2.3)mm]、重度组右心室游离壁[(13.2±4.6)mm]、室间隔三尖瓣环收缩期位移[(6.4±1.9)mm]均明显低于正常对照组[(23.5±3.4)mm、(10.2±2.1)mm],重度组低于中度组,差异均具有统计学意义(P<0.05),轻度组右心室游离壁[(20.8±4.1)mm]、室间隔三尖瓣环收缩期位移[(11.4±2.6)mm]和正常对照组间差异无统计学意义(P>0.05)。肺动脉高压患儿三尖瓣环收缩期位移与肺动脉收缩压呈显著负相关。结论超声Tei指数联合三尖瓣环收缩期位移能较好评价肺动脉高压患儿右心室功能。     

超声心动图在窒患儿和早产儿肺动脉高压治疗中的价值

目的 探讨超声心动图在窒息儿和早产儿肺动脉高压治疗中的诊断价值.方法 选取超声心动图首诊为肺动脉高压的窒息儿和早产儿175例,轻度肺动脉高压组60例,中度组97例,重度组18例,排除先天性心脏病诊断,治疗后复查超声心电图,对比分析治疗前后的肺动脉压力及右心系统参数变化.结果 各组肺动脉高压患儿治疗后肺动脉压力均低于治疗前（P〈0.01）,其中重度肺动脉高压组下降明显,治疗前后对比为（72.89±2.61） mmHg vs （35.2±2.98） mmHg,各组肺动脉收缩压均降至正常范围（〈40 mmHg）,降压效果显著,主肺动脉内径及右心室前后径较治疗前减小（P〈0.01）,其中中度肺动脉高压组减小明显,主肺动脉内径治疗前后的对比为（8.57±0.52） mm vs （6.86±0.60） mm,右心室前后径治疗前后对比为（9.38±0.57） mm vs （7.40±0.50） mm,临床治疗效果满意,各组间差异有统计学意义.结论 超声心动图能够对窒息儿和早产儿治疗前后的肺动脉压力进行客观评价,为临床早期治疗、防止肺动脉高压的进一步发展及改善预后提供指导.     

内皮祖细胞治疗肺动脉高压新进展

肺动脉高压是一种由已知或未知原因引起的以肺血管收缩、重构、原位血栓形成为主要病变特征,肺血管阻力进行性升高及血流受限,肺动脉压力异常升高的病理生理综合征,最终可导致右心功能受损,甚至死亡。恢复血管内皮结构和功能的完整性,逆转肺血管重构,促进血管新生替代永久性闭塞血管是治疗肺动脉高压的关键。近年研究发现,内皮祖细胞在维持血管内稳态、逆转肺血管重构及促进血管新生方面有重大意义,本文就肺动脉高压的内皮祖细胞治疗作一综述。     

C-型利钠肽、神经肽Y与缺氧性肺动脉高压的关系

目的:研究缺氧性肺动脉高压(HPH)患者血浆C-型利钠肽(CNP)和神经肽Y(NPY)的水平变化,探讨CNP、NPY与HPH的关系,以揭示HPH的发病机制。方法:选择慢性阻塞性肺疾病(COPD)并肺动脉高压、肺心病患者30例和对照组20例,用放免法测定血浆CNP、NPY的含量,并同时测定其血氧分压和肺动脉压力。结果:(1)血浆CNP、NPY的含量在HPH组均高于对照组[HPH组为(78.20±22.31)、(209.01±42.25)pg/mL,对照组为(20.51±4.96)、(135.52±20.12)pg/mL;t=13.36,7.29;P<0.01]。(2)血浆CNP、NPY与氧分压呈负相关关系(r=-0.78,-0.67;P<0.01)。(3)血浆CNP与NPY呈正相关关系(r=0.68,P<0.01)。结论:CNP、NPY参与了HPH发生、发展的病理生理过程。在HPH中,收缩血管与舒张血管因子均升高,二者比例可能决定肺动脉高压的发生、发展。     

硫化氢逆转脂多糖诱导大鼠肺动脉低反应性以及与一氧化碳的关系

目的 观察整体水平应用硫化氢(H2S)后脂多糖(LPS)诱导的离体肺动脉对H2S舒张反应的变化及其与一氧化碳(CO)的关系.方法 将48只大鼠按照随机数字表法分为对照组[给予生理盐水(NS)]、LPS组、H2S供体硫氢化钠(NaHS)+LPS组和NaHS+NS组4组,每组12只.采用经大鼠气管内滴注LPS(0.8 ml/kg)染毒;NaHS±+LPS组和NaHS±NS组滴注LPS或NS之前10 min和之后2 h腹腔注射NaHS各0.5 ml(28 μmol/kg).各组取6只大鼠于染毒后12 h制备肺动脉环(PARs),采用离体血管环张力测定技术检测用血红素氧合酶-1(HO-1)抑制剂锌原卟啉Ⅸ(ZnPPⅨ)孵育前后PARs对累积浓度NaHS的舒张反应变化;各组另取6只大鼠于染毒后12 h检测出肺血(EPB)和入肺血(APB)中碳氧血红蛋白(COHb)含量,以其差值反映肺循环CO生成的水平.结果 与对照组相比,滴注LPS后PARs对NaHS的最大舒张反应百分比明显降低[(75.72±7.22)%比(96.40±4.40)%,P＜0.01＝;用ZnPPⅨ孵育PARs后,LPS诱导的PARs对NaHS舒张反应进一步降低[(62.91±8.22)%比(75.72±7.22)%,P＜0.01＝.腹腔注射NaHS可明显逆转LPS诱导的PARs对NaHS的低反应性,PARs对NaHS的最大舒张反应百分比明显升高[(94.65±8.45)%比(75.72±7.22)%,P＜0.01＝;但用ZnPPⅨ孵育PARs后,PARs对NaHS的舒张反应较孵育前显著下降[(83.75±9.76)%比(94.65±8.45)%,P＜0.01＝.NaHS+NS组中PARs对NaHS的舒张反应与对照组相比无明显差异,且在ZnPPⅨ孵育前后也无明显变化.COHb检测结果显示,与对照组相比,滴注LPS后APB和EPB中COHb水平的差值明显增高[(3.12±0.48)%比(2.12±0.32)%,P＜0.05＝;腹腔注射NaHS后,COHb水平的差值[(4.03±0.56)%]较LPS组进一步升高(P＜0.01＝.结论 腹腔注射H2S可以改善LPS诱导的离体肺动脉对H2S的低反应性,其机制可能与增强肺动脉HO-1/CO体系有关.

Abstract：

Objective To explore the effect of hydrogen sulfide (H2S) on abnormal pulmonary artery reactivity induced by lipopolysaccharide (LPS) and its relationship with carbon monoxide (CO). Methods Forty-eight rats were divided into four groups randomly according to table of random number: control group (normal saline, NS), LPS group, a donor of H2S sodium hydrosulfide (NaHS)+LPS group, and NaHS+NS group (n=12 in each group). Rats were given LPS by intratracheal instillation (0. 8 ml/kg). 0. 5 ml of NaHS (28 μmol/kg) was injected intraperitoneally 10 minutes before LPS or NS instillation and 2 hours after LPS or NS instillation in NaHS+LPS and NaHS+NS groups. Twelve hours after instillation of LPS, 6 rats from each group were sacrificed. The pulmonary artery rings (PARs) were prepared and the changes in cumulative relaxation response of PARs to NaHS were detected before and after incubation with an inhibitor of heme oxygenase-1 (HO-1) zinc protoporphyrin Ⅸ (ZnPP Ⅸ ) using isolated vascular ring tension detecting technique. Twelve hours after LPS instillation, the remaining 6 rats in each group were sacrificed, and the contents of carboxyhemoglobin (COHb) in efferent pulmonary blood (EPB) and afferent pulmonary blood (APB) were measured, and the difference between the contents of COHb in EPB and that of APB was calculated to represent content of CO from pulmonary circulation. Results In the present study, compared with control group, after the instillation of LPS the percentage of relaxation response of PARs to NaHS was significantly declined [(75. 72±7. 22)% vs. (96. 40±4. 40)%, P＜0. 01]. After being incubated with ZnPP Ⅸ, the decreased relaxation response of PARs to NaHS induced by LPS was further depressed [(62. 91 ±8. 22) % vs. ( 75. 72 ± 7. 22) %, P ＜ 0. 01]. Administration of NaHS intraperitoneally reversed the hyporesponsiveness of PARs to NaHS, the percentage of relaxation response of PARs to NaHS was significantly increased [(94.65± 8.45)% vs. (75.72 ± 7.22)%, P＜0.01]. However ZnPP Ⅸ also attenuated the effect [(83. 75 ± 9. 76)% vs. (94. 65 ± 8. 45)%, P ＜ 0. 01]. NO significant changes were observed between NaHS+NS group and control group, also between the results before and after ZnPP Ⅸincubation. Compared with control group, the difference between the contents of COHb in EPB and that of APB increased after instillation of LPS [(3. 12±0. 48)% vs. (2. 12±0. 32)%, P＜0. 05], which further increased after intraperitoneal administration of NaHS [(4.03 ± 0. 56) %, P ＜ 0. 01]. Conclusion The results suggested that intraperitoneal administration of H2S could reverse hyporesponsiveness of PARs to H2S induced by LPS, and the result might be related to an intensification of HO-1/CO system in pulmonary artery tissue.     

妊娠期高血压患者视网膜病变及其与围生儿预后的关系

目的探讨妊娠期高血压患者的视网膜病变及其与围生儿预后的关系。方法前瞻性选取2016年1月至2019年6月复旦大学附属妇产科医院收治的妊娠期高血压患者196例,随访围生儿预后情况,观察母体视网膜病变分期与围生儿预后不良的关系,分析早产儿视网膜病变与母体妊娠期高血压严重程度和视网膜病变分期的关系。结果视网膜分期为III期患者的围生儿预后不良的发生率(62.50%)最高,显著高于视网膜分期为I期和II期的患者(6.86%,12.86%;χ^2=32.554,P<0.001)。早产儿视网膜病变分期与妊娠期高血压患者严重程度呈正相关关系(r=0.45,P<0.001)。早产儿视网膜病变分期与妊娠期高血压患者视网膜病变分期也呈正相关关系(r=0.41,P<0.001)。结论妊娠期高血压患者视网膜严重程度与围生儿不良预后有关,其中早产儿视网膜病变程度与母体妊娠期高血压疾病严重程度和视网膜病变严重程度密切相关。     

急性脑卒中患者动态心电图的特点及其与预后的关系

目的了解并探讨急性脑卒中患者动态心电图的改变及其与预后的关系。方法选择扬州大学附属医院2013年1月至2015年12月收治的首次发病的急性脑卒中患者160例作为研究对象,同期在我院住院治疗的非脑血管疾病患者160例为对照组,观察各组的心电图异常率、心电图异常的类型及构成以及不同部位脑卒中患者的心电图异常率,并随访获得预后的相关数据。数据采用SPSS 21.0统计软件进行分析,以P<0.05为差异具有统计学意义。结果试验组的心电图异常率要高于对照组(73.12%vs.10.62%,P<0.05),而且出血性脑卒中组心电图异常率高于缺血性脑卒中组(79.00%vs.63.33%,P<0.05)。左心室肥厚、心房扩大、心肌缺血、心房颤动、窦性心动过速在试验组和对照组间的差异存在统计学意义(P<0.05),试验组均高于对照组,此外,出血性脑卒中组的心肌缺血率和窦性心动过速率高于缺血性脑卒中组(P<0.05),缺血性脑卒中组的心房扩大率和心房颤动率高于出血性脑卒中组(P<0.05)。脑叶卒中是并发心电图异常概率最高的部位(84.21%,P<0.05)。心电图异常者预后情况较心电图正常者差(29.06%vs.9.3%,P<0.05),同时,在心电图异常的患者中,出血性脑卒中较缺血性脑卒中预后差(35.44%vs.15.79%,P<0.05)。结论急性脑卒中动态心电图异常的发生率与脑卒中类型、脑卒中发生部位有关,心电图异常卒中患者的预后情况较心电图正常者更差。     

新疆哈萨克族原发性高血压患者血浆硫化氢与血尿酸关系研究

目的 探讨新疆哈萨克族(哈族)原发性高血压(EH)患者血浆硫化氢(H2S)与血尿酸(BUA)的关系.方法 以新疆哈族EH组68例及哈族健康对照组65例为研究对象,测量身高、体质量,计算体质量指数(BMI),取空腹静脉血测定血浆H2S、BuA、空腹血糖(FPG)、空腹胰岛素(FINs),计算胰岛素抵抗指数(IRI).结果 哈族EH组血浆H2S水平显著低于健康对照组,(24.55±5.62)μmol/L vs(27.35±6.63)μmol/L(P<0.01);哈族EH组BUA水平显著高于健康对照组,(264.03±71.77)μmol/L vs(228.71±79.42)μmol/L(P<0.01).哈族EH组血浆H2S与收缩压(SBP)、BUA、BMI、FINS、IRI呈显著负相关;哈族健康对照组血浆H2S与BUA、BMI呈显著负相关;调整年龄、血压、血糖、肥胖、胰岛素、胰岛素抵抗等因素后进行偏相关分析,哈族EH组血浆H2S与BUA仍呈显著负相关.结论 哈族EH患者血浆H2S水平降低,BUA水平升高,且两者存在相关性.     

气体信号分子硫化氢在新鲜骨折患者血浆中的变化

目的:观察新鲜骨折患者血浆中内源性气体信号分子硫化氢水平的变化探讨其可能的临床意义。方法:检测骨折患者血浆白细胞计数、中性粒细胞分类计数、血小板计数、纤维蛋白原、碱性磷酸酶含量和血浆硫化氢水平并与正常对照组进行对比分析。结果:与对照组相比,血浆白细胞计数、中性粒细胞分类计数、血小板计数、纤维蛋白原和碱性磷酸酶含量在骨折时明显升高,而血浆硫化氢水平明显降低。结论:新鲜骨折患者血浆硫化氢含量下降,其可能参与了骨折的病理过程。     

西地那非治疗小儿肺动脉高压疗效观察

西地那非是一种具有高度选择性的磷酸二酯酶抑制剂,通过抑制第二信使cGMP的代谢,发挥其治疗作用。研究表明西地那非口服对多种类型的肺动脉高压具有较高疗效,且价格相对便宜,因此其治疗前景是令人鼓舞的。但对原发性心肌病及未根治的先天性心脏病效果不十分理想。     

Street children and their relationship with the police

Background: This paper explores and analyses the experiences of school‐age street children. It specifically addresses the relationship of the street children who live on the streets of São Paulo (a large Brazilian metropolis), in relation to their experiences, with the policemen. Methods: The paper is a secondary analysis of date previously collected in 1999. The data were collected through individual semi‐structured interviews, with 14 school‐age children frequenting two city public refuges, with their legal guardians' consent. The text from transcribed interviews was organized according to the validity norms of ‘thematic analysis’, a technique of contents analysis method. The decomposing and reconstructing process of that analysis gave rise to thematic categories (among which ‘the police category’) that represented the reconstruction of the difficulties faced by the children in their development. Results and discussion: The children portrayed the police as an enemy, a fearful figure and one of the most agonizing street experiences. Rarely did the police have a positive image to them. According to the children, police violence occurs in three forms: through systematic police persecution in an effort to remove the children from the streets against their will; actions that had the deliberate intent to humiliate them with verbal or physical aggression; and through alleged sexual abuse, revealed by the children in a veiled manner. The authority that is supposedly intended to protect them is portrayed as one of the most feared social agents. Conclusion: The reported hostile behaviour of the policemen shows the state of vulnerability of those children living on the street. This situation must be focused like a health problem because it causes injury to development of children. Nurses can help them through organizing assistance to children in situation of personal and social risk in the school nursing and health institution.     

Noninvasive imaging for the diagnosis and prognosis of pulmonary hypertension

Pulmonary hypertension (PH) is a major cause of morbidity and mortality, but it often presents with nonspecific symptoms, thereby delaying diagnosis and treatment. While invasive cardiac catheterization is essential to confirm the diagnosis, patients with breathlessness are commonly encountered in clinical practice creating a demand for noninvasive screening methods. Preliminary investigations such as the electrocardiogram and chest radiograph lack sensitivity even in advanced cases. Echocardiography is used to screen patients; however, over-reliance on a single estimation of pulmonary artery systolic pressure is unwise, instead multiple parameters should be assessed. Once a diagnosis of PH is made, radionuclide imaging should be performed to exclude chronic thromboembolic disease, and computed tomography is vital for eliminating parenchymal lung disease as a potential etiology. Currently, the primary contribution of cardiac MRI is the accurate assessment of right ventricular size and function. In this respect, cardiac MRI may be supportive during diagnosis of PH, but the main importance of this is in defining prognosis although new outcome variables are anticipated.