30例二尖瓣重度狭窄合并小左心室围手术期护理实践

目的总结风湿性二尖瓣重度狭窄合并小左心室患者围手术期护理经验。方法回顾性分析本科室2014年1月至2018年12月收治的30例接受外科治疗的风湿性二尖瓣重度狭窄合并小左心室患者的临床资料。汇总统计术后低心排发生率。结果术后患者低心排发生例数为5,发生率为16.7%。明显低于以往文献统计的此类患者低心排发生率。结论二尖瓣重度狭窄合并小左心室患者因病程长、病情重、心功能差,术后低心排发生率高,严重影响患者早期下床活动,进而引起其他并发症的发生,延长住院时间。因此重视此类患者围手术期护理对术后患者恢复,降低低心排发生率,缩短住院时间有着重要的作用。     

危重心脏瓣膜病23例外科治疗及围手术期处理

目的 探讨危重心脏瓣膜病的手术治疗和围术期处理。方法 对23例危重心脏瓣膜病患者行手术治疗。术前心功能Ⅲ级16例，Ⅳ级7例。二尖瓣置换术11例，主动脉瓣置换术8例，二尖瓣加主动脉瓣置换术4例；同时行三尖瓣成形术12例，左房血栓清除术10例。结果 早期主要并发症为室性心律失常、低心排血量综合征、多器官功能衰竭。早期死亡1例，存活22例。结论 危重心脏瓣膜病的外科治疗应注重围术期处理，适当选择手术时机，合理纠正病变，加强术后并发症的防治。     

成年人小左心室体外循环心脏手术41例治疗体会

目的 总结成年人小左心室体外循环手术围术期的治疗方法及经验.方法 41例成年人小左心室病例,包括先天性心脏病27例,风湿性心脏病13例,Lutembacher综合征1例,左心室舒张期末内径(LVEDD) 32～40mm,平均36.5 mm,均接受体外循环手术治疗.结果 本组术后均使用多巴胺,部分加用多巴酚丁胺、肾上腺素,术后应用呋塞米等药物利尿、地高辛等治疗.术后1例ASD发生脑栓塞,2例ASD病人发生低心排血综合征(LCOS),其中1例致二尖瓣中度关闭不全,1例风心病二尖瓣狭窄发生顽固性室速、室颤,其余病例均心功能Ⅱ级出院.全组病例无死亡.结论 对于成年人小左心室患者,正确的术中决策及在围术期积极使用正性肌力药物增强心肌收缩力、应用扩血管药物及利尿剂减轻心脏负荷,是治疗成功的关键.     

合并巨大左心室心脏瓣膜手术的临床分析

目的总结心脏瓣膜病合并巨大左心室患者外科治疗经验,提高疗效。方法回顾性分析2008年1月至2014年6月我院收治的27例心脏瓣膜病变合并巨大左心室患者的临床资料,其中二尖瓣置换术11例,主动脉瓣置换术7例,二尖瓣加主动脉瓣置换术9例。结果术后发生并发症11例(44.4%),死亡2例(7.4%),死亡原因1例为低心排综合征、1例为恶性心律失常。结论合并巨大左心室的心脏瓣膜病术后并发症和死亡率均较高。充分的术前准备、术中良好的心肌保护、切当的手术方法及合理的术后处理是降低围手术期死亡率和术后并发症发生率的关键。     

153例合并巨大左心室的风湿性心瓣膜病临床分析

目的 总结合并巨大左心室瓣膜病行心脏瓣膜置换术的临床资料和治疗效果,探讨影响手术效果的高危因素、手术适应证和围术期处理措施.方法 对1996年9月～2006年7月施行瓣膜置换术的153例巨大左心室患者进行回顾性分析研究.术前左室舒张末期内径为(82.0±8.5)mm,左室射血分数(LVEF)为0.45±0.17;心功能Ⅲ级132例,Ⅳ级21例,二尖瓣置换39例,主动脉瓣置换51例,双瓣置换术63例.结果 术后早期出现心衰、呼衰和室性心律失常等并发症28例,占18.3%,术后早期死亡7例,占4.5%.结论 影响早期疗效的主要因素是术前严重左室扩大和左室收缩功能下降、术后低心排、呼衰和室性心律失常,加强围术期管理是治疗合并巨大左心室的风湿性心瓣膜病的关键.     

再次二尖瓣瓣膜置换术的术后监护

随着心脏手术的广泛开展,需要再次行瓣膜置换术的患者日趋增多,文中总结72例再次二尖瓣瓣膜置换术患者的术后护理经验。采用回顾性分析的方法,总结72例心脏手术再次行二尖瓣瓣膜置换术患者的术后护理。72例患者中,手术早期死亡2例,死亡率2.8%,其余随访期间无死亡,心功能均得到明显改善。采取相应护理措施,包括加强围手术期对低心排血量综合征心律失常的护理与治疗,加强呼吸管理,密切观察引流及肾功能,及时根据情况调整抗凝药用量,这是再次二尖瓣瓣膜置换成功的关键。     

62例心脏瓣膜病变的外科治疗

目的:总结瓣膜置换术围手术期处理的临床经验。方法:回顾性分析62例瓣膜置换术病人围手术期处理的临床资料。结果:发生围手术期并发症共30例,其中发生低心排血量综合征4例、发生心律失常19例。长期存活60例;死于多器官功能衰竭1例;死于其他疾病1例。结论:对于心脏瓣膜置换术必须加强术前准备,以提高病人手术的安全性;术中良好的心肌保护和熟练的手术技巧直接关系到手术的成败;围手术期内应及时纠正心律失常,严密监护,积极防治低心排综合征。     

风湿性心脏病瓣膜替换术围手术期护理

风湿性心脏病在我国成人各种病因心脏手术中占首位，其特点是病史长、心功能差，术后易发生低心排血量综合征、心律紊乱、电解质失调等并发症。我们1998年8月－2000年6月行风湿性心脏病瓣膜替换术31例，现就围手术期护理总结如下。     

巨大左心室心脏瓣膜病手术的麻醉策略及围术期处理

目的 探讨巨大左心室心脏瓣膜手术的麻醉策略及围术期处理要点.方法 选择126例合并巨大左心室的心脏瓣膜病患者接受手术.均采用全凭静脉方法,持续泵注异丙酚维持麻醉,并根据血流动力学及脑电双频指数(BIS)监测,间断静注舒芬太尼及哌库溴铵,保证BIS＜ 50.结果 全部患者麻醉诱导平稳,顺利度过手术期.术后早期发生室性心律失常46例(36.5％),多器官功能不全26例(20.6％),低心排综合征14例(11.1％).本组患者围手术期死亡4例,病死率3.2％.2例死于继发于低心排综合征的多脏器功能衰竭,2例死于室颤.结论 巨大左心室危重心脏瓣膜病应积极采取左心功能辅助,以及加强对室性心律失常的防治.术后早期左心室即开始明显回缩,但左心室收缩功能较术前降低.     

涉及三瓣膜的手术早中期效果探讨

目的回顾性总结97例重度心功能不全患者,主动脉瓣、二尖瓣、三尖瓣联合瓣膜病变的手术疗效和早中期随访结果。方法 2009年5月至2011年3月,97例联合瓣膜病变患者接受主动脉瓣、二尖瓣及三尖瓣的外科治疗,对所有患者进行围术期分析及术后随访。结果早期死亡率为7.22%,住院期间出现并发症患者为30例,并发症发生率为33.3%,主要并发症为低心排血量综合征、术后纵隔出血、呼吸衰竭、室性心律失常和急性肾衰竭。术后存活患者随访6～25个月,患者术后心功能明显改善,大多数患者生活自理。结论对主动脉瓣、二尖瓣、三尖瓣联合瓣膜病变患者进行手术治疗,其早中期效果满意,术后患者心功能和生活质量有明显改善。     

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.