浅低温体外循环心脏不停跳心内直视术

介绍浅低温体外循环心脏不停跳心内直视术。方法：自１９９３年７月～１９９９年６月,经正中或 前外胸切口,在浅低温体外循环心脏不停跳下行心内直视术１４３例,其中房间隔缺损６７例,室间隔缺损３５例,部 分性房室共同通道１６例,法乐三联症１３例,肺动脉瓣狭窄成形术７例,二尖瓣关闭不全成形３例,二尖瓣替换术 ２例。结果：全组平均体外循环时间４２．３ｍｉｎ,平均腔静脉阻断时间为３１．５ｍｉｎ,术后恢复良好,无低心排、严重心 律失常、栓塞及脑部并发症,全部治愈。结论：浅低温体外循环心脏不停跳心内直视手术有更好的心肌保护作 用,可广泛用于包括左右心系统相通的许多心内手术及二尖瓣替换术等。此技术的主要环节是预防术中心室纤 颤和动脉气栓。     

体外循环术后急性心包填塞的预防和治疗

目的：总结我科１０８０例体外循环（ＣＰＢ）术后急性心包填塞（ＡＣＴ）的防治经验。临床资料：全组病例１０８０例，先心病８７６例，瓣膜置换２０４例，全部手术均在全麻低温ＣＰＢ下完成心内操作，升主动脉阻断时间：先心病１０～８９ｍｉｎ（２８６±１４９ｍｉｎ），瓣膜置换３４～６８ｍｉｎ（４３２±７２ｍｉｎ）。结果：全组发生ＡＣＴ１６例（１４８％），１４例为全心性心包填塞，２例为局限性心包填塞。１６例ＡＣＴ主要原因包括活动性出血（６／１６），试用凝血酶冲洗纵隔创面（６／１６），心包、纵隔引流管管理不善（４／１６）。１６例中无１例死亡。结论：ＡＣＴ的预防在于手术中彻底止血，术后定期挤压引流管。纵隔创面忌用凝血制剂冲洗。ＡＣＴ一经诊断，应及时开胸探查止血，清除血块，解除心脏压塞。     

腺苷静脉预处理对缺血/再灌注心肌的保护作用

目的：比较腺苷静脉预处理在体外循环心内直视手术中对缺血/再灌注心肌的保护作用。方法：将在体外循环下行心内直视术非紫绀型先心病及瓣膜病患者30例,随机分为两组（每组15例）。A组：腺苷静脉预处理组;B组：空白对照组;两组其他处理相同。分别于阻断升主动脉前、阻断升主动脉30分钟、开放升主动脉15分钟及术后24小时检测血清肌酸激酶同工酶-MB（CK-MB）、乳酸脱氢酶（LDH）水平。结果：两组血清CK-MB、LDH水平均有明显升高,实验组术中、术后血清CK-MB、LDH水平均明显低于对照组（P〈0.05）。结论：腺苷静脉预处理能模拟缺血预处理（IPC）的心肌保护效应,在体外循环心内直视手术中对缺血/再灌注心肌具有保护作用。     

微创体循环不阻断升主动脉心内直视手术35例临床分析

目的评价微创体外循环下不阻断升主动脉心内直视手术对患者心肌保护作用。方法回顾性分析2000年7月-2002年10月，35例应用此法手术的先天性心脏病病例。全组男24例，女11例；年龄1～30岁，平均11岁；心功能1级33例，2级2例；轻度肺动脉高压13例，中度肺动脉高压5例。经右侧腋下6cm切口第四肋间进胸建立体外循环心内直视下。行房间隔缺损12例，室间隔缺损17例，法乐四联症3例，脉动脉狭窄3例。均在浅低温心脏跳动下手术。结果全组无脑气栓发生及死亡。随访2～25个月。术后未发生低心排。结论微创浅低温体外循环下不阻断升主动脉心脏跳动下心内直视手术，用于先天性心脏病矫治，心肌保护安全有效，临床效果满意。     

浅低温体外循环心脏博动下心内直视手术75例

浅低温体外循环心脏博动下心内直视手术７５例宁夏医学院附属医院胸心外科（７５０００４）郭德和方刚陆向阳韩育宁何学志为进一步加强心肌保护，我们自１９９５年９月～１９９６年２月采用浅低温体外循环，不阻断升主动脉，在心脏搏动下行心内直视手术７５例，获得了良好...     

心内直视手术时持续温血灌注的临床应用

心内直视手术时持续温血灌注的临床应用祁小纪王金萍王连银新乡市第一人民医院外四科（４５３０００）１９９４年５月至６月，我们采用持续温血灌注心肌保护方法，给３例患者行心内直视手术效果满意，现介绍如下：１资料与方法病人胸正中切口，常规建立体外循环用２～３个...     

右前胸小切口不阻断升主动脉治疗先天性房室间隔缺损临床分析

目的总结右前胸小切口不阻断升主动脉低温室颤下进行心内直视手术的经验。方法 2002年4月—2010年6月,采用右前胸小切口不阻断升主动脉低温室颤下修补先天性房室间隔缺损53例,其中房间隔缺损20例,室间隔缺损33例。结果无手术死亡及手术并发症,体外循环时间15～70min,平均（30.0±7.5）min,术后胸管引流40～110ml,平均（80.0±23.6）ml,术后12例出现血红蛋白尿。结论右前胸小切口不阻断升主动脉低温室颤下进行心内直视手术安全、可靠,对一些简单的先天性心脏病有良好的手术和美容效果。     

心肌缺血再灌注对心脏合成一氧化氮影响的临床研究

从临床角度出发，观察体外循环心内直视手术中心肌缺再灌注对心脏合成一氧化氮水平的影响。选用的病例为单纯室缺患者（ｎ＝１４）。在体外循环心内手术中，分别于阻断主动脉前，开放主动脉后１ｍｉｎ，５ｍｉｎ，２０ｍｉｎ，采取主动脉根部血液，冠状静脉窦血液。镀铜镉法测定血样中的ＮＯ２＾－／ＮＯ３＾－浓度。用同一采血时点的冠状静脉窦￣主动脉根部血液中ＮＯ２＾－／ＮＯ３＾－浓度差代表核时点心脏合成一氧化氮水平。实验     

不阻断与阻断升主动脉室间隔缺损修补术临床对比分析

目的总结28例体外循环不阻断升主动脉室间隔缺损修补术的应用经验，评价其对患者心肌保护作用。方法选择我院近年来28例不阻断升主动脉先天性心脏病室间隔缺损修补术为实验组，全组年龄3．20岁；随机抽取相同年龄段的体外循环阻断升主动脉室间隔缺损修补术28例作为对照组。对术中体外循环转流时间、术后辅助呼吸时间、术后引流量及术后住院天数进行比较。结果实验组不阻滞升主动脉体外循环时间、术后辅助呼吸时间、术后引流量较对照组阻断主动脉显著减少与降低p〈0．01与〈0．05（t=8．510，2．648，2．477）；两组住院天数无差异。结论体外循环不阻断升主动脉心内手术能简化操作，缩短体外循环转流时间，减少术中心肌损伤；从根本上避免了心肌缺血和再灌注损伤的发生，促进了心功能的恢复。手术效果与经典阻断升主动脉手术无差异。     

体外循环阻断与不阻断升主动脉心内直视术临床研究

目的 对比分析体外循环不阻断升主动脉不停跳心内直视手术、不阻断升主动脉停跳心内直视手术、阻断升主动脉心内商视手术的心肌保护效果. 方法 45例先天性心脏病患者,随机选择分为不阻断升主动脉不停跳组(n=15),不阻断升主动脉停跳组(n=15),阻断升主动脉组(n=15).比较心肌细胞三磷酸腺苷含量、血浆丙二醛和心肌钙蛋白Ⅰ浓度,以及电子显微镜下对比观察心肌细胞超微结构. 结果 阻断升主动脉组心肌细胞三磷酸腺苷含量、血浆丙二醛浓度、血浆心肌钙蛋白-Ⅰ浓度均小于不阻断升主动脉停跳组和不阻断升主动脉不停跳组,后两组比较无统计学差异;电子显微镜下观察发现阻断组心肌细胞超微结构破坏较为严重,而不阻断升主动脉停跳组和不阻断升主动脉不停跳组心肌细胞超微结构基本正常. 结论 体外循环不阻断升主动脉心脏跳动或停跳下行心内直视术具有较好的心肌保护作用.     

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.