小儿病毒性心肌炎34例治疗前后心功能变化研究

目的 :观察急性病毒性心肌炎患儿左室容积与收缩功能、左室射血分数(L VEF)、左室舒张末期容积 (L VEDV)、左室收缩末期容积 (L VESV)、左室每搏输出量(L VSV)、左室收缩末期内径 (LVESD)、左室舒张末期内径 (L VEDD)和左室短轴缩短率(L VFS)之间的关系。方法 :将 3 4例急性病毒性心肌炎患儿分为轻症 (1 0例 )和重症 (2 4例 )两组 ,所有患儿病程初期接受超声心动图检查 ,重症心肌炎患儿组第 1、3个月分别进行超声心动图复查 ,分别测 LVEDV、L VESV、L VSV、L VEF、L VESD、LVFS值。并以 1 5例正常患儿 (对照组 )作为对照。结果 :病程初期重症病毒性心肌炎左室容积 (收缩、舒张 )大于对照组(P<0 .0 1 )。LVEF为 78± 6 %。重症病毒性心肌炎患儿病程 1个月和 3个月左室容积 (收缩、舒张 )与病初左室容积 (收缩、舒张 )相比有极显著性差异 (P<0 .0 1 ) ;左室舒张末期容积明显小于病程初期 (P<0 .0 1 ) ;左室收缩末期内径、左室舒张末期内径均低于病程初期 (P<0 .0 1 )。LVEF均高于病程初期 (P<0 .0 1 )。轻症病毒性心肌炎初期组左室腔大小的变化与对照组相似 ,无统计学差异 (P>0 .0 5 )。结论 :急性重症病毒性心肌炎初期心室发生球形变化和心室重构。这些变化与心室扩大和 L VEF降低有关。     

心包开窗术在重度心肌钝挫伤中的治疗作用

目的研究心包开窗术在重度心肌钝挫伤中的治疗作用。方法回顾性分析8例重度的心肌钝挫伤患者救治的临床资料;建立大鼠重度心肌挫伤模型,记录撞伤前、撞伤后3 h及心包开窗术后2 h心率(HR)及左室收缩末期容积(LVESV)、左室舒张末期容积(LVEDV),射血分数(EF)、每搏输出量(SV)、左心室收缩压(LVSP)、左心室舒张末期压力(LVEDP)等指标。结果急诊心包开窗术8例,抢救成功6例;大鼠撞伤后射血分数(EF)、每搏输出量(SV)、左心室收缩压(LVSP)明显下降,而心率(HR)、左室收缩末期容积(LVESV)、左室舒张末期容积(LVEDV)、左心室舒张末期压力(LVEDP)较前上升(P0.05);心包开窗术后大鼠心率明显好转,射血分数(EF)、每搏输出量(SV)、左心室收缩压(LVSP)上升,而左室收缩末期容积(LVESV)、左室舒张末期容积(LVEDV)、左心室舒张末期压力(LVEDP)较撞伤后下降(P0.05)。结论心包开窗术是治疗重度心肌钝挫伤的有效手段。     

磷酸肌酸治疗重症病毒性心肌炎伴心衰的疗效观察

目的观察磷酸肌酸（CP）治疗重症病毒性心肌炎伴心衰患者的临床疗效。方法将我院心内科诊断为重症病毒性心肌炎伴心衰的住院患者50例。分成磷酸肌酸组25例,使用磷酸肌酸加常规治疗,对照组25例,使用常规治疗（包括干扰素、1,6-二磷酸果糖等）。治疗1个月后,观察两组患者心功能的改善以及左房内径（LA）、左室舒张末期内径（LVEDD）、左室收缩末期内径（LVESD）、左室射血分数（LVEF）。结果磷酸肌酸组与对照组比较,两组治疗后心功能的改善以及左心房、左心室舒张末期内径、EF值差异均有显著性。结论在常规治疗基础上加用CP对重症病毒性心肌炎伴心衰心功能的改善有较好疗效。     

真武汤加味治疗对急性心梗后心衰患者左室功能的影响

目的 观察真武汤加味治疗对急性心肌梗死后心力衰竭患者左室功能的影响.方法 60例急性心肌梗死后心力衰竭患者随机分为治疗组和对照组各30例,对照组用西医常规药物治疗,治疗组用西医常规药物加真武汤加味治疗,于入院当天和入院第30天行二维超声心动图(2DE)测量,计算左心室舒张末期容积指数(LVEDVI)、左心室收缩未期容积指数(LVESVI)和左室射血分数(LVEF),并抽血查血浆N端脑钠肽前体(NT- pro-BNP)水平的变化.结果 与对照组相比,治疗组的左心室收缩末期容积显著缩小,左心室射血分数增加(P＜0.05),血浆N端脑钠肽前体水平降低.结论 西医常规药物加真武汤加味治疗可以显著改善急性心肌梗死后心力衰竭患者的左室收缩功能.     

双平面Simpson法在急性心力衰竭的临床应用

目的探讨Simpson法测量左室功能指导急性心力衰竭(AHF)的临床应用意义。方法选取急性心力衰竭患者82例及对照组(非心力衰竭患者)60例,采用传统M型超声心动图技术和双平面Simpson法技术测量左心室射血分数(LVEF)、左室舒张末期容积(LVEDV)及左室收缩末期容积(LVESV)。结果急性心力衰竭患者左心室射血分数(LVEF)、左室舒张末期容积(LVEDV)、左室收缩末期容积(LVESV)在两种检测方法比较差异具有统计学意义(P 0.05);对照组(非急性心力衰竭患者)在两种检测方法比较差异无统计学意义(P0.05)。传统M型法诊断急性心力衰竭诊断符合率为81.7%,双平面Simpsons法诊断率为93.9%,双平面Simpsons法优于传统M型法(P 0.05)。结论在急性心力衰竭患者中使用双平面Simpson法技术测量左室功能优于传统M型超声心动图技术。     

超声心动图Tei指数在小儿病毒性心肌炎心功能评价中的应用价值

目的探析小儿病毒性心肌炎应用超声心动图Tei指数评估心功能的应用价值。方法选择2015年6月‐2017年1月该院收治的50例超声心动图确诊为重症病毒性心肌炎病例为观察组,选择同期10例因患儿家属忽视入院即为临床4期,经综合治疗无效死亡或放弃治疗后死亡作为对比病例(死亡组),选择同期40例健康儿童作为对照组,检测超声心动图Tei指数,比较观察组与死亡组、观察组与对照组的左心室射血时间(LV-ET)、左室等容舒张间期(LV-IRT)及左室等容收缩间期(LV-ICT)等指标。结果死亡组的左心室射血时间(LV-ET)、左室等容舒张间期(LV-IRT)及左室等容收缩间期(LV-ICT)显著高于观察组,差异有统计学意义(P0.05);观察组的左心室射血时间(LV-ET)、左室等容舒张间期(LV-IRT)及左室等容收缩间期(LV-ICT)显著高于对照组,差异有统计学意义(P0.05)。结论超声心动图Tei指数能够及时评价小儿病毒性心肌炎的心功能,为临床早发现、早诊断及早治疗提供可靠影像学依据,对阻止病情进展具有积极作用,对减低病死率有一定的指导意义。     

沙库巴曲缬沙坦治疗慢性心力衰竭的疗效

目的 分析沙库巴曲缬沙坦治疗慢性心力衰竭(CHF)的疗效,为CHF的药物治疗提供参考.方法 将三亚中心医院2018年1～12月收治的108例CHF患者按随机数字表法分观察组与对照组,每组54例.两组均接受规范抗心力衰竭治疗,对照组联合贝那普利,观察组联合沙库巴曲缬沙坦.比较两组疗效、心室重构指标及血可溶性ST2受体(sST2)、B型尿钠肽(BNP)和高敏心肌肌钙蛋白T(hs-TnT)水平差异,并记录随访情况.结果 观察组治疗前后的左心室收缩末期容积(LVESV)﹑左心室舒张末期容积(LVEDV)下降差值,左心室射血分数(LVEF)上升差值高于对照组,观察组治疗后LVESV、LVEDV低于对照组,LVEF高于对照组(P均<0.05);观察组治疗前后的左室收缩末期内径(LVESD)、左室舒张末期内径(LVEDD)、舒张期室间隔厚度(IVST)、左室后壁厚度(LVPWT)、左心室质量指数(LVMI)下降差值高于对照组,且治疗后的LVESD、LVEDD、IVST、LVPWT、LVMI低于对照组(P均<0.05);观察组治疗前后的sST2、BNP、hs-TnT下降差值高于对照组,治疗后的sST2、BNP、hs-TnT低于对照组(P<0.05);另两组不良反应及心源性猝死占比情况比较,差异无统计学意义(P>0.05),但观察组心力衰竭再入院率低于对照组(P<0.05).结论 沙库巴曲缬沙坦治疗CHF疗效确切,对CHF患者心功能、心室重构、心肌纤维化、心肌损伤改善显著,并能降低心力衰竭再入院率.     

倍他乐克联合依那普利对心脏瓣膜置换术后心功能的影响

目的观察倍他乐克联合依那普利对心脏瓣膜置换术后心功能的影响。方法将78例风湿性心脏病瓣膜置换术后患者随机分为治疗组和对照组,对照组给予强心、利尿治疗,治疗组在对照组治疗的基础上加用倍他乐克和依那普利口服,观察两组治疗前后左心室舒张末期直径(LVEDd)、左心室射血分数(LVEF)。结果治疗组在缩小左心室舒张末期直径、提高左心室射血分数方面均优于对照组(P0.01)。结论倍他乐克与依那普利联合对心脏瓣膜置换术后对心功能有较好的疗效。     

参芪强心胶囊对慢性心力衰竭患者心功能及细胞因子的影响

目的观察参芪强心胶囊对慢性心力衰竭(CHF)患者心功能及血浆N端前脑钠肽(NT-pro BNP)与肿瘤坏死因子(TNF-α)水平的影响。方法把80例心衰患者随机分为对照组、治疗组。对照组常规抗心力衰竭治疗,治疗组加服参芪强心胶囊,2组疗程均为4周。观察两组临床疗效、左室收缩末期容积(LVESV),左室舒张末期容积(LVEDV)、左室射血分数(LVEF),检测治疗前后血浆NT-pro BNP、TNF-α水平。结果治疗组加用参芪强心胶囊后临床症状、左室收缩末期容积(LVESV),左室舒张末期容积(LVEDV)、左室射血分数(LVEF)、血浆N端前脑钠肽(NT-pro BNP)与肿瘤坏死因子(TNF-α)比治疗前明显改善,且明显优于对照组,并有显著性差异(P<0.05)。对照组治疗后临床疗效、左室收缩末期容积(LVESV),左室舒张末期容积(LVEDV)、左室射血分数(LVEF)、血浆N端前脑钠肽(NT-pro BNP)与肿瘤坏死因子(TNF-α)也有明显改善(P<0.05)。结论参芪强心胶囊治疗心衰能改善心衰患者临床疗效并降低左室收缩末期容积(LVESV),左室舒张末期容积(LVEDV)、血浆N端前脑钠肽(NT-pro BNP)与肿瘤坏死因子(TNF-α)水平,提高心衰患者左室射血分数(LVEF),改善左室功能。     

卡维地洛治疗高血压性心脏病心力衰竭的临床观察

目的评价卡维地洛治疗高血压性心脏病心力衰竭的疗效与安全性。方法72例高血压性心脏病心力衰竭患者随机分为两组,卡维地洛治疗组和基础治疗对照组,比较治疗前后心率、血压、左心室功能和病情变化。结果在试验结束后,两组的射血分数均增高,左室舒张末期容积及左室收缩末期容积均减少;但左室射血分数,左室舒张末期容积,左室收缩末期容积在卡维地洛组的改变更明显。结论在积极控制血压及纠正心力衰竭的基础上加用卡维地洛治疗高血压性心脏病心力衰竭是安全和有效的。     

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.