中低温诱导室颤性停搏对心内直视手术心肌保护效果的临床研究

目的探讨中低温室颤性停搏对心内直视手术的心肌保护效果。方法选择行心脏瓣膜置换手术患者60例,ASA分级Ⅱ~Ⅳ级,随机分为中低温室颤性停搏组(A组)和浅低温不停跳组(B组)各30例。各组分别于麻醉后体外循环前、体外循环后60 min、120 min和停机时、手术后6 h、手术后24 h抽取动脉血检测肌酸磷酸肌酶(CK)、心肌型肌酸磷酸肌酶同工酶(CKMB)、乳酸脱氢酶(LDH)、乳酸(Lac)、心肌肌钙蛋白T(cTnT)指标,并取左室心肌标本作扫描电镜观察。结果在麻醉后体外循环前、体外循环后60 min、120 min和停机时、手术后6 h、24 h各时点A组和B组的CK、CKMB、LDH、Lac、cTnT指标水平差异无显著性;心肌电镜扫描发现两组差异无显著性,仅在体外循环120 min后心肌细胞轻度受损。结论中低温诱导室颤性停搏对心内直视手术的心肌保护效果是一种安全有效的心肌保护方法 。     

中低温室颤性停搏下心内直视手术的麻醉和体外循环临床分析

目的 观察对中低温室颤性停搏对心肌的保护作用.方法 94例病人在全麻气管内插管下常规建立体外循环,转机后阻断上、下腔静脉并降温,不阻断升主动脉(如手术位于主动脉根部的成人患者,则阻断升主动脉并经冠状静脉窦持续逆行灌注),不使用心脏停搏液.鼻咽温度控制在27～28℃下行心内直视手术.鼻咽温度降至27～30℃出现室颤性停搏.结果 本组94例病人手术均成功,早期死亡3例.无麻醉和体外循环原因死亡.结论 中低温室颤性停搏下心内直视手术具有较好的心肌保护效果,并且更有利于心内的操作.     

体外循环下不停跳及持续逆灌心肌保护效果临床研究

目的评价浅低温心脏不停跳及中低温室颤性停搏下心内直视手术对心肌保护的效果。方法常规建立体外循环,转机后阻断上、下腔静脉并降温,不阻断升主动脉(如手术位于主动脉根部的成人患者,则阻断升主动脉并经冠状静脉窦持续逆行灌注),不使用心脏停搏液。浅低温心脏不停跳组鼻咽温度控制在(32±1)℃、中低温室颤性停搏组鼻咽温度控制在27～28℃下行心内直视手术。中低温组的病例在鼻咽温度降至30～27℃的范围内出现室颤性停搏。结果两组术中转机时间、术后呼吸机辅助时间、强心药物的使用及心律失常的发生情况等在统计学上均无显著性差异。结论浅低温心脏不停跳及中低温室颤性停搏下心内直视手术都具有较好的心肌保护效果,但中低温下手术更有利于心内的操作。     

常温不停搏心内直视手术对术后心肌酶活性的影响

目的观察常温心脏不停搏与冷停搏心内直视手术后心肌酶活性的变化,明确不停搏手术方法对心肌损伤的保护作用.方法40例心内直视手术病人随机分成常温不停搏和冷停搏2组,每组20例,分别于术前和术后20h测定心肌酶.结果2组术后心肌酶活性都升高,常温不停搏组低于冷停搏组,有显著性差异(P＜0.01).结论常温不停搏手术较冷停搏手术能降低心内直视手术患者AST、CK、LDH活性,减轻心肌损伤.     

心肌肌钙蛋白T对体外循环心内直视手术不同停搏液对心肌损伤的判定价值

目的：探讨心肌肌钙蛋白T（cTnT）对体外循环心内直视手术不同灌注方法心肌损伤的判定价值。方法：40例心瓣膜置换术病人随机分为两组，冷晶体停搏液组（A组）及含血停搏液组（B组），每组20例，分别于围手术期多时点采取静脉血，测定血清cTnT。结果：术前两组的cTnT水平均在正常范围，开放主动脉后1h至术后24h达峰值，其后缓慢下降。术后24h、48h，B组cTnT水平明显低于A组。cTnT峰值浓度与主动脉阻断时间呈正相关。结论：cTnT是判定心内直视手术围手术期心肌损伤的敏感指标，含血停搏液比晶体停搏液具有更好的心肌保护效果。     

浅低温心脏不停搏心内手术对心肌保护效果的比较

目的:探讨浅低温体外循环(CPB)心脏搏动中心内直视手术对心肌保护的效果.方法:40例患者随机分为观察组(浅低温心不停搏组)和对照组(中低温心停搏组).分别在术前、转机、停机及术后6 h、12 h、24 h、48 h、72 h,取冠状静脉窦或中心静脉血样,测定血气分析及血清中肌酸磷酸激酶(CK)及其同功酶(CK-MB)、天门冬氨酸氨基转换酶(AST)、乳酸脱氢酶(LDH)、丙二醛(MDA)、超氧化物歧化酶(SOD)的含量.并取心房间隔肌观察心肌含水量及心肌超微结构的改变.临床观察CPB时间、脱机、呼吸支持、多巴胺应用、严重心律失常和血红蛋白尿等指标.结果:冠脉循环血气、电解质、酸碱水平与体循环的组内组间对比基本一致.CK、CK-MB、AST、LDH两组在CPB和术后均有增加,且以对照组升高显著,与观察组相同时点相比,差异均有显著性(P＜0.01).对照组术后MDA明显升高,SOD明显降低(P＜0.01),而观察组变化不大.心肌含水量和超微结构观察,对照组变化显著,而观察组轻微改变.临床指标观察,观察组优于对照组.结论:浅低温体外循环心脏不停搏心内直视手术对心肌损伤很轻,有很好的心肌保护效果.     

中低温室颤法下行二尖瓣置换术临床分析(附30例报告)

目的总结中低温室颤法下行二尖瓣置换术的临床经验,以提高手术疗效。方法常规插管建立体外循环,转机后阻断上、下腔静脉并降温,阻断升主动脉并经冠状静脉窦持续逆行灌注氧合机血,不使用心脏停搏液;鼻咽温度降至中低温(27~28℃)下行心内直视手术,心脏手术完毕即可停机。经右心房—房间隔切口,均保留二尖瓣后瓣;同时行三尖瓣Devaga或Kay法成形;左房血栓清除术。结果术后无一例死亡,均痊愈出院。结论中低温室颤性停搏下行二尖瓣置换术具有良好的心肌保护效果,有利于心内手术的操作,尽可能保留后瓣,积极纠正三尖瓣关闭不全,对于提高手术疗效极为重要。     

体外循环心脏停跳与不停跳下心内直视手术中心肌保护效果的对比研究

目的探讨浅低温体外循环心脏不停跳下心内直视手术中对心肌的保护作用。方法选择行心内直视手术患者50例,随机分为实验组(心脏不停跳法)和对照组(心脏停跳法)。两组分别在术前、停机即刻、术后6h、术后24h四个时点采静脉血测定磷酸肌酸激酶(CK)、磷酸肌酸激酶同工酶(CK-MB)、天门冬氨酸转移酶(AST)含量、心肌肌钙蛋白I(cTnI)含量。结果两组CK、CK-MB、AST、cTnI转机后均升高,CK、CK-MB、AST停机即刻、术后6h,对照组高于实验组,24h逐渐恢复。对照组停机即刻至24h cTnI均高于实验组,两组高峰期均出现于术后6h,术后6~24h两组相比差异更明显(P<0.01)。结论不停跳手术对心肌具有更好的保护作用。     

体外循环心脏不停跳法心内直视手术保护心肌的疗效分析

目的分析体外循环心脏不停跳法心内直视手术对心肌的保护作用。方法将2012年1月-2013年10月在我院行心内直视手术的110例患者按随机数字表法分为两组各55例,观察组采用体外循环心脏不停跳法心内直视手术,对照组采用体外循环心脏停跳法心内直视手术,对比两组疗效。结果①观察组转流时间低于对照组（P〈0．05）,两组患者动静脉阻断时间、ICU停留时间无统计学差异（P〉0．05）。②手术前,两组患者天冬氨酸氨基转移酶（AST）、乳酸脱氢酶（LDH）、α-羟丁酸脱氢酶（HBDH）、肌酸激酶（CK）、心肌肌钙蛋白I（cTnI）无统计学差异（P〉0.05）。手术停机时与术后24h,两组AST、LDH、HBDH、CK、cTnl均显著升高（P〈0．05）,但观察组AST、LDH、HBDH、CK、cTnI均低于对照组（P〈0．05）。结论体外循环心脏不停跳法心内直视手术具有良好的心肌保护作用。     

低温体外循环心肌逆行灌注下双瓣膜置换术的临床研究

目的:评价浅低温心脏不停跳法及中低温室颤法于冠状静脉窦逆行灌注下双瓣膜置换手术的临床效果.方法:将63例患者分为中低温(26～27℃)室颤性停搏组(31例)及浅低温(32±1)℃心脏不停跳组(32例),常规插管建立体外循环,转机后阻断上、下腔静脉并降温,阻断升主动脉并经冠状静脉窦持续逆行灌注氧合机血,不使用心脏停搏液;于心内直视下行双瓣膜置换手术.结果:浅低温组手术死亡1例,中低温组死亡1例.两组术中转机时间、术后呼吸机辅助时间、强心药物的使用及心律失常的发生情况等在统计学上均无显著差异.结论:浅低温心脏不停跳及中低温室颤性停搏下心内直视手术都具有较好的心肌保护效果,但中低温下手术更有利于心内的操作,对血液的保护效果更优,可推荐成为一种安全、可行的心肌保护方法.     

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.     

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.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.