体表心电图预测左心室条束的初步探讨

目的　尝试用体表心电图来预测左心室条束存在的可能性。方法　选择 60例观察对象 ,以体表心电图标准双极肢导RⅡ ≥ 1.5mV 3 0例为甲组 ,RⅡ <1.5mV 3 0例为乙组 ,甲乙两组全部进行常规心电图及超声心动图检查对照。结果　甲组 3 0例中 2 2例 (73 .3 3 % ) ,乙组 3 0例中仅 1例 (3 .3 3 % )被超声心动图证实为左心室条束。两组比较P <0 .0 1。结论　以体表心电图标准双极肢导RⅡ ≥ 1.5mV来预测左心室条束存在是可能的 ,但一定要结合临床表现。     

心阻抗图波形重建的初步探讨

2 0 0 1年作者设想用阻抗波形重建来解决从胸部体表的混合阻抗信号中获得左心室、右心室及胸部各大血管本身的阻抗化。经过一年多研究 ,提出了较为可行的数学模型和测量方法 ,研制了一台心阻抗波形重建的实验装置。     

颈动脉易损斑块的形成机制及诊断进展

颈动脉易损斑块评估已成为研究的热点。在防治急性缺血性卒中方面,监测和评估易损斑块的形态学、组织学变化更具临床意义。选择合适的检查方法,准确评估颈动脉内斑块的位置、大小及易损性等有助于临床医师选择合理的诊治方案及疗效评估,可有效控制病情,减少缺血性卒中的发生。     

压疮形成机制及预防对策的研究现状

压疮（pressure ulcer）又称褥疮、压力性溃疡，是指局部组织长时间受压，血液循环障碍，局部持续缺血、缺氧、营养不良而致的软组织破损和坏死。压疮一直是护理领域研究的热点，而其发生机制却并不完全明确，笔者通过回顾国内外文献，总结和探讨压疮形成的相关机制，为研究压疮的形成机制和预防提供参考。     

四种体表测量指数预测内皮功能紊乱的初步探讨

腰围／身高（WHtR）是一个评判中心性肥胖的新指标,近年来研究逐渐增多,因其避免了性别、身高的影响,是一个有可能取代体质量指数（BMI）、腰臀比（WHR）、腰围（WC）体表测量指数,描述腹型肥胖,对普通人群的糖尿病和冠心病风险具有很高的预测价值。内皮细胞是一个功能介面,当代谢性的物质增加时会影响到内皮功能,其功能系乱导致早期内皮功能损害,即早期动脉硬化。本文就4种体表指数对内皮功能预测作用进行初步研究。     

心阻抗图检测舒张期主动脉向外周供血量的初步探讨

目的探讨心舒张期主动脉向外周的供血量。方法基于心阻抗图非线性理论，导出舒张期流向外周的供血量（Ｖｄ）、流量（ＦＱ）、流量指数（ＦＱＩ）的计算公式，分别测量心衰组（ｎ＝５２）和正常对照组（ｎ＝５０）的Ｖｄ、ＦＱ、ＦＱＩ。结果心衰组的Ｖｄ、ＦＱ、ＦＱＩ非常显著地低于对照组（Ｐ＜０．０１），但收缩期向外周的供血量下降不多。结论患者心输出量的减少，对收缩期向外周的供血量影响不大，而主要表现为舒张期向外周供血的减少。     

吗啡耐受的形成机制及治疗进展

在治疗中至重度疼痛的药物中,阿片类镇痛药一直发挥着中流砥柱的作用。许多患者,尤其是癌症晚期患者,需要长期大剂量使用阿片类药物。要同时实现临床疗效以及对治疗方案的耐受,阿片类药物耐受是一个亟待解决的问题。本文简要综述了吗啡耐受的定义、形成机制及治疗进展等方面。     

探讨脂肪肝内正常肝岛的增强CT表现及其形成相关机制

目的:分析脂肪肝内正常肝岛的多期增强CT的影像学表现及其相关形成解剖学机制。方法:回顾性分析52例患者为不均匀脂肪肝中表现为肝岛类型的影像学资料。结果:肝岛有其独特的发病部位及影像学表现;在平时、动态增强三期扫描中,52例肝岛区与其周围肝组织比较均呈相对高密度,且两者平均密度差值在CT平扫和增强三期中均无显著性差异(P>0.05);增强三期肝岛内部均可显示正常走行的血管;1例首次动脉期及8例首次门脉期显示异常引流胃右静脉(Aberrrant Gastric Venous Drainage,AGVD)分别引流入肝Ⅰ段、Ⅲ段、Ⅳ段肝岛内。结论:肝岛具有特征性CT表现,AGVD可能是肝Ⅰ段、Ⅲ段、Ⅳ段易形成肝岛的重要因素。     

视网膜光化学损伤机制及组织学变化的研究进展

视网膜是视觉器官中重要的组织结构，其结构和功能非常复杂并且精细，既是光的接受器又是传导器，是形成视觉关键的第一站。光线只有到达结构和功能正常的视网膜，才能形成视觉图像。然而，当光线的强度、光照的时间超过眼组织对视网膜的防护范围，将会造成视网膜的损伤，引起视网膜细胞结构的改变。本文总结国内外学者对视网膜光化学损伤机制的影响因素和光化学损伤后视网膜细胞结构变化的研究进展作简要的综述。     

Multiple Shocks Affect Thoracic Electrical Impedance During External Cardioversion of Atrial Fibrillation

Background: Thoracic impedance (TI) influences the success of external cardioversion (ECV) or defibrillation because current intensity traversing the heart is inversely related to TI. Experimental data suggest that TI decreases after multiple shocks. We undertook a clinical study to determine changes of TI values in patients with atrial fibrillation or flutter requiring ECV. Methods: We enrolled 222 consecutive patients (age 73 ± 11 years; males 67%; body weight 75 ± 13 kg) who underwent ECV between January 2004 and February 2007. Biphasic shocks were delivered through adhesive pads placed in the anteroposterior position. The initial energy was set at 1 J/kg, with progressive increases up to a maximum of 180 J in case of failure. In the last 39 elective patients, plasma concentration of interleukin‐6 (IL‐6) and tumor necrosis factor (TNF)‐α were determined before and 6 hours after ECV. Results: Sinus rhythm was restored in 202 patients (91.0%). Of these, 155 (69.8%) required more than one shock (on average, 2.5 ± 1.5 shocks/patient). Final values of energy and peak current intensity were 136 ± 47 J and 50 ± 14 A, respectively. TI decreased significantly by 6.2% from baseline after ≥2 shocks (P < 0.001). The absolute reduction was correlated with baseline TI, number of delivered shocks, and hemoglobin oxygen saturation. IL‐6 and TNF‐α increased with ECV (P < 0.001 and P = 0.014, respectively). Conclusions: TI decreases significantly after multiple shocks, possibly by activation of acute inflammation.     

经皮肾镜碎石术术中胸腔液体含量的变化

目的:探讨经皮肾镜碎石术中胸腔液体含量(TFC)的变化。方法:ASAⅠ、Ⅱ级经皮肾镜碎石术患者31例,采用0.9%NaCl为灌流液。麻醉前、麻醉后10min、俯卧位后及术中每30min为记录时间点,监测血压、心率;胸电生物阻抗法连续监测心输出量、胸腔液体含量。结果:手术前后HR无显著变化;与麻醉前比,俯卧位后BP显著下降;TFC逐渐增高,与麻醉前比有显著性差异。结论:经皮肾镜碎石术术中TFC增高,监测TFC可以增加手术安全性。     

Prospective Investigation into the Influence of Various Stressors on Skin Impedance

Background The control mechanisms during general anesthesia include circulation parameters and vegetative reactions. A possible way to quantify vegetative reactions is to measure the impedance of the skin. An activation of the eccrine sweat glands via sympathetic sudomotor fibers induces a secretion of sweat, which generates a drop in skin impedance. The aim of the present study was to investigate the influence which different stressors and measurement electrodes have upon skin impedance. Material and Method The changes in skin impedance and were measured after application of various stimuli (T1 value at rest, T2 acoustic stimulus, T3 visual stimulus, T4 tactile stimulus, T5 pain stimulus, T6 Valsalva manoeuvre, T7 forced inspiration/expiration). About 62 awake subjects underwent four standardized test sequences, during which several types of electrodes and recording sites (palmarly, plantarly) were explored. Results All physiological (T6–T7) and external stimuli (T2–T5) led to significant changes in skin impedance (14.9 ± 18.2 kΩ) and heart rate. These changes happened independently of BMI, gender and measurement electrode types. The time it took to react to the stimuli was significantly shorter for palmar applications than that obtained from plantar sites. The reaction times were as follows: palmarly 1.2 ± 0.5 seconds for solidgel electrodes and 1.15 ± 0.5 seconds for hydrogel electrodes, plantarly 2.3 ± 1.0 seconds for solidgel electrodes and 2.21 ± 1.2 seconds for hydrogel electrodes. The forced inspiration and expiration manoeuvres generated greater variations in skin impedance than did pain stimulus and acoustic stimulus. Measurements that were performed with solidgel electrodes revealed significantly greater average decreases in skin impedance following exposure to a stimulus. Conclusion(s) External, but primarily also physiological stressors, generate direct and reproducible variations in skin impedance. Solidgel ECG electrodes should be used for all measurements. Winterhalter M, Schiller J, Münte S, Bund M, Hoy L, Weilbach C, Piepenbrock S, Rahe-Meyer N. Prospective investigation into the influence of various stressors on skin impedance.     

Needlescopic Video-assisted Thoracic Surgery for Primary Spontaneous Pneumothorax

Minimally invasive surgery is the current trend of approach in various fields. Since May 2006, our team has started implementing needlescopic video-assisted thoracic surgery as the standard surgical treatment for primary spontaneous pneumothorax.

During a seventeen-month period, 62 consecutive patients with primary spontaneous pneumothorax were operated on. The ages, sex ratio, operative times, blood loss, postoperative pain in visual analog scale (VAS), length of stay and hospital costs were recorded and compared with that of another 62 consecutive patients who received conventional video-assisted thoracic surgery between July 2004 and April 2006. Only the postoperative pain in VAS was significantly lower in the needlescopic video-assisted thoracic surgery group; the rest remained the same. Also the wounds were almost undetectable in the needlescopic video-assisted thoracic surgery patients. There were no major complications, mortality or recurrence in either group.

Needlescopic video-assisted thoracic surgery is a high-tech technique which provides safety, effectiveness, economy and outcome comparable to that of conventional techniques. It is also associated with less pain and better cosmetics.     

Bronchial Rupture by an Unusual Mechanism of Thoracic Hyperextension

Background: Tracheobronchial disruption usually occurs in the setting of blunt chest trauma and may be overlooked due to co-existing injuries and non-specific symptoms. Objectives: Review the mechanism, diagnosis, and therapeutic management of tracheobronchial disruption. Case Report: We present a case of a young woman with a bronchial rupture 3 weeks after accidental strangulation. Initial diagnosis was delayed due to the unusual presentation. She presented with acute respiratory failure and hemodynamic collapse after slowly progressive shortness of breath with exertion. Conclusions: This case report provides an overview of the clinical features of bronchial disruption by highlighting the varying degrees of clinical presentation and management. Urgent bronchoscopy is indicated for diagnosis, and surgical intervention for treatment.     

胸部肿瘤放疗后肺组织灌注变化的临床研究

目的 探讨不同剂量照射后肺组织CT灌注参数预洲放射性肺炎的临床价值.方法 对37例胸部肿瘤病人接受放疗前中后行64排螺旋CT灌注成像扫描,得到局部肺组织感兴趣区内各灌注参数值.观察不同剂最(OGy、40-50Gy、60～66Gy)照射后局部肺组织灌注参数值变化的相对值及特点.结果 (1)照射后肺组织灌注参数血流量(BF)、血容量(BV)、表面通透性(PS)随照射剂最增大而升高(P＜0.05)(2)照射后肺组织灌注参数的研究,相对血流最(rBF)、相对血容量(rBV)、相对表而通透性(rPS)均上升者(P＜0.05)将发生放射性肺炎(RP).结论 CT灌注成像能反映照射后肺组织灌注状况的变化规律,可预测放射性肺损伤的发生及其严重程度.     

Mechanism of Effect of Thoracic Inferior Vena Cava Constriction on Renal Water Excretion

Persistent secretion of vasopressin and/ or diminished distal fluid delivery have been proposed to explain the impaired water excretion associated with low-output cardiac failure. In the present investigation cardiac output (CO) was diminished in anesthetized dogs undergoing a water diuresis by constriction of the thoracic inferior vena cava (TIVC). In intact animals (group I) acute TIVC constriction decreased CO from 3.5 to 2.2 liters/min (P < 0.005) as urinary osmolality (U(osm)) increased from 103 to 543 mosmols/ kg (P < 0.001) and free water clearance (C(H2o)) decreased from 2.1 to -0.6 ml/min (P < 0.001). This antidiuretic effect was disassociated from changes in renal arterial and venous pressures, glomerular filtration rate, solute excretion, and renal innervation. To examine the role of vasopressin in this antidiuresis, studies (group II) were performed in acutely hypophysectomized, steroid-replaced animals. In these animals TIVC constriction decreased CO to a similar degree from 3.4 to 2.1 liters/min (P < 0.001). However, the effects on U(osm) (87-104 mosmols/kg) and C(H2o) (2.1-1.6 ml/min) were significantly less than in intact dogs. In another group of hypophysectomized animals, (group III) renal arterial and venous pressures were not controlled, and the effect of TIVC constriction on U(osm) was not significant (65-79 mosmols/kg) although C(H2o) decreased from 3.3 to 1.9 ml/min (P < 0.001). In both the group II and III studies, there were linear correlations between the changes in C(H2o) and the urine flow. Studies were also performed in baroreceptor-denervated animals with intact hypothalamo-neurohypophyseal tracts, and acute TIVC constriction altered neither U(osm) nor C(H2o) when renal arterial pressure was controlled. These results therefore indicate that the effect of TIVC constriction on U(osm) is primarily vasopressin mediated while the effect on C(H2o) is mediated both by vasopressin release and diminished distal fluid delivery. A decrease in renal arterial pressure, or some consequence thereof, seems to be an important determinant of the latter effect.     

The Immediate Effects of Thoracic Spine and Rib Manipulation on Subjects with Primary Complaints of Shoulder Pain

Shoulder pain is a common orthopedic condition seen by physical therapists, with many potential contributing factors and proposed treatments. Although manual physical therapy interventions for the cervicothoracic spine and ribs have been investigated for this patient population, the specific effects of these treatments have not been reported. The purpose of this investigational study is to report the immediate effects of thoracic spine and rib manipulation in patients with primary complaints of shoulder pain. Using a test-retest design, 21 subjects with shoulder pain were treated during a single treatment session with high-velocity thrust manipulation to the thoracic spine or upper ribs. Post-treatment effects demonstrated a 51% (32mm) reduction in shoulder pain, a corresponding increase in shoulder range of motion (30°-38°), and a mean patient-perceived global rating of change of 4.2 (median 5). These immediate post-treatment results suggest that thoracic and rib manipulative therapy is associated with improved shoulder pain and motion in patients with shoulder pain, and further these interventions support the concept of a regional interdependence between the thoracic spine, upper ribs, and shoulder.KEYWORDS: Manipulation, Manual Therapy, Shoulder Pain, Thoracic SpineRegional interdependence, as described by Wainner and col-leagues^1,2, “refers to the concept that seemingly unrelated impairments in a remote anatomical region may contribute to, or be associated with, the patient''s primary complaint”. This model suggests that many musculoskeletal disorders may respond more favorably to a regional examination and treatment approach that, in addition to localized treatment, encourages physical therapists to examine and treat distant dysfunctions that may be influencing the patient''s symptoms. Although the specific mechanism (whether neurophysiologic, biomechanical, or other) has yet to be elucidated, several high-quality clinical trials have demonstrated the effective use of this regional examination and treatment approach in achieving positive functional outcomes for patients with a variety of musculoskeletal disorders^3–10.Three of these studies^3–5 have investigated the effects of including cervicothoracic spine and rib manual physical therapy into an overall treatment approach for patients with shoulder pain. Winters et al⁵ found that manipulative therapy applied throughout the shoulder girdle was more effective than physiotherapy in reducing the duration of shoulder pain in a subgroup of 58 patients whose shoulder pain was attributed to dysfunctions within the cervical spine, upper thoracic spine, or upper ribs. Bang and Deyle³ reported improved outcomes in strength, function, and pain when manual physical therapy techniques for the shoulder, cervical spine, and thoracic spine were added to an exercise program for patients with shoulder impingement syndrome. In a more recent clinical trial, Bergman et al⁴ assessed the added benefit of applying cervicothoracic and rib manipulations and mobilizations to a standardized treatment regimen of anti-inflammatory and analgesic medications, corticosteroid injections, and physical therapy (exercises, massage, and modalities) for patients with shoulder pain and dysfunction. The addition of manipulative therapy to this usual medical care resulted in significant improvements in short- and long-term recovery rates and symptom severity for these subjects.Although the overall treatment effect of manual physical therapy has been demonstrated in these studies, the relative contribution of specific manipulative techniques applied to the cervical spine, thoracic spine, and/or ribs towards the improvement in functional outcomes for patients with shoulder pain cannot be determined. The purpose of this preliminary study is to report the immediate effects of thoracic and rib manipulation on subjects with primary complaints of shoulder pain. Exploratory studies of this nature are needed to help define the potential interdependence between anatomic regions such as the thoracic spine, upper ribs, and shoulder.