用重建心阻抗图探讨O波形成的机制

目的:探讨胸部体表O波形成的机制. 方法:6对方片电极检测胸部体表阻抗变化,用波形重建获得重建心阻抗微分图,对比正常组和异常组的O波幅度,用阻抗变化叠加原理分析胸部体表O波形成的机制. 结果:胸部体表O波是重建心阻抗微分图的血管分量O波和心室分量O波叠加而成的;在心功能正常的情况下,体表O波以心室分量O波为主;在心功能不全的情况下,当血管分量O波大于心室分量O波时,体表O波中以血管分量O波为主. 结论:血管分量PL',PR'的O/C比值可以用于评价左室舒张功能.     

重建心阻抗容积图的初步探讨

目的 探讨重建心阻抗容积图的波形、波幅.方法 用15个电极法同步检测胸部体表6个导联的阻抗变化,通过波形重建,得到重建心阻抗容积图.对180例正常成人的波形图进行统计分析.结果 重建心阻抗容积图有主动脉(AO)、左侧肺部血管(PL)、右侧肺部血管(PR)、左心室(LV)、右心室(RV)5个阻抗变化分量;心室分量LV、RV的基本波形与血管分量AO、PL、PR的基本波形反相位,LV、RV的负峰点与第二心音基本对齐;在5个分量中AO的波幅最大,PL、PR次之,LV、RV最小.结论 重建心阻抗容积图能够反映心血管活动的生理过程和变化.     

六导联胸部阻抗微分图的波形分析

目的 对六导联胸部阻抗微分图进行波形分析。方法 选择63例心功能正常成年人为受试者,按性别分为2组:男性组32例、女性组31例。采用由3个电流电极和12个电压电极构成的六导联同步检测六路胸部阻抗容积图,然后利用软件微分得到六导联的微分图。对各导联的基础阻抗（Z0）、波幅（C波、X波、O波）、Q-Z间期等进行统计分析。结果 各导联的微分波形态、Z0、C波幅度、Q-Z间期基本一致（P>0.05）。女性组Z0及C波、X波、O波的幅度均显著大于男性组（P<0.05）,但女性组Q-Z间期显著小于男性组（P<0.001）。左侧导联（E1-E′1、E2-E′2、E3-E′3）的X波幅度大于右侧导联（E4-E′4、E5-E′5、E6-E′6）,其中E1-E′1与E5-E′5差异有统计学意义（P<0.05）。各导联的O波幅度差别较大,其中E1-E′1导联的O波幅度最大,而E4-E′4导联的最小,二者比较差异有统计学意义（P<0.001）。结论 六导联胸部阻抗微分图可为胸部阻抗图的波形重建奠定基础。     

家兔心阻抗一阶和二阶微分图的分析

本文对30只家兔的心阻抗一阶和二阶微分图进行了分析,家兔一阶微分图中有A、C、O波和B点,二阶微分图中有a、c、o波和b、p、x、k、f点。但是家兔的b-p间期(快速射血期)比p-x间期(缓慢射血期)长,k-f间期(快速充盈期)比f-a间期(缓慢充盈期)长。结扎冠状动脉前降枝(中上1/3处)和注射垂体后叶素(0.5u/kg)后,阻抗法测定的心收缩间期和心舒间期指标均出现明显改变,结扎冠状动脉组更为显著。注射异丙基肾上腺素(2.5mg/kg)24小时后,仅有心舒间期指标出现异常。三种实验性急性心肌缺血均能使二阶微分图中的正向a波(a′)增大,注射垂体后叶素后10分钟,心电图ST段已复位,但增大的正向a波仍然存在,提示正向a波能够灵敏地反映心脏功能的异常改变。     

诱发室性早搏对重建心阻抗图AO分量影响的实验研究

目的 探讨重建心阻抗图AO分量的阻抗变化与主动脉容积变化的关系.方法 用心导管刺激狗的左室后壁心内膜,诱发室性早搏,改变射入主动脉的血量,用六导联同步检测狗的胸部体表阻抗变化,通过波形重建得到狗的重建心阻抗微分图,分别测量正常时、早搏时对应的AO、PL和PR分量的C波幅度.结果 与早搏前正常的C波幅度相比,早搏时AO分量的C波幅度下降(80.4±20.0)%,PL分量下降(25.4±21.4)%,PR分量下降(21.8±29.6)%;这表明主动脉容积变化对AO分量的影响比对PL、PR分量的影响大得多(P＜0.001).结论 重建心阻抗图AO分量的阻抗变化能够间接地反映主动脉的容积变化.     

胸部阻抗图中左右心循环作用的探讨

目的:探讨人体胸部阻抗图中左、右心循环作用的比例.方法:利用重建心阻抗图计算胸部阻抗图中左、右心循环作用的比例.结果:在容积图中左心循环作用为(54.3±6.0)%,右心为(45.7±6.1)%;在微分图中左心循环作用为(53.0±4.7)%,右心为(47.0±4.6)%;对于人体胸部阻抗图的贡献,左心循环的作用大于右心的,主动脉的作用大于肺部血管的,而心室的作用很小.结论:重建心阻抗图的计算结果能够反映人体实际情况.     

心阻抗血流图的临床应用

心阻抗血流图近年来用于测量心排量,测定收缩间期、舒张间期,测定外周阻力、血管顺度,测定心肌收缩力、冠状动脉功能,以及分析心阻抗微分波图变化等作为心功评定和心脏病的诊断,已展示广阔的前途。一、测定心排量     

用血流动力学探讨心阻抗微分图 O 波抬高的机制及临床意义

心阻抗微分图是一种无创伤性检测,分析其波形变化以估量心排出量。对心阻抗微分图O 波抬高与肺毛楔嵌压的相关性研究,国内外尚未见报道。本文应用 Swan—Ganz 漂浮导管与阻抗仪检测临床各种心脏病人,通过观测血流动力学的变化来探讨 O 波抬高的机制。     

重建心阻抗图测定左室功能的计算方法

为了解决传统心阻抗图测定心功能的非唯一性问题，我们采用波形重建的方法，得到了重建心阻抗图（包括主动脉、左侧肺部血管、右侧肺部血管、左心室、右心室五个阻抗变化分量）。本对重建心阻抗图测定左室功能的计算方法进行探讨。     

心阻抗容积图与M型超声心动图同步显示的应用价值

心阻抗容积图(ICG)计测收缩时间间期(STI)和应用Kubicek氏公式计算心输出量,为无创伤性心功能检查方法之一。最近又用肺阻抗图(IPG)诊断肺心病,但影响因素甚多,微分波射血始点(简称B点)的定     

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.     

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.     

Electro-Acupuncture Combined with the Trigger Point Needle-Embedding for Treatment of Primary Trigeminal Neuralgia in 31 Cases

In recent years, the author of this essay has applied electro-acupuncture combined with the trigger point needle-embedding for treatment of primary trigeminal neuralgia in 31 cases, yielding satis- factory results as reported in the following.     

Investigation of Matrix Metalloproteinase -1, 2 and tissue inhibitor of matrix metalloproteinases-1 in Endometriosis

Objective： To explore the role of matrix metalloproteinase-1,2 （MMP-1, MMP-2） and tissue inhibitor of matrix metalloproteinases-1 （TIMP-1） in endometriosis. Methods： The eutopic and ectopic endometria from 40 subjects suffering from endometriosis and regular.endometria from 40 subjects （excluding endometriosis） were collected and examined by in situ hybridization technology and western blot assay. Results： Both expressions of MMP-1 and -2 were stronger in ectopic endometrium and eutopic endometrium than in normal endometrium. On the contrary, the expression of TIMP-1 in ectopic endometrium and eutopic endometrium was lower. The differences were significant （P 〈 0.01 ）. Moreover, there was no relationship among the expressions of MMP-1, 2 and TIMP-1 in ectopic endometrium. Conclusion： The expressions of MMP-1, 2 and TIMP-1 lose balance and lack of periodic changes in ectopic endometrium , which explains the biological invasive behavior of endometriosis. It was suggested-that regulating the balance between the MMPs and TIMP-1 should be an ideal therapeutic target to endometriosis.     

Shi Da-zhuo (史大卓) —An outstanding cardiologist of integrative medicine

Prof. SHI Da-zhuo, Ph.D., male, was born on March 20, 1960. Prof. SHI entered the Ph.D. program in 1990 at the China Academy of Chinese Medical Sciences under the supervision of Prof. CHEN Ke-ji, majoring in the treatment of cardiovascular diseases. After receiving his Ph.D. degree in 1993, Prof. SHI started working at the Cardiovascular Center in Xiyuan Hospital affiliated to China Academy of Chinese Medical sciences.     

Persist in and Carry Forward the Integrative Medical Research——Speech at the 6th National General Congress of Chinese Association of Integrative Medicine by Academician CHEN Zhu,Minister of Ministry of Health

The 6th National General Congress of Chinese Association of Integrative Medicine （CALM） was convened at 19-20, April 2008 in Beijing. Academician CHEN Zhu, the minister of Ministry of Health indicated at the congress that the integration of Chinese and Western medicine is very well in keeping with the situation of our country and the general rule of development in medical science; and as a good integration of Chinese medicine and Western medicine, it is mutually beneficial and advantageous to both of them. Seeing the creativity shown in integrative medical investigation in theoretic and methodological sides, we should and must persist in and develop it.