阵发性心房颤动患者抗栓治疗观察

目的:探讨不同抗栓药物对阵发性非瓣膜性心房颤动(Paroxysmal nonvalvular atrial fibrillation,PAF)心、脑及外周血管疾病血栓的预防作用.方法:选取PAF病例807例,其中80例因各种原因失访,有效病例727例,分别使用华法林和阿司匹林进行抗栓治疗,随访心脑血管疾病发生情况,比较二者预防主要终点、次要终点事件、主要出血事件及次要出血事件发生率.结果:高危PAF组,使用华法林治疗主要终点事件及次要终点事件均较阿司匹林组低(P<0.05),出血事件二者间无差异(P0.05);中危PAF组,使用华法林及阿司匹林治疗,二者在主要终点事件及出血事件发生率间无差异(P0.05),而应用华法林抗凝较应用阿司匹林抗栓能降低次要终点事件、及次要事件(P<0.05).结论:对高危PAF病例,应用华法林抗凝较优于应用阿司匹林抗栓;对中危PAF病例,主要事件二者疗效相当,但应用华法林抗凝能减低次要事件发生率.     

华法林与苯妥英钠合用导致出血1例报道

华法林是全世界使用最多的口服抗凝药,治疗窗狭窄,个体差异大,可与多种药物和食物发生相互作用,抗凝不当很容易导致出血或栓塞等不良事件[1].美国FDA收集的1990 ～ 2000年间药物不良事件报告显示华法林为导致严重不良事件的10种药物之一[2].因此,临床上常通过严密监测PT(凝血酶原时间)和INR(国际标准化比值)判断抗凝强度,从而做出相应调整.苯妥英钠与华法林合用可发生药物相互作用,并且该作用具有双向性,难以预测.     

心脏人工机械瓣膜置换术后出血原因分析

目的:探讨和分析我国心脏人工机械瓣膜置换术后患者口服华法林抗凝治疗的出血原因。方法:心脏机械瓣膜置换术后服用华法林患者102例,其中主动脉瓣置换术(AVR)28例,二尖瓣置换术(MVR)55例,双瓣置换术(DVR,主动脉瓣置换+二尖瓣置换术)19例。监测口服华法林抗凝治疗中凝血酶原时间(PT)值及国际标准比值(INR),观察患者的出血和血栓栓塞事件。结果:术后25例发生32次一般性出血,PT出现不同程度延长,INR多数超过2.5。结论:出血是华法林抗凝治疗最主要的不良反应,而抗凝过度、饮食、药物联用等是出血事件的重要危险因素。换瓣术后抗凝治疗应在严密监测下进行。     

心脏瓣膜置换术后华法林抗凝治疗的安全性

目的:探讨心脏瓣膜置换术后应用华法林抗凝治疗的效果,达到国际标准化比值(INR)2.0~3.0的安全性及使用华法林发生并发症的情况.方法:回顾性分析2012年1月-2016年12月我院行心脏瓣膜置换术300 例病人作为研究对象,均进行术后华法林抗凝治疗,随访并记录患者使用华法林的用量和并发症情况.结果:随访期间发生抗凝相关事件,出血事件25 例(8.3%),血栓事件6 例(2.0%),正常269例(89.67%);出血组华法林用量、凝血酶原时间(PT) 和国际标准化比值(INR) 均明显大于正常组和栓塞组,差异有统计学意义(P<0.05).结论:心脏瓣膜置换术后常规使用华法林进行抗凝治疗,将INR 控制在2.0~3.0 范围内可以满足抗凝要求,并且明显减少并发症.     

使用口服抗凝药物出血的处理与预防

口服抗凝药物(华法林)在有适应证的病人能有效防止血栓栓塞的发生。理想的抗凝水平应在有效预防血栓栓塞发生的同时,避免严重出血(尤其脑出血)事件。1.华法林严重出血的发生率 使用口服抗凝药物脑出血的发生率非常低,总体上年发生率0.5％或更低,与阿司匹林(年发生率0.3％)比较无显著性差别,出血事件与INR增高和年龄相关。75岁以上老年病人出血发生率稍有增加,但此人群又是血栓栓塞的高危人群,抗栓的获益也最大。     

新型口服抗凝药物治疗高龄非瓣膜性房颤患者的疗效分析

目的 比较新型口服抗凝药物(NOAC)利伐沙班、达比加群酯和传统抗凝药物华法林用于高龄非瓣膜性房颤患者抗凝治疗的有效性和安全性.方法 将264例高龄非瓣膜性房颤患者分为3组,利伐沙班组88例,述比加群酯组88例;华法林组88例,根据国际标准化比值(INR)调整剂量,将INR控制在2.00～2.50.结果 卒中或血栓栓塞事件在利伐沙班组发生2例(2.27％);达比加群酯组发生3例(3.41％);华法林组发生4例(4.55％).出血事件在利伐沙班组发生7例(7.95％);达比加群酯组发生6例(6.82％);华法林组发生13例(14.77％).3组间卒中或血栓栓塞的发生率比较差异无统计学意义(P＞0.05);利伐沙班组和达比加群酯组出血事件的发生率低于华法林组(P＜0.05),但利伐沙班组与达比加群酯组比较差异无统计学意义(P＞0.05).结论 NOAC利伐沙班、达比加群酯与华法林比较,在降低高龄非瓣膜性房颤患者卒中和血栓栓塞事件方面,治疗效果与华法林相当,而出血事件的发生率低于华法林.     

左心耳封堵术在非瓣膜性心房颤动患者卒中预防中的价值

心房颤动（房颤）的最大危害是引起卒中或血栓栓塞事件,临床上常以抗凝药物,包括华法林或新型口服抗凝药物来有效降低血栓栓塞事件,但药物治疗有增加出血的风险。基于非瓣膜性房颤患者90％的血栓是来自左心耳,近年有些临床研究显示,左心耳封堵术（ LAAC）可用于卒中风险高危、不能耐受华法林治疗或不愿长期口服抗凝药物的房颤患者的治疗,不仅能减少卒中、体循环栓塞与心血管死亡复合事件,而且在降低心血管死亡与全因死亡事件方面较口服华法林有更优的结局。但LAAC的远期预后、与新型口服抗凝药物的比较以及在国人房颤患者的应用经验仍需进一步研究。     

心脏机械瓣膜置换术后华法林抗凝出血的临床研究

目的 研究心脏机械瓣膜置换术后华法林抗凝治疗中出血的原因及防治措施.方法 调查2002年1月～2010年2月,该院机械瓣膜置换术后行华法林抗凝治疗中,发生出血的临床病例,分析其原因,并探讨其诊治经验.结果 心脏机械瓣膜膜置换术后华法林抗凝出血患者共计22例,治愈20例,死亡2例.结论 心脏机械瓣膜置换术后华法林抗凝出血应早期发现早期治疗.     

华法林预防房颤病人血栓性疾病的抗凝强度研究

目的通过前瞻性随机对比研究,评价华法林低强度抗凝预防非瓣膜性房颤发生血栓栓塞的有效性和安全性。方法将102例持续性房颤病人分为华法林低强度抗凝观察组及华法林标准强度抗凝对照组。观察组抗凝目标值INR1.5～2.0,对照组抗凝目标值INR2.1～3.0。常规门诊随访,检测INR调整华法林剂量,并记录两组病人的终点事件及出血事件。结果随访3年,低强度抗凝与标准强度抗凝相比,血栓栓塞事件的发生率无显著差别,而出血并发症低强度抗凝组明显低于标准强度对照组(0.0%vs14%,P0.01)。结论华法林低强度抗凝(INR1.5～2.0)预防非瓣膜性房颤发生血栓栓塞并发症是安全有效的。     

华法林抗凝剂量与其影响因素的研究进展

华法林的治疗安全范围窄,剂量的个体差异大,即使同一个体,在不同时期所需的剂量也会不同,但是华法林仍然是目前国际上应用最为广泛的口服抗凝药。临床上因华法林剂量调整不及时而导致的出血或栓塞事件经常发生。华法林主要用于机械心脏瓣膜置换术术后、非瓣膜性心房颤动以及深静脉血栓等患者的抗凝治疗。影响华法林抗凝作用的因素有很多,最主要的有遗传因素、人口学因素以及其他药物因素。该文综述近几年国际上进行的有关影响华法林剂量的许多因素的研究,并介绍基于基因多态性、人口学因素及药物因素的华法林剂量预测模型的最新进展,为指导临床上华法林的个体化用药提供参考。     

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.