永久心脏起搏器植入术治疗Ⅲ°AVB的观察

目的:探讨Ⅲ度房室传导阻滞(Ⅲ°AVB)患者植入永久起搏器安全性及有效性。方法:1999年1月至2005年12月我院52例Ⅲ°AVB患者经静脉植入永久性人工心脏起搏器。观察治疗后的临床疗效及并发症。结果:所有患者植入起搏器后症状明显改善,体力劳动和生活质量明显提高。结论:永久心脏起搏植入是治疗Ⅲ°AVB最有效且安全的方法。     

68例儿童植入心脏起搏器临床分析

目的:探讨植入心脏起搏器儿童的临床特点。方法:回顾性分析重庆医科大学附属儿童医院2011年9月至2017年10月植入心脏起搏器病例的临床资料,年龄2 h至18岁11个月,平均(66.96±58.14)个月,包括病因、临床表现、辅助检查、起搏方式、植入后心脏大小、心功能改变等情况。结果:共收集68例患儿,初期植入临时起搏器61例,永久起搏器7例。临时起搏器组中心外膜起搏25例,均为先天性心脏病(心脏外科手术术中植入),心内膜起搏36例,包括暴发性心肌炎25例,先天性心脏病术后Ⅲ度房室传导阻滞(Ⅲdegree atrio ventricular block,Ⅲ°AVB)5例,心律失常3例(导管消融术后Ⅲ°AVB、房性心动过速、室性心动过速各1例),心肌病3例(伴Ⅲ°AVB、室上性心动过速);临时起搏器植入同时给予药物综合治疗,46例患儿4周内恢复窦性心律,其中心外膜起搏20例(20/25,80%),心内膜起搏26例,包括暴发性心肌炎20例(20/25,80%),先天性心脏病术后2例(2/5,40%),心律失常3例(3/3,100%),心肌病1例(1/3,33.3%),8例最终植入永久起搏器...     

老年人急性心肌梗死合并房室传导阻滞的护理

目的:探讨老年人急性心肌梗死(AMI)合并房室传导阻滞(AVB)的抢救及护理.方法:对19例AMI合并AVB采用药物、临时起搏或安置永久性人工心脏起搏器方式来提高心率,加强心电监护,保持静脉通畅及用药时监护.结果:梗死部位前壁3例,广泛前壁加正后壁4例,下壁12例.经药物逆转7例,12例药物治疗无效或发生阿-斯综合征,紧急行临时心脏起搏术,其中7例1周内恢复窦性心律,5例安装永久性人工心脏起搏器,1例死亡.结论:提高AMI抢救成功率,做好老年人AMI合并AVB的临床护理十分必要.     

非亲缘异基因骨髓移植后并发严重肝静脉闭塞病和Ⅲ度房室传导阻滞的诊治

目的探讨非亲缘异基因骨髓移植后严重肝静脉闭塞病(VOD)和Ⅲ度房室传导阻滞(AVB)并发症的临床表现和治疗措施.方法 1例非亲缘异基因骨髓移植患者+36天发生严重VOD,+129天发生Ⅲ度AVB.予肝素钠、前列腺素E1脂质微球治疗,以及安置人工心脏起搏器.结果患者抢救成功,已存活17个月,恢复情况良好.结论 VOD可在骨髓移植+20天以后出现;低剂量肝素和前列腺素E1防治严重VOD有效,安置永久性人工心脏起搏器对Ⅲ度AVB有效.     

24例围术期人工心脏起搏器的临床应用

<正>人工心脏起搏抢救严重心动过缓早已肯定,但在围术期应用却报道不多。本文结合我院1988年以来24例围术期人工心脏起搏临床应用的体会,来探讨人工心脏起搏器在围术期的应用价值,报告如下。临床资料一、临床资料24例均系住院病人,男15例,女9例;年龄24~83岁,平均58岁。起搏类型:临时起搏17例(VVl),永久起搏7例(VVl6例,DDD 1例)。心律失常类型:Ⅰ°~Ⅱ°房室传导阻滞(A—     

23例先天性心脏病患儿围术期永久起博器的植入及随访

目的：总结先天性心脏病（congenital heart diseases, CHD）儿童围术期植入永久性起搏器治疗完全性房室传导阻滞（atrioventricular block, AVB）的经验。方法选择需植入永久起搏器CHD患儿23例,男13例,女10例。年龄4个月～8岁,平均（2.8±2.5）岁,体重5～27 kg,平均（10.7±6.8）kg。结果植入心内膜起博器7例、心外膜起博器16例。起搏方式为频率应答心室按需起搏（VVIR）1例,固定频率心室按需起搏（VVI）22例,起搏频率为70～160次/min,平均（111±25.5）次/min,起搏阈值为0.5～0.75V,平均（0.74±0.30）V,感知灵敏度为2.5～2.8 mV,平均（2.78±0.11）mV,电极阻抗为271～726Ω,平均（445.5±148.9）Ω。21例（91.3%）获得随访,随访1个月～5.5年,起搏阈值术后早期略升高,后稳定。1例术后6个月猝死,原因不明。1例术后4.5年重新更换电池。1例随访中恢复窦性心律。4例术后6个月～2年心脏扩大、心功能低下,左室射血分数（LVEF）＆lt;50%。结论 CHD患儿围术期植入永久性起搏器治疗AVB是安全可行的,永久起搏器植入对其远期预后的影响需要长期随访。     

永久性心脏起搏器植入术患者的护理

人工心脏起搏是通过人工心脏起搏器发放脉冲电流,通过导线和电极的传导刺激心肌,使之兴奋,从而替代正常心脏起搏点,控制心脏按脉冲电流的频率有效地搏动[1].永久性心脏起搏器是治疗各种原因引起的不可逆的心脏起搏和传导功能障碍性疾病的重要方法.目前心脏起搏器的植入技术日趋成熟,起搏治疗的适应证也在不断拓展.虽然人工心脏起搏技术不断更新,越来越多的患者接受了这一治疗,但其安置方法是一种创伤手术,具有一定的手术风险性.我科2005～2007年植入永久性起搏器36例,通过系统化护理,均痊愈出院.现将护理报告如下.     

25例埋藏式永久心脏起搏的临床体会

我院自1987年12月到1991年8月经静脉埋藏式心脏起搏治疗25例。起搏器均为VVI型。Quantum253-19型4台,P_(101)和Pinna-cle 8619型14台,Telectronic OPTIMA147型1台,西安QB-Ⅰ型 5台,南京卫星HOP-4型1台。1 临床资料 25例中,男11例,女14例。年龄38～86岁,平均66.8岁。冠心病(伴高血压6例)20例,心肌炎后遗症3例,心肌病1例,原因不明1例。心律失常分为:Ⅲ°AVB、高度AVB及Ⅱ°Ⅱ型AVB共15例;SSS 9例,     

老年人人工心脏起搏器的临床应用

本文报道110例147例次因病态窦房结综合征、Ⅲ°房室传导阻滞、Ⅱ°Ⅱ型房室传导阻滞、三束支传导阻滞等心律失常伴有严重症状(包括阿-斯综合征)的老年患者安装人工心脏起搏器。起搏电极在荧光屏透视下经静脉插入后固定在左心室腔的顶端,全组均能有效起搏。67例起搏器安装已5年以上,42例安装2年以     

永久性人工心脏起搏器的临床应用效果及长期随访观察

目的观察分析永久性人工心脏起搏器的临床应用效果及长期随访结果。方法选取我院2009年3月～2011年8月收治的需要植入永久性人工心脏起搏器患者共308例。观察患者手术植入后的临床效果以及对患者进行随访跟踪治疗,观察患者植入永久性人工心脏起搏器的长期效果。结果植入永久性人工心脏起搏器后患者的临床症状明显得到改善,并且心房颤动发作次数明显减少,部分患者治疗后的LVEF值得到明显的提高,差异有统计学意义(P<0.01)。患者在运动耐量以及各种生活质量等均有显著提高和改善。患者在随访跟踪治疗过程中发现有36例并发症,其中并发症率为11.7%。结论永久性人工心脏起搏器能够有效治疗患者各种疾病引起的心动过缓临床症状,提高患者的生活治疗。长期治疗效果较好,并发症较少。     

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.