不停跳心内直视手术对心肌细胞凋亡的影响

 【目的】评价不停跳体外循环心内直视手术对心肌细胞凋亡的影响和探讨其临床意义。【方法】停跳心内直视手术患者25例（A组）,不停跳心内直视手术患者20例（B组）,取心肌组织作TUNEL细胞凋亡检测,比较分析术前和术后心肌细胞凋亡率并参照围手术期肌钙蛋白T（cTnT）检测。【结果】两组患者均无低心输出量综合征的发生。心肌细胞凋亡指数A组（0.003±0.002）和B组（0.004±0.003）术前无明显差别（P〉0.05）;术后心肌细胞凋亡指数A组（0.012±0.008,P〈0.001）和B组（0.006±0.004,P〈0.001）均高于术前;A、B两组术后心肌细胞凋亡指数差别有明显差别（P〈0.05）。围手术期cTnT水平A组在CPB末和术后2 h明显高于B组（P〈0.05）。【结论】本实验提示不停跳体外循环心内直视手术引起心肌细胞凋亡和心肌损害小于停跳手术。     

心脏不停跳直视手术治疗主动脉窦瘤破裂的临床分析

目的探讨心脏不停跳直视手术在主动脉窦瘤破裂外科治疗上的临床应用价值。方法将55例先天性主动脉窦瘤破裂患者根据所接受的心肌保护方法分为浅低温不停跳组29例和低温停跳组26例,分别行浅低温心脏不停跳心内手术及低温停跳心内手术。对两组患者术前一般情况、心功能、手术时间、体外循环时间、失血量、术中最低温度、术后多巴胺使用量、呼吸机支持时间、CCU停留时间和住院天数进行统计分析。结果两组患者的手术时间、术中失血量、CCU停留时间、住院天数比较差异无统计学意义（P〉0.05）;不停跳组转机时间、呼吸机支持时间均短于停跳组（P〈0.05）,术中最低温度高于停跳组（P〈0.001）,多巴胺使用量少于停跳组（P〈0.01）。结论在浅低温心脏不停跳直视下治疗主动脉窦瘤破裂安全、有效。     

停跳与不停跳心内直视术对血小板和P-选择素影响的对比研究

目的观察停跳与不停跳心内直视术对血小板及P-选择素表达的影响。方法风湿性心脏病患者40例,随机数字表法分成停跳组20例,在体外循环下行心脏停跳瓣膜置换术;不停跳组20例,在体外循环下行心脏不停跳瓣膜置换术。于术前（T1）、转机后20min（T2）、转机后40min（T3）、转机终了（T4）、手术终了（L）、术后12h（T6）、术后24h（T7）分别采集静脉血,立即离心分离血清后置入-20℃冰箱保存,用酶联免疫吸附法测定P-选择素的浓度,用全自动分析仪检测血小板计数。结果两组P-选择素表达水平在心内直视术转机后开始升高,术后逐渐减弱,至术后24h仍高于术前水平（P〈0．01）,但停跳组的升高和减弱程度均较不停跳组明显（P〈0．01）;两组血小板计数在心内直视术转机后开始下降,术后回升,至术后24h仍低于术前（P〈0．01）,但停跳组的下降和回升程度均较不停跳组明显（P〈0．01）。经直线回归与相关分析,心内直视术下血小板计数变化与P-选择素表达变化呈高度负相关（r=～0．964,P〈0．01）。结论不停跳心内直视术及停跳下心内直视术均可使血小板计数降低、P-选择素表达增强,其中前者血小板计数降低程度及P-选择素表达增强程度均低于后者。     

不停跳心内直视手术的临床研究

【目的】评价不停跳心肺转流术(CPB)心内直视手术对心肌保护的影响和临床效果。【方法】回顾研究不停跳心内直视手术患者32例,对照组停跳心内直视手术患者40例,比较分析术中和术后心功能等诸项临床观察指标。【结果】不停跳组的体外循环时间、术后辅助呼吸时间明显短于停跳组(分别为P<0.001和p<0.05)。术中的酸碱平衡和血液稀释度较停跳组更易维持,术后需正性肌力药维持的比例低于停跳组。而两组患者的术后引流量、用血量之间的比较差异均无统计学意义(P>0.05)。两组患者均无气栓后遗症和神经系统并发症,无低心输出量综合征的发生。【结论】不停跳心内直视手术可安全应用于简单的心脏病手术患者,且有操作简便、减少体外循环时间和术后辅助呼吸时间等优点。     

不停跳心内直视手术对患者术后早期认知功能和S100b的影响

目的比较停跳与不停跳心内直视手术后早期认知功能障碍和血清S100b的差别方法心内直视手术的患者60例。分为停跳组和不停跳组,分别接受停跳和不停跳心内直视手术。分别在术前第1天和术后第7天对患者进行神经精神测验。术前及术后24h取患者血标本,运用酶联免疫吸附法测定血清S100b蛋白。结果停跳组、不停跳组术后认知功能障碍发生率分别为42．9％、34．8％,两组之间差异无统计学意义。停跳组和不停跳组术后24h血清中S100b的浓度比较差异无统计学意义。结论心脏不停跳心内直视手术不减少患者术后早期认知功能障碍和血清S100b的释放。     

微创不停跳心内直视手术在先天性心脏病中的应用

目的探讨微创不停跳心内直视手术在先天性心脏病手术治疗中的临床应用价值。方法选取房室间隔缺损患者随机分为两组,每组28例。微创不停跳组不阻断升主动脉,在微创常温体外循环（CPB）、心脏跳动下行心内直视手术;停跳组在常规方法下行心内直视手术。分别于术前、术后2、6、12、24、48h取外周静脉血测定心肌肌酸激酶同工酶（CK-MB）、肌钙蛋白I（cTnI）的水平,并观察手术时间、CPB时间、术后辅助呼吸时间,多巴胺和硝普钠的用量、住ICU时间,术后住院时间,引流量,用血量等。结果微创不停跳组的手术时间、CPB时间、术后辅助呼吸时间和术后住院时间较停跳组明显缩短,术后进ICU时的多巴胺用量较停跳组少,术后引流量、用血量较停跳组少,差异均有统计学意义（均P〈0．05）。术后2、6、12、24h,停跳组CK-MB和cTnI较微创不停跳组显著升高,差异也均有统计学意义（均P〈0．01）。结论微创不停跳心内直视手术有良好的心肌保护效果,损伤相对较小,是一种安全有效的手术方法,适用于简单先天性心脏病的矫治。     

不停跳心内直视手术体外循环灌注对血浆S-100蛋白和NSE的影响

目的：比较心脏不停跳与心脏停跳心内直视手术体外循环患者,围手术期血浆S-100蛋白和神经元特异性烯醇化酶（NSE）的含量变化,探讨它们造成脑损伤的差异。方法：40例接受心内直视手术患者,分为A组（n=20例）,在心脏停跳下施行手术。B组（n=20例）,在心脏不停跳下施行手术,均在CPB前,CPB20min,CPB停止,CPB后6h和24h采取血样本,应用电化学发光免疫分析方法测定血浆S-100蛋白和NSE含量。结果：CPB20min后两组患者血浆S-100蛋白均明显升高,CPB停止时达峰值（P〈0．01）,CPB后24hS-100蛋白浓度低于CPB前（P〈0．01）。A组S-100蛋白升高程度较B组明显。两组NSE浓度CPB20min升高,CPB停止达高峰（P〈0．01）,CPB后24hA组高于CPB前（P〈0．01）,B组仍高但接近CPB前水平（P〉0．05）,A组CPB停止时NSE浓度较B组水平高（P〈0．05）。结论：中低温心脏停跳心内直视手术体外循环比浅低温不停跳心内直视手术脑损伤更明显,不停跳体外循环脑保护优于心脏停跳体外循环方法。     

不停跳体外循环下心内直视手术对S100β、NSE的影响

【摘 要】 目的 观察不停跳体外循环下心内直视手术与传统体外循环下心内直视手术对S100β、神经元特异性烯醇化酶（Neuronspecific enolase NSE）、简易智能评分（Mini-mental state examination MMSE）影响的差异。方法 选择心功能Ⅱ-Ⅲ级风湿性心脏病的成年患者32例,采用电脑随机的方法分为停跳组16例和不停跳组16例,两组患者心功能差异无显著性,无高血压,糖尿病,脑血管疾病,精神障碍,心脏手术史、左房血栓及其它相关病史。常规正中开胸下行心内直视手术。术中观察时间点T0：入室后麻醉诱导完成;T1：体外循环30分钟;T2：体外循环结束后10分钟;T3：体外循环后4小时;T4: 体外循环后24h;T5：体外循环后72h。记录指标为：血浆中的S100β、NSE的含量,术前和术后第七天患者MMSE评分。结果 不停跳和停跳组体外循环开始后S100β、NSE在手术开始后逐渐升高,体外循环后4小时达到高峰,体外循环后72小时基本恢复到正常;不停跳组和停跳组相比,S100β、NSE指标变化幅度较小,组间相比差异有统计学意义;术前与术后第七天MMSE差值不停跳组低于停跳组。结论 不停跳下体外循环下心内直视手术对S100β、NSE、MMSE的影响小于停跳手术。     

不同的腺苷预处理方法在心内直视手术中的心肌保护效果对比

目的比较心内直视手术中应用不同的腺苷预处理方法的心肌保护效果。方法将行心内直视手术非紫绀型先天性心脏病及瓣膜病患者60例,按术中应用腺苷预处理的方法的不同随机分为四组（每组15例）。A组：静脉腺苷组;B组：停跳液腺苷组;C组：静脉腺苷＋停跳液腺苷组;D组：空白对照组。各组其他处理相同。分别于阻断升主动脉前、阻断升主动脉30 min、开放升主动脉15 min及术后24 h检测血清心肌肌钙蛋白T（cTnT）和丙二醛（MDA）水平。结果各组血清cTnT、MDA均有明显升高,A组、B组和C组术中、术后血清cTnT、MDA水平均明显低于D组（P〈0.05）。B组与C组cTnT水平在术后24 h有显著性差异（P〈0.05）。结论腺苷能模拟缺血预处理（IPC）的心肌保护效应,并且各种处理方法均对缺血心肌有保护作用。在心内直视手术中可以根据客观条件灵活实施不同的腺苷处理方法。     

体外循环心脏停跳与不停跳行心内直视手术对血浆心肌肌钙蛋白Ⅰ和丙二醛的影响

目的 通过心脏不停跳与停跳心内直视术对患者血浆心肌肌钙蛋白Ⅰ和丙二醛影响的对比研究,客观评价心脏不停跳心内直视术的心肌保护效果。方法 随机将２７例二类瓣病变患者分两组,测定术前、后心肌肌钙蛋白Ⅰ和丙二醛的变化。不停跳组１３例,二尖瓣替换在浅低温体外循环心脏不停跳下进行;停跳组１４例,二瓣替换在常规停跳方法下进行,结果 不停跳组患者术后心肌肌钙蛋白Ｉ和丙二醛显著低于停跳组（Ｉ〈０．０１）。结论 浅低     

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.