用球囊漂浮起搏电极床旁行心脏临时起搏58例临床观察

目的 探讨经静脉途径应用球囊漂浮电极在床旁行心脏临时起搏的可行性、有效性、安全性.方法 在无X线透视条件下,床边经右锁骨下静脉、左锁骨下静脉、右股静脉及右颈内静脉4种不同的途径穿刺插管,用气囊漂浮起搏电极行心脏临时起搏.观察其成功率、操作时间及并发症.结果 58例患者中57例在无X线透视条件下起搏成功,成功率98.3%,无严重并发症发生.其中经左锁骨下静脉途径5例,右颈内静脉途径2例,右股静脉途径6例均盲插起搏成功,从穿刺到起搏成功用时左锁骨下静脉途径2～12 min,平均4.5 min,右颈内静脉途径3 min及4 min,右股静脉途径5～18 min,平均9.2 min.经右锁骨下静脉途径45例盲插成功42例,成功率93.3%,从穿刺到起搏成功平均5 min,3例未成功者1例为起搏电极置入失败,2例为置管失败,其中2例改行左锁骨下静脉途径成功2例,另1例经左锁骨下静脉途径及右股静脉途径均未成功,后在X线透视条件下从左股静脉途径起搏成功.结论 应用球囊漂浮电极导管行床旁临时起搏有创伤小、置入迅速、成功率高、并发症少、操作简单容易掌握、所需设备简单等优点,适合于急危重患者的抢救.     

床边心脏临时起搏的临床应用

目的总结16例经锁骨下静脉、右颈内静脉途径穿刺插管,应用气囊电极导管行床边紧急心脏临时起搏的经验。方法按改良Seldinger方法行静脉穿刺置管,按Swan-Ganz球囊导管操作方法推送气囊电极导管,在无X线透视条件下,根据心电监护仪出现室性早搏或起搏心电图判断电极进入右室,调整导管位置,行右室心内膜临时起搏。结果16例全获成功,其中右颈内静脉2例、锁骨下静脉14例,两者开始穿刺至起搏成功时间为2～15分钟。起搏效果肯定,起搏时间3～13天。全部病例未发生气胸、血胸及感染等并发症,均痊愈出院。结论本法创伤小、方便快速、安全有效、无需X线引导,值得基层急救推广应用。     

床边心脏临时起搏的体会

目的:探讨床边心脏临时起搏的实用性。方法:对31例缓慢性心律失常经不同静脉途径床边心脏临时起搏进行分析。结果:31例起搏全获成功,选择左锁骨下静脉穿刺16例,右股静脉15例,误穿左锁骨下动脉1例,经右股静脉插管时间长于经左锁骨下静脉插管。无穿刺部位血肿、血气胸、气体栓塞、心脏穿孔的发生。结论:应用气囊电极导管床边心脏临时起搏,具有操作快捷、成功率高、患者创伤小的特点,值得推广应用。     

床旁球囊漂浮电极心脏临时起搏的疗效评价及观察

目的探讨球囊漂浮电极床旁心脏内临时起搏的可行性及其临床疗效。方法对36例病人经左锁骨下静脉途径,通过插入导管的长度和起搏心电图QRS波形态的指导,植入球囊漂浮导管至右心室行临时心脏起搏。结果成功起搏55例（97．22％）,开始穿刺到成功起搏时间（6．7±3．5）min,植入深度（37．5±3．5）cm,留置电极导管时间1—14d。无严重并发症发生。结论经锁骨下静脉途径植入球囊起搏电极导管能迅速安全行心室起搏。     

气囊电极床旁紧急心脏临时起搏的临床观察

总结84例经右颈内静脉、左锁骨下静脉两种不同的穿刺插管,行气囊电极床旁紧急心脏临时起搏的经验.按Seldiger方法行静脉穿刺置管,按Swan-Ganz球囊导管操作方法推送气囊电极导管,在X线透视条件下,根据室性早搏的出现或体表起搏心电图判断电极进入右心室,行右心室心内膜临时起搏.结果84例全部获得成功,其中左锁骨下静脉76例,右颈内静脉8例.两者开始穿刺至起搏成功时间3～10min,起搏效果肯定,起搏时间2～15天.术后胸片证实导管头位置与体表心电图图形定位的部位完全一致.除5例电极移位外,全部病例未发生心脏穿孔、气胸、血胸及感染等并发症,除4例死于原发病外,余均痊愈出院.结论:本方法创伤小、安全有效,无需X线引导,值得急救推广应用.     

经锁骨下静脉安植心脏永久起搏28例

安植埋藏式永久心脏起搏电极的径路繁多,本组经锁骨下静脉植入２８例,迅速省时,安全准确,从穿刺引导入起搏电极平均１０ｍｉｎ,均置入顺利,此法勿需结扎远端静脉及切开缝合,无血种、气胸及空气栓塞等并发症发生,收到良好临床效果。     

起搏脉冲引导下紧急床旁心脏临时起搏

目的探讨应用起搏脉冲引导下紧急床旁普通电极心脏临时起搏的可行性、安全性及实用性。方法对26例不同原因引起的严重缓慢型心律失常和意外心跳骤停患者,脉冲引导下床旁经左锁骨下和右颈内静脉,置入普通电极导管行紧急临时右心室心脏起搏。结果26例病人成功起搏20例,占76.9%。从开始静脉穿刺到右室成功起搏时间5-20（10.0±2.2）m in,术后24 h内发生导管微脱位2例,经调整导管后恢复正常起搏。所有患者无误穿动脉、气胸、深静脉内血栓形成、心肌穿孔、感染等并发症。3例意外心跳骤停患者起搏失败。结论起搏脉冲引导下紧急床旁普通电极心脏临时起搏简便、安全、有效,值得临床应用。     

3种不同方法定位穿刺腋静脉行永久起搏器电极植入术72例

目的 评价3种不同的定位方法穿刺腋静脉置入起搏电极的安全性和实用价值.方法 腋静脉组72例,术中用造影剂、导丝定位或透视下直接穿刺腋静脉植入电极;另选性别、年龄与之匹配的72例经锁骨下静脉植入电极的患者作对照组.结果 72例患者穿刺腋静脉均获成功,与对照组比较穿刺次数和耗时相似.用造影剂定位穿刺最容易成功,其次为用导丝定位穿刺,直接在透视下解剖定位的穿刺次数和耗时稍高于前2种方法.结论 造影剂和导丝定位下穿刺腋静脉成功率高,耗时短,但费用高、烦琐、增加患者痛苦.在透视下以骨性标志定位直接穿刺腋静脉方法安全、简便,成功率高,随着经验的增加可取代造影剂、导丝定位和锁骨下静脉穿刺,以避免锁骨下静脉穿刺的缺点和并发症,可作为常规方法.     

普通电极床旁临时心脏起搏治疗严重缓慢性心律失常的临床观察

目的探讨普通电极床旁临时心脏起搏治疗缓慢性心律失常的有效性和安全性。方法将115例患者分为床旁体表心电引导组(83例)和介入室X线引导组(32例),通过穿刺左锁骨下静脉置入普通电极导管进行临时心脏起搏,观察手术成功率、操作时间、起搏参数及并发症。结果床旁体表心电引导83例即刻成功率100%,最后起搏成功率98.8%;从穿刺开始到起搏成功时间两组分别为(8.5±1.2)min和(7.4±1.6)min,起搏阈值为(0.87±0.31)V和(0.83±0.27)V,两组比较差异无统计意义。起搏电极留置时间3~15 d起搏和感知功能均正常,无并发症出现。结论紧急床旁经左锁骨下静脉置入普通电极导管进行临时心脏起搏安全有效,具有操作简便、时间短、并发症少等优点,便于急救。     

经锁骨下静脉床旁临时心脏起搏导管电极滞留1例

经锁骨下静脉床旁临时心脏起搏导管电极滞留１例一院心内科杨树森孟繁超李为民赵进军肇东市医院内科徐炳柱近来，我们在对１例急性下壁心肌梗塞并心动过缓患者实施经左锁骨下静脉临时心脏起搏时出现导管电极在锁骨下滞留，现报告如下。患者，男，６７岁。以剧烈胸痛１８ｈ...     

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.     

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.     

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.     

股骨远端粉碎性骨折双板固定的生物力学研究

目的探讨治疗股骨远端粉碎性骨折的新方法。方法应用10件成人鲜尸股骨,造成股骨远端髁间、髁上粉碎性骨折,内侧采用聚乙烯板、外侧采用钢板双向固定,分别作压缩、弯曲、扭转等生物力学实验研究。另取10件标本进行单向外侧钢板固定作为对照。结果双向固定组抗弯曲、扭转能力显著增强(P<0.01),抗压缩能力也较单侧固定组强(P<0.05)。结论双向固定治疗股骨远端粉碎性骨折有明显的应用价值。     

Cloning and sequence analysis of β-actin gene from Aedes albopictus （Diptera： Culicidae）

Objective: To obtain the complete β-actin gene from Aedes albopictus. Methods: Total RNA was extracted from C6/36 cells. Degenerate primers were designed based on the β-actin sequences of An. gambiae, Ae. aegypti, Cx. pipiens pallens and D.melanogaster. By RT-PCR, the product was amplified, purified, cloned into the pGT vector and sequenced. The β-actin sequence was aligned and phylogenetically analyzed by the BLAST program and the CLUSTAL W program. Results: A sequence of 1132 bp including an open reading frame of 1131 bp was obtained (GenBank DQ657949). The deduced protein had 376 amino acids.Aligned to SWISS-PROT, it exhibited a high level of identity with β-actins from Anopheles, Drosophila and Culex at the amino acid sequence level. Phylogenetic analysis indicated that Ae. albopictus β-actin was much more homologous with invertebrate β-actin than with vertebrate β-actin. Conclusion: The gene may be used as the internal control in the experiments of Ae. albopictus.     

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.     

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.     

基层医院急性心肌梗死249例临床用药分析

近年来,随着我国经济社会的发展,冠状动脉粥样硬化性心脏病（冠心病）发病率明显升高,已成为威胁我国人民健康的重大疾病。急性心肌梗死是冠心病的重要类型,具有病死率高。致残率高的特点。其治疗的关键在于尽早。充分及持续开通梗死相关血管。大量临床病例已经证实早期再灌注治疗和早期使用受体阻滞剂（BB）。血管紧张素转换酶抑制剂（ACEI）。     

Treatment of 256 cases of Osteoarthritis of Knee Joint with Guo Jianhua''''s Four-step Therapy

256 cases of osteoarthritis of knee joint were treated with Professor Guo Jianhua's four-step therapy,i.e.acupuncture at five points in the knee to remove obstruction of collaterals and stop pain,massotherapy to separate adhesion and relieve spasm,fumigation and steaming with hot decoction to promote blood circulation and expel swelling,and functional exercises to consolidate the therapeutic effects.121 cases were cured,117 cases markedly effective,and 18 cases ineffective,with a total effective rate of 92.97%.     

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.