经皮球囊扩张术治疗风湿性二尖瓣狭窄的临床疗效

目的评价经皮球囊扩张术(PBMV)治疗风湿性二尖瓣狭窄的临床疗效.方法82例风湿性二尖瓣狭窄患者行胸前超声心动图(TTE)检查,对二尖瓣病变行Wilkin法评分(16分制),合并心房纤颤(AF)患者,再行食道超声心动图(TEE)检查,评分≤11分入选.手术采用改良Inove法,术前、后48～72 h分别测定二尖瓣口面积(MVA)、二尖瓣口跨瓣压差(MVPG)、左房内径(LAD)、二尖瓣返流(MR),术中测左房压力(LAP).AF者术后口服乙胺碘呋酮基础上电复律.结果术后MLAP及MVPG均较术前显著降低(P均＜0.01),MVA较术前明显增加(P＜0.01).而LAD在手术前后无显著变化(WT5"BX P).结论PBMV是治疗风湿性二尖瓣狭窄有效而可靠方法.     

无血流动力学监测完成经皮球囊二尖瓣成形术一例

患者男,48岁,因胸闷、心悸6年入院.临床诊断:风湿性心脏病,二尖瓣狭窄,心功能Ⅱ级.治疗选用深圳美迪科公司产球囊扩张导管,按有关文献方法进行经皮球囊二尖瓣成形术(PBMV).PBMV术中测压设备故障,未行血流动力学监测.术前及术后二尖瓣区听诊及心脏彩色多普勒超声心动图结果:二尖瓣区舒张期杂音、左房前后径(cm)、二尖瓣口面积(cm2)术前、术后分别为Ⅲ/6、4.7、1.44和Ⅰ°/6、3.8、2.32.     

心房颤动伴左房血栓患者的经皮二尖瓣球囊扩张术

目的 评价经皮二尖瓣球囊扩张术(PBMV)治疗心房颤动(AF)伴左房血栓的二尖瓣狭窄患者的临床疗效.方法 选具备PBMV指征的风湿性二尖瓣狭窄(MS)合并心房颤动患者10例,经食管超声心动图(TEE)证实存在左房内血栓,均为2000年4月以后的住院患者,均予华法林治疗2个月后进行PBMV.扩张前后测左房压力,术后1周内...     

经皮球囊二尖的瓣成形术70例疗效分析

目的：了解经皮球囊二尖瓣成形术治疗风湿性心脏病二尖瓣狭窄的疗效,方法：对70例风湿性二尖瓣狭窄接受PBMV治疗的患者进行回顾性分析,运用超声心动图对二尖瓣活动度,增厚度,钙人,瓣下病变进行评分,同时检测瓣口面积,二尖瓣跨瓣压差。结果：显示PBMV前后二尖瓣瓣口面积,二尖瓣平均跨瓣压差,左房平均压力差异显著（P＜0．05）,52例随访,平均瓣口面积较术后略有缩小（P＞0．05）,无再狭窄发生,对63例进行二尖瓣病变超声评分,总评分≤8分组PBMV效果好于总评分＞8分组,结论：PBMV是治疗风湿性二尖瓣狭窄的有效方法。     

经皮二尖瓣球囊成形术后肺功能评估

为了解经皮二尖瓣球囊成形术(PBMV)后风湿性二尖瓣狭窄患者肺功能的变化,对38例病人在PBMV术前及术后24～48小时内作肺功能检查。结果显示PBMV术后二尖瓣口面积显著增加,左房压下降(P<0.01),随之肺通气功能及小气道功能一系列指标亦明显改善(P<0.05)。术后肺动脉收缩压降低的程度△PASP)与1秒时间肺活量增加的程度(△FEV_1)呈正相关(r=0.74,P<0.01),术前心功能Ⅲ～N级患者,术后其最大通气量(MVV)明显增大,优于术前心功能Ⅱ级患者(P<0.001)。研究提示:PBMV术后24～48小时内肺功能即可明显改善,术前心功能越差,术后肺功能改善越明显,肺功能检查可作为一项评定PB-MV手术效果的辅助手段。     

经皮二尖瓣球囊成形术中长期疗效观察

目的观察经皮二尖瓣球囊成形术(PBMV)后5~12年的中长期疗效。方法采用Inoue单球囊对286例风心病二尖瓣狭窄者行PBMV术治疗,对其中160例进行5~12年(平均7.6年)的随访。结果PBMV术前二尖瓣口面积(MVA)为1.06±0.20cm2,术后显著扩大,为2.01±0.35cm2,与术前比较,t=29.81,P<0.01;随访5~12年,MVA逐渐减少至1.62±0.21cm2,与术前比较,t=24.43,P<0.01。再狭窄发生率为9.38%,术后心功能改善1级以上100%,5~12年心功能维持1级者占63.75%。结论PBMV术后5~12年中长期疗效令人满意。     

重度二尖瓣狭窄经皮球囊扩张术前后心脏血流动力学改变及意义

选择风心重度二尖瓣狭窄患者10例在行经皮二尖瓣球囊扩张术(PBMV)前后进行血流动力学监测和左心功能测定。结果显示:原明显升高的右室收缩压,肺动脉收缩压和舒张压、肺楔嵌压及左房压在PBMV成功后即刻明显下降接近正常范围(P<0.001);左心功能术后明显改善,左室舒张末期容量,每搏量和射血分数均增加(P<0.05～0.01),而左室舒张末期压力未见增加。     

二尖瓣狭窄并发左房机化血栓经皮球囊二尖瓣扩张术护理

风湿性心脏病二尖瓣狭窄(MS)并发左房附壁血栓是经皮球囊二尖瓣扩张术(PBMV)禁忌症,我院自2000年以来对12例此类患者成功实施了PBMV,取得了满意效果,现将护理体会报告如下:     

经皮球囊二尖瓣成形手术的护理

经皮球囊二尖瓣成形术 ( PBMV)是将特制的球囊导管 ,通过经皮穿刺的方法 ,经股静脉、右心房、房间隔、左心房送到狭窄的二尖瓣口 ,加压充盈球囊扩张狭窄的二尖瓣 ,增加瓣口面积 ,改善心功能衰竭及劳力性呼吸困难。我院 1 999～ 2 0 0 0年对 6例患者行PBMV治疗 ,手术均获成功 ,现将护理体会介绍如下。1　临床资料　　本组病例男 1例 ,女 5例 ,年龄 2 3～ 47岁 ,均为风湿性二尖瓣狭窄 ,病史 3～ 8年。其中单纯性二尖瓣狭窄 1例 ,伴发房颤 2例 ,伴轻度二尖瓣关闭不全3例。诊断均经心脏彩超检查证实。伴发房颤者经食管超声心动图检查证实左…     

经皮球囊二尖瓣成形术

25例风湿性二尖瓣狭窄患者行经皮球囊二尖瓣成形术,24例成功。扩张后患者心功能得到明显改善,左房平均压、二尖瓣压力阶差、肺动脉平均压明显下降,心排血量、二尖瓣口面积明显增加,P<0.001。     

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.