72例重症心脏瓣膜病的外科治疗临床分析

目的 探讨重症心脏瓣膜病外科治疗及围术期的处理措施.方法 对重症心脏瓣膜病患者72例给予以瓣膜置换为主的综合处理.门诊或电话随访1～6个月.结果 住院死亡4例（5.5％）,出院2周死亡1例,心功能恢复至Ⅰ级8例、Ⅱ级32例、Ⅲ级28例.结论 对重症心脏瓣膜病患者,全面评估手术风险,注重改善术前心功能及营养状况,缩短手术时间,加强术后并发症的防治,可提高手术成功率及价值.     

重症心脏瓣膜病的外科治疗

目的:总结重症心脏瓣膜病行心脏瓣膜置换术外科治疗经验,探讨提高手术成功率的措施.方法:分析2000年1月至2010年10月收治的224例重症心脏瓣膜病患者的临床资料.结果:本组有10例术后7d内死亡,死亡率为4.5％.其死亡原因:低心排血量综合症6例,心室纤颤3例,呼吸衰竭1例,手术早期并发症:低心排综合症42例,心律...     

重症心脏瓣膜病外科的营养支持

目的:探讨营养支持在重症心脏瓣膜病外科治疗中的作用。方法:对2000年5月～2005年5月182例重症心脏瓣膜病行瓣膜置换术,135例行三尖瓣成形术,37例进行左房折叠术,围术期采用营养支持疗法。结果:182例患者中在院死亡5例,死亡率2.7%。术后并发低心排血量综合征15例,随访151例,死亡1例。结论:科学的应用营养支持方案,可以明显地提高重症心脏瓣膜病外科手术成功率。     

37例重症心脏瓣膜病手术治疗体会

目的:总结重症心脏瓣膜病的外科治疗经验。方法:对2008年1月～2011年1月我科37例重症心脏瓣膜病患者的术前准备、手术方法和术后处理等外科治疗进行分析。结果:术后低心排15例,严重心律失常7例,肺部感染9例,肾功能衰竭3例,死亡3例,死因低心排2例,肾功能衰竭1例。29例术后随访,心功能Ⅰ级19例,Ⅱ级6例,Ⅲ级3例,Ⅳ级1例。结论:重症心脏瓣膜病术后并发症多,恰当的围手术期处理、合理的手术方式选择是外科治疗重症心脏瓣膜疾病的关键。     

重症心脏瓣膜病28例围手术期治疗体会

目的:回顾性总结重症心脏瓣膜病瓣膜置换术围手术期处理的经验。方法:对2006年2月-2011年3月共28例重症心脏瓣膜病行瓣膜置换术患者的临床资料进行回顾性的总结分析。结果:围术期死亡3例,死亡率10.7%;并发症:早期出现低心排综合8例,其中1例并发多器官功能衰竭死亡。出现室性心律失常6例,其中1例因顽固室性心律失常死亡。心包、纵隔引流多二次开胸止血或(和)延迟关胸3例。术后感染性心内膜炎伴肾功能衰竭1例。术后脑梗死1例死亡。结论:注意重症心脏瓣膜病外科治疗的围手术期处理和手术时机选择对减少术后并发症和提高手术成功率有重要意义。     

重症心脏瓣膜病外科20例治疗体会

目的:探讨重症心脏瓣膜手术治疗和围手术期处理的经验。方法:对2000年8月~2004年8月收治的重症心脏瓣膜病患者20例进行回顾性分析。结果:20例中死亡2例,死亡率10%,余18例术后恢复好,心功能分别恢复至I-II级。结论:重症心脏瓣膜病的治疗应注重围手术期处理,选择适当手术时机,合理纠正病变,加强术后并发症的防治。     

83例重症心脏瓣膜病的外科治疗体会

目的 总结重症心脏瓣膜病的手术治疗经验.方法 2004年6月至2011年6月我院共对82例重症心脏瓣膜病患者实行了心脏瓣膜置换术.结果 术后早期死亡4例,3例死于术后低心输出量综合征,1例于术后一周出现心包填塞,呼吸、循环功能衰竭,抢救无效死亡,余病例全部康复出院.死亡率4.82%.术后随访,复查心脏彩超示心脏均有不同程度缩小,心功能均有改善,其中心功能Ⅰ级20例,Ⅱ级56例,Ⅲ级4例.结论 只要严格掌握手术适应证,积极有效的术前准备,加强心肌保护和提高手术技巧,严密的术后监护,就可以提高重症心脏瓣膜病手术的成功率.     

老年二尖瓣瓣膜病的外科治疗

[目的]探讨老年心脏瓣膜病患者施行二尖瓣手术的临床效果.[方法]连续选择66例年龄≥60岁的二尖瓣手术患者的临床资料进行回顾性分析.建立logistic回归模型,分析围术期各个相关因素对于治疗效果的影响.[结果]早期死亡6例,病死率为9.09%.心功能NYHA分级、复发性心脏瓣膜病、转机时间长是影响患者术后死亡的危险因素.术后发生并发症27例,主要包括:低心排出量综合征、多脏器功能不全综合征、肺部感染、急性肾衰竭、术后呼吸功能不全.[结论]对症状严重而合并症少的老年心脏瓣膜病患者进行二尖瓣手术是安全、有效的.     

重症心脏瓣膜病192例的外科治疗体会

目的探讨重症心脏瓣膜病手术治疗和围手术期处理的经验,提高手术成功率。方法对2007年1月至2009年12月192例接受外科手术治疗的重症心脏瓣膜病患者的围术期处理、术中心肌保护及术中手术方法进行回顾性分析。结果发生并发症38例,发生率为19.8%;术后早期死亡8例,死亡率4.2%。结论重症心脏瓣膜病的外科治疗应注重围手术期处理,适当选择手术时机,合理纠正病变,加强术后并发症的防治。     

重症心脏瓣膜病患者瓣膜置换术后ICU护理对策探讨

目的分析重症心脏瓣膜病患者行瓣膜置换术后的护理措施,以此评定其临床护理价值。方法选取我院于2016年5月至2017年3月期间所收治的行瓣膜置换术患者12例,手术完成后,对所有患者行术后常规的呼吸系统测定、循环系统监测、电解质测定,对患者ICU术后进行严格护理。结果本次研究的12例患者中,术后出现并发性低心排患者1例,术后出血1例,严重性的心律失常2例,肺不张患者1例,未出现死亡的患者。结论对行瓣膜置换术的重症心脏瓣膜病患者进行有效的术后护理指导,加强ICU护理措施,这对于临床研究具有重要作用。     

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.