大连市房颤住院患者诊治状况调查分析

[目的]了解大连地区心房纤颤（房颤）住院患者年龄、病因、房颤类型、脑卒中等流行病学特征及不同类型房颤的治疗现状。[方法]对2003～2004年大连市6家综合医院诊断的房颤患者的住院病历进行回顾性分析。[结果]（1）共964例,房颤病因主要为高血压44．6％,冠心病30．4％。心力衰竭22．3％。（3）房颤类型中阵发性房颤28．6％,持续性房颤14．1％,持久性房颤57．2％。阵发性房颤复律及维持窦律治疗占56％,发作时治疗药物多为西地兰、胺碘酮,其次为普罗帕酮、β阻滞剂。慢性房颤78％采用心室率控制治疗,常用药物为地高辛、β阻滞剂,其次为钙拮抗剂及胺碘酮。（4）本组脑卒中患病率为9．4％,各种类型房颤之间比较无明显差异。（5）本组患者69．7％接受抗血小板治疗,长期华法林抗凝治疗者仅占4％,抗凝治疗严重不足。[结论]大连地区心房纤颤住院患者年龄、病因、房颤类型、脑卒中等流行病学特征与国内其他地区相似,阵发性房颤以节律控制为主,慢性房颤绝大多数采用心室率控制治疗。抗凝治疗严重不足。     

普罗帕酮不同用药途径转复急性房颤的疗效比较

心房颤动(简称房颤)是一种常见的心律失常，房颤的发作呈阵发性或持续性。急性房颤可见于正常人，在情绪激动、手术后、运动或急性酒精中毒时发生，其处理原则除病因治疗外，主要为转复和维持窦性心律，控制心室外率，预防栓塞事件。普罗帕酮(又称心律平)为IC类抗心律失常的药物，可应用于房颤的复律，本研究的目的是观察比较心律平静脉用药和口服用药转复急性房颤的疗效。     

287例心房颤动的临床分析

目的：分析心房颤动的流行病学及其治疗现状。方法：对287例心房颤动患者的临床资料进行综合分析。结果：此组病人最常见病因冠心病、高血压、风湿性心脏病分别占58．2％、43．9％、9．6％。心房颤动患者合并心力衰竭的发生率较高,约占51．9％。胺碘酮转复阵发性房颤成功率高,有效率达78．8％。持续性或永久性房颤以洋地黄、B阻滞剂等控制心室率占56．9％,应用抗凝治疗患者占74．2％。结论：287例心房颤动的主要病因为冠心病、高血压、风湿性心脏病,心房颤动患者合并心力衰竭的发生率高,胺碘酮转复房颤成功率高,持续性及永久性心房颤动药物控制心室率效果佳,预防卒中,高危组需用华法林,低危组可用阿司匹林。     

胺碘酮用于房颤心律转复后维持窦性心律的临床观察

33例持续性房颤患者心律转复后应用胺碘酮维持窦性心律，服药后1－2周行电转复。6例在胺碘酮负荷量期间转为窦性心律，27例电转复为窦性心律，维持窦性心律有效率：半年为72．72％，1年为63．63％，2年为45．45％。说明胺碘酮因为慢性房颤转复后维持窦性心律的有效药物。     

胺碘酮用于房颤心律转复维持窦性心律的临床观察

３３例持续性房颤患者心律转复后应用胺碘酮维持窦性心律，服药后１－２周行电转复。６例在胺碘酮负荷量期间转为窦性心律，２７例电转复为窦性心律，维持窦性心律有效率；半年为７２．７２％，１年为６３．６３％，２年为４５．４５％。说明胺碘酮为慢性房颤转复后维持窦性心律的有效药物。     

普罗帕酮联合电复律转复房颤和房扑的临床观察

目的:探讨普罗帕酮联合电复律转复持续性心房颤动和心房扑动的有效性和安全性.方法:无左室功能不全的房颤和房扑患者55例,电复律前服用负荷量普罗帕酮治疗,未转复者给予电复律,转复后继续口服普罗帕酮维持治疗.结果:50例患者均转为窦性心律,5例患者转复后窦性心律不能维持,早期有效率为90.9％.结论:普罗帕酮联合电复律是持续性房颤和房扑安全有效的治疗方法,值得在临床上推广使用.     

顿服普罗帕酮联合电复律转复持续性心房颤动的临床观察

目的 探讨普罗帕酮联合电复律转复持续性心房颤动的效果.方法 30例持续性房颤患者电复律前服用负荷量普罗帕酮,房颤转复服用小剂量普罗帕酮100mg,每天3次维持.结果 29例患者均转为窦性心律,2例患者转复后窦性心律不能维持,早期有效率为90%.随访(12.3±2.0)月,期间5例(18.5%)复发,总体73.3%维持窦性心律.结论 普罗帕酮联合电复律是治疗持续心房颤动的有效方法.     

普罗帕酮、莫雷西嗪对阵发性房颤的疗效比较

目的：比较普罗帕酮、莫雷西嗪对阵发性房颤长期预防发作的疗效和安全性。方法：采用随机、较长期随访的方法将62例患者随机分成普罗帕酮组、莫雷西嗪组，随访12月。结果：普罗帕酮1-3个月的疗效为76．7％，4—6个月的疗效为63．3％，7—12个月的疗效为61．7％，莫雷西嗪在上述各个期间的疗效分别为45．6％、36．8％、29．8％。不良反应发生率普罗帕酮为21．9％，莫雷西嗪为26．7％。结论：普罗帕酮是疗效较好的比较安全的预防阵发性房颤的药物，莫雷西嗪预防作用较低。     

心房颤动120例临床分析

目的:探讨心房颤动(房颤)患者的病因分布特点及治疗方法.方法:对2006～2011年收治120例合并房颤的患者进行病因及治疗情况的回顾性分析.结果:房颤病因以冠心病居首,高血压次之.19例阵发性房颤用胺碘酮或普罗帕酮复律并维持窦性心律安全有效.持续性房颤33例,永久性房颤心68例,心室率控制均较满意.结论:房颤的主要病因为冠心病、高血压,关注房颤的病因,对预防和治疗具有重要意义.     

胺碘酮合用小剂量β受体阻滞剂治疗老年阵发房颤临床观察

目的 比较胺碘酮与小剂量β受体阻滞剂合用对老年阵发性房颤的疗效。方法 回顾分析30名老年阵发房颤患者,根据房颤复律后维持用药的不同,分为3组：单用胺碘酮组（n=11);单用β阻滞剂组（n=9);胺碘酮与小剂量β阻滞剂合用组（n=10)。比较3组患者用药后12个月中房颤控制情况及心室率、心脏传导情况。结果 单用胺碘酮组显效率54．5％,有效率45．5％,无效率0％;单用β受体阻滞剂组显效率22．2％,有效率44．5％,无效率33．3％;胺碘酮与小剂量β受体阻滞剂合用治疗房颤,显效率90％,有效率10％,其疗效明显优于单用胺碘酮（P＜0．05）或单用β阻滞剂（P＜0．01）组,且未见明显副作用：3组间心室率未见显著差别。结论 胺碘酮与小剂β受体阻滞剂合用可有效地控制老年阵发性心房纤颤的发作。     

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.