手术治疗缩窄性心包炎68例的体会

目的总结手术治疗缩窄性心包炎的经验。方法缩窄性心包炎患者68例,均行胸前正中切口劈骨入路心包剥离术,观察术后临床疗效及并发症。结果手术治疗缩窄性心包炎68例,存活67例,术后死亡1例,病死率为1.5%,死于严重低心排综合征。术后并发低心排综合征11例和心力衰竭9例;术后中心静脉压下降（10.7±2.8）cmH2O。心功能恢复至Ⅰ级52例,Ⅱ级15例。随访期间无缩窄复发及死亡病例。结论胸前正中切口劈骨入路心包剥离术治疗缩窄性心包炎临床效果好,可作为首选治疗手段。     

缩窄性心包炎手术治疗79例临床分析

目的探讨提高缩窄性心包炎的手术疗效方法.方法回顾性分析近10年来79例缩窄性心包炎患者的治疗.男性51例,女性28例.年龄7～71(29.21±12.98)岁.术前心功能Ⅱ级6例,Ⅲ级51例,Ⅳ级22例.前胸正中切口64例,左前外侧切口15例.均在全麻下行部分心包剥脱术.结果围术期死亡4例,其中术后低心输排量综合征2例,术中右室流出道破裂出血修补失败1例,术后全身衰竭1例.3例术后症状改善不明显.结论手术治疗缩窄性心包炎是最有效的方法,一旦确诊应尽早手术治疗.     

126例缩窄性心包炎的围手术期处理

目的探讨缩窄性心包炎的围手术期处理方法以及要点。方法统计分析1982年5月至2005年12月协和医院心脏外科手术治疗缩窄性心包炎患者126例,男88例,女38例,平均年龄(31.2±16.1)岁。术前大多有水肿、呼吸困难、胸痛等症状。X线检查有93例提示心包钙化灶,钙化率73.81%。术前心功能NYHA分级Ⅰ级7例、Ⅱ级21例、Ⅲ级98例,术前中心静脉压为(22.13±8.24)kPa,左心射血分数(EF)值为(34.3±17.4)%。其中47例行全心包切除术,79例行部分心包切除术。结果123例术后心功能均明显改善,2例术后早期死于低心功能排出量,死亡率1.6%,1例手术后出现昏迷,于术后第10天自动出院。中心静脉压下降为(9.33±4.36)kPa。术后超声心动图示左心射血分数升至(51.8±12.1)%,心功能Ⅰ级47例、Ⅱ级76例。术后随访,2例行部分心包切除术患者分别于术后第3年和第5年死于心力衰竭。结论早期处理、彻底剥离、围手术期慎重处理对提高缩窄性心包炎手术成功率具有重要意义。     

外科治疗缩窄性心包炎128例

目的总结分析128例缩窄性心包炎的外科治疗经验。方法回顾分析128例经外科手术治疗的慢性缩窄性心包炎患者的临床资料。结果本组术后早期死亡2例,死亡率1.57%,死亡原因:均为严重低心排综合征。其它并发症有:低心排综合征17例(13.2%),心律失常9例(7.02%),急性肾功能不全5例(3.9%),呼吸功能不全4例(3.1%),伤口感染3例(2.3%),术后胸内出血2例(1.6%),脑梗塞1例(0.78%)。早期1例因心包切除不彻底而复发。结论缩窄性心包炎应尽早确诊,积极手术,术中心包切除范围因病情而定,力求彻底松解病变心包,术后积极预防各种并发症的发生。     

慢性缩窄性心包炎20例的诊断及手术治疗

目的　总结慢性缩窄性心包炎的诊断、手术技巧及围术期处理经验。方法　回顾性分析手术治疗慢性缩窄性心包炎2 0例 ,总结其手术经验及围术期管理方法。结果　本组 1例术后死于顽固性低心排综合征 ,其余患者症状明显改善。结论　心包剥脱术是手术治疗慢性缩窄性心包炎的最佳方法 ,早期明确的诊断 ,最佳手术时机和方法及完善的围术期管理是手术成功的几大关键要素。     

手术治疗缩窄性心包炎42例临床观察

目的探讨手术治疗缩窄性心包炎的效果及方法。方法回顾性分析2009年3月～2011年3月收治的42例缩窄性心包炎患者临床资料。结果 42例患者成功剥离心包,围术期因重度低心排综合征死亡2例,死亡率4.8%,40例临床痊愈出院。术前术后收缩压变化差异无统计学意义（P〉0.05）,术后舒张压较术前下降（P〈0.05）,术后脉压差较术前脉压差升高（P〈0.05）,术后CVP较术前下降（P〈0.05）。结论手术治疗缩窄性心包炎安全有效,CVP、脉压差、血压及心功能等指标可作为评价手术效果及预后的因素。     

缩窄性心包炎的外科治疗

自１９８２年５月至１９９８年５月协和医院心脏外科手术治疗缩窄性心包炎患者３７例,男２６例,女１１例,平均年龄（３１．８±１６．４）岁。术前大多有水肿、呼吸困难、胸痛等症状。Ｘ线检查有２２例钙化,钙化率５９．５％。术前心功能ＮＹ－ＨＡ分级Ⅱ级（７例）,Ⅲ级（２１例）,Ⅳ级（９例）,术前中心静脉压为（０．２２±０．０６）ｋＰａ。其中２１例行全心包切除术,１６例行部分心包切除术。３６例术后心功能均明显改善,１例术后早期死于低心排,死亡率２．７％。术后随访,２例行部分心包切除术患者分别于术后第３年和第５年死于心力衰竭。还就手术时机、手术方式、手术意外和围手术期处理进行了介绍和讨论     

110例缩窄性心包炎的外科治疗

目的总结缩窄性心包炎外科手术治疗经验及手术效果。方法回顾性分析1985年2月-2010年12月,新疆医科大学第一附属医院心脏外科收住的外科治疗缩窄性心包炎110例的临床资料,男性75例,女性35例。术前心功能Ⅰ级3例,Ⅱ级15例,Ⅲ级54例,Ⅳ级38例。手术采用左前外侧切口60例,胸骨正中切口50例。其中35例行心包切除,75例行心包部分切除。结果术后中心静脉压平均降至(12.2±4.4)cmH2O;12例出现低心排综合征,2例死亡,死亡率1.8%;术后复查心功能Ⅰ级42例,Ⅱ级63例,Ⅲ级5例;术后病理诊断示结核42例,非特异性病变68例。结论恰当的手术时机、手术径路的选择、合理的心包切除范围及围术期处理是缩窄性心包炎外科手术治疗获得满意疗效的关键。     

体外循环在重症缩窄性心包炎外科治疗中的应用--附4例报告

缩窄性心包炎通常由于急性心包炎发展成慢性炎症、疤痕和纤维化 ,导致心包增厚 ,且无顺应性。常见病因有结核、肿瘤、放疗手术创伤 ,由于其病程进展的不可逆性 ,常需外科手术介入 ,而在重症患者 ,手术时极易误伤心肌及冠脉血管 ,手术风险大且难以彻底切除病变心包 ,在体外循环下行心包剥脱术 ,安全、可行。报告如下 :1　临床资料本组患者 4例 ,均为女性 ,年龄 35～ 4 7岁 ,平均年龄 4 1.5岁。术前心功能一级 ,术前CVP为 2 8～36cmH2 O ,平均 31.2cmH2 O。心电图 :房颤 2例 ,室上速 1例 ,均有不同程度的ST -T改变。胸部X光 :0 .5 1～ 0 …     

60例缩窄性心包炎手术的临床分析

目的：通过研究60例缩窄性心包炎手术的治疗经过，总结外科手术治疗经验。方法：1992年2月～2003年10月，60例缩窄性心包炎病人均在全麻下行心包剥脱术。均采用左前外侧第4肋间切口进胸。术中尽量切除心包20例，分段切除心包40例。结果：术后7例出现低心排综合征，1例死亡，死亡率1．7％；手术剥离过程中出现右心房破裂2例，右心室破裂5例，均采用邻近心包加压缝合止血，均获成功。余病人症状消失，均痊愈出院。结论：手术是治疗缩窄性心包炎的有效方法，若能早期诊断、手术可获得满意效果。     

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.     

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.     

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.