先天性心脏病并肺动脉高压围术期的治疗

对47例先天性心脏病（先心病）伴肺动脉高压的病人进行了手术。男31例,女16例,室间隔缺损22例,成人巨大房间隔缺损2例,室间隔缺损并房间隔缺损12例,室间隔缺损合并动脉导管未闭6例,原发孔房间隔缺损2例,室间隔缺损并主-肺动脉间隔缺损、右室双出口并动脉导管未闭及完全性肺静脉异位引流各1例。15例患者行右心导管检查,肺动脉压（73±24）mmHg,全肺阻力（78.0±61.2）kPa/（L/s）,7例患者术中测压,平均肺动脉压（55±13）mmHg,其余为超声心动测压（49±15）mmHg。术前给予吸氧、高压氧及前列腺素E1等治疗,术中应用抑肽酶及低温肺保护液肺动脉灌注等手段。手术死亡率4.3％（2/47）,术后并发症4.3％（2/47）。作者认为,先心病伴肺动脉高压病人围术期的合理治疗可减少术后并发症的发生。     

婴儿先天性心脏病合并肺动脉高压的外科治疗

目的:总结婴儿先天性心脏病合并肺动脉高压的外科治疗和围术期处理的经验。方法:2004年1月～2006年6月共手术治疗婴儿先天性心脏病合并肺动脉高压患者72例,男性45例,女性27例;年龄2个月～1岁,平均(7.3±2.8)月,体重3.5～9.2kg,平均(6.2±3.6)kg。术前肺动脉收缩压为47.4～89.2mmHg,平均(64.3±7.6)mmHg;动脉血氧饱和度81%～98%。结果:手术死亡3例(4.17%)。主要并发症有肺动脉高压危象、低心输出量综合症、肺不张、张力性气胸、呼吸机相关肺炎、血源性感染,呼吸衰竭等。死亡原因:肺动脉高压危象2例,低心输出量综合症1例。术后SaO287%～98%。随访6个月～2年,无晚期死亡,余患者心功能较术前改善。结论:肺动脉高压危象和低心输出量综合症是婴儿先天性心脏病合并肺动脉高压患者术后的主要并发症和死亡原因,早期手术及搞好围术期的处理是提高生存率的关键。     

高海拔地区小儿先心病合并肺动脉高压的围术期护理

目的：探讨高海拔地区小儿先天性心脏病合并肺动脉高压患儿的围术期护理措施和要点。方法：总结56例先天性心脏病合并肺动脉高压患儿手术后护理要点。结果：54例患儿均顺利撤离呼吸机,痊愈出院。2例患儿术后出现肺动脉高压危象,经处理后1例患儿好转出院,1例抢救无效死亡,无护理并发症发生。鳍论：高海拔地区先天性心脏病合并肺动脉高压患者围术期护理,术前要注重吸氧及肺动脉压力的降低;术后要特别加强呼吸道的护理、呼吸机的管理、心功能的维护,才能有效降低肺部并发症,提高手术成功率。     

诊断性治疗先天性心脏病伴重度肺动脉高压围手术期的护理

目的探讨先天性心脏病伴重度肺动脉高压围手术期的观察与护理。方法 32例先天性心脏病伴重度肺动脉高压患儿入院后应用肺血管扩张药物作为诊断性治疗手段,通过动态观察患儿四肢末梢血氧饱和度的变化情况,为筛选手术和评估预后提供依据。对接受手术的患儿术后加强肺高压的监护和呼吸道管理。结果 32例中,26例经治疗后判断肺血管病变尚属可逆性病变,接受了手术治疗;其中,25例治愈出院,1例因术后出现肺动脉高压危象死亡。结论联合应用肺血管扩张药物,可以为肺动脉高压患儿争取到手术治疗的机会。四肢末梢血氧饱和度是判断患儿能否手术的重要观察指标。术后监护的重点在于预防肺动脉高压危象的发生。     

动脉导管未闭50例手术治疗疗效分析

目的总结先天性心脏病动脉导管未闭（PDA）50例手术治疗经验。方法对手术治疗先天性动脉导管未闭（PDA）50例进行回顾性总结分析。结果除1例4月龄患儿重度肺动脉高压因呼吸循环衰竭于术后第1天死亡外，其余病人均痊愈出院，随访均健在，生活质量改善，心脏杂音消失，未发现导管再通病例。结论动脉导管未闭确诊后除有禁忌症外，原则上应手术治疗，手术治疗效果良好，并发症少，病死率低。加强围术期处理是降低手术死亡率的重要措施。     

先天性心脏病合并中重度肺动脉高压82例

先天性心脏病合并中重度肺动脉高压,是先天性心脏病常见的严重并发症之一,手术治疗风险和难度较大,术前准备、术后管理非常重要.我院于2002-05至2009-04手术治疗先天性心脏病合并中重度肺动脉高压患者82例,临床近、中期疗效良好.     

高原体外循环血浆内皮素-1、一氧化氮含量变化对肺动脉高压的影响

目的：观察高原地区体外循环(CPB)心内直视术围术期血浆内皮素—1(ET—1)与一氧化氮(NO)含量变化，探讨其与肺动脉高压的关系；方法：选择2002年6月至2002年8月在高原地区(3700m)开展CPB手术的先天性心脏病患者24例(非肺动脉高压10例，肺动脉高压14例)，围术期内检测ET—1、NO的动态变化，结合肺动脉压的变化进行分析；结果：与非肺动脉高压组相比，肺动脉高压组在围术期内血浆ET—1、NO含量变化差异显著，ET—1／NO与肺动脉压的改变密切相关；结论：高原地区PB可引起ET—1／NO含量变化，又与肺动脉高压关系密切。ET—1／NO失衡是CPB心内直视术围术期肺动脉压变化的重要因素。     

先天性心脏病伴重度肺动脉高压的外科治疗

目的 :总结先天性心脏病 (先心病 )合并重度肺动脉高压 (肺高压 )外科治疗和围术期处理的经验。方法 :2 0 0 0 - 0 4～ 2 0 0 3- 0 4共手术治疗合并重度肺高压的先心病患者 4 8例 ,男 2 0例 ,女 2 8例 ,年龄 2～ 4 7岁 ,平均 (17.0± 10 .5 )岁。术前肺动脉和体动脉收缩压比 (Pp/Ps)均 >0 .75 ,平均 0 .98± 0 .18,动脉血氧氧饱和度 (SaO2 ) 72 %～ 94 %。结果 :手术死亡 3例 (6 .2 5 % )。主要并发症 :低心排血量 14例 ,肺高压危象 4例 ,阵发性室上性心动过速 4例 ;死亡原因 :低心排血量 2例 ,呼吸衰竭 1例。术后SaO2 90 %～ 97% ,平均 (93± 1.3) %。随访 3个月～ 3年 ,死亡 1例 ,余患者心功能 (NYHA)均较术前改善。结论 :低心排血量和肺高压危象是合并重度肺高压的先心病患者术后的主要并发症和死亡原因 ,搞好围术期的处理是提高生存率的关键     

复杂先天性心脏病合并严重肺动脉高压婴幼儿术后呼吸系统的护理

复杂先天性心脏病患儿在新生儿或婴幼儿期即处于危重状态,如果不及时给予手术治疗,绝大部分因难以救治的肺炎合并心力衰竭或严重缺氧而导致死亡[1].肺动脉高压是左向右分流先天性心脏病常见的一种严重并发症,容易在术后早期诱发肺动脉高压危象,由于患儿低龄、低体重,术后病情变化快而复杂,呼吸系统的护理尤为重要,如处理不得当、不及时将会危及患儿生命.我院2005年6月～2008年12月共收治16例复杂先天性心脏病合并肺动脉高压的患儿,现将术后呼吸系统的护理要点总结如下.     

40例婴幼儿室间隔缺损合并重度肺动脉高压的术后护理

先天性心脏病室间隔缺损合并中重度肺动脉高压患儿病情严重,这些患儿不论手术还是护理有它不同于儿童和成人心脏病的特殊性[1],许多因素都可以导致病情恶化,而且手术治疗并发症多,如肺动脉高压危象、肺部感染、低心排、心律失常、心衰等,这也是导致患儿死亡的主要原因,加强术后护理是提高手术成功率的有效措施.我科2009年9月~2010年10月共收治室间隔缺损合并重度肺动脉高压患儿40例,现将其术后护理体会报告如下.     

Knee injury and Osteoarthritis Outcome Score (KOOS) - validation of a Swedish version

The Knee injury and Osteoarthritis Outcome Score (KOOS) is a self-administered instrument measuring outcome after knee injury at impairment, disability, and handicap level in five subscales. Reliability, validity, and responsiveness of a Swedish version was assessed in 142 patients who underwent arthroscopy because of injury to the menisci, anterior cruciate ligament, or cartilage of the knee. The clinimetric properties were found to be good and comparable to the American version of the KOOS. Comparison to the Short Form-36 and the Lysholm knee scoring scale revealed expected correlations and construct validity. Item by item, symptoms and functional limitations were compared between diagnostic groups. High responsiveness was found three months after arthroscopic partial meniscectomy for all subscales but Activities of Daily Living.     

Endovascular management of carotid-cavernous fistulas

Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas （CCF） and their complications such as pseudoaneurysms. Methods： Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coll embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stem management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% （4/22）. A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% （8/22）. Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.     

The acutely limping child

Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered.     

Do Balance Board Training Programs Reduce the Risk of Ankle Sprains in Athletes?

Introduction Ankle sprains are the most common musculo-skeletal injury that occurs in athletes,particularly in sports that require jumping and landing on one foot such as soccer,and basketball(1-4).These injuries often result in significant time loss from participation,long-term disability,and have a major impact on health care costs and resources(5-8).     

High Intensity Interval Training:New Insights

KEY POINTS ·High-intensity interval training(HIT)is characterized by repeated sessions of relatively brief，intermittent exercise.often performed with an“a11 out”effort or at an intensity close to that which elicits peak oxygen uptake(i.e.，≥90%of VO2 peak).     

Developmental validation of the PowerPlex(®) ESI 16 and PowerPlex(®) ESI 17 Systems: STR multiplexes for the new European standard

In response to the ENFSI and EDNAP groups’ call for new STR multiplexes for Europe, Promega^® developed a suite of four new DNA profiling kits. This paper describes the developmental validation study performed on the PowerPlex^® ESI 16 (European Standard Investigator 16) and the PowerPlex^® ESI 17 Systems. The PowerPlex^® ESI 16 System combines the 11 loci compatible with the UK National DNA Database^®, contained within the AmpFlSTR^® SGM Plus^® PCR Amplification Kit, with five additional loci: D2S441, D10S1248, D22S1045, D1S1656 and D12S391. The multiplex was designed to reduce the amplicon size of the loci found in the AmpFlSTR^® SGM Plus^® kit. This design facilitates increased robustness and amplification success for the loci used in the national DNA databases created in many countries, when analyzing degraded DNA samples. The PowerPlex^® ESI 17 System amplifies the same loci as the PowerPlex^® ESI 16 System, but with the addition of a primer pair for the SE33 locus. Tests were designed to address the developmental validation guidelines issued by the Scientific Working Group on DNA Analysis Methods (SWGDAM), and those of the DNA Advisory Board (DAB). Samples processed include DNA mixtures, PCR reactions spiked with inhibitors, a sensitivity series, and 306 United Kingdom donor samples to determine concordance with data generated with the AmpFlSTR^® SGM Plus^® kit. Allele frequencies from 242 white Caucasian samples collected in the United Kingdom are also presented. The PowerPlex^® ESI 16 and ESI 17 Systems are robust and sensitive tools, suitable for the analysis of forensic DNA samples. Full profiles were routinely observed with 62.5 pg of a fully heterozygous single source DNA template. This high level of sensitivity was found to impact on mixture analyses, where 54–86% of unique minor contributor alleles were routinely observed in a 1:19 mixture ratio. Improved sensitivity combined with the robustness afforded by smaller amplicons has substantially improved the quantity of data obtained from degraded samples, and the improved chemistry confers exceptional tolerance to high levels of laboratory prepared inhibitors.