外科手术与导管介入封堵术治疗动脉导管未闭的临床疗效观察

目的比较应用外科手术与导管介入封堵术治疗动脉导管未闭的临床疗效。方法选取我院2003年1月一2006年4月经超声心动图检查确诊动脉导管未闭患者200例,所有病例根据临床判断已经自然愈合的可能,将所有患者随机分为两组,外科手术组采用非体外循环下动脉导管未闭闭合术;介入封堵术治疗组采用常规右心导管从肺动脉经动脉导管进入降主动脉进行介入封堵术。术后复查心脏彩色超声及心电图检查,观察有无分流,心脏功能的改变和心律失常。检测左、右心室Tei指数、A峰等指标。结果外科手术组和介入封堵术治疗组技术成功率分别为100．0％和99．2％（P〉0．05）,两组动脉导管未闭完全封堵率分别为100．O％和99．0％（P〉0．05）。但是介入封堵术治疗组并发症9例（18．3％）,外科手术组并发症仅2例（1．7％）,两组间的差异具有统计学意义（P〈0．05）。介入封堵术治疗组患者的住院天数和住院费用均高于外科手术组患者,两组间差异均具有统计学意义（P〈0．05）。治疗后两组肺动脉和主动脉收缩压、舒张压术、平均脉均显著不同于外科手术治疗组,两组治疗后三组指标的差异均具有统计学意义（P〈0．05）。外科手术组治疗后心室Tei指数和Vp、R—R均显著优于介入治疗组,治疗后两组间各指标的差异均具有统计学意义（P〈0．05）。结论外科手术治疗动导管未闭具有安全、并发症少、治疗效果好的特点。     

室间隔缺损介入治疗与手术治疗效果的对比研究

目的探讨室间隔缺损（VSD）介入封堵治疗（国产封堵器）的治疗效果,并与外科手术方法进行比较。方法收集符合单一左向右分流VSD 60例,应用国产封堵器介入治疗,研究其可行性及早中期疗效,并与外科手术组比较在疗效、费用、并发症、输血量、住院时间等方面的差异。结果两组手术成功率均为100%,介入封堵组均未输血,外科手术组均行输血治疗（P〈0.01）;术后住院时间介入封堵组少于外科手术组（P〈0.01）;并发症介入封堵组少于外科手术组（P〈0.01）;治疗费用两组比较差异无统计学意义（P〉0.05）。结论应用国产封堵器介入封堵治疗单一VSD操作简单、安全,损伤小,成功率高,早中期疗效满意,与外科手术比较不需输血,住院时间短,并发症少,治疗费用相当。     

高危冠心病患者经桡动脉及经股动脉介入治疗术的疗效比较

目的：探讨高危冠心病患者经桡动脉途径行冠状动脉介入治疗术的临床效果及其对心功能的影响.方法：选择2010年1月至2013年6月我院收治的高危冠心病患者190例,按照介入途径的不同分为经桡动脉介入治疗组（观察组130例）和经股动脉介入治疗组（对照组60例）,观察并比较两组患者行介入术的穿刺成功率、手术成功率、心功能、术后卧床时间、穿刺并发症、下肢深静脉血栓形成发生率、体循环栓塞发生率及肺动脉栓塞发生率等指标.结果：两组患者穿刺成功率和手术成功率比较无明显差异（P＞0.05）;PCI术后两组患者心功能比较差异无统计学意义（P＞0.05）;观察组和对照组在术后卧床时间、穿刺并发症、下肢深静脉血栓形成、体循环栓塞发生率及肺动脉栓塞发生率比较,差异有统计学意义（P＜0.01）,经桡动脉组优于经股动脉组.结论：高危冠心病患者经桡动脉途径与经股动脉途径介入术的治疗效果相当,术后心功能明显改善,且损伤小、并发症少、术后卧床时间短,是一种安全、有效地治疗高危冠心病患者的治疗方法.     

国产封堵器介入治疗先天性心脏病的效果观察

目的探讨进口封堵器与国产封堵器在先天性心脏病治疗中的疗效差别及其对患者心功能的影响。方法选取2013年1月~2015年1月右江民族医学院附属医院心血管内科诊治的68例先天性心脏病患者为研究对象,分为观察组和对照组,两组均采用输送系统实施介入封堵治疗,观察组选用国产封堵器和输送系统实施,对照组选用Amplatzer进口封堵器和输送系统实施。分别观察两组患者一次封堵成功率,术前、术后左向右分流量和分流量占肺循环血流量比例及心功能的变化,并记录所有患者并发症的发生情况。结果观察组患者一次封堵成功率为97.22%,对照组的成功率为93.75%;两组比较差异无统计学意义(χ~2=0.011,P=0.917)。术后4周,观察组患者左向右分流量和分流量占肺循环血流量比例降低幅度大于对照组,但两组比较差异无统计学意义(P>0.05)。观察组患者左房内径(LAd)、左室舒张末期内径(LVDd)降低幅度及左心室射血分数(LVEF)升高幅度大于对照组,两组比较差异具有统计学意义(P<0.05)。观察组患者术后并发症发生率为5.56%,对照组术后并发症发生率为9.38%,比较差异无统计学意义(χ~2=0.019,P=0.891)。结论国产封堵器治疗先天性心脏病的临床疗效与进口封堵器的疗效相当,国产封堵器能更好地促进患者心功能恢复,且价格低廉,安全系数较高,值得在桂西南地区推广应用。     

国产封堵器介入封堵和外科修补治疗膜部室间隔缺损的对比研究

目的研究国产封堵器介入封堵和外科修补治疗膜部室间隔缺损的疗效、并发症。方法对80例膜部室间隔缺损(VSD)患者,外科组40例和TCVSD组40例进行了3~10个月随访,并比较两组的疗效、并发症。结果TCVSD组38例封堵成功(技术成功率95%),术后出现少量残余分流2例(均小于2mm),出现完全性左束支传导阻滞1例,无其他严重并发症发生;外科手术组全部手术成功,无死亡,术后出现残余分流1例(3~4mm),心包积液1例,完全性左束支传导阻滞1例。2组间技术成功率和并发症均无明显差异,而术前、后比较各组组内LVEDD、LVEF、LAD、SPAP、FS均P<0.05;术后组间比较LVEDD、LVEF、LAD、FS、SPAPP均P<0.05,均有显著性差异,具有统计学意义。结论TCVSD术组与外科手术组的成功率和并发症发生率无显著差异。     

室间隔缺损介入治疗与外科修补术后血流动力学及心功能变化的对比研究

目的 探讨介入封堵与外科手术治疗对室间隔缺损(VSD)患者心功能及血流动力学的影响.方法 选择VSD患者30例,其中16例行介入封堵治疗,14例行外科手术治疗,分别于术前及术后3d、1个月、3个月、6个月行超声心动图检查,观察瓣膜峰值流速、左心室大小及心功能变化.结果 VSD介入组与外科手术组患者术后二尖瓣口及肺动脉瓣口峰值流速降低,三尖瓣口峰值流速增加,随访期间无明显改变.两组患者左心室舒张末期前后径(LVEDD)、左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)、左心室搏出量-左心室排血量(LVSV)于术后3d即显示明显减小,并随观察时间延长而进一步改善;但LVEF术后随访期间与术前比较均无明显变化.介入治疗组与外科手术组比较各项指标均无统计学差异.结论 介入封堵术及外科手术治疗室间隔缺损均可迅速扭转血流动力学改变,有效改善左心室功能.     

中老年房间隔缺损患者介入封堵术前后心电图对比分析

目的 探讨中老年房间隔缺损(atrial septal defect,ASD)患者(年龄≥40岁)介入封堵术前后心电图(ECG)的改变.方法 经导管介入治疗成功的305例ASD患者,每例封堵术前及术后24 h均常规行12导联ECG各1次,其中19例术前有各种心律失常行24 h动态心电图检查.观察分析介入封堵前后ECG变化.结果 封堵术后QRS电轴由术前(79.1±36.1)°转变为(76.4±36.8)°,差异有统计学意义(P＜0.05);与术前比较,术后正常心电图比例增加,右束支传导阻滞发生率明显减少(P＜0.01);术后右心房肥大、右心室肥厚例数虽然减少,但差异无统计学意义(P＞0.05);术后窦性心动过缓例数显著增加(P＜0.01),但年龄、缺损直径和封堵器大小与心率≥60次/min的非窦性心动过缓者相比较差异无统计学意义(P＞0.05);7例患者术后出现心房颤动,术后发生心房颤动患者的年龄、缺损直径和封堵器大小与非心房颤动者比较差异有统计学意义(P＜0.01).其他心律失常封堵前后无明显变化(P＞0.05).结论 中老年ASD患者封堵治疗后短期内即可使与右心容量负荷有关的部分心电图指标有所改善,封堵治疗术后可出现新的心律失常,对于已经形成的持续心律失常短期内不会改善.     

小儿室间隔缺损67例封堵术与外科手术治疗对比分析

目的:探讨国产封堵器与外科手术治疗室间隔缺损(VSD)的临床效果。方法:对采用封堵术治疗VSD33例患儿,和同一时期采用外科手术的34例VSD患儿,进行年龄、体重、室间隔缺损大小、手术及住院时间、手术成功率、并发症及费用等对比分析。结果:封堵组与外科手术组的年龄分别为10.54±8.00岁,5.90±4.17岁;体重分别为32.79±13.79kg,18.99±10.07kg;VSD大小分别为6.28±1.99mm,11.77±5.56mm;手术时间分别为0.97±0.15h,3.18±0.73h;住院天数分别为6.24±1.84d,19.38±5.03d。两组VSD患儿的年龄、体重均数比较有显著性差异(P<0.05)。封堵术组的VSD较手术组的小,而且以单纯VSD为主,但手术及住院时间较短。封堵组封堵VSD的成功率为94.3%;外科手术组中14例单纯VSD,合并其他畸形20例,手术成功率为100%,但两组比较无显著性差异(P>0.05)。封堵组术后出现左前分支或完全性右束支阻滞较外科手术组多见。结论:外科手术和介入封堵各有优缺点,临床进行VSD治疗方案的选择时,要进行个体化分析。     

介入封堵术治疗先天性心脏病的疗效分析

目的对介入封堵术治疗先天性心脏病的临床疗效进行分析,为今后临床治疗提供可靠的参考依据。方法抽取我院收治的先心病患者86例,将其分成对照组和观察组,对照组患者接受传统开胸手术治疗,观察组患者则是接受介入封堵术治疗,对这两组患者的治疗情况进行对比。结果两组患者手术成功率、围术期并发症发生率等差异无统计学意义（P〉0.05）;然观察组患者ICU滞留时间、住院时间以及抗生素使用时间等均较对照组发生明显缩短（P〈0.05）。结论经介入封堵术对先天性心脏病进行治疗的临床疗效显著,在保证手术成功率和并发症发生率低的同时可有效缩短患者住院时间,减少了经济负担,值得推广。     

血管腔内介入联合外科手术治疗下肢多节段动脉硬化闭塞症临床分析

目的评价在下肢多节段动脉硬化闭塞症治疗中血管腔内介入联合外科手术的应用效果。方法比较采用血管腔内介入联合外科手术治疗的研究组患者和采用单纯外科手术治疗的对照组患者的手术成功率、ABI变化、临床疗效、并发症发生率、动脉通畅率。结果在手术成功率、ABI变化、临床疗效、并发症发生率、动脉通畅率上,研究组都比对照组有优势,组间差异具有统计学意义(P0.05)。结论血管腔内介入联合外科手术更值得在下肢多节段动脉硬化闭塞症治疗中应用和推广。     

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.