婴幼儿先心病不阻断升主动脉心内直视手术42例分析

目的：分析４２例〈３岁的婴幼儿在不阻断升主动脉下,行心内直视手术的效果。方法：４２例患儿均常规建立体外循环,不阻断升主动脉,不做心脏停跳液灌注,转机后立即阻断上下腔静脉,其中１１例小体重复杂先心者降温,使心脏完全停跳后行心内操作,余３１例均在浅低温或常温心脏跳动下行心内操作,体外循环时间１０￣８７ｍｉｎ,平均３７．６４ｍｉｎ。结果：本组４２例死亡２例,余４０例均痊愈出院。经术后半年随访３６例,无任     

常温心脏不停跳心内直视手术43例报告

１９９２年８月至１９９３年１２月，我科采用常温心脏不停跳心内直视手术纠正各种心脏畸形４３例，该手术主要特点是心肺转流建立后不降温，不阻断主动脉，阻断腔静脉，在心脏空跳情况下手术。术中鼻温维持在３５－３７℃。腔静脉平均阻断时间１９．９ｍｉｎ，体外循环平均转流时间３１．５ｍｉｎ。全组病例术中自始至终维持窦性心律。心内操作结束，不需要进行心脏复苏，不需要等待复温，停止体外循环，结束手术，术后无并发症，结果全部痊愈出院。     

心肌缺血再灌注对心脏合成一氧化氮影响的临床研究

从临床角度出发，观察体外循环心内直视手术中心肌缺再灌注对心脏合成一氧化氮水平的影响。选用的病例为单纯室缺患者（ｎ＝１４）。在体外循环心内手术中，分别于阻断主动脉前，开放主动脉后１ｍｉｎ，５ｍｉｎ，２０ｍｉｎ，采取主动脉根部血液，冠状静脉窦血液。镀铜镉法测定血样中的ＮＯ２＾－／ＮＯ３＾－浓度。用同一采血时点的冠状静脉窦￣主动脉根部血液中ＮＯ２＾－／ＮＯ３＾－浓度差代表核时点心脏合成一氧化氮水平。实验     

常温不停跳心内直视手术冠脉血心肌酶活性变化

目的：观察常温心脏不停跳心内直视手术与冷停跳手术冠脉血心肌酶学的变化,明确不停跳手术对心肌保护的保护作用。方法：２８例心内直视手术病人随机分成不停跳与冷停跳组,每组１４便。不停跳组分别于体外循环前,体外循环１５ｍｉｎ、体外循环停止时及停后３０ｍｉｎ、６０ｍｉｎ采血。冷停跳组分别于体外循环前、主动脉阻断时、 主动脉开放时、开放后３０ｍｉｎ、６０ｍｉｎ采冠脉血测心肌酶。结果：不停跳组体外循环开始后各时     

常温体外循环心脏不停跳心内直视手术(附8例报告)

我院自1986年4月开始应用常温体外循环心脏不停跳心内直视房间隔缺损修补术8例．手术基本方法：建立体外循环后不阻断主动脉，术中鼻温维持在34℃～38℃，心脏不停跳下进行手术．本组始终维持窦性心律，腔静脉平均阻断时间为21分～2分，心内操作结束后不需进行心脏复苏，不需复温，停止体外循环，结束手术．均治愈出院．     

微创小切口体外循环心脏手术20例

目的：探索心脏外科微创新技术。方法：２０例患者，行主动脉瓣替换术者经第２肋间正中横切口，行室缺修补、房缺修补及二尖瓣替换术者经后胸骨旁纵切口，儿童８￣１０ｃｍ，成人１０￣１２ｃｍ；升主动脉阻断１８￣１１０ｍｉｎ。结果：术中术后出血量明显减少，其中８例（４０％）未输血。结论：微创小切口体外循环心脏手术有创伤小、恢复快、疼痛轻、出血少等优点，但其视野小，操作要求高，遇有特殊情况时处理较困难，应严格掌握     

心脏不停跳心内直视手术瓣体外循环灌注管理

目的：探讨心脏不停跳心内直视手术的体外循环灌注管理。方法：８０例心内直视术，体外循环采用血液稀释，完全心肺转移期间保持心脏跳动，高流量灌注，鼻咽温维持３２￣３５℃。结果：转流时间１８￣１９０ｍｉｎ，其中先天性心脏病（４８±３０）ｍｉｎ，瓣膜病（９９±４８）ｍｉｎ；８例在转流初期一过性低血压，蓁平均动脉压（ＭＡＰ）在６．６７￣１２ｋＰａ，转流中无室颤；５％碳酸氢钠溶液用量（１０．３±６．２）ｍｌ，碱     

浅低温不阻断升主动脉心内直视手术体外循环总结

为观察浅低温不阻断升主动脉体外循环心内直视手术的效果。对５０７例病人常规插管建立体外循环,阻断上、下腔静脉,不阻断升主动脉,不灌注心肌保护液。依据手术、心跳情况选择适当的降温,鼻温控制在３０℃左右,心跳在４０～６０次／ｍｉｎ。术中室颤７３例,占１４．４％（７３／５０７）,ＭＡＰ在５０ｍｍＨｇ左右,体外循环时间８～１３５ｍｉｎ,平均３７．０４ｍｉｎ。结果本组死亡４例,余５０３例均痊愈出院,短期随访效果良好。该方法避免了心肌缺血、再灌注损害和心肌深低温、电除颤等医源性损害,简化了手术操作步骤,减少了术后并发症。     

不阻断主动脉心脏直视手术

常温或低温体外循环下阻断腔静脉，不阻断升主动脉和冠状动脉血流进行心脏直视手术１６７例，十余病种。在心脏跳动或诱颤下实施手术，最大限度减轻心肌缺血再灌注损伤。本组手术死亡率１．１％（２／１６７），余病例术后恢复顺利，无低心排综合症或脑部等并发症。就该方法的利弊和安全性进行简要讨论     

浅低温体外循环心内直视手术中的心肌保护（65例报告）

６５例浅低温体外循环心内直视手术中采用二种心肌保护法。Ａ组（２５例）用４：１血液晶体停跳液（Ｓａｍｕｅｌ法），Ｂ组（４０例）用微量晶体停跳液（Ｍｅｎａｓｃｈｅ法）。体外循环不降温，阻断主动脉期间冠状循环用８￣１０℃氧合机血（红细胞压积２５％左右）持续灌注。阻断主动脉后两组心脏均迅速停跳，停跳期间心脏均呈鲜红色，柔软滑润；开放主动脉后心脏迅速恢复活动，在２ｍｉｎ内除各有２例经电除颤复跳外，均自动恢复     

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.