室间隔缺损合并重度肺动脉高压的治疗

影响先天性心脏病室间隔缺损（简称ＶＳＤ）手术效果的主要因素是肺动脉高压（简称ＰＨ）。我院自１９８７年５月￣１９９３年５月手术治疗ＶＳＤ３０７例，病死率２．９％，其中合并重度ＰＨ（Ｐｐ／Ｐｓ≥８０％）２４例，病死率２０．８％。本文通过对心导管材料、心脏杂音、胸片、心电图等的材料分析，对照手术结果，结合文献，对ＶＳＤ合并重度ＰＨ的手术适应证和围术期的处理加以讨论。     

室间隔缺损合并主动脉瓣关闭不全的外科治疗

我院自１９７４年５月～１９９８年８月共施行室间隔缺损（ＶＳＤ）修补手术１１６０例,其中合并主动脉瓣脱垂（ＡＰ）和域主动脉瓣关闭不全（ＡＩ）５８例,占５％。现对本组病例的临床特点和手术治疗加以分析和讨论。１临床资料１．１一般资料本组５８例中,男３６例,女２２例。年龄２～２１岁,平均７．４±２．５岁．体重８～５８公斤,平均２３．２±１０．１公斤。ＶＳＤ直径０．６ｃｍ～２．５ｃｍ,平均１．３ｃｍ±０．６ｃｍ．同时合并ＡＩ２３例,其中轻度１４例,中～重度９例。１．２ＶＳＤ分类在合并ＡＰ和／或ＡＩ的ＶＳＤ…     

室间隔缺损伴肺动脉高压患儿围术期肺功能变化

目的检测室间隔缺损伴肺动脉高压（ＶＳＤ＋ＰＨ）患儿围术期呼吸力学及呼吸指数变化，探讨其肺功能的变化规律及可能的影响因素。方法以ＮａｖｉｇａｔｏｒＧＭ２５０旁气流型肺功能仪测定术前、术后即刻、术后４ｈ肺动态顺应性（Ｃｄｙｎ），在同一时点检测吸入氧浓度（ＦｉＯ２）并查血气得ＰａＯ２、ＰａＣＯ２值，计算呼吸指数（ＲＩ）。结果术前ＶＳＤ＋ＰＨ组Ｃｄｙｎ明显低于ＶＳＤ组（Ｐ＜０．０１），ＲＩ明显高于ＶＳＤ组（Ｐ＜０．０１），术后两组患儿Ｃｄｙｎ均较术前明显下降（Ｐ＜０．０１），ＲＩ明显增高（Ｐ＜０．０１），ＶＳＤ＋ＰＨ组增高幅度更为明显（Ｐ＜０．０５）。结论伴有肺高压的室间隔缺损患儿肺功能较差。经体外循环心内直视术后其肺功能下降尤为明显，且在术后短期内不能迅速改善。     

卡托普利治疗高血压病伴糖尿病及糖尿病肾病的临床观察

选择２６例原发性高血压（ＥＨ）伴Ⅱ型糖尿病（ＮＩＤＤＭ），其中糖尿病肾病（ＤＮ）１２例，加用卡托普利３７．５～１１２．５ｍｇ／日口服治疗，共４周．结果：收缩压（ＳＢＰ）／舒张庄（ＤＢＰ）由２１．９±２．３／１３．５±０．５ｋｐ＿ａ降为１９．３±１．５／１２．２±０．８Ｋｐ＿ａ（Ｐ＜０．０１），空腹血糖／餐后２小时血糖由１０．７±４．５／１３．７±３．９ｍｍｏｌ／Ｌ减为６．５±１．６／１０．２±２．７ｍｍｏｌ／Ｌ（Ｐ＜０．０１）；２４小时尿蛋白由１．９±０．３ｇ减为０．６±０．３ｇ（Ｐ＜０．０１）．表明该药在降压的同时确有改善糖代谢、降低尿蛋白排泄的作用。     

幼儿先天性心脏病伴肺动脉高压的外科治疗

目的：先天性心脏病伴有肺动脉高压（ＰＨ）是婴幼儿期常见的并发症,尽早手术纠正心内畸形,阻断分流可防止病情进一步恶化。方法：自１９８６ 年８ 月至１９９８ 年５ 月,共收治６ 周岁以下患儿５７ 例,男３４ 例,女２３ 例,年龄２～６ 岁,其中动脉导管未闭（ＰＤＡ）６ 例,房间隔缺损（ＡＳＤ）１４ 例,室间隔缺损（ＶＳＤ）３１ 例,ＶＳＤ合并ＰＤＡ １例,ＶＳＤ合并ＡＳＤ ５例。患儿肺动脉平均压６．６７～９．３ｋＰａ（１ｋＰａ＝ ７．５ ｍ ｍ Ｈｇ）,安静状态下血氧饱和度（ＳａＯ２）大于９５％ ,５ 例患儿活动后ＳａＯ２ 降至８８％ ～９５％ 。５７例患儿中５１ 例在体外循环下行心内修补术。结果：手术死亡５ 例,死亡率８．８％ 。结论：为阻止先天性心脏病合并ＰＨ 的发生和病情的恶化,必须对幼儿期先天性心脏病行早期手术治疗,才可预防肺动脉高压的发生和心肺功能衰竭。应严格掌握手术时机和适应证,保护心肺功能,预防术后发生肺动脉高压危象,其诱因多和缺氧有关,致肺血管痉挛,使患儿病情突然恶化     

人胃、十二指肠粘膜SS，AVP，EK和β－EP含量测定及其临床意义

作者应用放免分析法对２４例十二指肠溃疡（ＤＵ），１５例胃溃疡（ＧＵ）患者胃、十二指肠粘膜进行了生长抑素（ＳＳ），精氨酸加压素（ＡＶＰ）、脑啡肽（ＥＫ）和β－内啡肽（β－ＥＰ）含量测定．同时以２０例慢性浅表性胃炎（ＣＳＧ）为对照．结果表明，ＤＵ患者球、窦和体部粘膜ＳＳ含量（依次为１５３．５±２７．５，３３０．９±２３．９和１７７．１±３０．９ｐｇ／ｍｇ）显著低于（Ｐ＜０．０５）对照（依次为２５３．７±３４．２，５８８．９±８５．３和２８８．８±４０．５ｐｇ／ｍｇ），ＥＫ（依次为９８．６±１３．２，１０８．２±１６．５和５８．５±１０．３）和β－ＥＰ（依次为１１３．０±２２．６，８８．７±１６．８和８２．８±１８．８ｐｇ／ｍｇ）显著高于（Ｐ＜０．０１）对照（ＥＫ依次为５０．１±８．８，６２．９±１１．４和３０．９±３．０；β－ＥＰ依次为８２．３±８．１，３９．８±６．８和４９．８±９．１）．ＤＵ患者球部粘膜ＡＶＰ（５２．３±７．０ｐｇ／ｍｇ）显著高于（Ｐ＜０．０５）ＣＳＧ（３７．７±４．３ｐｇ／ｍｇ）．ＧＵ组上述激素含量与对照组比较均无显著差异．提示：①ＡＶＰ，ＳＳ，ＥＫ和β－ＥＰ在人胃、十二指肠皆有分布；②粘     

经皮穿刺二尖瓣球囊成形术135例临床应用

目的研究总结１３５例经皮穿刺二尖瓣球囊成形术（ＰＢＭＶ）的成功率、效果及并发症。方法采用改良Ｉｎｏｕｅ单球囊技术对１３５例风湿性二尖瓣狭窄（ＭＳ）患者行ＰＢＭＶ。结果术后血液动力学显著改善,左心房平均压（ＭＬＡＰ）从２３．５±６．２降至１０．７±５．１ｍｍＨｇ（Ｐ＜０．００１）,跨二尖瓣压力阶差（ＭＶＰＧ）从１９．４±６．８降至３．８±２．９ｍｍＨｇ（Ｐ＜０．００１）,二尖瓣口面积（ＭＶＡ）从１．０３±０．３２ｃｍ２扩大到２．１４±０．２８ｃｍ２（Ｐ＜０．００１）,左心房内径（ＬＡＤ）从４７．７±６．８ｍｍ缩小至４０．２±６．５ｍｍ（Ｐ＜０．０１）;有１例手术未成功,无１例发生严重并发症。结论表明只要术前准备充分,术中仔细操作,ＰＢＭＶ已成为治疗风湿性ＭＳ安全有效的方法。     

经尿道汽化切割治疗前列腺增生症

经尿道前列腺汽化切割（ＴＶＰ）治疗良性前列腺增生症（ＢＰＨ）５６例。其中２８例单纯采用电汽化切割,另２８例合并使用电切割。两组前列腺症状评分（ＩＰＳＳ）,分别由术前的２９．６±２．８和２８．９±２．６,降至术后的７．６±２．５和６．７±２．７,获得了满意的效果。但术后尿道刺激症及短暂尿失禁,前者明显高于后者（Ｐ＜０．０５）。因此我们提出,在采用ＴＶＰ的同时配合使用ＴＵＲＰ术,既减少或避免了尿道局部症状的发生,又加快了手术的进展。     

小剂量G—CSF对化疗引起的粒细胞减少症的治疗作用

应用小剂量（２μｇ／ｋｇ）粒细胞集落刺激因子（Ｇ－ＣＳＦ）于１８例肺癌患者化疗中，以观察预防发生中性粒细胞减少症的疗效。其中小细胞肺癌５例，非小细胞肺癌１３例，随机分成Ｇ－ＣＳＦ组及对照组各９例，化疗方案为ＣＥ（卡铂－ＶＰ１６）。结果Ｇ－ＣＳＦ组粒细胞绝对计数（ＡＮＣ）＜２．０×１０９／Ｌ，发生例数５例，持续天数为３．６±３．５天；对照组持续天数１６．８±７．１天，Ｐ＜０．０５。ＡＮＣ最低值至恢复正常（ＡＮＣ＞２．０×１０９／Ｌ）的天数Ｇ－ＣＳＦ组及对照组分别为２．６±１．３天，８．９±５．３天（Ｐ＜０．０５）。Ｇ－ＣＳＦ组化疗后的第２０天ＡＮＣ均已恢复正常，ＡＮＣ为（９．７±６．８）×１０９／Ｌ故可在第２２天顺利接受第二周期化疗。对照组ＡＮＣ（１．６６±０．８）×１０９／Ｌ（Ｐ＜０．０１）。由此可见，小剂量Ｇ－ＣＳＦ能有效地防治肺癌化疗引起的粒细胞减少症     

胃癌CD44V6的表达与浸润转移的关系

目的：研究胃癌ＣＤ４４Ｖ６的表达与肿瘤浸润、淋巴结转移的关系。方法：应用ＣＤ４４Ｖ６单克隆抗体,用Ｓ－Ｐ法免疫组织化学技术进行观察。结果：７０例胃癌中２４例（３４．３％）ＣＤ４４Ｖ６阳性。淋巴结转移组ＣＤ４４Ｖ６阳性率４５．７％明显高于无转移组的１２．５％（Ｘ＾２＝１１．２４,Ｐ〈０．０１）;结论：提示ＣＤ４４Ｖ６的表达可作为预测胃癌转移的较好指标。     

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.