不完全纵膈子宫中晚期妊娠超声检查的临床诊断价值

〔摘 要〕 目的：评估不完全纵膈子宫中晚期妊娠患者实施超声检查的临床诊断价值。方法：将 2018 年 4 月至 2019 年 4 月北镇市妇幼保健计划生育服务中心诊治的 45 例不完全纵膈子宫中晚期妊娠患者纳入本研究,所有患者均予行超声检查, 讨论其超声诊断结果与优势。结果：45 例患者中,经由超声诊断确诊为不完全纵膈子宫患者共计 43 例,准确率为 95.56 %。 超声声像图可见其宫腔上段横截面为 “ 哑铃状 ” 有 38 例,占比 84.44 %,患者子宫纵膈上部与宫底子宫肌层可见加厚现象, 其厚度为 2.2 ~ 5.3 mm,厚度均值是（3.47 ± 0.61）mm。宫底部胎盘增厚或变形患者 12 例,占比 26.67 %。所有不完全纵 膈子宫中晚期妊娠患者中,13 例患者正常分娩,占比 28.89 %;余下 32 例均为剖宫产分娩,占比 71.11 %。共计 42 例患者 胎位异常,占比 93.33 %,其中胎儿横位 23 例,占比 51.11 %;胎儿臀围 9 例,占比 20.00 %。结论：不完全纵膈子宫中晚 期妊娠患者通过超声检查的准确度较高。     

参松养心胶囊干粉提取液对兔肺静脉肌袖心肌细胞动作电位和部分离子通道的影响

目的 探讨参松养心胶囊干粉提取液对兔肺静脉肌袖心肌细胞(PVC)动作电位和某些离子通道的影响,对治疗心房颤动的可能机制.方法 采用全细胞膜片钳技术的电流钳记录动作电位和电压钳制记录兔肺静脉肌袖心肌细胞动作电位、L-型钙离子通道电流(LCa-L)、内向整流钾电流(IK1)和瞬时外向钾电流(ITo),并观察不同浓度参松养心干粉提取液对动作电位和各离子通道电流的影响.结果 参松养心干粉提取液明显延长PVC动作电位时程(APD),APD90基础状态下(187±49)ms,在浓度5 mg/ml时延长至(286±76)ms(P<0.05),在浓度10 mg/ml时延长至(312±82)ms(P<0.05);参松养心胶囊干粉提取液对PVC的LCa-L、IK1,和ITo电流呈浓度依赖性抑制作用.结论 参松养心胶囊干粉通过对肺静脉多个离子通道的作用,可能对心房颤动起到治疗作用.     

外伤性硬膜窦血栓一例

患者 女,54岁.因头外伤3 d伴头痛恶心入院.3 d前患者乘坐汽车,因道路颠簸,头顶碰在车顶上,当时受力局部头痛,2 d前出现持续性全头胀痛.入院查体:无明显阳性体征.患者既往体健,近来未服用任何药物,月经不规律,尚未绝经.凝血酶原时间、活化部分凝血活酶时间、纤维蛋白原、凝血酶时间各项值均正常.头CT提示:窦汇、右侧横窦、部分矢状窦、直窦血栓形成.入院诊断:硬膜窦血栓.     

CT导引下尿激酶溶解治疗高血压脑出血22例

高血压脑出血为神经科常见急症 ,病死率、病残率极高[1] ,存活者中重残率40 %以上。我们于 1994年来采用ＣＴ导引下立体定向尿激酶 (ＵＫ)溶解抢救治疗重症高血压脑出血 2 2例 ,取得了满意的疗效 ,现报告如下。1　资料与方法1.1　一般资料　高血压脑出血患者 2 2例 ,其中男 8例 ,女 14例 ,年龄 2 9～ 72岁 ,平均 5 7岁。发病至就诊时间 2ｈ～ 7ｄ。其中浅昏迷者 16例 ,中度昏迷者 4例 ,深昏迷 2例。二次出血 2例 ,并发脑梗死 2例。1.2　血肿部位及出血量　血肿位于丘脑内囊区 9例 ,壳核、外囊区 12例 ,小脑半球1例 ,其中破入脑室者 14例。出…     

食管造影及温度监测指导环肺静脉消融治疗心房颤动

Objective Because of the severe consequences of an atrial esophageal fistula,it is vital to avoid this complication. The most safe way is to avoid ablating the segment of esophagus behind left atrium (LA). What we do is to image the relationship of esophagus to posterior LA wall and real-time esophageal tem-perature monitoring to ablate the posterior LA wall. Methods Sixty-four patients with paroxysmal atrial fibrilla-tion (PAF) were enrolled to pulmonary veins (PV) isolation. Swallowing a radiocontrast agent at the same time when imaging of LA to observe the relationship of esophagus to posterior LA wall and according to the different relationship between the segment of esophagus behind LA and PV, the esophagus were divided into type Ⅰ , type Ⅱ and type Ⅲ. A esophageal temperature probe was inserted and advanced into the esophagus directly posterior to the LA. Three steps ablation strategy and real-time esophageal temperature monitoring were applied to guide the PV isolation. The procedure was interrupted when the esophageal temperature was 39℃ until] the tempera-ture renormalized and ended when PV were isolated. Results There were 48 type ⅠI , 11 type Ⅱ and 5 type Ⅲ esophagus in the 64 patients. After three steps ablation,all PV isolations were completed. Only 18.8% of the patients needed to ablate the posterior LA close to the esophagus. Conclusion Only one PV ostiolum close to the posterior LA wall in most PAF patients and many of them can achieve complete PV isolation without ablating the posterior LA close to esophagus which could minimize the risk of esophageal injury dramatically.     

食管造影及温度监测指导环肺静脉消融治疗心房颤动

Objective Because of the severe consequences of an atrial esophageal fistula,it is vital to avoid this complication. The most safe way is to avoid ablating the segment of esophagus behind left atrium (LA). What we do is to image the relationship of esophagus to posterior LA wall and real-time esophageal tem-perature monitoring to ablate the posterior LA wall. Methods Sixty-four patients with paroxysmal atrial fibrilla-tion (PAF) were enrolled to pulmonary veins (PV) isolation. Swallowing a radiocontrast agent at the same time when imaging of LA to observe the relationship of esophagus to posterior LA wall and according to the different relationship between the segment of esophagus behind LA and PV, the esophagus were divided into type Ⅰ , type Ⅱ and type Ⅲ. A esophageal temperature probe was inserted and advanced into the esophagus directly posterior to the LA. Three steps ablation strategy and real-time esophageal temperature monitoring were applied to guide the PV isolation. The procedure was interrupted when the esophageal temperature was 39℃ until] the tempera-ture renormalized and ended when PV were isolated. Results There were 48 type ⅠI , 11 type Ⅱ and 5 type Ⅲ esophagus in the 64 patients. After three steps ablation,all PV isolations were completed. Only 18.8% of the patients needed to ablate the posterior LA close to the esophagus. Conclusion Only one PV ostiolum close to the posterior LA wall in most PAF patients and many of them can achieve complete PV isolation without ablating the posterior LA close to esophagus which could minimize the risk of esophageal injury dramatically.     

唇鳞癌中VEGF表达和微血管密度的临床意义

目的：研究微血管密度(microvessel density,MVD)和血管内皮生长因子(vascular endothelial growth factor,VEGF)在唇鳞癌中的表达，探讨其临床意义。方法:采用SABC免疫组织化学染色方法检测37例唇鳞癌中MVD和VEGF的表达，采用SPSS软件行统计分析。结果：62．16％唇癌组织呈VEGF阳性表达。VEGF表达阳性的唇癌组织MVD显著高于VEGF表达阴性者(P＜0．05)。VEGF表达与肿瘤的分化程度、淋巴结转移及浸润深度密切相关，而与肿瘤的临床分期无关。MVD记数与肿瘤的分化程度、淋巴结转移、浸润深度及临床分期密切相关。结论：唇癌组织VEGF表达与微血管密度有明显的相关性，是唇癌主要的新生血管诱导因子之一，VEGF、MVD可做为反映唇癌生物学行为的一个有效指标。     

通心络对大鼠心肌梗死后心肌炎症反应及肿瘤坏死因子-α表达的影响

目的 研究通心络对大鼠心肌梗死后心肌炎症反应及肿瘤坏死因子-α（tumor necrosis factor-α,TNF-α）表达的影响.方法 应用结扎冠脉前降支的方法制备大鼠心梗模型,将SD大鼠随机分为3组：假手术组、心梗组、通心络干预组[2.0g/（kg·d）],应用组织病理学的方法观察术后1、2及4周梗死区与非梗死区炎性细胞浸润的情况;以半定量RT-PCR及蛋白免疫印迹（Western blot）的方法检测炎性因子TNF-α的表达情况.结果 心肌梗死后1周及2周,在心梗组及通心络干预组,梗死区与非梗死区炎性细胞浸润明显,至心肌梗死后4周,炎症反应消退,但TNF-α表达持续增加.通心络干预后炎性细胞浸润减轻,TNF-α表达降低.结论 通心络能减轻心梗后心肌炎症反应,降低炎性因子TNF-α的表达,发挥抗炎作用.     

永久起搏器植入常见并发症及防治措施

目的 回顾性分析710例永久起搏器植入术并发症的发生率及原因,以提高起搏器植入技术的安全性和有效性.方法 连续选择2005年1月至2010年6月在我院行永久起搏器植入术的患者710例,随访0.5 ～6年,观察并发症的发生率及原因.结果 起搏器植入常见的并发症分别是囊袋内积血及血肿（n=10,1.41％）、电极导线移位（n=8,1.25％）、起搏阈值升高（n=6,0.93％）及囊袋侵蚀（n=2,0.28％）.出血的发生与年龄偏大有关;电极导线的脱位主要是电极导线固定不良所致;囊袋侵蚀与患者体型偏瘦、囊袋制作偏小,或与原起搏器形状不相称引起皮肤受压缺血有关.结论 随着技术熟练及采取相应措施,可以减少并发症发生.     

静脉注射伊布利特与胺碘酮转复消融术后复发房性心动过速的对比研究

目的观察和比较伊布利特和胺碘酮转复心房颤动（房颤）射频消融术后早期复发房性心动过速（房速）的疗效和安全性。方法连续46例接受房颤射频消融后复发房速的患者,男性32例,女性14例,平均年龄（56±12）岁,分别静脉应用伊布利特（ibutilide,1．0mg／次,1～2次,10min内静脉推注）和胺碘酮（150me,／次,1～2次,10min内静脉推注）。观察转复率和转复时间,记录不良反应。结果4h内伊布利特组和胺碘酮组转复率分别为86．4％和41．7％（P=0．0023）;24h时内转复率分别为90．9％和62．5％（P=0．0376）。伊布利特组对持续时间〈24h的房速转复率为100％,胺碘酮组转复率为66．7％（P=0．0421）。伊布利特组平均转复时间为（13±8）min,胺碘酮组转复时间为（364-25）min（P〈0．01）。两组均未发生致命性不良反应,不良反应发生率差异无统计学意义。结论伊布利特和胺碘酮均能终止射频消融术后复发房速,伊布利特更快速、安全、有效。