慢性中重度缺血陛二尖瓣关闭不全的外科治疗及中期随访

Objective To compare the results of mitral valve reconstruction and replacement as treatments for moderate to severe ischemic mitral regurgitation(IMR), and report the mid-term outcome. Methods From June 2002 to May 2008, 83 pa-tients with moderate IMR(35 cases) and severe IMR (48 cases) underwent coronary artery bypass grafting(CABG) combined with mitral valvuloplasty (MVP) (n = 43) or mitral valve replacement (MVR) (n = 40). There were 49 males and 34 females with a mean age of (59.3±7.5) years(51 -77years). The procedures of MVP included annuloplasty with a Dacron or autologous per-icardium ring in 21cases, commissural annuloplasty in 9, quadrangular resection of the posterior leaflet in 9 and using St. Jude mitral annuloplasty ring in 4. In the cases underwent MVR, 28 patients received mechanical prostheses and 12 received biopros-theses. Results 30-day mortality rate was 2.3% for MVP and 5.0% for MVR (P >0.05). The 30-day complication rate was similar for the 2 groups but mechanical ventilation time was longer for MVR patients. Mild MR ocurred in 6 patients with MVP (P <0.05). Sevonty-six patients were followed by outpatient department visit or telephone for (20.2 ± 4.9) months (3 - 60 months). During the follow-up period, 7 patients with MVP had mild insufficiency but free off etber complications. All the valve prothesis functioned well. However, 3 cases had thromboembolic complications and 7 late deaths were recorded in MVR group. Five-year complication-free survival rate was 90% for MVP group and 61% for MVR. Conclusion MVP resulted in excellent durability and provided significant mid-term survival benefit over MVR. MVP should be the first choice for patients with chronic IMR.     

基层医院严重多发伤一体化救治模式的效果评价

目前我国基层医院创伤救治尚处于起步阶段,创伤救治没有固定的模式,影响了救治水平和效果。为此,我院结合基层医院自身特点成立了急诊外科急救中心,形成院前急救、院内救治、创伤病房的一体化救治模式。现报告如下。     

32例下颈椎骨折脱位合并脊髓损伤患者的近期随访结果分析

目的探讨下颈椎骨折脱位并颈脊髓损伤后手术治疗及术后综合治疗对患者功能恢复的影响。方法 2008年1月至2010年12月,对32例下颈椎骨折脱位的患者进行了后路减压复位,前路融合固定手术治疗,术后给予药物治疗和中西医结合的综合康复治疗。结果所有手术顺利完成,未发生严重的围手术期并发症。所有患者复位满意,无内固定失败。30例患者获得1年以上随访的患者均获得骨性融合。患者脊髓功能均有不同程度的改善,ASIA分级平均提高1.8级。结论后路单纯减压联合前路融合固定治疗下颈椎骨折脱位临床效果满意,术后中西医结合的综合康复治疗能有效促进患者功能康复。     

慢性中重度缺血陛二尖瓣关闭不全的外科治疗及中期随访

Objective To compare the results of mitral valve reconstruction and replacement as treatments for moderate to severe ischemic mitral regurgitation(IMR), and report the mid-term outcome. Methods From June 2002 to May 2008, 83 pa-tients with moderate IMR(35 cases) and severe IMR (48 cases) underwent coronary artery bypass grafting(CABG) combined with mitral valvuloplasty (MVP) (n = 43) or mitral valve replacement (MVR) (n = 40). There were 49 males and 34 females with a mean age of (59.3±7.5) years(51 -77years). The procedures of MVP included annuloplasty with a Dacron or autologous per-icardium ring in 21cases, commissural annuloplasty in 9, quadrangular resection of the posterior leaflet in 9 and using St. Jude mitral annuloplasty ring in 4. In the cases underwent MVR, 28 patients received mechanical prostheses and 12 received biopros-theses. Results 30-day mortality rate was 2.3% for MVP and 5.0% for MVR (P >0.05). The 30-day complication rate was similar for the 2 groups but mechanical ventilation time was longer for MVR patients. Mild MR ocurred in 6 patients with MVP (P <0.05). Sevonty-six patients were followed by outpatient department visit or telephone for (20.2 ± 4.9) months (3 - 60 months). During the follow-up period, 7 patients with MVP had mild insufficiency but free off etber complications. All the valve prothesis functioned well. However, 3 cases had thromboembolic complications and 7 late deaths were recorded in MVR group. Five-year complication-free survival rate was 90% for MVP group and 61% for MVR. Conclusion MVP resulted in excellent durability and provided significant mid-term survival benefit over MVR. MVP should be the first choice for patients with chronic IMR.     

一期前路病灶清除植骨融合内固定治疗胸腰椎结核

目的总结一期前路病灶清除植骨融合内固定治疗胸腰椎结核的经验。方法采用一期前路病灶清除、自体植骨、前路内固定治疗胸腰椎结核19例。结果平均随访15个月,脊髓神经功能得到不同程度地恢复,术后平均5.2个月达满意植骨融合,无内固定失败和脊柱结核病灶复发,后凸畸形矫正满意,Cobb角平均23.4°,平均矫正21.3°。结论一期前路病灶清除植骨融合内固定术可使病变节段在术后即刻重建稳定性,为脊柱融合和结核病灶的静止提供良好的力学环境,是外科治疗脊柱结核安全、有效的方法。     

大鼠骨髓间充质细胞经SDF-1预处理后移植对急性心肌梗死的治疗效果

目的 探讨大鼠骨髓间充质细胞(BMSC)经基质细胞衍生因子-1(SDF-1)预处理后移植对急性心肌梗死(AMI)的治疗效果.方法 (1)全骨髓贴壁法培养大鼠BMSC;逆转录聚合酶链反应(RT-PCR)和免疫组织化学法检测BMSC趋化因子受体(CXCR4)基因的表达;将BMSC分别与10和100μg/L的SDF-1作用24 h后,在无氧、无血清条件下培养6 h,流式细胞仪和末端标记(TUNEL)法检测细胞凋亡率.(2)建立大鼠急性心肌梗死模型,将经100μg/L SDF-1预处理的BMSC和未经处理的BMSC植入大鼠梗死心肌周边,2周后采用超声心动图观察心脏功能的变化.结果 BMSC表达CXCR4基因;在无氧和无血清条件下,经SDF-1预处理的BMSC凋亡率与对照组比较明显降低(P<0.05),而经100 μg/L SDF-1预处理的BMSC凋亡率最低.成功建立大鼠急性心肌梗死模型;与未经处理的BMSC移植比较,经SDF-1预处理的BMSC移植后改善心肌梗死大鼠的心功能作用更为明显(P<0.05).结论 用SDF-1预处理大鼠BMSC能抑制其在无氧和无血清条件下的凋亡.用SDF-1预处理BMSC能增强其移植后治疗大鼠急性心肌梗死的效果.     

进行性偏侧萎缩症5例报告

1999年8月至2008年5月我科诊治5例进行性偏侧萎缩症,报道如下。例1.女性,42岁,5年前发现进行性左面部萎缩。于2年前开始左颈、左肩亦逐渐萎缩,左上、下肢变细,左乳房缩小。查体：颅神经未见异常。四肢肌力和肌张力正常,反射对称（＋＋）。左面、左颈、左肩、左胸、腹部萎缩,左上、下肢较对侧细,左乳房较右侧小。上述受累部位皮肤松弛而薄,皮下脂肪消失,皮肤弹性差而有皱折,与对侧明显不同。EEG正常,头颅CT扫描未见异常。例2.女性,39岁,于3年前发现右面部萎缩,呈缓慢进行性发展,未引起注意。1年前开始右颈、右肩、右上、下肢亦逐渐萎缩,右乳房变小。查体：颅神经未见异常,四肢肌力和肌张力正常,反射对称（＋＋）。以躯干中线为界,两侧明显不对称。右侧鼻唇沟略浅,右面、右颈、右肩部及右侧躯干萎缩,右上、下肢较对侧细,右乳房较左侧小。受累部位皮肤松弛变薄,没有弹性,有皱折,皮下脂肪消失,颇似老年妇女外貌。EEG及头颅CT扫描未发现异常。例3.女性,46岁,约6年前开始左脸逐渐变小,左脸皮肤变薄,但未能引起注意。1年前发现左上、下肢变细,左手、脚和乳房逐渐变小呈进行性发展。查体：颅神经未见异常,四肢肌力和肌张力正常,     

三维电极氧化与生物处理组合工艺处理渗沥液试验研究

以三维电极氧化与UASB＋BAF组合工艺进行渗沥液降解试验,研究发现：以电压20V、pH5．3～5．5、极距4mm的电解条件降解渗沥液处理效果最佳;且出水COD、色度的去除率分别可达98．5％、98．1％。结果表明,采取该组合工艺能有效去除渗沥液中难降解有机物,出水可达到GB16889--1997的二级排放标准。     

惊厥儿童血清神经元特异性烯醇酶与脑损伤关系的探讨

神经元特异性烯醇酶 (ＮＳＥ)特异存在于神经元和神经内分泌细胞中。据国内外报道脑脊液中ＮＳＥ浓度可作为脑损伤较为理想的生化指标 ,血清ＮＳＥ与惊厥儿童脑损伤关系的研究国内外罕见报道。本研究通过测定惊厥患儿早期血清ＮＳＥ浓度变化 ,以探讨血清ＮＳＥ与脑损伤的关系。　　临床资料 :惊厥组 36例 ,纳入标准 :自 1999年 10月至 2 0 0 0年 4月住院的不同原因引起的惊厥患儿 ,男∶女为 1.2∶1,年龄 5个月至 12岁。病因及例数 :高热惊厥 9例、癫疒间15例 (其中癫疒间持续状态 5例 )、颅内感染 6例、肺炎中毒性脑病 2例、毒蕈中毒 1例、…     

脑脓肿误诊为脑梗塞及脑转移瘤一例

1　病例报告患者男,52岁。因左侧肢体活动欠灵活于1998年1月17日入院。既往有“高血压病”病史4年,“糖尿病”史2年,“甲状腺癌”术后1年。查体:Ｔ36.8℃,Ｐ70次/分,Ｒ19次/分,Ｂｐ22/12ｋＰａ,神志清,精神可,双侧瞳孔正常,口角无歪斜,颈软,双肺无异常,心界无扩大,心率70次/分,节律规整,Ａ2>Ｐ2,瓣膜听诊区未闻及病理性杂音,腹部未见异常,双下肢无浮肿,四肢肌张力正常,左侧肢体肌力4级,右侧5级,左侧巴氏征(±)。血、尿、大便常规正常,电解质及肝肾功正常,血糖8.2ｍｍｏｌ/Ｌ,胆固醇6.9ｍｍｏｌ/Ｌ,胸片及肝肾胆胰Ｂ超、甲状腺Ｂ超均正常,Ｅ…