女性心脏介入术后尿潴留的诱导排尿效果观察

心脏介入术后要求患者多饮水,以利造影剂的排泄[1],并预防造影剂对肾功能的损害,但因术后长时间卧床、肢体制动、患者不习惯在床上平卧位排尿和精神紧张等因素而易发生尿潴留.为减少或避免导尿给患者带来的不适及并发症,降低住院费用,将150例行心脏介入术后的女性尿潴留患者随机分成3组,分别采取按摩下腹部、听流水声、冲洗会阴三种方法对患者进行诱导排尿.     

右位心并冠状动脉畸形1例

患者 ,女 ,5 8岁。因反复胸痛 3年余 ,胸闷气促 1 0余天入院 ,胸痛位于右侧胸前区 ,与活动无关。原诊断内脏反位及高血压 2年。入院体检 :ＢＰ 1 60 /80ｍｍＨｇ( 1ｍｍＨｇ =0 .1 33ｋＰａ) ,两肺未及明显干湿性音 ,右位心 ,心界略扩大 ,心率 80次 /ｍｉｎ ,未及杂音 ,腹平软 ,肝脾肋下未及。入院后彩色多普勒Ｂ超检查提示镜像右位心 ,左房室增大 (左房内径 45ｍｍ ,左室舒张末期内径 61ｍｍ,射血分数 38% ) ,室间隔增厚 (厚度为 1 2ｍｍ) ,内脏及大血管反位。诊断为胸痛待查 ,镜像右位心 ,原发性高血压 ,高血压性心脏病。运动平板试验检…     

家兔动脉粥样硬化与血小板源内皮型氧化氮合酶表达的相关性

Objective To explore the correlation of atheroselerosis progression and the expression of platelet derived endothelial nitric oxide synthase (eNOS) in rabbits. Methods A total of 24 male New Zealand white rabbits were used in this study. Six of the animals were fed with normal food (control group). Eighteen rabbits were fed with cholesterol-rich food (1 g/d) for 12 weeks to establish the atherosclerosis model. Among 18 models, 6 rabbits were executed immediately and their aorta and platelet samples were collected for further analysis (model group), 6 rabbits were orally administered with pravastatin (10 rag/d) for additional 12 weeks (treated group), and the remaining 6 rabbits were left untreated until the end of the study (untreated group). The control, treated and untreated animals were then killed, and the aorta and platelet samples were collected for eNOS expression analysis (RT-PCR). Results The aorta samples in model and untreated group exhibited rough intima and a lot of longitudinal fatty streaks, which indicated that atherosclerosis models were established successfully. While in treated group, the degree of atherosclerosis was decreased. The average percent of thickness of fatty streaks or atheroselerotic plaques relative to the whole thickness of vessel walls was 0. 04±0. 02, 0. 82±0. 16, 0. 33±0. 18,0. 77±0. 14 in control, model, treated and untreated group, respectively. The thickness of fatty streaks or atherosclerotic plaques was significantly increased in the model and untreated groups and decreased in treated group compared with the control group (both P<0. 05). The expressions of platelet derived eNOS/mRNA were 1. 02± 0. 28, 0. 41± 0. 27, 1.00 ± 0. 77, 0. 40±0. 29 in control, model, treated and untreated group, respectively. The expression of eNOS/mRNA was markedly decreased in model group and untreated group compared with the control group, but was increased in treated group compared with untreated and model groups (F=3. 544, P = 0. 024). Conclusions There is a negative correlation between eNOS expression and atherosclerosis development, which suggests that the reversal effect of pravastatin on atheroselerosis progression and plaque formation may relate to the expression of platelet derived eNOS.     

冠状动脉导引钢丝在多发性肺动静脉瘘封堵术中的应用

冠状动脉 (冠脉 )导引钢丝的出现是冠脉介入治疗的革命性进展[1] ,由于导引钢丝的方向可控 ,具有柔软性及一定的推送力和支持力等特点 ,使其在冠脉介入治疗中得到广泛的应用。但其在肺动静脉瘘介入治疗中的作用尚未见报道。本文报道冠脉导引钢丝在两例多发性肺动静脉瘘介入封堵     

艾滋病人常见机会感染的预防

艾滋病人常见机会感染的预防西安医科大学第一临床医学院张树林，岳亚飞机会感染与艾滋病（ＡＩＤＳ）病人的免疫缺陷互为因果，机会感染的处理十分重要。本文就ＨＩＶ病人常见机会感染研究现状简要综述。一、弓形体病弓形体脑炎（ＴＥ）为ＡＩＤＳ病人最常见的中枢神经系...     

低温体外循环期间动脉pH对人体全身摄氧的影响

低温体外循环期间,何为最理想的动脉pH,目前尚有争论。为估价低温体外循环期间动脉 pH 对氧摄取的影响,作者研究了50例冠状动脉架桥或瓣膜置换术中动脉 pH 与摄氧的关系。第1组17例,在衡定的低温期间,通过调节进入氧合器气体的 CO_2分数来改变动脉 pH 值,同时计算出相应的摄氧量。第2组33例,在衡定低温期间,每个患者的动脉 pH 保持不变,而不同患者其 pH 值不一,同时算出相应的摄氧量。结果表明,第1组 pH 为7.31和7.52时,摄氧量分别为31.4ml·m~(-2)·min~(-1)和40.3ml·m~(-2)·min~(-1),     

高渗盐水合并大剂量呋噻米治疗难治性心力衰竭临床研究

符合入选条件的难治性心力衰竭患者103例,随机分为两组,治疗组54例,在常规治疗基础上加用高渗盐水（HSS）并大剂量呋噻米（500-1 000 mg/d）静滴30 min,2次/d,4-10 d为一疗程;对照组49例,在常规治疗基础上只静脉应用大剂量呋噻米,用法同治疗组。观察近期疗效及脑利钠肽（BNP）变化。治疗后所有患者临床症状均有所改善,与对照组比较,治疗组每日尿量及尿钠均明显增加,血钠增高,体质量明显减少,住院时间及再住院率明显降低,BNP水平在第6、30天时明显降低。提示HSS合并大剂量呋噻米治疗难治性充血性心力衰竭安全,短期疗效明显,对患者神经内分泌有调节作用。     

经桡动脉冠状动脉腔内成形术治疗急性冠状动脉综合征

目的　评价急性冠状动脉综合征的患者采用经桡动脉冠状动脉腔内成形术的可行性。方法　急性冠状动脉综合征的患者 96例 ,经桡动脉穿刺冠状动脉成形术 (TRCA)组 5 3例 ;经股动脉穿刺冠状动脉成形术 (TFCA)组 4 3例。观察两组手术的成功率、并发症等。结果　两组手术过程中均无死亡和心肌梗死并发症发生。两组插管成功率分别为 96 2 %与 97 7% ,两组冠状动脉成形术成功率分别为 94 3%与 95 4 % ;两组间差异无显著性。但出血并发症TRCA组为 0 ,而TFCA组为 7 2 % ,两组间差异有显著性 (P <0 0 1)。术后持续卧床时间两组分别为 0与 (12 8± 5 6 )h ;住院天数两组分别为 (2 5± 0 4 )d与 (3 8± 0 6 )d ;两组比较差异均有显著性 (P <0 0 1)。结论　经桡动脉冠状动脉成形术治疗急性冠状动脉综合征安全有效 ,出血并发症少 ,住院时间短 ,且不影响术后患者活动。     

灌洗液温度对腰麻下经尿道前列腺电切术患者中心体温和血流动力学的影响

目的观察灌洗液温度对腰麻下经尿道前列腺电切术(TURP)患者中心体温和血流动力学的影响。方法选择腰麻下行TURP的老年患者80例,随机分为2组,每组40例。对照组膀胱尿道灌洗液为室温液体(21℃),试验组膀胱尿道灌洗液为加温液体(37℃)。2组患者均连续监测收缩压(SBP)、舒张压(DBP)、心率(HR)及体温,术中每10 min对患者进行寒战评分并记录。结果对照组患者在手术前体温为(36.79±0.05)℃,手术结束时下降至(34.59±0.14)℃,降低了2.2℃;试验组手术前体温为(36.89±0.04)℃,手术结束时为(36.17±0.59)℃,体温降低了0.72℃,2组患者间体温变化比较差异有统计学意义(P<0.05)。对照组术中寒战发生率(18例,45%)显著高于试验组(6例,15%)(P<0.05)。2组患者血流动力学指标变化比较差异无统计学意义。结论 TURP中应用加温灌洗液(37℃)可有效地预防围术期低体温的发生,减少寒战的发生。