PCI及溶栓疗法对AMI患者的疗效及再灌注的影响

目的:比较经皮冠状动脉介入治疗(PCI)及溶栓治疗对急性心肌梗死(AMI)患者的疗效及再灌注的影响。方法:选择2013年1月~2016年12月我院收治的AMI患者118例作为研究对象,并被分为溶栓组(38例)及PCI组(80例),比较两组疗效、心功能及再灌注指标。结果:与溶栓组比较,PCI组总有效率(84.21%比97.50%)显著升高,而总不良事件率(18.42%比2.50%)显著降低(P均<0.01)。与治疗前比较,治疗后两组左室收缩末内径(LVESd)、PCI组的左室舒张末内径(LVEDd)显著降低,两组肌酸激酶同工酶(CK-MB)水平均显著升高,P均=0.001。与溶栓组比较,PCI组治疗后LVEDd[(32.45±2.21)mm比(29.86±3.96)mm]、LVESd[(49.85±1.32)mm比(46.86±2.34)mm]降低更显著,CK-MB水平[(389.74±2.74)ng/ml比(706.96±3.78)ng/ml]升高更显著,P均=0.001。结论:与溶栓治疗相比,PCI治疗AMI的效果更显著,改善患者心功能更显著,而且CK-M水平升高更显著,具有更好的临床价值。     

视神经萎缩42例临证观察

一、临床资料一般情况:本组患者均有不同程度的视力减退、视野缩小,经其它治疗效果不佳,病情逐渐发展加重。本组男,27例;女,15侧。25岁以下3例,25—35岁2例,36—45岁15例,46—55岁7例,56—65岁3例,65岁以上12例。病程3年以下5例,4—6年15例,7—11年10例,12—19年5例,19年以上7例。双眼发病28例,单眼发病14例,共70只眼。其中视力分布:黑蒙、光感、手动、指数15只眼,视力在0.01     

双切口和双侧内固定治疗复杂胫骨平台骨折24例

目的 探讨双切口和双侧内固定治疗复杂胫骨平台骨折的效果.方法 应用前外侧和后内侧双切口及双侧钢板固定治疗24例复杂胫骨平台骨折.结果 24例患者随访时间为10～30个月.骨折均获愈合,时间为15～24周.按Rasmassen评分标准,优12例,良9例,可3例,优良率为87.5%.切口无感染和裂开,无内固定失效.结论 只要严格选好手术时机,操作正确,双切口和双侧内固定治疗复杂的胫骨平台骨折是一种有效可行的方法.     

超声定量诊断慢性乙型肝炎肝纤维化的临床价值探讨

目的 探讨超声定量诊断慢性乙型肝炎(CHB)肝纤维化的临床价值.方法 采集186例有肝活组织病理检查结果的CHB患者的超声标准声像图,观测肝包膜厚度,并提取声像图纹理的14个灰度共生矩阵参数,与肝纤维化病理诊断进行比较.各定量指标在纤维化病理分期间的差异及与其相关性分别采用方差分析和Spearman相关分析,由定量指标分别建立对纤维化分期和分组的判别分析模型.结果 14个灰度共生矩阵参数和肝包膜厚度共15个指标中,仅方差(F=0.55,r=0.06;均P＞0.05)、均值和(F=0.61,r=0.05;均P＞0.05)、和熵(F=1.68,r=0.09;均P≥0.05)及熵(F=1.39,r=0.12,P＞0.05)在病理分期间的差异无统计学意义且与其不相关.交互检验表明,建立的判别分析模型对肝纤维化按S0至S4分期正确率分别为80.0%、64.9%、61.3%、74.1%和80.6%,73.1%的病例能被准确分期,诊断不同程度纤维化的敏感度、特异度、准确度,≥S1为97.6%、80.0%、91.9%,≥S2为92.1%、89.7%、90.9%,≥S3为94.8%、96.1%、95.7%,S4为80.6%、97.4%、94.6%.按S0无纤维化、S1轻度纤维化、S2和S3中重度纤维化、S4早期肝硬化分组,正确率分别为81.7%、78.4%、56.9%和90.3%,74.7%的病例能被准确分组,诊断不同程度纤维化的敏感度、特异度、准确度,≥轻度纤维化为97.6%、81.7%、92.5%,≥中重度纤维化为83.1%、94.8%、89.2%,早期肝硬化为90.3%、93.5%、93.0%.结论 无创的超声检查结合声像图纹理分析对定量诊断CHB肝纤维化具有一定参考价值.

Abstract：

Objective To evaluate the value of ultrasonic quantitative method in the diagnosis of liver fibrosis in chronic hepatitis B (CHB) patients. Methods Ultrasonography was performed in 186 CHB patients who underwent liver biopsies. Fifteen indices including liver capsule thickness and fourteen texture parameters of gray level co-occurrence matrix were extracted from standard sonograms and compared with fibrosis stages by histopathology. The status of liver fibrosis was divided into five stages from S0 to S4 by histopathology based on the disease severity. ANOVA and Spearman correlation analysis were applied to analyze the differences and relationships between these indices and pathological stage, respectively. Then discriminant analysis models were established based on the indices for quantitative diagnosis of liver fibrosis. Results Among the fifteen indices, including liver capsule thickness, only the variance (F=0. 55, r=0. 06; both P＞0. 05), sum average (F=0.61, both r=0.05 ; P＞0.05), sum entropy (F=1.68, r=0.09; both P≥0.05) and entropy (F=1.39,r=0.12; both P＞0.05) were not significantly associated with the stages and not manifested linear correlation. Using biopsy results as gold standard, the correct rank rate of discriminant analysis model analysis in the patients staged from S0 to S4 were 80. 0%, 64. 9%, 61.3%, 74. 1% and 80.6 %, respectively. There were 73.1% of cross-validated cases who were accurately classified by the model analysis. The sensitivity, specificity and accuracy in patients with stage ≥ 1 were 97. 6%,80.0% and 91.9%, respectively; those in patients with stage≥2 were 92.1%, 89.7% and 90.9%,respectively; those in patients with stage≥3 were 94.8%, 96.1% and 95.7%; and those in patients with stage 4 were 80. 6%, 97.4 % and 94.6%, respectively. When considered S0 as no fibrosis, S1 as mild fibrosis, S2 and S3 as moderate to severe fibrosis and S4 as early cirrhosis, the consistence rates between discriminant analysis model and biopsy result were 81.7%, 78. 4%, 56. 9% and 90.3%,respectively. There were 74.7% of cross-validated cases who were correctly classified. The sensitivity, specificity and accuracy of the models for determining the fibrosis severity in patients≥mild fibrosis were 97.6%, 81.7% and 92.5%, respectively; those in patients ≥ moderate to severe fibrosis were 83. 1%, 94.8% and 89.2%, respectively; those in patients with early cirrhosis were 90.3%, 93.5% and 93.0%, respectively. Conclusion As a novel and noninvasive method, ultrasonic texture analysis could quantitatively determine liver fibrosis in CHB patients and is worthy of further investigation.     

超声定量诊断大鼠肝纤维化的研究

目的 探讨超声定量诊断大鼠肝纤维化的价值.方法 收集正常或肝纤维化大鼠共90只的标准化声像图,观测肝包膜厚度并提取声像图纹理的13个灰度共生矩阵参数(熵、对比、方差、均值和、方差和、和熵、方差差、差熵及相关信息2递增、相关信息1、角二阶矩、相关及逆差矩)与肝纤维化病理学诊断结果比较,进行逐步判别分析建立判别大鼠肝纤维化程度的超声定量模型,用交互检验评价模型的效率.结果 肝包膜厚度及其他13个指标与肝纤维化病理学分期均具有相关性(r值依次为0.817、0.894、0.808、0.844、0.828、0.795、0.864、0.725、0.821、0.848、-0.743、-0.909、-0.438、-0.855,P值均＜0.05),14个指标在病理学分期间的差异均具有统计学意义(F值分别为43.12、60.55、50.70、43.65、45.68、23.63、56.60、21.48、46.19、24.66、39.52、75.74、15.37、63.98,P值均＜0.05).交互检验结果显示建立于超声定量指标基础上的判别模型对大鼠肝纤维化S0、S1、S2、S3和S4分期的准确率分别为83.3％、84.2％、70.0％、50.0％和88.2％,73.3％的大鼠能够被准确分期;对无纤维化组(S0),轻度纤维化组(S1),中重度纤维化组(S2及S3)和早期肝硬化组(S4)分组的准确率分别为91.7%、84.2％、69.0％和88.2％,78.9％的大鼠能够被准确分组.结论 超声检查结合声像图的纹理分析对定量诊断大鼠肝纤维化具有较高的准确性.     

关于人体信号和医学超声信号

一、引言 疾病的危险程度可以分为高、中、低三等.目前临床检查手段又可分为侵入及损伤、微侵入及微损伤、非侵入及无损伤,显然非侵入及无损伤的检查手段受到各种患者和健康检查者的欢迎.见表1.     

深化中医药教育改革的思考

21世纪我国的高等教育将面临着重大的挑战,江泽民主席曾指出:在新的形势下,我们的教育工作必须进一步解决好两个重要问题,一是教育要全面适应现代化建设对各类人才培养的需要,二是要全面提高办学的质量和效益,这也可以说是当前全国教育工作面临的"两个重要转变".因此,我们说迎接21世纪高等教育面临的挑战,转变我们的教育思想和观念,深化中医药教育改革至关重要.     

四肢血管损伤的手术治疗

本文总结１９９０年１０月～１９９７年４月我们收治的四肢主要血管损伤５６例（６８条血管）,除１例截肢外,余均获成功,现报道如下。１临床资料１１一般资料本组５６例,男３９例,女１７例,年龄１５～５４岁。血管致伤原因：锐器伤３４例,压砸伤１６例,火器伤５...     

血流测量中的dP/dt dv/dt及其物理意义——兼论dP/dt dv/dt的命名

目的探讨dP/dt dv/dt的物理意义，寻找合理的允孝。方法通过类比和量纲分析的方法，阐明该参数的物理意义。结果提出四种dP/dt dv/dt的命名方案以供选择。结论提出关于dP/dt dv/dt命名的几个建议