右心室功能评价的影像学方法进展

右心室功能的改变对肺动脉高压和多种心脏疾病的生存率及预后有重要意义.在多种影像学检查技术中,近十年来发展最快的当属超声心动图、螺旋CT和磁共振技术,这些新技术可以准确、客观、全面地评价右心室功能,具有很大的临床意义和广泛的应用前景.     

腹腔镜子宫切除并发症的防治

近年来,腹腔镜手术并发症随着手术例数的增多,特别是手术操作的多样化而增多.1998年美国妇科腹腔镜医师协会并发症委员会报道腹腔镜手术中较严重并发症的发生率为1.54%,比1973年增加15倍[1,2];国内1999～2002年报道发生率为0.43%～4.81%[3,4],比1994年增加5倍[5].     

上唇短缩畸形的手术治疗

目的 针对微笑时鼻唇部出现上唇上提并短缩,鼻小柱下方褶沟,上唇牙龈外露等现象,探讨一种治疗上唇短缩畸形的手术方法.方法 采用经口或鼻前庭切口,将鼻小柱根部鼻中隔降肌肌纤维切断及部分切除,并广泛剥离使上唇下降.结果 共为27例上唇短缩畸形患者进行手术治疗.其中9例采用了双侧鼻小柱外侧与前庭基底贯穿切口,18例采用了上唇唇龈沟切口.通过手术,患者获得微笑时上唇中部适度降低,鼻小柱下方褶沟变浅或消失,上唇牙龈外露消失的效果.6例患者还在手术矫正上唇动态短缩畸形的同时,实施了鼻整形术.通过手术可矫正鼻唇牙龈部的综合动态缺陷,获得满意的美学效果.结论 手术方法治疗上唇短缩畸形,可改善患者微笑时的表情,是值得推广的治疗方法.     

肾功能损伤分级系统在成人心脏术后的应用

Objective The aim of this study was to evaluate of adilty of two acute renal failure-specific scoring systenms (the classification by Bellome et al and the AKIN criteria) for predicting hospital mortality after cardiac surgery in adult patients. Methods Between October 1 st 2006 to Decemjber 31 st 2006, 509 adult patients who ungerwent coronary artery bypass grafting (CABG) and/ or valve operation were enrolled in this study. The medical data collection included gender, age, types of operation, perioperative he- modynamic parameters, urine output, biochemical parameters and outcome. Renal function was assessed daily according to the classi- ficatinn by Bellomo and the AKIN criteria, respectively. As references, Acure Physiology and Chronic Health Evaluation(APACHE) Ⅱ and Sepsis-related Organ Failure Assessment (SOFA) score were also calculated. Resuits Three hundred and forty-one patients were male (67.0%), and 168 were female (33.0%), mean age was (56.2±12.0) years old. Tnree hundred and nine patieats un- derwent CABG, 182 underwent valve operation and 18 underwent CABG plus valve operation, Mean duration of ventilation support was (20.4±17.7) houra, and the ICU stay was (1.4±1.0) days. Postoperative hospital stay was (13.8±9.1) days. According to the classification by Bellomo., the highest in-hospital mortality was 52.9% in ARFS group. Mahiplicatinn of in-hospital morality rate was abserved (X2 for trend, P<0.01) in 0.4% (non-ARF), 1.2% (stage 1), 12.0% (stal～ 2) and 32.4% (stage 3) of pa- tients based on the AKIN criteria. By applying the area under the receiver operating characteristic ourve, the classification by Bellomo and the AKIN criteria had good discriminative power. Furthering, multivariate logistic regression analysis verified that the Odds Ratio of the AKIN criteria was 5.478 (P =0.028, 95% Confidence Interval 1.027- 24.856), after adjusting for gender and age. Con- clusion Analytical data confinned good discriminative power of both the AKIN criteria and the classification by Bellomo for predicting hospital mortality of adult postoperative patient with ARF.     

美国心律协会2007年年会心房颤动临床研究热点评析

2007年5月9～12日,第28届美国心律学会(Heart Rhythm Society,HRS)年度会议(HRS2007)在美国西部城市丹佛隆重召开。据统计,本次会议的与会代表中仅医生就超过了1万人,真可谓名副其实的一届盛会。本届HRS会议的研讨内容虽然涉及心律失常研究的各个方面,但报告最多、最深入、同时     

双源CT低剂量前瞻性心电触发序列扫描在冠状动脉血管成像的应用

Objective To evaluate low-dose CT coronary angiography with prospective electrocardiogram (ECG)-triggering using dual-source CT scanner.Methods Sixty-eight patients who underwent coronary CT angiography using a dual-source CT scanner were divided into 2 groups: group A (38 cases) and group B (30 cases).Prospective ECG-triggering sequence scan mode was employed for group A.Inclusion criteria included: heart rate <70 bpm, sinus rhythm, and heart rate fluctuation less than 10 bpm.Data acquisition was set at 70% of the RR-interval.Retrospective ECG-gating helical scan was performed for group B.Inclusion criteria included heart rates < 70 bpm and sinus rhythm.The exclusion criteria included heart failure and serious arrhythmias.In both groups, patients with a BMI≥24 kg/m2 were examined with a tube voltage of 120 kV, whereas patients with a BMI <24 kg/m2 were examined with a tube voltage of 100 kV.All images were transferred to a workstation for further processing and analysis.The imaging quality was evaluated.The imaging quality of coronary artery segments were compared with rank sum test between the two groups, and the radiation dose were compared with t test.Results A total of 476 coronary artery segments were evaluated in group A and 372 segments were evaluated in group B.The mean score of imaging quality for coronary artery segments in group A was 3.48±0.59 and that in group B was 3.53±0.58.There was no statistical difference in imaging quality between the two groups (Z=-1.432, P=0.187).The effective dose was on average (2.51±0.54) mSv (range 1.3--3.3 mSv) in group A, whereas on average (14.55±3.54) rosy (range 7.1--20.2 mSv) in group B.There was a statistical difference between the two groups (t=18.484, P=0.000).Conclusions Low-dose prospective ECG-triggering sequence scan in dual-source CT coronary angiography is feasible in patients with low heart rate and regular cardiac rhythm.This scan mode can substantially reduce radiation doses while preserving good diagnostic image quality.     

以血性胸水为主要表现的肝癌1例报告

以血性胸水为主要表现的肝癌１例报告首都医科大学附属北京安贞医院呼吸科高元明刘双高明哲胡尚基梁瑛１病例报告患者男，７７岁，因胸闷、乏力２月余收入院。患者２月余前无明显诱因感胸闷、气促，活动后加重，伴乏力、纳差，无咳嗽、咯痰、咯血、胸痛和发热，无腹痛、腹...     

心脏瓣膜替换术后急腹症手术17例分析

心脏瓣膜替换术后急腹症手术１７例分析首都医科大学附属北京安贞医院外科梁杰雄孙建辉骆兵吴强李磊１９８９～１９９４年，共施行心脏瓣膜替换术后急腹症手术１７例，现报告如下。１临床资料本组男９例，女８例，年龄１３～６０岁，平均４５岁。凝血酶原时间（ＰＴ）１８...     

5例气管原发性肿瘤的外科治疗

1998年 4月至 2 0 0 2年 1月 ,我们共手术治疗胸内气管原发性肿瘤 5例 ,部分手术难度较大 ,麻醉困难。现报道如下。资料和方法　本组病人均为男性 ,年龄 2 5～ 72岁。临床表现主要为咳喘 ,其中 2例伴血痰。从出现症状到明确诊断平均 6个月。所有病人初诊均为哮喘或肺炎 ,后因治疗效果差 ,经胸部CT发现 ,再经支气管镜检查确诊。肿瘤分布在气管下段或隆凸嵴。手术全部采用后外侧开胸 ,行气管楔形切除 1例 ,环形切除 2例 ,环形切除加隆凸成形 2例。 1例并发单侧喉返神经损伤 ,术后误吸导致肺炎 ,行气管切开治疗后痊愈。病理结果为横纹肌肉瘤…     

健康教育在口服抗凝药患者用药指导中的应用

血栓和栓塞是目前临床常见的疾病之一 ,严重危害大众的生命和健康。口服抗凝药作为预防、控制和治疗栓塞形成和发展已被广泛应用。在医院开展健康教育 ,正确指导此类人群合理用药、正当饮食、健康生活 ,更能体现医务人员以人为本的服务宗旨。北京安贞医院药剂科自 2 0 0 0年 4月至 2 0 0 2年 6月针对来院就诊、取药的此类患者人群通过举办讲座、发放科普手册、开办用药咨询门诊等方式 ,开展了在用药指导的同时给予健康教育的方法 ,使患者在用药过程中了解疾病、药物、饮食、生活方式等对口服抗凝药的影响 ,对提高患者用药的安全性 ,减少危险…