运动致急性肾衰竭3例临床病理分析

目的:总结运动致急性肾衰竭(EIARF)病例的临床病理特点。方法:回顾分析本科2007年收治的3例EIARF患者的临床和肾脏病理资料。结果:EIARF临床表现为厌氧运动后恶心呕吐、腹痛、腰痛,血肌酐、尿酸升高,尿渗透压降低,伴或不伴肌酸激酶和肌红蛋白升高。肾脏病理1例表现为急性间质性肾炎伴局灶增生性肾小球肾炎,1例为IgA肾病(系膜增生性肾小球肾炎)。结论:EIARF少见,早期易误诊,临床应予重视。     

孟鲁司特对慢性阻塞性肺疾病患者情绪和肺功能的影响及相关因素分析

目的:探讨孟鲁司特对慢性阻塞性肺疾病患者肺功能和情绪的影响及相关因素。方法:选择慢性阻塞性肺疾病60例患者,随机分为实验组(30例)和对照组(30例)。实验组口服孟鲁司特10 mg,1日1次,对照组口服富马酸酮替酚1 mg,1日2次,持续6周。2组均按需吸人β2受体激动剂,实验期间不用糖皮质激素。评估2组患者实验前后的肺功能和焦虑、抑郁分值及运动耐力,实验期间评估呼吸系统症状参数。结果:实验组患者的焦虑和抑郁评分在实验结束时明显降低;实验组患者的症状计分和肺功能指标及运动耐力与实验前比较差异均有统计学意义(P<0.05)。结论:孟鲁司特能有效改善慢性阻塞性肺疾病肺功能,减轻症状,提高运动耐力,减轻患者的不良心理情绪。     

有氧体育锻炼对不同程度青春期原发性痛经症状及子宫血流的影响

目的观察有氧运动方式对不同程度的原发性痛经症状和子宫血流的影响。方法将不同程度原发性痛经的女生分组进行12周的有氧体育锻炼,对其锻炼前后痛经评分及子宫血流指标进行检测分析,观察有氧体育锻炼对不同程度原发性痛经的治疗效果。结果12周适中强度的体育锻炼对轻、中度原发性痛经的疗效优于重度痛经。12周适中强度的体育锻炼对轻、中、重度原发性痛经的子宫动脉A/B、RI、PI指标有明显改善,但对轻度原发性改善更为明显。结论适中强度的体育锻炼对不同程度的原发性痛经症状和子宫血流均有效果,而对轻度痛经效果较好。     

综合疗法治疗腰椎间盘突出症临床研究

目的：探讨运用疼痛疗法及医疗体操治疗腰椎间盘突出症，提高临床症状显效率，缩短住院天数，减少复发率的疗效。方法：120例住院病人随机分为对照组59例，治疗组61例，接受牵引、按摩、针灸、中频电治疗。观察治疗后最快疼痛缓解时间，最短维持有效时间，住院天数，入、出院时下腰痛评测、显效率，出院后3～12个月复发率。结果：两组对比，治疗组平均疼痛缓解时间缩短5min，最短维持有效时间延长70min，住院天数减少10．04d，显效率提高15．36％，复发率为1．64％，与对照组差异显著（P〈0．05）。结论：两组在入、出院时下腰痛评测方面无明显差异，但治疗组在其他五方面均优于对照组。     

The role of stress echocardiography in children

Exercise and pharmacological stress echocardiography are well-accepted techniques of evaluating coronary artery disease in adults. In children, however, experience with stress echocardiography is limited and continues to evolve. The objective of this focused review was to describe the experience with exercise and dobutamine stress echocardiography in the pediatric population, with an emphasis on technique, current indications, and future directions. Experience is reported in children with prior Kawasaki disease or heart transplant recipients, as well as patients with congenital coronary abnormalities. In addition, stress echocardiography has been used in patients who have undergone coronary artery bypass graft surgery to evaluate short- and long-term graft patterning. Stress echocardiography appears to be a feasible, safe, and useful modality for the noninvasive assessment of flow-limiting stenosis in the pediatric population and can be used serially in the routine follow-up and risk stratification in children at risk for coronary events.     

平板运动试验变时性不全对冠心病诊断价值分析

目的对照平板运动试验与冠状动脉造影结果，探讨平板运动试验心脏变时性不全对冠心病诊断的价值。方法在行平板运动试验检查者中选择资料完整的行平板运动试验与冠状动脉造影的患者进行结果对照，观察运动引起心脏变时性不全与冠状动脉造影之间的联系，并与ST段压低诊断冠心病相比较。结果846例平板运动试验中有6例心脏变时性不全，并且冠状动脉造影均阳性。结论在平板运动试验中心脏变时性不全可以准确诊断冠心病，并且较ST段压低更加敏感。     

Assessment of cardiac function by M-mode echocardiography in selenium-deficient phenylketonuric children

Selenium (Se) deficiency is associated with cardiac and skeletal muscle dysfunction. Twenty well children aged 2-16 years (10 male) attending the Phenylketonuria (PKU) Clinic at the Royal Children's Hospital, Brisbane, had low Se levels (mean 0.29 +/- 0.02 s.e.m. mumol/L; normal range 0.56-1.16 mumol/L). Their myocardial function was assessed at rest and after exercise provocation by M-mode echocardiography in order to exclude occult left ventricular dysfunction. At rest, fractional shortening (FS) was normal (mean 38.1 +/- 1.1 s.e.m. %, n = 20). After exercise, FS increased significantly (P less than 0.001) from 37.6 +/- 1.4% to 44.3 +/- 1.2%, n = 12). This was associated with a significant rise (P less than 0.001) in heart rate (HR) from 77.3 +/- 3.1 beats/min to 125.8 +/- 5.2 beats/min (n = 12). The normal resting FS and normal increase in FS and HR with exercise is evidence against significant cardiac impairment in this group of Se-deficient children.     

Psychological and Respiratory Physiological Effects of a Physical Exercise Programme on Boys with Severe Asthma

ABSTRACT. Ten boys 9–12 years of age with severe perennial asthma participated in a physical exercise programme lasting 8 months. Pulmonary function and psychological tests were performed before training, immediately after, and one year after the end of the exercise programme. Static lung volumes, flow-volume variables and histamine tolerance were used as indicators of pulmonary function. Ego structure, body image, social development and concentration capacity were used as indicators of personality development. Before the study, the group had high FRC ( p < 0.05) and RV ( p < 0.001), low FEV₁, MEF50 and MEF25 (all p < 0.001) and low histamine tolerance. They showed marked disturbances in their personality development with low scores in psychological variables. During the training period, MEF50 and MEF25 increased slightly ( p < 0.01). Marked improvement was observed in all psychological variables ( p < 0.001). The positive effects remained during the following year. The marked and lasting improvement in personality development was regarded as an essential factor behind the more modest positive clinical and pulmonary function changes. The results emphasize the importance of including exercise programmes in the treatment of children with asthma.     

Exercise-Induced Ventricular Arrhythmia after Repair of Tetralogy of Fallot

Treadmill exercise electrocardiography (TE) was recorded in 50 patients to evaluate the incidence of exercise-induced ventricular arrhythmias (VAs) in a group of patients who underwent corrective surgery of tetralogy of Fallot (TF) more than four years previously. The results of rhythm evaluation were correlated with cardiac catheterization data as well as clinical information such as the age at surgery and the interval from surgery. Of the 50 patients tested, ventricular premature contraction (VPC) was confirmed in 12 patients (24%) on TE, while five patients (10%) demonstrated VPC on the standard ECG. The interval from surgery was significantly longer in those patients with VA (Group 1) than those without VA (Group 11) on TE (p<0.05). There was no significant difference of the age at corrective surgery between the two groups. In group I, the preoperative hemoglobin level was higher (p<0.05) and the right ventricular ejection fraction was lower (p<0.01). Exercise-induced VAs are closely related to the length of period after surgery and the depressed right ventricular function.     

Myocardial perfusion imaging with technetium-99m sestamibi SPECT in the evaluation of coronary artery disease

Technetium-99m hexakis-2-methoxy-isobutyl-isonitrile(^99mTc sestamibi) has been used for myocardial perfusion imaging in the evaluation of coronary artery disease (CAD) since 1990. The experience of its use in an Asian population with and without previous myocardial infarction (Ml), diabetes mellitus (DM), hypertension (HPT) and collateral circulation (COL) is reported. One hundred and thirty-nine patients who underwent treadmill exercise testing with ^99mTc sestamibi single photon emission computed tomography (SPECT) and coronary angiogram were studied. The overall sensitivity for the detection of CAD was 91.0% and specificity was 64.7%. For patients without previous myocardial infarction, the sensitivity was 83.8% and specificity was 83.3%. Patients with COL had a higher sensitivity while those with HPT had a lower specificity. Sensitivity was higher in patients with multi-vessel disease (MVD) than single vessel disease (SVD). The overall detection for individual artery stenosis was 74.1% with a specificity of 73.1 %. Amongst the three major coronary arteries, sensitivity was highest for the right coronary artery and specificity was highest for the left circumflex artery. Specificity was higher in patients without MI or COL. We found that the agreement between ^99mTc sestamibi SPECT and coronary angiogram for the extent of CAD was only 52.5%. The concordance rate was higher for patients with MVD than SVD. It is concluded that ^99mTc sestamibi SPECT is a sensitive and specific test for the detection of CAD and localization of disease to individual coronary arteries in our patients with some differences in the subgroups. Agreement between coronary angiogram and ^99mTc sestamibi for the extent of coronary artery disease was also satisfactory.