下腔静脉加压法与Valsalva动作在提高卵圆孔未闭检出率中的对比研究

目的 探讨下腔静脉加压法与Valsalva动作在经食道超声心动图(Transesophageal echocardiography,TEE)对卵圆孔未闭(Patent foramen ovale,PFO)检出率中的差异。方法 回顾性分析手术证实的PFO患者114例,包括对比增强经颅多普勒超声(Contrast-enhanced transcranial Doppler ultrasonography,c-TCD)少量右向左分流(Right-to-left shunt,RLS)(n=51)组、中量RLS(n=37)组、大量RLS(n=26)组,记录常规TEE超声、Valsalva动作配合下TEE检查、PFO封堵术前无痛TEE下下腔静脉加压检测,分析3组房间隔右向左一过性分流信号发生率的不同和其它临床因素在3组间的差异。结果 3组身体质量指数(Body mass index,BMI)、高血压病、高脂血症及冠心病的比例无明显差异(P>0.05); 大量RLS组患者年龄明显小于少量RLS及中量RLS组(P<0.05)。少量RLS及中量RLS组患者Valsalva动作和下腔静脉加压后较常规TEE下PFO的显示率均有提高(P<0.01); 大量RLS组患者Valsalva动作和下腔静脉加压后PFO显示率改变不明显(P>0.05)。结论 大量RLS患者较少量及中量RLS患者的年龄小,更容易早期出现临床症状; 下腔静脉加压法可以替代Valsalva动作提高TEE超声对PFO的检出率。     

Atrial Tachycardias Arising from the Atrial Appendages and Aortic Sinus of Valsalva

Focal atrial tachycardias arising from the atrial appendages and the aortic sinuses of Valsalva are less frequently encountered in clinical practice. This review article describes the clinical presentation, surface P wave morphology, electrophysiologic characteristics and treatment of these arrhythmias. Catheter ablation of these focal tachycardias has a high success rate. It is however important to be aware of specific anatomic considerations in these locations for optimal treatment outcomes with low complication rates.     

Aortic flow after valve sparing root replacement with or without neosinuses reconstruction

Objectives

This study applied advanced 4-dimensional flow magnetic resonance imaging processing to assess differences in aortic flow dynamics after valve sparing root replacement, with and without reconstruction of the Valsalva sinuses.

Unexpected death in a young child associated with anomalous aortic origin of the left main coronary artery without physical exertion: A case of an anomalous coronary artery with highly abundant elastic fibers

Sudden death due to anomalous aortic origin of a coronary artery is far less common among young children in the absence of exercise stress. This report describes the case of a 2-year-old boy with a lower respiratory tract infection who suffered sudden cardiac arrest in his bed at home. The autopsy revealed that the left coronary artery (LCA) originated from the right sinus of Valsalva with an acute angle takeoff and traveled between the aorta and the pulmonary trunk (an interarterial course). Upon histological examination, the LCA, before reaching its major branches, was located adjacent to the outside of the aortic wall without an intramural passage, and the arterial wall was composed almost exclusively of elastic fibers without media containing smooth muscle cells throughout the entire length of the abnormal running. Screening tests for respiratory virus infection detected enterovirus in the lung tissue. In association with an acute angle takeoff and interarterial course, the wall structure with highly abundant elastic fibers that are more flexible tissues among blood vessel components might suggest their vulnerability to compression during the great vessels’ systolic expansion in the sympathetic activation induced by the viral infection, leading to fatal myocardial ischemia without physical exertion.     

两种镇痛方式改善静脉输液港无损伤针穿刺疼痛的效果比较

目的 观察Valsalva呼吸、复方利多卡因乳膏减轻输液港无损伤针穿刺疼痛感的效果。方法 采用便利抽样法选取148例接受抗肿瘤药物治疗患者作为研究对象,随机分为对照组、利多卡因组和Valsalva组,分别在无损伤针穿刺前1 h涂抹医用凡士林(安慰剂)、复方利多卡因乳膏和穿刺时采用Valsalva呼吸。观察患者穿刺疼痛程度。结果 利多卡因组疼痛评分显著低于Valsalva组和对照组(均P<0.05)。结论 涂抹复方利多卡因乳膏可缓解输液港无损伤针穿刺疼痛,提升患者舒适度。     

Influence of pleural pressure variations on cardiovascular system dynamics: a model study

A mathematical model of the human cardiovascular system (CVS) is used to study the effect of different respiratory manoeuvres on the circulation. The model simulates the normal CVS and the interaction between the heart and the intrathoracic pressure. The vascular system is represented by resistive, capacitive and inertial elements whereas the ventricles are assumed to function according to the time-varying elastance concept based on their transmural pressures. The model predicts that normal inspiratory effeort effects an increase in the venous return, an increase in the pulmonary flow and a slight decrease in the left ventricular stroke volume (LVSV), which represents a decrease in ejection due to the increased LV transmural pressure. A step decrease in pleural pressure to −40 mm Hg, representing the Müller manoeuvre (MM), accentuates these findings, showing a decrease in LVSV in spite of an increase in the LV end-diastolic volume (LVEDV), LV end-systolic volume (LVESV) and the LV filling pressure, expressed as the mean left atrial transmural pressure. Simulating intermittent positive pressure ventilation (IPPV) with added positive end expiratory pressure (PEEP) shows an 18·6 per cent decrease in the cardiac output compared with quiet respiration. The calculated results of the model are in good agreement with available experimental data, suggesting that most of these findings may be explained by basic haemodynamic principles in the uncontrolled CVS.     

盐酸戊乙奎醚联合深呼吸法抑制麻醉诱导时芬太尼诱发咳嗽反应的有效性和安全性

目的探讨盐酸戊乙奎醚（PHC）联合深呼吸法抑制麻醉诱导时芬太尼诱发的咳嗽反应（FIC）的有效性和安全性。方法选取2015 年9 月-2016 年9 月该院行手术治疗的220 例患者的临床资料,随机分为4 组,每组55例。H组：于静脉注射芬太尼前10 min给予PHC 0.01 mg/kg,用生理盐水稀释成10 ml静脉注射。P组：芬太尼静脉注射前,患者完成3 次深呼吸后立刻静脉注射芬太尼。M 组：静脉推注芬太尼前10 min给予PHC0.01 mg/kg用生理盐水稀释成10 ml 静脉注射,完成3 次深呼吸后立即给予患者静脉注射芬太尼。N 组：按照一定诱导顺序给予静脉快速诱导。记录患者静脉注射芬太尼后2 min 内咳嗽出现的时间及严重程度,并计算咳嗽发生率;记录静脉注射芬太尼前10 min 或静脉注射PHC（T0）、静注芬太尼后1 min（T1）、2 min（T2）的心率（HR）、收缩压（SBP）、舒张压（DBP）和脉搏血氧饱和度（SpO2）;并分别计算平均动脉压（MAP）。结果4组患者咳嗽程度比较差异有统计学意义（χ2=153.424,p =0.001）;4组咳嗽发生时间比较差异有统计学意义（χ2 =26.509,p=0.019）。4 组患者FIC发生率差异有统计学意义（χ2=12.488, p=0.006）。H 组、P 组、M组和N组FIC 发生率分别为8 例（14.5%）、7 例（12.7%）、4 例（7.3%）和17 例（30.9%）,将H 组、P 组和M 组合并后,并与N 组比较,差异有统计学意义（χ2=11.337,p =0.001）;4 组患者HR、SpO2及MAP 在T0、T1和T2时逐渐降低;T2时HR和MAP 比T0时降低,差异有统计学意义（p <0.05）,T0、T1 和T2 时间的SpO2差异无统计学意义（p >0.05）。4 组不良反应发生率及不良反应比较无统计学意义（p >0.05）。结论PHC 联合深呼吸法能有效抑制FIC 的发生,优 于单独使用PHC 和深呼吸法,且对患者血流动力学影响小,不良反应少,安全性高。