双频谱指数在心脏瓣膜置换术中的观察

目的应用脑电双频谱指数(BIS)监测常规经验麻醉下瓣膜置换术病人的麻醉深度(意识水平),观察BIS在伤害性刺激时的变化.方法选择30例瓣膜置换术病人,采用芬太尼、咪唑安定、哌库溴铵及心血管活性药物对病人实施麻醉;术中监测并有专人分别记录入室(基础值)、诱导后、插管后、切皮后、锯胸骨时、缝胸骨时及术毕BIS和MAP,HR各参数值,观察不同阶段各参数的变化.结果诱导后各参数均明显降低,虽然切皮后、锯胸骨及缝胸骨等强刺激后MAP和HR未见统计学意义的显著改变,但BIS却显著增高(P＜0.01);全部病人锯胸骨时BIS均在60(67.28±8.97)以上,缝胸骨时63(68.46±8.70)以上,而无1例低于50者.结论该组瓣膜置换术病人麻醉偏浅,尤以锯胸骨、缝胸骨及术毕等时段为甚,表现为BIS值偏高,有知晓发生;知晓可发生在临床认为满意的麻醉中;应用BIS监测,可更加合理地评价麻醉深度.     

彩色多普勒超声图指导风湿性心脏病二尖瓣狭窄球囊扩张术91例

目的：应用彩色多普勒超声心动图指导经皮二尖瓣球囊成形术(PBMV)治疗风湿性二尖瓣狭窄的价值、方法：运用彩超对行PBMV的患进行术前术后检查，观察二尖瓣钙化程度及部位、开口形状、瓣口面积、二尖瓣返流(MR)程度、瓣下病变、左房左室大小、左房有无血栓．结果：91例PBMV术后患中，术后MR72例，其中MR新出现19例，MR加重8例、与术前对比，术后二尖瓣开放幅度、二尖瓣口面积、二尖瓣跨瓣压、二尖瓣压差半降时间较术前有明显改善趋势，左房内径、肺动脉内径较术前有缩小趋势．同时，术后左房压、右室压及肺动脉压也有下降趋势。结论：彩超能明确PBMV治疗二尖瓣狭窄的效果。影响：PBMV效果的因素较多，但二尖瓣钙化的程度、部位和瓣膜形态较为重要。     

Artificial trachea reconstruction with two-stage approach using memory-alloy mesh

Artificialtrachealprosthesisisnowachallengetotheentiresurgicalfieldallovertheworld Previously ,allkindsofprosthesiswere“innerstent”thatcouldnotbeintegratedwithnativetrachea Sincethereisaninterfacebetweensmoothsurfaceofthe prosthesisandlivingtissues,andtheinnersideoftheprosthesisisnotcoveredwithlivingmembrane,infectionsalwayshappenaroundtheprosthesis Wethendevelopedanewtechnique,whichcombinedmemory alloymeshwithtraditionaloperativeprocedures Memory alloymeshisextensible,flexibleandcanmaintain…     

人工心脏起搏器的植换

探讨人工心脏起搏器植换方式选择。方法：起搏器植换２２例，其中，能源耗竭１４例，感知和起搏功能障碍４例，囊袋感染破溃致ＰＭ外露４例。非感染者起搏阈值，〈２．５Ｖ，行原位植换：ＰＴ值〉３．０Ｖ或有感染者，更换全套起搏系统。结果：非感染的１８例中，１０例ＰＴ〈２．５Ｖ，实行原位植换；８例ＰＴ值〉３．０Ｖ和其余４例有感染者，植入新的起搏系统。     

Factors affecting the neonatal response to artificial surfactant

Objective : To define the individual neonatal response to the artificial surfactant, Exosurf, and factors that may influence the response.
Methodology : Eighty-two consecutive, preterm neonates with respiratory distress syndrome, who received Exosurf at <12h of age were studied. Their response was categorized from the graphical change in the oxygenation index with postnatal age, for 12h after each of two doses of surfactant and assessed independently by two observers. Clinical factors were analysed for their effect on the four pre-defined categories of response, namely: none; mild; good; relapsed; and good: sustained.
Results : Within the first 12h, 11% of the neonates showed no response, 5% a mild response and 84% a good response, but 34% relapsed. By 24h, 6% still showed no response (all died), 11% showed a mild response and 83% a good response, of whom half relapsed. At 24h, no response was significantly associated with low gestational age and asphyxia mild response with less severe lung disease. According to the response there was a gradation in the risk of death during the first week.
Conclusions : The response to Exosurf can be individually and reproducibly categorized and demonstrated that 83% of neonates had a good response but half relapsed. No response was associated with extreme prematurity and asphyxia     

Transesophageal Echocardiographic Analysis of the Systolic Pattern of the Anterior Mitral Leaflet in Patients with Flat Chest

Transesophageal echocardiography was conducted to determine the systolic pattern of the anterior mitral leaflet in patients with flat chest, and to differentiate it from that associated with mitral valve prolapse. The fronto-sagittal index (an index of chest flattening) was determined in 50 subjects using chest radiographs, and was used to classify them into a flat chest group (index < 0.38, n = 28) and a normal chest group (index ≥ 0.38, n = 22). We then used transesophageal echocardiography to examine the anterior leaflet in these subjects. A significant positive correlation was observed between the fronto-sagittal index and the short-to long-axis diameter ratio of the left ventricle in all patients. These parameters, and the left atrial dimension were lower in the flat than the normal chest group. The clear zone area of the anterior leaflet during mid-to late-systole was significantly larger in the flat chest group. However, no intergroup differences existed in the rough zone area of the anterior leaflet or in the middle scallop area of the posterior leaflet. Mitral regurgitation was observed in 20 and 12 subjects in the flat and normal chest groups, respectively. The maximum mitral regurgitant area did not differ between the two groups. The clear zone area of the anterior leaflet increased significantly following inhalation of amyl nitrite in 22 subjects of both groups, but the other areas did not increase. The mitral regurgitant area decreased or disappeared after amyl nitrite at a similar rate in each group. Thus, the decrease in the antero-posterior dimension of the thorax in subjects with flat chest affects the systolic pattern of the clear zone of the anterior leaflet more than that of the rough zone of the anterior leaflet or the posterior leaflet. This systolic pattern in such patients differs from that associated with mitral valve prolapse.     

微晶蜡非催化氧化反应的神经网络模型

对微晶蜡进行了非催化空气氧化，并利用人工神经网络将氧化微晶蜡的酸值、酯值及微晶蜡的氧化条件（反应温度、空气流量和反应时间）进行关联，建立了微晶蜡非催化氧化的酸值、酯值的神经网络模型，并用该模型预测了反应条件对微晶蜡氧化反应过程的影响。结果表明，该模型不但具有较高的计算精度，而且具有满意的预测能力。     

CDIC人工牙种植体的临床应用

目的：探讨种植牙的临床应用及酯套冠的修复疗效。方法：对80例失牙患者植入CDIC锥状螺旋种植体94枚，术后7－10d行暂时冠修复，6个月左右行永久性酯套冠修复。结果：随访2－5年，种植成功率达91.5%（86／94)。结论：3M聚碳酸酯套冠安全可以替代烤瓷牙冠作为前牙种植体的上部结构，CDIC锥状螺旋种植体操作方法简单，配合酯套冠修复成功率高，适合在基层医院推广应用。     

抑肽酶对瓣膜置换术患者心肌粘附分子表达及细胞凋亡的影响

目的探讨抑肽酶对二尖瓣置换术患者围体外循环（CPB）期心肌细胞及心肌血管内皮细胞上细胞间粘附分子-1（ICAM-1）、血管细胞粘附分子-1（VCAM-1）表达及心肌细胞凋亡的影响。方法择期二尖瓣置换术患者30例,年龄24～59岁,体重46～73 kg,心功能分级Ⅱ级或Ⅲ级,随机分为2组（n=15）：对照组和抑肽酶组,抑肽酶组于CPB转机前,预充液中加入抑肽酶300万KIU,对照组则给予等容量生理盐水,分别于CPB前和CPB停止时取右心房心肌组织标本,采用免疫组织化学SP法染色,检测心肌细胞和心肌血管内皮细胞上ICAM-1、VCAM-1的表达,采用病理图像分析系统对ICAM-1、VCAM-1表达的灰度值作定量分析,采用TUNEL法检测凋亡心肌细胞。结果抑肽酶组CPB停止时ICAM-1、VCAM-1的表达低于对照组（P〈0.01）;2组CPB停止时心肌细胞凋亡指数较CPB前增高（P〈0.05）,抑肽酶组CPB停止时心肌细胞凋亡指数低于对照组（P〈0.05）。结论预充液中加入抑肽酶300万KIU可抑制二尖瓣置换术患者CPB期间心肌细胞和心肌血管内皮细胞ICAM-1、VCAM-1的表达及心肌细胞的凋亡。     

Accessory atrioventricular pathway, supra-, and infrahisian conduction impaired due to mitral annulus calcification

Disorders of conduction occurring simultaneously in both normal and accessory pathways of patients with Wolff-Parkinson-White (WPW) syndrome have only rarely been observed. To our knowledge this is the first report of impaired conduction in both pathways in WPW syndrome due to mitral annulus calcification (MAC). This case of WPW syndrome type A presented the following conduction abnormalities: (1) right bundle-branch block; (2) transient second-degree AV block with prolonged PR interval of the conducted beats; (3) during electrophysiological study, induction of tachycardia, dependent (phase 3) second-degree AV block, and occasionally conduction of two consecutive beats, the second showing an increased H-V interval (from 25 to 60 ms) and left bundle-branch block (LBBB) pattern, due to (4) infrahisian conduction abnormality.