局部晚期肺癌外科手术治疗(附18例报告)

目的为提高晚期肺癌患者的外科手术切除率及提高手术疗效,总结18例晚期肺癌患者手术治疗中切开心包处理肺静脉或切除部分左心房的经验。方法对18例晚期肺癌患者施行肺叶或全肺切除时,在心包内处理肺静脉或切除部分左心房。左肺下叶切除5例、左全肺切除3例、右肺中下叶切除4例、右肺下叶切除4例、右全肺切除2例;术中发现13例患者的肺静脉根部有癌侵犯或有癌栓,在心包外元法常规处理肺静脉,在切开心包后可较满意地处理肺静脉,切开心包后发现其中有9例明显有左心房侵犯,行肺切除的同时切除部分左房;5例虽可在心包外处理,但癌肿离肺静脉根部太近处理肺静脉困难,而切开心包后处理肺静脉很轻松。结果18例均无手术死亡,术后有2例发生心律失常,2例并发肺炎,1年生存率61．2％（11／18）、3年生存率38．8％（7／18）、2例生存〉5年。结论晚期肺癌累及肺静脉根部或左心房时应切开心包处理肺静脉或同时切除部分左心房以达到肿瘤学上的根治性切除,从而延长病人的寿命。     

川崎病患儿心型脂肪酸结合蛋白质量浓度变化及其与心功能关系探讨

目的探讨心型脂肪酸结合蛋白(h-FABP)在川崎病(KD)患儿中的水平变化及其与心功能的关系。方法选择青岛市儿童医院2004-02—2006-11收治的KD患儿40例为研究对象,采用酶联免疫吸附法检测血清h-FABP;并行心脏彩超多普勒(UCG)检测冠状动脉内径及左室射血分数(LVEF)并进行分组。结果急性期血清h-FABP质量浓度明显高于恢复期(P<0.01);冠状动脉病变(CAL)组和非冠状动脉病变(NCAL)组血清h-FABP质量浓度对比差异显著(P<0.01);KD患儿血清h-FABP质量浓度与LVEF呈负相关(r=-0.35,P<0.05)。结论血浆h-FABP质量浓度能够反映KD患儿心肌损害的严重程度,与LVEF相结合可估计患儿病情及预后。     

Depression and anxiety levels of the mothers of children and adolescents with left ventricular assist devices

Ozbaran B, Kose S, Yagdi T, Engin C, Erermis S, Yazici KU, Noyan A, Ozbaran M. Depression and anxiety levels of the mothers of children and adolescents with left ventricular assist devices. Abstract: VADs have been used to provide treatment for end‐stage heart failure. Parents may feel overwhelmed with the VAD regimes responsibility and be affected from this process beside children. In this study, we aimed to evaluate the depressive and anxiety symptoms of mothers of the first eight children equipped with a VAD in Turkey. The mothers of eight pediatric patients living with VADs were filled BDI and STAI at first month of VAD implantation (E.I) and secondly six months after their first evaluation (E.II). In E.I, the BDI mean score of mothers was 20.87, in E.II 14.37. STAI‐S mean score was 53.37 in E.I and 43.62 in E.II. The Wilcoxon nonparametric‐paired t‐test revealed significant difference between baseline and end‐point STAI‐S scores (Z: ?2.035; p: 0.042), and for BDI scores (Z, ?1.965; p, 0.049). Prolonged usage of VAD may increase distress in parents. Psychiatric evaluation and support of the primary caregiver is important for the well‐being of the pediatric patients.     

超声斑点追踪成像技术在右心功能评估中的研究进展

一直以来,右心室被认为在心功能构成中并未发挥主要作用.随着对右心室结构和功能研究的深入,人们逐渐意识到右心室形态与功能在临床与预后评价中的重要作用,各种用于整体评估右心室功能的成像技术不断得到发展.随着超声心动图技术的发展,斑点追踪成像(STI)技术在右心室功能评估中得到了广泛应用,为不同临床条件下右心室功能评估与研究,以及为与右心室功能相关的心肺疾病诊断与预后评价提供了简单且实用的新方法.对STI技术在右心室功能评估中的原理、方法和意义,以及其在临床应用中的问题作一综述.     

基于集中参数模型的左心室辅助装置血流动力学仿真

目的新一代植入式心室辅助装置(ventricular assist device,VAD)采用旋转式血泵(rotary blood pumps)技术,目前已成为治疗严重心力衰竭的重要手段,因而研究VAD与人体间的生理相互作用机制有着重要的意义。本研究通过在Matlab Simulink环境中建立人体心血管循环系统的集中参数数学模型,模拟左心衰患者在植入左心室辅助装置(left ventricular assist device,LVAD)后,循环系统的血流动力学特性。方法通过弹性腔和电路原理建立集中参数模型,主要包括心脏、肺循环、体循环、冠状动脉循环。调整模型的输入值使得模型的仿真结果符合设定的目标值。结果仿真结果证实LVAD可以使心衰患者的总心排量恢复正常,同时对于心脏有明显的除负荷效果、增加冠脉血流量并降低肺动脉楔压,因此可以缓解心衰末期患者重要器官供血不足、心肌缺氧以及肺水肿等并发症。同时通过改变左心室辅助装置的转速,末期左心衰患者可以恢复一定的运动能力。结论 CAMSIM集中参数模型符合人体血液循环特点。模型仿真结果证实了LVAD对心衰的辅助作用。     

Reliability and agreement of adipose tissue fat fraction measurements with water–fat MRI in patients with manifest cardiovascular disease

The supraclavicular fat depot is known for brown adipose tissue presence. To unravel adipose tissue physiology and metabolism, high quality and reproducible imaging is required. In this study we quantified the reliability and agreement of MRI fat fraction measurements in supraclavicular and subcutaneous adipose tissue of 25 adult patients with clinically manifest cardiovascular disease. MRI fat fraction measurements were made under ambient temperature conditions using a vendor supplied mDixon chemical‐shift water–fat multi‐echo pulse sequence at 1.5 T field strength. Supraclavicular fat fraction reliability (intraclass correlation coefficient_agreement, ICC_agreement) was 0.97 for test–retest, 0.95 for intra‐observer and 0.56 for inter‐observer measurements, which increased to 0.88 when ICC_consistency was estimated. Supraclavicular fat fraction agreement displayed mean differences of 0.5% (limit of agreement (LoA) ?1.7 to 2.6) for test–retest, ?0.5% (LoA ?2.9 to 2.0) for intra‐observer and 5.6% (LoA 0.4 to 10.8) for inter‐observer measurements. Median fat fraction in supraclavicular adipose tissue was 82.5% (interquartile range (IQR) 78.6–84.0) and 89.7% (IQR 87.2–91.5) in subcutaneous adipose tissue (p < 0.0001). In conclusion, water–fat MRI has good reliability and agreement to measure adipose tissue fat fraction in patients with manifest cardiovascular disease. These findings enable research on determinants of fat fraction and enable longitudinal monitoring of fat fraction within adipose tissue depots. Interestingly, even in adult patients with manifest cardiovascular disease, supraclavicular adipose tissue has a lower fat fraction compared with subcutaneous adipose tissue, suggestive of distinct morphologic characteristics, such as brown adipose tissue. Copyright © 2015 John Wiley & Sons, Ltd.     

Analysis of the O-wave in acute right ventricular apex impedance measurements with a standard pacing lead in animals

Modern pacemakers (implantable devices used for maintaining an appropriate heart rate in patients) can use an intracardiac ventricular impedance signal for physiological cardiac stimulation control. Intracardiac ventricular impedance from nine animal subjects is analysed and presented (seven sheep: 49.0±6.5 kg, sinus rhythm 100.3±16.5 beats min⁻¹, average impedance 629.8±72.6Ω; and two dogs: 30 kg each, sinus rhythm 86.0 beats min⁻¹, 862.1Ω and 134.0 beats min⁻¹, 1114.6Ω, respectively). The averaged curve and standard deviation curve of the impedance in sinus rhythm were analysed in MATLAB to clarify and study consistent impedance shape over one heart cycle. In eight of nine (89%) animal subjects, a consistent impedance slope change (notch) was observed in the early stage of the cardiac filling phase. This result was reproduced in an additional subject with simultaneous echocardiographical measurements of mitral valve blood flow. The notch occured soon after rapid early filling (E-wave in mitral flow) but prior to ventricular filling caused by atrial contraction, indicating that the impedance notch was caused by rapid ventricular filling and that it might be a sensed feature of diagnostic value. The intracardiac impedance notch in the present study had similar features to the non-invasive transthoracic impedance O-wave reported by others, and it is shown here that an O-wave is found in intracardiac impedance signals, strongly suggesting that the non-invasive O-wave is caused by cardiac events.     

大鼠下丘脑室旁核一氧化氮和外周血白细胞介素1β含量的昼夜节律变化及相关性的探讨

目的:探讨大鼠外周血白细胞介素1β(IL-β)和下丘脑室旁核中的一氧化氮是否具有昼夜节律以及两者的相关性。材料和方法:成年雄性SD大鼠24只随机分为4组,分别在16:00、22:00、4:00和10:00时腹腔注射细菌脂多糖。两小时后,分别麻醉采血及灌注取脑。采用放射免疫分析法测定外周血IL-1β的含量,运用β-NADPH-酶组化和计算机图像分析技术对室旁核中NADPH-d阳性神经元的切面面积和平均灰度值进行分析。结果:1.6:00时组外周血IL-1β含量最高,12:00时组最低,显示出明显的昼夜节律性。2.四组大鼠室旁核内NADPH-d阳性神经元的切面面积12:00时组最大,18:00时组最小,差异有显著性。3.外周血IL-1β含量昼夜节律变化的时相比室旁核一氧化氮产生量昼夜节律变化的时相早6小时。结论:大鼠外周血中IL-1β和室旁核一氧化氮的产生量均有昼夜节律性变化,外周血中IL-1β可能对室旁核一氧化氮的产生有促进作用。