外科治疗56例心脏非黏液性肿瘤的临床分析

目的探讨心脏非黏液性肿瘤临床特点,总结外科治疗经验。方法对我院1996年10月至2005年3月进行外科治疗的56例心脏非黏液性肿瘤的临床资料进行回顾性分析,总结其临床表现、发生部位、肿瘤性质和外科治疗特点等。结果心脏非粘液性肿瘤占本院同期手术患者的0.14%,良性肿瘤28例,恶性肿瘤28例,其中继发性心脏肿瘤8例。良性肿瘤最常见的是生长在心室,共18例;恶性肿瘤最常见的生长部位是心房,共15例。外科治疗行急诊手术者12例。心包开窗引流术2例,探查术1例,术中肿瘤全部切除者26例,部分切除27例,术后住院期间死亡1例。结论心脏非黏液性肿瘤临床表现各异、病理类型多样、病变广泛,手术原则为尽可能切除肿瘤和保持心脏结构的完整性和功能。     

A case of acute heart failure associated with Guillain-Barré syndrome

Abstract Guillain-Barré syndrome (GBS) is a disease of the peripheral nervous system, which is caused by aberrant immune responses directed against some components of peripheral nerves. GBS is rarely accompanied by cardiovascular involvement. We describe a case of acute neuropathy complicated by sudden heart failure and left ventricular dysfunction which had a presumably neurogenic origin. Pathogenesis of acute heart failure is probably due to transitorial stunned myocardium and neurogenic cardiac injury. We show a rare case of transitorial and acute cardiac dysfunction by echocardiography and laboratory markers of heart failure.     

心血管造影在复杂和(或)复合先天性心脏病诊断中的应用

目的 探讨心血管造影在先天性心脏病（简称先心病）复杂和（或）复合畸形中的应用价值。方法 分析360例复杂和（或）复合畸形造影所见及其与超声心动图等临床检查的联系。结果 本组360例（包括75例肺动脉闭锁合并室间隔缺损、62例右室双出口、60例法乐四联症、52例单心室、42例大动脉错位、15例三尖闭锁、6例冠状动脉异常、5例完整型肺静脉畸形连接、5例完全型心内膜垫缺损、4例共同动脉干、3例室间完整的肺动脉闭锁、7例其他病例和24例外科术后检查）心血管造影和超声对比，纠正后者误、漏诊分别为34、30例及对合并畸形误诊16例。对复杂和（或）复合畸形中体肺侧支血管、冠状动脉畸形和肺动脉段分支及其异常的检测和诊断优于超声心动图，并可测量肺动、静脉压力及体肺侧支血管压力而优于其他影像学检查方法。结论 对于先心病复杂和（或）复合畸形的疑难病例诊断和鉴别诊断，尤其显示体、肺及冠状动脉分支的全貌及相关病变，以及测量肺动脉和心室压力等，心血管造影（含DSA）仍有重要或不可替代的作用。     

颅内动脉瘤的血管内栓塞治疗

目的探讨应用电解可脱性弹簧圈(GDC)栓塞治疗颅内动脉瘤的临床效果。方法2002年6月-2004年6月我们采用GDC栓塞颅内动脉瘤126例(其中4例有2个动脉瘤,共130个)。前交通动脉瘤42个,后交通动脉瘤53个,颈内动脉瘤6个,大脑中动脉瘤10个,大脑后动脉瘤8个,大脑前动脉瘤6个,小脑后下动脉瘤2个;基底动脉瘤3个。按Hunt-Hess分级:Ⅰ级38例,Ⅱ级54例,Ⅲ级23例,Ⅳ级11例。必要时辅以篮筐技术、重塑技术、支架技术、双微导管或连环技术、蚕食技术。结果成功栓塞126例动脉瘤,其中103例为100%栓塞,21例为95%,2例为90%。12例在栓塞后6~18个月进行造影随访,所栓塞动脉瘤均未见复发征象。结论GDC栓塞颅内动脉瘤是安全、有效和微创的治疗手段。联合运用多种栓塞技术有助于减少术后并发症,提高治愈率。     

塞来昔布对大鼠心脏移植急性排斥反应的抑制作用

目的观察塞来昔布对大鼠心脏移植急性排斥反应的抑制作用。方法以SD大鼠为供者,Wistar大鼠为受者,进行40次腹部异位心脏移植。采用HE染色和原位末端标记(TUN EL)技术检测移植心切片,进行排斥反应的病理分级并计算移植心肌细胞的凋亡指数(AI)。结果移植心的细胞凋亡主要发生于心肌细胞;移植后第3、5d,塞来昔布治疗组心肌细胞凋亡指数分别为:1.03±0.42和3.28±2.42;对照组分别为2.35±1.51和11.35±3.46;两组比较,差异有统计学意义(P<0.001)。结论细胞凋亡是心脏移植急性排斥中组织损伤的重要机制;塞来昔布能明显抑制心肌细胞凋亡。     

From Innumeracy to Insight: The Uncertainty of Help versus Harm in Treatment of Asymptomatic Aortic Aneurysms

There is insufficient evidence that the surgical treatment of asymptomatic infrarenal aneurysms > 5.5 cm. is beneficial to patients. This is the result of serious complications of aneurysm surgery and the dearth of information from randomized trials. Based on evidence from the literature we defined scenarios and translated data into natural frequency trees to improve understanding of the uncertainty of help versus harm due to treatment of aneurysms. Our analysis shows that the majority of patients can expect little on longevity from surgery while they are at risk of dying from surgery or suffering from serious morbidity. We conclude that, as long as uncertainty persist, patients should be treated in hospitals that can show very low surgical mortality and major morbidity rates. To further resolve the problem of uncertainty randomized trials for larger aneurysms should be performed. Important issues to discuss are the lower and upper limits of the diameter of the aneurysms and the age and risk profiles of the patients to be included in such trials.     

天文潮汐对心脏病患者心力衰竭发生率影响的研究

目的　研究天文潮汐对心脏病患者发生心衰的影响。方法　分析 118例心脏病患者发生心衰在各潮汐期的分布。结果　在强天文潮汐期内心脏病患者发生心衰显著多于其余时期 ,而且在朔、望期发生的人数多于上、下弦期。结论　护理人员要了解天文潮汐的变化规律 ,教育心脏病患者在强天文潮汐期内要保持情绪稳定 ,必要时在强天文潮汐期内可给予心脏病患者适量的镇静剂和安眠药。