体外循环浅低温心脏不停跳心内直视手术的临床研究

目的:探讨体外循环浅低温心脏不停跳心内直视手术的方法、疗效评价及其对心肌保护作用。方法:总结2004年3月～2008年12月间12例施行浅低温心脏不停跳心内直视手术病例,并行循环不阻断主动脉,鼻咽温维持在32～35℃,阻断上、下腔静脉,完成心内直视手术。结果:全组无围手术期死亡,心脏手术结束能顺利停机,术后血流动力学平稳,无严重心律失常,血尿发生率0%,无1例发生空气栓塞。1例心房切口缝合针眼渗血,行再次开胸止血,1例术后第32h发生急性肺梗塞,均经治疗痊愈。结论:浅低温心脏不停跳心内直视手术技术安全可行,是一种接近生理状态的心肌保护方法,可避免再灌注损伤,有较理想的心肌保护效果。     

质疑Frank—Starling心脏定律

心脏收缩释放的能量（作功）是心肌纤维长度（心室舒张末期容积，EDV）的函数，即Frank—Star一1ing（FS）心脏作功定律，被誉为心脏生理学中的“经典”理论。对此，笔者从各种不同角度进行了探讨：首先分析了Frank伸展离体心肌和Starling及其同事使用心肺制备做的实验与动物生理实际的差异，以及人们在实验中观测到的增加心肌前负荷引起收缩力增强的现象（FS现象），认为：①在正常生理条件下的动物体内，来自心脏以外的、如同心肺制备中那样人工控制心室充盈压力升高、引起EDV增加的那种血液的重力动力是不存在的。②另一方面，人为地增加前负荷，那是改变了心肌收缩时的外环境条件。③由此而激发出的FS现象，是心脏适应其外环境条件变化所作出的反应。④此种心肌收缩力增强的反应，需通过心肌细胞内部与收缩过程发生有关的心肌兴奋一收缩和化学一力学偶联等一系列生化机制（不恒定因素）方能得以实现。⑤根据他们实验中观测到的FS现象，在逻辑上不能得出前负荷这一心肌收缩时的外环境条件变化调控其作功的推论。换言之，所有的在实验中被激发出来的FS现象，都不足以成为支持FS心脏定律的证据。然后，引用国内外公认的计算心脏每搏射血作功（w）的生物物理学公式“w=P×（EDV—ESV）”，证明了w和EDV之间没有函数关系。根据心脏作功的医用物理学和生物数学的基本原理，笔者认为Frank—Starling心脏定律表达的不是心脏作功的规律。     

拉萨地区冠心病与幽门螺杆菌感染相关性研究

目的探讨西藏拉萨地区幽门螺杆菌（Helicobacter pyloric，Hp）感染与冠心病及多种危险因素的关系。为该地区冠心病的防治提供依据。方法分为冠心病组46例和非冠心病组51例，应用检测血抗HpIgG及-C-尿素呼气试验方法检测Hp感染情况，并分别测定各组血脂、血糖、餐后2h血糖、C反应蛋白、纤维蛋白原、白细胞总数。结果冠心病组患者血清抗HpIgG阳性率为50．0％（23／46），明显高于非冠心病组的23．5％（12／51），P〈0．05；冠心病患者Hp现症感染率为54．3％（25／46），明显高于非冠心病组的31．3％（27／51），P〈0．05；冠心病组Hp感染患者血脂、空腹及餐后2h血糖、C反应蛋白、纤维蛋白原较非感染患者明显升高（P〈0．05）。结论Hp感染与冠心病相关，可能是拉萨地区冠心病发病的独立危险因素。     

The plasma kallikrein–kinin system and risk of cardiovascular disease in men

BACKGROUND: The plasma kallikrein-kinin system (PKKS) has been implicated in cardiovascular disease, but activation of the PKKS has not been directly probed in individuals at risk of coronary heart disease (CHD) or stroke. OBJECTIVE: To determine the involvement of the PKKS, including factor XI, in cardiovascular disease occurring in a nested case-control study from the Second Northwick Park Heart Study (NPHS-II). METHODS AND RESULTS: After a median follow-up of 10.7 years, 287 cases of CHD and stroke had been recorded and 542 age-matched controls were selected. When FXIIa-C1 esterase inhibitor (C1-inhibitor) concentrations were divided into tertiles (lowest tertile as reference), the odds ratios (ORs) at 95% CIs for CHD were 0.52 (0.34-0.80) in the middle tertile and 0.73 (0.49-1.09) in the highest tertile (P = 0.01 for the overall difference; P = 0.01 for CHD and stroke combined). For kallikrein-C1-inhibitor complexes, the ORs for stroke were 0.29 (0.12-0.72) and 0.67 (0.30-1.52) in the middle and high tertiles, respectively (P = 0.02). FXIIa-C1-inhibitor and kallikrein-C1-inhibitor complexes were negatively related to smoking and fibrinogen (P < 0.005). FXIa-inhibitor complexes correlated strongly with FXIIa-inhibitor complexes. CONCLUSIONS: Lower levels of inhibitory complexes of the PKKS enzymes and particularly of FXIIa contribute to the risk of CHD and stroke in middle-aged men. This observation supports the involvement of the PKKS in atherothrombosis.     

舒张功能障碍对冠心病的诊断价值

目的应用超声多普勒方法评价冠心病患者的左室整体舒张功能及舒张功能障碍的发生率，探讨舒张功能障碍在冠心病无创诊断中的价值。方法对入选病人行常规检查，同时进行二尖瓣血流频谱、肺静脉血流频谱及二尖瓣环组织多普勒检查，对比临床标准与舒张功能障碍标准对冠心病的诊断率。结果舒张功能障碍标准对冠心病的检出率显著高于临床标准。结论舒张功能检查可作为冠心病诊断的初筛检查。     

Predicting work status following interdisciplinary treatment for chronic pain.

The effectiveness of interdisciplinary treatments for chronic pain is well established. In general, these treatments decrease psychosocial distress and increase physical abilities. Further, return to work rates following interdisciplinary treatment tend to be quite high. Previous studies have highlighted a number of factors that individually influence return to work rates; however, there is a need for more comprehensive and unified models that allow an evaluation of the inter-relations among these factors. The present investigation examined how demographic and treatment outcome variables interacted to influence post-treatment return to work rates in a sample of individuals with chronic pain following interdisciplinary treatment. Results indicated that patient age, lifting ability, pain duration, depression level, and reported disability were individually related to return to work; however, when these variables were evaluated relative to one another, level of depression and patient age had the best ability to predict post-treatment work status. These results add to the literature by specifically highlighting post-treatment factors that best discriminate patients who had returned to work from those that had not. Furthermore, they provide evidence that general emotional distress is perhaps the most important predictor of work status following treatment.     

慢性乙型病毒性肝炎治疗新方法

就当前慢性乙肝治疗的新方法、新进展作一综述。     

Undersensing of VF in a Patient With Optimal R Wave Sensing During Sinus Rhythm

We describe a case of potentially fatal undersensing of VF by a third generation ICD with predetermined automatic gain control. In this patient, ventricular sensing was optimal, as R wave amplitudes during sinus rhythm were at least 16 mV. Cyclical, high amplitude signals during VF elevated the sensing floor to such an extent that complete undersensing of subsequent lower amplitude local electrograms occurred. This led to bradypacing and complete ICD therapy failure. Therefore, high R wave amplitudes during sinus rhythm do not warrant flawless sensing during VF. (PACE 2004; 27[Pt. I] 833–834)