斑点追踪分层应变技术评价蒽环类药物化疗患者早期心肌毒性

目的 本研究采用二维斑点追踪显像技术（2D-STI）评价使用蒽环类化疗药物患者左室收缩功能及左室收缩同步性,探讨2D-STI在评价蒽环类药物化疗早期心肌毒性中的应用价值。方法 选取我院诊断为乳腺癌的女性患者40例,所有患者均接受表柔比星化疗。分别在化疗前（T0）、第一周期及第二周期化疗后（T1、T2）进行二维超声心动图检查,用EchoPAC软件分析蒽环类药物化疗患者左室心肌内膜、心肌外膜、整体纵向应变（EndoGLS、EpiGLS、GLS）、环向应变（EndoGCS、EpiGCS、GCS）及左室整体径向应变（GRS）;获取纵向、环向及径向整体达峰时间标准差（Tssl-SD、Tssc-SD,Tssr-SD）及纵向、环向及径向达峰时间最大差值（Tssl-Dif、Tssc-Dif、Tssr-Dif）,获取纵向、环向及径向延迟指数（LSDI、CSDI、RSDI）。结果 与T0周期相比,GLS、endoGLS及endoGCS在T2周期化疗后的变化有统计学意义（p2均＜0.05）;与T0周期相比,患者Tssl-SD及LSDI 在T2周期化疗后的变化有统计学意义（p2均＜0.05）。结论 2D-STI技术获取的分层应变参数及同步性参数可以准确分析蒽环类药物化疗患者早期心肌收缩功能的损伤及室壁运动协调性的损伤,能够敏感发现蒽环类药物化疗后的早期心肌毒性表现。     

实时三维超声心动图左心房容积成像评价高血压患者左心室舒张功能

在高血压的发生和发展过程中,左心室及左心房的结构和功能都会发生不同程度的变化.准确定量左心房容积对于评估高血压患者左心室舒张功能有重要临床意义[1].本研究应用实时三维超声心动图(real-time three-dimensional echocardiography, RT3DE)估测高血压患者左心房容积和功能.     

Detection of Suction and Regurgitation of the Implantable Centrifugal Pump Based on the Motor Current Waveform Analysis and Its Application to Optimization of Pump Flow

In this study, a detection algorithm for suction and regurgitation of the centrifugal pump during left heart bypass without relying on external flow or pressure sensors was developed and evaluated in acute studies using adult goats. The detection scheme relies on power spectral density (PSD) analysis of the motor current waveform through which the waveform deformation index (WDI) is obtained. This index is defined as the ratio of the fundamental component of the PSD to the higher PSD components, and its value increases with the deformation of the basic waveform. By assuming that the undistorted motor current waveform can be represented by a pure sine waveform, we theoretically synthesized various waveforms which have different second harmonic components. We were able to synthesize the waveform whose shape was close to the distorted motor current waveform under varying suction levels obtained in a mock loop study. From this study, we came to the conclusion that the WDI value of 0.2 can serve as a threshold level in deciding the suction and regurgitation speeds (rpm) during left heart bypass. In the study using adult goats, we were successful in minimizing both regurgitation and suction when the centrifugal pump speed was adjusted based on the WDI algorithm. The resultant bypass flow ranged from 1.5 to 2.0 L/min which was around 60% of the total flow. Further study is underway to evaluate the applicability of the WDI method in optimizing bypass pump flow.     

Studies on plasma endothelin changes in varicocele patients

Aim: To investigate the possible role endothelin may play in the pathogenesis of varicocele and varicocele-induced infer-tility. Methods: In varicocele patients, radioimmunoassay is used to determine the blood endothelin concentration inthe spermatic vein and the antecubital vein separately. Results: The blood endothelin concentration of the spermaticvein (66.8±23.5 pg/mL) was significantly higher (P <0.05) than that of the antecubital vein (55.3±25.3 pg/mL).The endothelin concentration in the spermatic vein in Grade Ⅱ varicocele patients was not significantly different from thatin Grade Ⅲ patients ( P = 0.87). Conclusion: The higher blood endothelin level in the spermatic vein may indicate theinvolvement of endothelin in the pathophysiology of varicocele and varicocele-induced infertility. (Asian J Androl 1999Sep ; 1: 159 - 160)     

经皮左锁骨下动脉插管

目的：探讨经皮锁骨下动脉穿刺插管的适应证，操作技术及并发症。方法：６６例胸部、腹部及盆腔恶性肿瘤患者中，６０例行经皮左锁骨下动脉导管药盒植入术，６例因严重动脉粥样硬化作股动脉穿刺插管和／或选择或超选择肝动脉和髂内动脉插管失败，而行经皮左锁骨下动脉穿刺插管共７２人次。经左锁骨中外三分之一下２ｃｍ向内上或水平穿刺。用Ｓｅｌｄｉｎｇｅｒ法把导管顺向引入靶动脉，然后再行血管造影和介入治疗或导管药盒系统植入。结果：穿刺锁骨下动脉，选择或超选择肝动脉，肠系膜上、下动脉，髂内动脉及它们分支动脉和支气管动脉插管共８８次，均获成功。发生局部血肿１１例，无气胸、血胸等重要并发症发生。结论：熟悉经皮锁骨下动脉穿刺插管对导管药盒系统的植入及不适应作经皮股动脉穿刺插管或经股动脉穿刺插管作选择或超选择靶血管有困难和失败者有意义。     

发病时间对选择性经皮冠脉腔内成形术围术期左室功能的影响

 为观察冠心病发病时间对选择性PTCA围术期左室功能的影响,应用二维超声心动图(2DE),对成功地实施选择性经皮冠脉腔内成形术(FIVA)的25例患者,动态观察其围术期左室射血分数(LVEF)、每搏量(SV)、左室舒张末容积(LVEDV)及左室收缩末容积(LVESV)的演变.发现发病≤2 a者围术期LVEF增加(P<0.05),LVEDV及LVESV缩小(分别P<0.05及P<0.01),SV无变化(P>0.05);发病>2 a者虽有LVEDV及LVESV减少(均P<0.05),但LVEF及SV无变化(均P>0.05).提示较早实施选择性PTCA者左室功能改善较明显;反映左室功能改善的2DE指标中,LVEDV及LVESV较LVEF及SV敏感.     

国产埋入式药泵经皮左锁骨下动脉植入术

目的：研究国产导管药盒系统（ＰＣＳ）经皮左锁骨下动脉植入术治疗晚期恶性实质性肿瘤的操作方法、安全性及临床应用价值。材料与方法：对６０例胸、腹部及盆腔恶性肿瘤患，经皮左锁骨下动脉穿刺行国产ＰＣＳ植入术。术后经ＰＣＳ行规律性化疗或碘油乳化剂栓塞。结果：所有病人ＰＣＳ植入术全部成功，导管留置于降主动脉１８例，肝固有动脉２０例，肝总动脉１２例，腹腔动脉６例，左右髂内动脉各２例。并发症有穿刺局部血肿６例（     

两种术式治疗精索静脉曲张疗效的比较

目的对比分析显微镜下精索内静脉低位结扎与传统Palomo术式治疗精索静脉曲张的手术并发症发生率及精子质量改善情况。方法研究对象为西京医院收治的142例精索静脉曲张患者,其中68例接受了显微镜下精索静脉低位结扎术（A组）,74例接受了传统的Palomo术式（B组）,对两组手术时间、并发症发生率以及术前、术后精液分析结果进行对比分析。结果A组手术时间（53±11）min,B组手术时间（22±7）min,A组长于B组,P〈0．05;术后并发症两组比较,A组阴囊水肿4例（5．8％）,附睾炎4例（5．8％）,B组阴囊水肿15例（20．3％）,附睾炎9例（12．2％）,两组术后并发症发生率差异有统计学意义,P〈0．05;两组术后精子质量均有显著改善,但A组术后精子计数、密度、活力和活率均明显高于B组,A组术后精子计数（43．00±4．31）×10。、活率（65．00±4．55）％,B组术后精子计数（37．20±5．45）×10。、活率（53．34±6．73）％,P〈0．05。结论显微镜下精索内静脉低位结扎术治疗精索静脉曲张术后并发症少,精子质量改善程度优于传统Palomo术式。     

急性心肌梗死后延迟PTCA及支架植入对慢性期左室重构和心脏事件的影响

目的　探讨急性心肌梗死 (AMI)后延迟PTCA及支架术对慢性期左室重构和心脏事件的影响。方法　 5 2例初次AMI患者分为PTCA组 (n =2 7)和非PTCA组 (n =2 5 ) ,PTCA组于发病后平均 12d对梗死相关动脉行PTCA及支架术。随访两组患者的左室收缩末期容积 (LVESV)、左室舒张末期容积 (LVEDV)、左室射血分数 (LVEF)及心脏事件。结果　PTCA组患者术后LVEDV及LVESV与术前比较无显著差异 ,而非PTCA组患者随访后LVEDV及LVESV与随访前比较显著增加 (P <0 .0 5 )。LVEF在两组间无显著差异。PTCA组在心力衰竭 (4 %和 44 % ,P <0 .0 1)和复合终点事件 (33%和 72 % ,P <0 .0 5 )方面较非PTCA组明显下降 ,在死亡、不稳定性心绞痛及再次心肌梗死的发生率方面两组无显著差异。结论　AMI后延迟PTCA及支架术可抑制左室扩大 ,延缓慢性期左室重构 ,并显著减少心脏事件的发生     

二尖瓣返流对扩张型心肌病患者的左室充盈模式的影响

目的 :探讨二尖瓣返流对扩张型心肌病 (DCM)患者左室充盈的影响。方法 :对 30例有轻度二尖瓣返流的DCM患者和 30例二尖瓣返流较重的DCM患者与 30例正常人的舒张期二尖瓣口血流超声心动图检查结果进行分析。结果 :反映左室舒张功能的二尖瓣血流频谱早期充盈峰速度 (VE)、晚期充盈峰速度 (VA)、VE/VA等参数在轻微二尖瓣返流组与对照组比较有明显差异 (P <0 .0 0 0 1) ,而严重二尖瓣返流组上述参数与对照组相比却无显著差异 (P >0 .0 5 )。结论 :超声心动图二尖瓣口血流指标显示二尖瓣返流轻微的DCM患者左室主动充盈减弱 ,被动充盈相对增加 ,而对二尖瓣返流较重的DCM患者的VE/VA却表现为假性正常化。