以肺动脉高压为主要表现的肺梗塞1例

肺梗塞患者症状常不典型,呈非特异性,极易误诊。2002年我科诊治1例以肺动脉高压为主要表现的肺梗塞患者,在外院和我院多次被误诊,现报告如下。1临床资料患者女,90岁,活动后气促2个月入院。既往有高血压、高血脂、脑梗塞病史,无心绞痛及心肌梗塞病史。2个月来在外院和我院门诊多次就医,均诊断为冠心病、心力衰竭,治疗效果欠佳。入院查体:体温36.9℃,脉搏90次/min,呼吸26次/min,血压165/105mmHg。颈静脉充盈,双肺底少许湿性啰音脑辔拊右簟8卧辔创ゼ啊K轮枷菪运住Q治觯貉醴盅?0mmHg,氧饱和度0.80。心电图:胸前导联V5～7ST段压低…     

前列腺素E1对血管内皮生长因子含量的影响及其与肺小动脉病理分级的关系

目的 研究应用前列腺素E1(PGE1)对先天性心脏病合并肺动脉高压(PH)患者血清血管内皮生长因子(VEGF)含量的影响及其与肺小动脉病理分级的关系. 方法 2002年1月至2003年6月共收治先心病合并PH患者53例(MPAP＞20 mmHg),其中有明显紫绀6例(MPAP＞90 mmHg).入院后静脉滴注PGE1 10～15ng/kg*min,每天用药12小时,连续15天.分别于用药0、5、10和15天晨抽取静脉血,采用酶联免疫吸附法(ELISA)测定血清VEGF含量.做肺组织活检,按Heath和Edwards分类进行病理分级,观察肺小动脉的病理改变. 结果病理分级:Ⅰ级9例,Ⅱ级14例,Ⅲ级19例,Ⅳ级5例,≥Ⅴ级 (紫绀者)6例.应用PGE1前,肺小动脉病理分级Ⅲ级时血清VEGF达到峰值,Ⅳ级、特别是≥Ⅴ级后有明显下降的趋势;应用PGE1后,Ⅰ级血清VEGF与用药前比较差别无显著性意义(P>0.05),Ⅱ、Ⅲ级者血清VEGF明显降低(P<0.01),Ⅳ级者有轻度的降低(P<0.05),而≥Ⅴ级患者无明显变化(P>0.05). 结论 PGE1可降低血清VEGF含量, 其降低幅度与肺小动脉病理改变程度有较密切的关系,可作为术前判断肺小动脉病理分级的一个参考指标.     

顽固性腹水1例临床病案讨论

患者，男，30岁。因潮热、盗汗2月、腹胀1月入院。入院前2月，患者无明显诱因出现自觉夜间发热(未测体温)、盗汗、伴食欲下降，乏力，不伴咳嗽、咳痰。入院前1月，出现腹胀，偶伴恶心、呕吐。无腹痛，无肛门停止捧气。无厌油，无心累、气促、心悸及双下肢浮肿。体重下降15kg。PPD试验阳性，CT示“大量腹水”，给予抗结核药物，治疗无缓解。     

不同门奇断流术式对门静脉高压症犬食管下段血管再生的影响

Objective To explore the effect on blood vessel regeneration of distal esophagus in ca-nines of portal hypertension with liver cirrhosis after different procedures with paraesophagastrie devascular-ization. Methods Portal hypertension models were produced in canines by subcutaneous injection of 60% CC14 combined with food restriction. Forty eight model canines were randomly divided into 4 groups: group A, traditional paraesophagastrie devascularization;group B, selective paraesophagastric devascularization;group C, paraesophagastric devascularization plus distal esophageal transaction and reanastomosis with sta-pler;group D,control group. Every group had 12 canines which were randomly divided into A1 ,B1 ,C1 ,D1, A2,B2,C2 and D2 groups after the operation. Canines in groups A1 ,B1 ,C1 and D1 were executed at first month after the operation,and those in groups A2, B2, C2 and D2 were executed at the 6th month after the operation. The distal esophagus was segmented when the canines were executed. The upside and downside of the stoma in group C were distinguished and signed as Ca and Cb. Immunohistochemieal methods were used to detect VEGF,CD34 and FVⅧ-Rag,blood vessel-related factors,in lower esophagus. Results The expres-sion levels of VEGF and CD34 MVD,FⅧ-Rag MVD in groups A1 ,B1 and C1 were lower than those in group D1 one month after the operation (P <0.05). All the indices in group B1 were lower than those in groups A1 and Clb,but higher than those in group Cla (P <0.05). The indices in group Cla were lower than those in group C1b (P < 0.05 ). The indices in groups A2 and B2 were higher than those in groups A1 and B1, re-spectively at the 6th month after the operation (P <0.05). They were higer in outer membrane in group C1a than in group C2a (P <0.05). The indices in group C2b were higher than those in group Clb (P<0.05). Conclusion At the first month after operation, the expression of blood vessel-related factors was declined in three different procedures of paraesophagastric devascularization,which indicated that all three different pro-cedures could diminish the vessels in distal esophagus. The effect in group C was most obvious among all groups. At the 6th month after traditional paraesophagastrie devascularization and selective paraesophagastrie devascularization, the expression of blood vessel-related factors in distal esophagus was declined. But there were no significant changes in the expression of blood vessel-related factors in distal esophagus after parae-sophagastric devascularization plus distal esophageal transaction and reanastomosis with stapler. It indicated that the blood vessel regeneration in paraesophagastric devascularization pins distal esophageal transaction and reanastomosis with stapler was inferior to that in other procedures.     

门静脉高压症发病机制-侧支循环代偿障碍学说的探讨

门静脉高压症(PHT)目前仍被认为是腹部外科最复杂和难治的疾病之一。并发食管胃底静脉曲张，则可发生致命性的上消化道大出血或因肝硬化终末期导致肝衰竭而死亡，或因脾大脾亢对机体产生损害。二十世纪80年代保脾术的兴起．肝移植的出现，使得当今在PHT外科治疗的认识上观点难以统一，因而出现了手术方法之多、争议之大、疗效不够理想等临床上难以解决的外科难题。     

F34-1型深部X线治疗机常见故障排除

1．高压线路击穿 大多发生在4个高压电缆插头与发生器机头连接处。     

MZ.ESWL-Ⅴ型碎石机几种常见故障及排除

体外冲击碎石机治疗尿路结石具有创伤小,费用低治疗效果好等优点,广泛应用于临床,本文主要针对深圳慧康生产的MZ.ESWL-Ⅴ型水囊式液电冲击波碎石机易出现的几种故障进行剖析、排除做以总结探讨.     

颌面毁损伤的围麻醉期处理

颌面部血液循环丰富，损伤后骨折、软组织撕裂可导致大量出血，使大部分病人伴有休克及呼吸道不同程度的梗阻，常常危及生命。其麻醉处理有其特殊性。自2000年1月～2006年11月，作者先后对41例颌面毁损伤患者实施麻醉。为总结经验，现做回顾性报告如下。     

动脉导管未闭合并心内畸形的外科治疗——附125例分析

目的 :分析儿童动脉导管未闭 (PDA)合并心内畸形治疗的效果及其影响因素。方法 :对PDA合并心内畸形患儿 12 5例 ,其中并发重度肺动脉高压 (PH) 3 3例。按病情分同期根治和分期手术两组。结果 :分期手术组 3 1例结扎PDA ,术后 0 .5～ 2年有 17例行心内手术 ,死亡 2例 ;同期根治组 94例行心内直视手术 ,围术期死亡 7例 ,远期死亡2例。总死亡率 8.8% (11/12 5 ) ,期中合并重度PH死亡率 18.2 % (6/3 3 ) ;手术死亡率与病种、年龄、体重、PH程度等明显相关。结论 :根据病情选择适当的术式、把握手术时机、避免严重PH是手术成功的最重要因素。     

用单腔锁骨下静脉穿刺管做恶性胸腹水闭式引流26例报告

晚期癌症患者大量的胸腹水很常见,常可引起病人呼吸困难,由于生长迅速,频繁地穿刺抽液给患者增加痛苦,又增加感染的机会,也给治疗带来诸多不便;为此,我科自欺欺人1999年1月-2001年10月间采用一次性单腔锁骨下静脉穿刺管做恶性胸腹水闭式引流共26例,收到良好效果,具体方法、效果介绍如下: