高频超声检测颈动脉内膜-中层厚度及外周血管内皮功能评价动脉粥样硬化

目的 探讨高频超声检测颈动脉内膜-中层厚度与肱动脉内皮依赖性舒张功能在动脉粥样硬化中的诊断价值.方法 冠状动脉造影的老年患者69例及青年志愿者20例,分别行颈动脉超声检查,同时采用充气加压法测定肱动脉血流介导的内径扩张值,超声测值与冠脉造影结果对照分析.结果 ①颈动脉内膜-中层厚度值随粥样硬化斑块的增多、冠脉狭窄程度的加重而增高;②动脉粥样硬化患者在内膜-中层厚度值增高之前即可出现内皮功能损伤,肱动脉内径扩张值降低早于内膜-中层厚度值增高之前出现,内径扩张值随冠脉狭窄程度加重而下降.结论 高频超声检测颈动脉内膜-中层厚度、内径扩张值诊断早期动脉粥样硬化敏感性高,并且有助于对冠脉狭窄程度作出判断.     

彩色多普勒和磁共振对健康人颅内动脉影像学的比较研究

目的通过彩色多普勒和磁共振血管成像对健康人颅内动脉的检测,初步确定其操作规范及衡量标准。方法正常人200例,按照检查方法分为彩色多普勒血流显像(ColourDopplerFlowImaging,CDFI)组及磁共振血管成像(MagneticReso-nanceAngiography,MRA)组。CDFI组观察大脑中动脉(MiddleCerebralArtery,MCA)、椎动脉(VertebralArtery,VA)各段的血流动力学改变和相应点的血流束内径。MRA组检测相应血管对应部位的血管内径。结果同一条血管不同位置的血流速率有差异(P<0.05);同名血管相应位置的血流速率左侧略高于右侧,女组高于男组,但无统计学意义(P>0.05)。按年龄分组,相邻组间无显著性差异,相隔组间有显著性差异。CDFI所测血流束内径较MRA所测血管内径值偏高,且P<0.05,差异有显著性。结论a)应用CDFI能显示MCA,VA走行,可检测血管的血流动力学的改变。b)要提高临床脑血管疾病诊断的准确性,必须有规范的临床操作和可靠的检测指标。c)对血管内径的测量MRA更佳。     

球囊二尖瓣扩张术后心房纤颤复律的临床研究

目的探讨二尖瓣狭窄合并心房纤颤患者在球囊二尖瓣扩张后,转复心房纤颤的临床效果及影响心房纤颤转复后窦性心律维持的相关因素.方法 206例二尖瓣狭窄合并心房纤颤患者在球囊扩张术后,采用口服胺碘酮及电复律治疗心房纤颤,对复律成功的患者给予小剂量胺碘酮维持窦性心律并随访1年.结果服用胺碘酮者58例,17例转复成功(29.3%);189例行电转复,178例转复成功(94.2%),电转复成功率明显高于胺碘酮转复(P＜0.01).心房纤颤复发组与保持窦性心律组相比,左心房内径明显扩大(P＜0.01),心房纤颤持续时间明显长(P＜0.01),中度二尖瓣关闭不全人数的比率明显高(P＜0.05).随访1年,有45例患者心房纤颤复发.影响心房纤颤转复后维持窦性心律的相关因素有左心房内径扩大、心房纤颤持续时间长及明显的二尖瓣关闭不全.结论对左心房内径明显扩大、心房纤颤持续时间过长及有明显的二尖瓣关闭不全的患者,在选择心房纤颤转复时应慎重.     

雷米普利降低高血压患者心房颤动发生率以及改善左心房内径临床观察

目的观察血管紧张素转换酶抑制剂(ACEI)雷米普利降低高血压患者心房颤动(AF)发生率及对左心房内径的影响。方法将180例原发性高血压患者分为治疗组(90例)和对照组(90例)。治疗组给予雷米普利(2.5～15)mg/d口服,连服50个月。对照组苯磺碳氨氯地平(2.5～10)mg/d口服,连服50个月。结果治疗50个月后治疗组AF发生率3.4%,对照组AF发生率为8.05%;治疗组左心房内径缩小(2.0±1.5)mm,对照组左心房内径缩小(0.0±1.6)mm。2组相比P<0.05,有统计学意义。结论雷米普利可降低高血压患者AF的发生率并缩小左心房内径。     

曲美他嗪联合阿托伐他汀治疗原发性高血压伴阵发性心房颤动的疗效观察

Objective To study the efficacy of trimctazidine combined with atorvastatin for primary hypertension with paroxysmal auricular fibrillation,and its effects on LAD and CRP. Methods 160 patients of pri-mary hypertension with paroxysmal auricular fibrillation were randomly divided into 4 groups. Forty patients were treated with amiodarone (control group),600 mg/d for the first week,400 mg/d for the second week and 200 mg/d later;40 patients were treated with atorvastatin (20 mg/d,3 times per day) in addition to amiodarone (the atorvasat-in group);40 patients were treated with trimetazidine (20 mg/d,3 times per day) in addition to armiodarone (the trimetazidine group);40 patients were treated with combination of trimetazidine and atorvastatin in addition to amiod-atone (the combination group),and the dose was the same as the above groups. The treatment was started within 24 hours of recovering from paroxysmal auricular fibrillation and lasted for 1 year. Results After 1 year there was 1 pa-the control group,and 62.5% (25/40) for the atorvasatin group,64.1% (25/39) for the trimetazidine group,and 84.6% (33/39) for the combination group. Compared to the control group,the effective rate of the 3 treatment groups were all significantly higher (X2=4.56、5.13、17.55,P<0.05). The effective rate of the combination group was significantly higher than that of the atorvasatin group and the trimetazidine group (X2=4.95、4.30,P<0.05),and there was no significant difference of effective rate between the atorvasatin group and the trimetazidine group(X2= >0.05). After treatment LAD was (40.96+1.81) mm in the control group,(38.65±1.90) mm in the atorvasatin group,(39.15±1.85)mm in the trimetazidine group,and (37.22±1.74) mm in the combination group. LAD of the 3 treatment groups were all significantly different from the control group(F=3.42,P<0.05). LAD of the combina-tion group was significantly smaller than that of the atorvasatin group and the trimetazidine group (P<0.05),and there was no significant difference of the LAD between the atorvasatin group and the trimetazidine group(P>0.05). There was no significant difference between the 4 groups on CRP before treatment (F=0.96,P>0.05). After treat-ment CRP was (8.85±1.45) mg/L in the control group,(5.96±1.26) mg/L in the atorvasatin group,(6.81± 1.37) mg/L in the trimetazidine group,and (3.75±1.15) mg/L in the combination group. CRP of the 3 treatment groups were all significantly different from the control group (F=3.63,P<0.05). CRP of the combination group was significantly lower than that of the atorvasatin group and the trimetazidine group (P<0.05),and there was no signif-icant difference of CRP between the atorvasatin group and the trimetazidine group (P>0.05). Conclusion The treatment with trmetazidine combined with atorvastatin could prevent recurrence of paroxysmal auricular fibrillation though anti-inflammatory and inhibiting the remodeling of left atrial.     

超声心动图在主动脉瓣测量和置换术中的作用

目的探讨利用超声心动图(心超)测量主动脉瓣环内径,为患者在人工机械主动脉瓣置换术前选择一个大小型号合适的人工机械瓣膜.方法对291例顺序施行人工机械主动脉瓣置换术患者在术前作经胸壁超声心动图检查并测量主动脉瓣环内径,将测值与手术中实际采用的人工机械主动脉瓣的型号大小进行比较对照和相关性分析.结果术前经心超在胸骨旁左室长轴切面观所测量的主动脉瓣开放最大时间的主动脉瓣环内径的测值与手术中实际采用的人工机械主动脉瓣大小呈显著性相关性(r=0.830,P<0.05,n=291).同时推算出利用术前心超的主动脉瓣环的测值减去2或3 mm(进口人工机械瓣)或减去5或6个单位(国产人工机械瓣)所得到的数值即为手术所选的人工机械瓣的大小.结论利用心超测量主动脉瓣环内径的测值可作为临床手术医师术前选择合适的人工机械瓣膜的有用的参考数据.     

重组人纽兰格林对正常恒河猴心脏的影响

探索重组人纽兰格林对健康成年恒河猴心脏的作用.将10只健康成年实验恒河猴随机分为实验组及对照组,分别注射等量重组人纽兰格林及生理盐水,采用超声心动图对用药前、用药即刻60 s内及用药10 d后相关指标进行测量,比较两组之间及不同时间之间各指标的差异.结果表明:重组人纽兰格林对健康实验恒河猴的舒张末期左室内径及容积、收缩末期左室容积、每搏量有影响,且随着用药时间的延长4者均增大,而重组人纽兰格林对健康恒河猴的左室射血分数及短轴缩短率没有显著影响.本研究认为重组人纽兰格林对健康成年恒河猴左心室容积有影响,而对心肌收缩力无显著影响.     

输尿管狭窄的应用解剖学研究

目的:探讨输尿管生理狭窄的数目、位置及狭窄的程度,为选择性CT分段扫描诊断输尿管结石提供解剖学依据.方法:解剖30例国人成人尸体60条输尿管(男40条,女20条),分段观测输尿管形态、狭窄的数目、位置和管腔内径.结果:各段输尿管形态多样,主要有四类.输尿管生理狭窄的程度依次为膀胱壁内段＞输尿管盆段＞输尿管髂血管段＞输尿管腹段.结论:输尿管生理狭窄的数目不恒定.生理狭窄的部位除膀胱壁内段外其余部位均不恒定,膀胱壁内段狭窄程度最大.