急性梗阻的左半结肠癌Ⅰ期切除吻合体会

目的探讨左半结肠癌急性梗阻Ⅰ期切除吻合的Ⅰ临床应用价值。方法对1988年1月至2006年12月24侧实施左半结肠癌急性梗阻Ⅰ期切除吻合手术患者的资料进行回顾性总结。结果24例均未发生吻合口漏，仅3例发生切口感染，经局部换药处理Ⅱ期愈合。结论积极的术前准备、术中彻底的肠减压能为左半结肠癌急性梗阻Ⅰ期切除吻合提供安全保证.     

Blood pool ventriculography with a new technetium-labelled complex (99mTc-DEPIC) : a clinical evaluation

A new, single bolus method of in vivo blood pool imaging using a technetium Tc99m phosphine isocyanide complex (DEPIC) which binds to pre-albumin was evaluated in volunteers (n=4) and patients (n=20). DEPIC was assessed for its safety and possible drug interactions. Its duration of action and quality of ventriculography were compared with imaging using standard in vivo red cell labelling (PYP) during two 3-h scanning periods 1 week apart. DEPIC had a mean plasma halflife of 3.3 h. The count rate over the left ventricle was initially 42% higher with DEPIC than with PYP. However, removal of DEPIC by the liver resulted in equivalent count rates by 1 h, and by 3 h PYP count rates were 22% higher than DEPIC. Immediately post injection mean (SD) difference in the left ventricular ejection fraction between the two methods was 2.4% (7.7%). Satisfactory DEPIC scans were obtained up to 2 h post injection, but by 3 h there was a mean difference of 13% (11.3%). DEPIC was found to be a safe alternative to red all labelling for blood pool angiography, suitable for routine work. The single bolus methodology and high initial count rates offer improved efficiency and a capability for truly emergency scanning.     

非瓣膜病房颤患者左心耳血流动力学的TEE研究

应用多平面经食管超声心动图技术（Ｍ－ＴＥＥ），对３０例健康人和３０例非瓣病房颤患者（ＮＶＡＦ）心底短轴切面测量了左心耳最大直径，同一心动周期内左心耳最大及最小面积及左心耳最大空速度，产将ＮＶＡＦ患者按照自发显影及血栓的有无分为２组。发现ＮＶＡＦ组左心耳增大，收缩力及血流速度均减低，且这种变化在有血栓和有血栓形成倾向的患者中更为明显。     

Donor left ventricular hypertrophy increases risk for early graft failure

A review of factors contributing to early mortality after cardiac transplantation revealed that up to 25 % of deaths were due to primary graft dysfunction unrelated to rejection or infection. In light of this finding, evaluation of a donor heart with regard to its suitability for transplantation takes on added importance. In an effort to screen the suitability of donor hearts in the region covered by the Northwest Organ Procurement Agency (USA), all donors are evaluated by two-dimensional transthoracic echocardiography as part of the initial evaluation. A total of 110 donor echocardiograms were reviewed and an attempt was made to correlate the 30-day outcome with the parameters measured. An unexpected finding was that the presence of left ventricular hypertrophy in the donor heart was associated with an increase in the incidence of donor heart dysfunction compared with donors with normal echocardiographic profiles (33 % vs 3 %, P = 0.007). Received: 12 February 1996 Received after resision: 27 June 1997 Accepted: 14 July 1997     

超声心动图房室平面位移法对高血压病早期患者左室舒张功能的评价

目的:探讨超声心动图房室平面位移(AVPD)法评价高血压病早期患者(HT)左室舒张功能的可行性。方法:分别记录200例HT患者左房射血所致AVPD(AVPDa)值、AVPD与二尖瓣环4个位点上的AVPD均值(AVPDmean)比值,并与二尖瓣口E/A比值法(E/A分析法)进行对比。结果:200例HT患者AVPD法测值:AVPDmean值为(0·66±0·15)cm,AVPDa为(0·79±0·46)cm,E/A分析法:E/A最大峰值速度分别为(75·38±11·66)cm/s,(82·36±16·82)cm/s。根据AVPD方法诊断163例舒张功能异常,E/A分析法诊断171例舒张功能异常,二者之间差异无显著性意义(χ2=1·78,P>0·05)。结论:AVPD方法与E/A分析法有较好符合性,为一无创性评价HT患者左室舒张功能的新方法。     

原发性高血压患者微量白蛋白尿与血压及左室重塑的关系

目的探讨原发性高血压(EH)患者微量白蛋白尿(MCA)与血压及左室重塑的关系.方法 84名EH患者按24h尿微量白蛋白值分为微量白蛋白尿组(MCA组)和正常白蛋白尿组(NMCA组),进行动态血压、心脏超声检测,比较两组动态血压值、左室重量指数(LVMI)及左室重塑的特点.结果 MCA组平均收缩压、平均舒张压、脉压、平均动脉压均高于NMCA组(均P＜0.01);MCA组LVMI、左室肥厚与向心性肥厚的发生率均高于NMCA组(均P＜0.01),正常构型率低于NMCA组(P=0.01).LVMI与尿微量白蛋白值、平均收缩压、平均舒张压均呈显著的正相关(均P＜0.05).结论合并有MCA的EH患者血压较高,LVMI较大,左室肥厚与向心性肥厚的发生率较高.MCA与血压及左室重塑密切相关.     

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.     

Non-invasive estimation of the diastolic elastic and viscoelastic properties of the left ventricle

The present study applies a non-invasive method to the quantitative evaluation of left ventricular stiffness in normal subjects and in patients with ischaemic heart disease (IHD). We have studied 20 patients with IHD and 25 healthy subjects. The third heart sound (S3) was detectable in all patients. We have correlated the energy spectrum of S3, divided into 15 Hz bands, with a series of echocardiographic parameters. The existence of a significant correlation between the spectrum energy and the diameter and thickness of the left ventricle at the moment of S3 allowed us to explore the possibility of interpreting the origin of S3 based on a mathematical model. Our hypothesis has been that, once the left ventricle starts vibrating, it behaves as a simple physical model composed of a mass and an elastic element. To this purely elastic model one can add a factor accounting for viscosity, with a damping effect, to obtain a more complex viscoelastic model. The stiffness coefficient 'k' was computed in both models from the peak frequency of S3 and the left ventricular mass at the moment of S3. Furthermore, in the viscoelastic model, the damping element 'c' was also computed. Both parameters--k and c--were significantly increased in the group with IHD compared with the control group. Although a simplification of the vibrating system, these models make it possible to obtain non-invasively information on the characteristics of the left ventricle through the combined use of echocardiography and spectral analysis of S3.