Standford B型主动脉夹层腔内修复术后主动脉重塑效果

目的 系统性回顾Standford B型主动脉夹层腔内修复术(TEVAR)后主动脉重塑结果.方法 检索已发表的评估TEVAR术后主动脉重塑文献,系统性回顾Standford B型主动脉夹层形态学测量方法及结果.共纳入19篇文献,其中仅3篇文献采用三维重建软件进行测量.各文献测量变量多为夹层真腔、假腔直径或面积,仅有少数文献计算了真假腔体积.结果 各文献测量的主动脉平面、术后随访时间及测量方法不同,无法进行数据整合.但总体趋势为急性B型夹层患者术后主动脉重塑效果(胸主动脉假腔血栓化比率为80％～90％)优于慢性患者(38％～91.3％),且更具有一致性;降主动脉术后假腔完全血栓化比率高于腹主动脉,降主动脉近端的主动脉重塑效果良好,膈肌角平面以下重塑效果较差.结论 尽管TEVAR术后主动脉重塑的描述方式各异,但多数文献显示夹层累及主动脉范围广者术后重塑效果差,与夹层远端裂口旷置有关.覆膜支架长度、治疗时间等因素对术后重塑均有影响.统一的评估标准有利于评估主动脉重塑效果,并为临床决策提供更有力的科学支持.     

Standford A型主动脉夹层1例报告

患者,男,29岁。因食用变质水果后出现发热、恶心、呕吐、腹痛,于某医院门诊检查发现肾功能异常,血肌酐400umol／L左右,给予抗感染治疗（用药不详）,3d后,症状缓解,但感乏力、纳差,未复查肾功能,2d后因突发胸腹部及背部疼痛伴大汗,于该院住院治疗,复查肾功能血肌酐400／lmol／L,     

Cognitive evoked potentials in narcolepsy: a review of the literature

Subtle cognitive deficits have been described in narcolepsy. They have been hypothesised to be related to changes in the hypocretin system. Event-related potential (ERP) paradigms are known to be useful tools in the investigation of information processing and seem to be sensitive to subtle neuropsychological changes. We review empirical articles on ERPs in narcolepsy in order to contribute to clarify the pattern of cognitive deficits that are specific to this disease and, possibly, to identify specific cognitive domains that improve with treatment. Fourteen peer-reviewed articles were selected for this review. These studies were conducted with passive and active oddball paradigms and support the existence of changes in cognitive attentive processing in narcolepsy, possibly in association with altered functioning of the prefrontal cortex. ERP low-resolution electromagnetic tomography revealed that modafinil improved information processing speed and increased energetic resources in prefrontal cortical areas. These findings suggest that it is worthwhile to further evaluate the usefulness of ERPs in the detection of cognitive dysfunction in this disorder before and after treatment.     

Standford A型主动脉夹层累及冠状动脉外科治疗的手术护理

根据是否累及升主动脉可将胸主动脉夹层分离分为Stanford A、B两型。Stanford A型主动脉夹层累及升主动脉,其近端剥离常累及冠状动脉,冠状动脉血管内形成夹层,甚至导致冠状动脉开口完全从主动脉窦部内膜撕脱,     

Transluminal stent graft placements for the treatment of Standford B type aortic dissection

Management of patients with aortic dissection includes medical and surgical treatments.Because of the high surgical morbidity and mortality rate, transluminal stent graft placement （TSGP） has emerged as a new treatment instead of open surgery for aortic dissection of a descending aortic intimal tear.1 In our institute, we use TSGP to seal the entry site for both acute onset and chronic Standford B type aortic dissections. The implantation technique and outcome of this treatment are discussed.     

不同温度下停循环选择性脑灌注在急性Ⅰ型StandfordA主动脉夹层中的应用

目的：评价急性Ⅰ型 Standford A 主动脉夹层手术在不同温度下停循环选择性脑灌注技术中的临床效果。方法50例行主动脉全弓置换者按照开始停循环的最低温度分为5组：A 组(10例,鼻咽温16~18℃)、B 组(10例,18~20℃)、C 组(10例,20~22℃)、D 组(10例,22~24℃)、E 组(10例,24~26℃)。观察5组患者手术及临床预后情况。结果术后患者出现1例永久性神经功能障碍(PND)患者放弃治疗,5例短暂性神经系统功能障碍(TND),4例一过性肾功能障碍,手术中无死亡,术后无严重低心排出量综合征和多脏器功能衰竭,治愈出院。50例患者中,49例痊愈出院,1例自动出院。各组开始选择性脑灌注鼻咽温和直肠温度如下：A 组(17．1±1．8)℃、(20．5±1．2)℃;B 组(18．9±3．1)℃、(22．4±1．2)℃; C 组(21．2±1．1)℃、(24．4±1．9)℃;D 组(23±1．2)℃、(26．2±1．8)℃; E 组(25±1．1)℃、(27．2±1．7)℃。5组患者复温时间比较：体外循环时间差异均有统计学意义(F =6．572,P <0．05),5组患者术后1例 PND 发生率为2%,TND 发生率为10%,差异无统计学意义(F =1．283,P >0．05)。术后呼吸机辅助时间、肾功能衰竭发生率、监护室停留时间、住院时间差异无统计学意义(F =0．935,P >0．05)。结论急性 Standford A 型主动脉夹层在不同温度下,停循环选择性脑灌注技术用于手术,可以明确减少体外循环转机时间,并未增加患者术后神经系统并发症,在中低温下行停循环加选择性脑灌注在主动脉夹层中的应用更加安全可靠。     

Absence of rebound from diltiazem therapy in Prinzmetal's variant angina

To determine the frequency of rebound anginal symptoms on abrupt withdrawal of calcium channel blocking agents, anginal symptoms were retrospectively examined in patients with Prinzmetal's variant angina abruptly withdrawn from diltiazem therapy as part of the design of a placebo-controlled multiple crossover trial. Rebound was defined as a return of anginal symptoms to levels exceeding those of the pretreatment baseline state. Values for daily frequency of angina were compared (after subtracting corresponding baseline values) between placebo periods following diltiazem periods and placebo periods following placebo periods. No intergroup differences existed between mean changes in daily frequency of angina from baseline value (-0.61 for placebo following diltiazem versus -1.10 for placebo following placebo) (p greater than 0.4). Furthermore, in 13 (28%) of 46 occurrences when placebo followed placebo, daily frequency of angina exceeded baseline value in the immediate 3 day period following placebo compared with 17 (21%) of 80 occurrences when placebo followed diltiazem. There was no increased rebound occurrence comparing high dose (240 mg/day) with low dose (120 mg/day) diltiazem therapy. No significant symptoms such as myocardial infarction or unstable angina occurred after withdrawal of diltiazem or placebo. The lack of difference in rebound after diltiazem or placebo withdrawal was consistent using paired and unpaired analyses. In conclusion, there appears to be no evidence that abrupt withdrawal of therapy with diltiazem results in rebound anginal symptoms.