微创治疗房间隔缺损临床进展

房间隔缺损(ASD)是房间隔上的异常孔道,其位置与大小都不确定,但不管是何种缺损都会造成心房间血液流通,大约占所有心脏畸形的13％.而继发孔型ASD是较为常见的先天性心脏病,占所有先天性心脏病的1/10,原则都可行微创封堵治疗[1].目前临床常用的微创方法主要包括:X线引导下经皮封堵、单纯超声(TTE)引导经皮封堵、食...     

三种微创手术治疗房间隔缺损的比较

【目的】评价治疗先天性房间隔缺损（atrial septal defect,ASD）的3种微创手术方法。【方法】回顾性分析2003年3月-2007年12月我院收治的53例先天性房间隔缺损,A组：15例经皮导管介入封堵ASD。B组：18例胸壁小切口ASD封堵术。C组：20例右腋下小切口ASD修补术。比较ASD大小、术后住院时间及总治疗费用。【结果】全组无死亡。3组中,ASD大小组间无显著性差异;术后住院时间、治疗费用组间均有显著差异。【结论】严格掌握3种手术方法的适应症,3种手术方法均能取得满意的治疗效果。     

延边地区房间隔缺损流行病学特征分析

目的了解延边地区房间隔缺损流行病学特征。方法延边大学附属医院是地区唯一三甲综合医院,该院疾病数据趋于普查数据,收集该院2016年先天性心脏病,以统计局公开的"国民经济和社会发展统计公报"人口特征为基准,进行数据分析,估测出生儿房间隔缺损患病率、幼儿和小学生房间隔缺损患病率、成人房间隔缺损患病率和各个年龄段房间隔缺损直径大小。结果房间隔缺损(ASD)128例,男51例,女77例。继发孔型111例,占87%。0～1岁51例,估计出生儿ASD患病率28.776/万;4～7岁9例,估计幼儿患病率2.18/万;8～14岁3例,估计小学生患病率0.35/万;≥15岁病例57例,估计成人患病率0.27/万。小型ASD55例,占43.0%。结论延边地区先心病排列为ASD、室间隔缺损(VSD)、动脉导管未闭(PDA),ASD以继发孔型ASD、小型ASD为主。估计2016年出生儿ASD患病率28.776/万。     

国产封堵器介入治疗成人继发孔型房间隔缺损临床分析

目的探讨国产封堵器介入治疗成人继发孔型房间隔缺损(atrial septal defect,ASD)的临床疗效及其安全性。方法选择经胸超声心动图(transthoracic echocardiography,TIE)确诊的成人继发孔型ASD患者96例,年龄18～67(39.3±14.2)岁。局麻下应用TIE监测及X线引导下经导管行国产ASD封堵器的介入治疗。术后行TTE、心电图及胸片检查,随访6个月～4年。结果93例患者封堵成功,成功率达96.9%;其中2例封堵器脱落,1例发生急性心包填塞,并发症发生率为3.1%。随访期间右房、右室内径回缩,心功能改善,无封堵器移位、房缺再通及需要外科干预者,亦无外周栓塞及心内膜炎等并发症发生。结论国产ASD封堵器是较为安全和可控性强的装置,经导管介入治疗成人继发孔型ASD是一种有效的非外科手术治疗方法。     

房间隔缺损(修补术)单病种诊疗常规

先天性心脏病房间隔缺损(ASD)系指继发孔型房间隔缺损,是由于继发房间隔发育不良或原发房间隔组织吸收过多,第二房间孔不能闭合所致(不包括原发孔型房间隔缺损)。约占先心病的10%-20%。分为中央型、上腔型、下腔型、混合型等。     

继发孔型房间隔缺损封堵术的临床应用分析

目的评价继发孔型房间隔缺损（ASD）封堵术的临床疗效及安全性,探讨ASD介入治疗的影响因素.方法在经胸心脏超声（TTE）及X线透视下经导管置入封堵器,术后24h、72h、1个月行TTE检查评价治疗效果.结果 342例患者除4例因房缺太大,2例合并不可逆肺动脉高压外,置入均成功,技术成功率达100%,封堵效果佳,未见残余分流,1月后随访右室收缩压明显下降.结论 ASD封堵术是一种安全有效的介入治疗方法,但需掌握好手术适应症,ASD大小及边缘、合并其它先心病、房间隔膨出瘤和肺动脉高压等因素直接影响手术的成功。     

房间隔缺损(修补术)单病种诊疗常规

先天性心脏病房间隔缺损（ASD）系指继发孔型房间隔缺损，是由于继发房间隔发育不良或原发房间隔组织吸收过多，第二房间孔不能闭合所致（不包括原发孔型房间隔缺损）。约占先心病的10%-20%.分为中央型、上腔型、下腔型、混合型等。[编者按]     

成人继发孔型房间隔缺损的介入治疗

目的探讨成人继发孔型房间隔缺损(atrial septal defect,ASD)封堵术的疗效和安全性。方法选择经胸超声心动图(transthoracic echocardiography,TTE)确诊的成人继发孔型ASD患者59例,年龄18~71(38.3±11.2)岁,所有患者均在局麻下,应用TTE及X线引导下,接受了经导管应用国产房间隔封堵器的介入治疗。术后24h,1,3,6个月,1年及2年行经胸超声心动图、心电图及X-ray检查随访。结果57例患者封堵成功,成功率96.6%。57例堵塞后即刻封堵率为94.7%(54/57);堵塞1个月后的封堵率96.5%。57例堵塞后即刻封堵率为94.7%(54/57);堵塞1个月后的封堵率96.5%(55/57),堵塞1年后的封堵率100%(57/57)。随访时间1~42个月,无封堵器移位、房缺再通及需外科干预者,也无栓塞及心内膜炎等并发症的发生。右房、室缩小,心功能明显改善。结论经导管置入封堵器关闭继发孔型房间隔缺损是一种有效的非外科手术方法,操作简便、创伤小、成功率高。TTE可以准确应用于ASD封堵术中。     

下壁导联钩形R波对诊断小儿继发孔型房间隔缺损的价值

目的探讨小儿心电图下壁导联钩形R波对继发孔型房间隔缺损的诊断价值。方法观察比较继发孔型房间隔缺损38例(Ⅰ组),其他各类先天性心脏病59例(Ⅱ组)及正常小儿106例(Ⅲ组)的下壁导联钩形R波及右束支传导阻滞的出现率。结果至少一个导联出现钩形R波,Ⅰ组为:78.9%,Ⅱ组:20.3%,Ⅲ组:14.1%。组间差异均有统计学意义(P<0.05),其诊断房间隔缺损(ASD)的特异度75%,认为下壁导联钩形R波是小儿继发孔型ASD的一种独立的心电图征象。结论3个下壁导联均出现钩形R波或至少一个下壁导联出现钩形R波且伴右束支传导阻滞对诊断继发孔型ASD有高度意义。     

先天性房间隔缺损病人出现迟发性紫绀——艾森门格综合征？（附2例分析）

【目的】探讨先天性房间隔缺损（ASD）出现迟发性紫绀与艾森门格综合征的鉴别，提高对此类疾病的诊疗水平，以免判断失误，丧失治疗机会。【方法】复习2例曾在外院诊断为艾森门格综合征的先天性房间隔缺损患者的临床资料，分析其误诊的原因及危害。其临床表现均有口唇、指甲轻-中度紫绀，并伴有胸闷气促、乏力及明显右心功能不全的相关症状和体征。超声心动图（UCC）提示：右心房、右心室增大，房间隔缺损，彩色多普勒血流显像（CDH）示双期双向分流，肺动脉瓣轻度，三尖瓣中-重度关闭不全。心导管检查证实肺动脉高压仅为轻-中度。【结果】2例患者均经术中探查进一步排除艾森门格综合征，1例为下腔型巨大房间隔缺损，另1例为心房间隔缺损合并原发性重度三尖瓣环扩大，两例均顺利施行手术矫治，并康复良好出院。【结论】某些迟发性紫绀的先天性心脏病与艾森门格综合征较难鉴别，诊断务必谨慎。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

Development on Adjustable Calibration Marker for Shock Wave Focus

Shock wave lithotripsy （SWL） is a treatment of choice for upper urinary stones. However, this procedure is inappropriate for obese patients because the focus is often unable to reach the target owing to the limited focal distance in shock wave source. Although treating such patients in a blast path may increase the application length of shock wave source, it＇s difficult to find this path on the lithotripter monitor. For this reason, we invented an adjustable calibration marker in order to set an effective focus in the shock wave hath.     

Study on the TCM Pathogenesis of Angiopathic Complications of Type II Diabetes

Excess production of reactive oxygen species(ROS)of mitochondrion mediated by hyperglycemia is the common pathogenesis of angiopathic complications of diabetes.TCM holds that the damp from the dysfunction of spleen.kidney and liver is the causative factor of complications of diabetes.This is similar to the mechanism of Ros resulting in angiopathic complications of diabetes.When the angiopathic complications of type II diabetes mellitus(T2DM)are difierentiated as caused by turbid damp in TCM can be explained as ROS.Since the obstruction of pathogenic damp in channels and collaterals is said to be the main pathogenesis,the treating principle should be dissolving the damp to remove the obstruction.     

Leptin, Ghrelin and TNF-α before and after Hypo-caloric Traditional Chinese Diet and Auricular Acupuncture

INTRODUCTION Obesity is a complex emergent problem, which can be possibly solved not only by the diet but also by the life style and promotion of a constant physical exercise. 1, 2 No doubt careful attentions must be given to the nutritional condition of obese people, the dietary habits, the somatic build (i.e. distribution of fat mass) and the organic functions linked to formation of the fat mass. All the parameters should be constantly monitored before, during and after a diet treatment. 3, 4, 5     

Relationship between Dysglycemia and Carotid Atherosclerosis in Tibetan Population

People with dysglycemia are at high risk for atherosclerotic diseases. This study aims at investigating the atherosclerotic vascular damage in dysglycemia and its metabolic origin in Tibetan population.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

CLINICAL SIGNIFICANCE OF SERUM CYTOKINES IL-1β,sIL-2R,IL-6,TNF-α,AND IFN-v IN ACUTE CORONARY SYNDROME

Objectives To explore serum cytokines levels (including IL-1 β, sIL-2R, IL-6, TNF-α, and IFN-v) and their significance in patients with acute coronary syndrome (ACS) and the subsequent follow-ups, with attempt to estimate the role of various serum inflammatory markers in the diagnosis and assessment of ACS.Methods The study population include 40 patients with acute myocardial infarction (AMI), 40 patients with unstable angina pectoris (UAP), and 40 controls. Among the 80 patients, 60 patients attended a follow up 4 months later. Serum inflammatory markers including IL-1 β, sIL-2R, IL-6, TNF-α, and IFN-v were measured by enzyme linked immunosorbent assay.Results Serum IL- 1 β, sIL-2R, IL-6, TNF-α were significantly higher in AMI group or UAP group compared to the control group and became significantly lower 4 months later in the follow-up patients. Serum levels of IFN-v shows no significant difference between AMI group or UAP group and controls, also showing no significant change when measured in follow up patients. There was no correlation between serum creatine kinase-MB isoenzyme levels and serum inflammatory markers either in UAP or AMI group. Furthermore, when divided into two subgroups using Wagner's QRS scoring system in the AMI group, there is no difference of each serum inflammatory marker between ≤ 6 scores group and ＞ 6 scores group.Conclusion Serum levels of certain inflammatory markers may have some diagnostic value for ACS, and can be a useful marker reflecting disease stability.