43例巨细胞病毒性肝炎患儿T细胞亚群及细胞因子测定的临床意义

目的研究婴儿巨细胞病毒（CMV）肝炎治疗前后T细胞亚群、IL-10、IL-12水平的变化及临床意义。方法检测43例CMV肝炎患儿治疗前后T细胞亚群、IL-10、IL-12的水平。结果CMV肝炎组上述指标较对照组差异有统计学意义。临床治疗有效组治疗后除CD8^＋外各项均有显著性改变。结论T细胞亚群、IL-10、IL-12共同参与婴儿CMV肝炎的发病，对预测疗效有重要意义。     

超声心动图评价完全性大动脉转位快速二期大动脉调转术中左心室血流动力学

目的:观察完全性大动脉转位(D-TGA)患者快速二期大动脉调转术(ASO)中左心室血流动力学变化,评价肺动脉环缩对左心室的影响。方法:15例室间隔完整或合并小型室间隔缺损的D-TGA患者,应用多普勒超声心动图观察快速二期ASO手术前、后左心室舒张期直径(LVDD)、舒张期左心室后壁厚度(LVPWT)、舒张期室间隔厚度(IVST)的变化,计算左心室质量及射血分数。结果:15例均行肺动脉环缩及体肺分流术,13例在肺动脉环缩后10±3.5天行ASO。肺动脉环缩后左、右心室压力比从0.42±0.18上升至0.83±0.08,左心室质量指数从29.0±10.6g/m2上升至69.6±18.6g/m2(P<0.01),平均每天上升4.06g/m2。肺动脉环缩后左心室射血分数从75.3%±15.4%下降至51.9%±19.2%(P<0.05),大约3~4天后恢复正常(65.7%±5.1%)。结论:肺动脉环扎后,左室质量明显增加;左心功能明显下降,但可迅速恢复正常;快速二期大动脉调转术对大年龄室间隔完整或合并小型室间隔缺损的D-TGA患者是可行的。     

婴幼儿主动脉缩窄的外科治疗

目的评价近年来婴幼儿主动脉缩窄（CoA）手术疗效。方法外科治疗118例婴幼儿主动脉缩窄病例。年龄21d～3岁,平均（1．8±1．1）岁;体重2．9～13．5 kg,平均（7．5±2．2）kg。单纯CoA或伴动脉导管未闭（PDA）32例,合并其他心内畸形86例,后者大部分在正中切口深低温停循环（DHCA）或深低温低流量（DHLF）下一期纠治CoA和合并畸形。术中停循环21～48min,平均（32．13±11．72）min。结果因肺高压危象和心律失常死亡2例,病死率1．7％。呼吸机应用11～256 h,平均（98．51±6．68）h。术后随访6～24个月,无神经系统并发症,6例有声音嘶哑,其中5例经正中胸骨切口、1例外侧切口进胸施术。超声检查示2例有残余主动脉缩窄,压力阶差分别为29和36min Hg（1mmHg=0．133 kPa）。结论CoA无论是否合并心内畸形,均主张早期手术,正中切口一期根治术手越来越成为首选方案;主动脉远端与主动脉弓下缘广泛端端吻合术（EEEA）等手术方法的应用扩大了手术根治的指征,也提高了术后疗效。     

从传统哲学思维模式论中医饮食养生

本文运用中医特色思维方法就中医饮食养生进行必要的探讨，以解析其建构之路与丰富内涵。     

深低温低流量灌注心脏直视手术中的脑干听觉诱发电位变化

为了解心脏直视手术时深低温低流量灌注对脑功能的影响，对６例复杂型先天性心脏病患儿在手术时进行了脑干听觉诱发电位（ＢＡＥＰ）监测。结果显示：（１）ＢＡＥＰ的各波峰和峰间潜伏期在体外循环前均正常；（２）肛温降至３５℃￣２５℃以下ＢＡＥＰ波形全部消失；（３）流量恢复后在升温过程中Ｖ波首先复出；（４）肛温恢复３５℃时波形恢复至深低温低流量灌注前，在体外循环前后ＢＡＥＰ的波峰和各峰间潜伏其无明显差异（Ｐ〉０     

深低温低流量灌注方法在小儿四联症纠治术中的应用

本文总结我院采用深温低流量灌注方法纠治小儿先心四联症，与常规方法比较。低流量组转流降温至江温２０℃，流量降至２５ｍｌ／ｋｇ．ｍｉｎ，灌注时间１５－４０分。     

中医院校临床医学专业学位试点工作的并展与实践

通过多年的摸索和实践,本着“突出中医临床特色,保证专业学位授予质量”的指导思想,以中医临床诊疗能力培养为重点,优化课程设置,强化技能训练,规范临床技能考核制度,加强临床基地建设,有效地保证了临床医学专业学位试点工作的顺利开展。     

小肠黏膜下层复合骨髓间充质干细胞体外构建心肌组织薄片的实验研究

目的 探讨利用小肠黏膜下层（SIS）复合骨髓间充质干细胞（BMSCs）体外构建心肌组织薄片的可行性。方法 将自大鼠骨髓分离培养的BMSCs经5-氮胞苷（5-Aza）诱导培养3周后种植在经脱细胞处理的SIS浆膜面,在体外动态条件下共培养2周,构建组织工程心肌组织薄片,并进行病理组织学、超微结构和免疫组织化学染色观察。结果 与BMSCs体外共培养2周的SIS经苏木精-伊红（HE）染色显示,细胞在SIS上不只局限于材料表层,呈多层分布,部分细胞逐步向深层迁移和渗透。扫描电子显微镜观察发现,细胞较好地在SIS上黏附、生长和迁移,细胞分泌大量的细胞外基质。免疫组织化学染色结果显示,SIS上的细胞为表达α-actin、cTnⅠ和connexin-43的心肌样细胞。结论 在体外将SIS复合经5-Aza诱导的BMSCs,成功地初步构建出组织工程化心肌组织薄片。SIS是一种良好的心肌组织工程生物支架材料。     

心脏右侧径路纠治心下型肺静脉异位回流

目的 评估经心脏右侧径路纠治心下型完全性肺静脉异位回流方法的价值.方法 2005年9月至2007年12月,采用经心脏右侧进路方法纠治心下型完全性肺静脉异位回流7例.平均年龄(70.57 -44.67)天;平均体重(4.07±0.87)kg.其中3例肺静脉回流梗阻,2例卵圆孔未闭较小.结果 无手术死亡.术后并发症包括:低心排5例,发生肺动脉高压危象3例,呼吸机辅助7天以上2例,肺部感染2例.术后随访6个月至2年,超声检查心房内无残余分流,吻合口无明显梗阻,流速1.20～1.47m/s;心功能:射血分数0.70～0.79,短轴缩短率0.32～0.44;1例出现肺静脉回流的流速增快,其右上肺静脉2.60m/s,右下肺静脉2.12m/s,继续随访中.结论 采用经心脏右侧径路方法纠治心下型完全性肺静脉异位回流,取得了较好效果.手术成功取决于左房与垂直静脉的吻合口大小,保证肺静脉回流无梗阻.

Abstract：

Objective Infracardiac total anomalous pulmonary venous connection, a rare congenital cardiac defect, is associated with high mortality. A modification was designed for the procedure to reduce the post-operative obstruction in the pulmonary venous. Methods From September 2005 to December 2007, seven patients with infracardiac total anomalous pulmonary venous connection were treated with repair surgery through right side approach. The patients' age at operation was (70.57 ±44.67) days , the weight was (4.07 ±0.87) kg. Three patients had pulmonary venous obstruction, and 2 with small PFO. A modified right - side approach for repairing this defect was used. Results No death occurred after the operation. The postoperative complications included low cardiac output in 5 patients (71.43%), pulmonary hypertension crisis in 3patients ( 42.86% ) , mechanical ventilation for more than 7 days, which happened in 2 patients (28.58%) and pulmonary infection. All of the patients received follow-up. No residual shunt and pulmonary venous return obstruction were identified on echocardiogram(with a velocity from 1.2 m/s to 1.47 m/s). The heart function of patients was within the normal range(EF 0.70 -0.79, FS 0.32 -0.44). Conclusion The modified surgical procedure for the correction of infracardiac total anomalous pulmonary venous connection by right side approach was associated with favorite clinical outcomes, The post-operative outcomes depended on the size of anastomosis between the common vein and left atrium and the patency of the pulmonary venous return. Adequate size of anastomosis and maintenance of the spatial structures in adjacent regions were helpful in decreasing the adverse effect of postoperative obstruction.     

Allegro Oculyzer眼前节诊断系统测量激光原位角膜磨镶术后早前房参数变化

Objective To investigate early changes in anterior chamber parameters with the Allegro Oculyzer system after laser in situ keratomileusis （LASIK）. Methods Thirty-nine patients （77 eyes） were recruited for this prospective self-control study. An Allegro Oculyzer anterial segment analysis system was used to measure the parameters of the anterior chamber （i.e. the anterior chamber volume, the anterior chamber angle of the four quadrants, and the central and peripheral anterior chamber depths） before and after LASIK. The Wilcoxon signed rank test was used for data analysis. Results Before surgery, the posterior corneal tangential curvature, the anterior chamber volume, the anterior chamber angle（average/superior/inferior/nasal/temporal）, and the central and peripheral anterior chamber depths （superior/inferior/nasal/temporal） were： 6.19±0.23 D, 207±30.2 mm3, 40.4°±4.53°, 33.8°±8.57°, 33.9°±4.72°, 42.9°±5.00°, 42.9°±4.68°, 3.23±0.23 mm, 1.51±0.20 mm, 1.43±0.24 mm, 0.98±0.20 mm, and 1.03±0.21 mm, respectively. Seven days after the surgery, the parameters had changed to： 6.19±0.22 D,197±31.1 mm3, 40.6°±4.91°, 34.8°±8.15°, 33.9°±4.72°, 41.3°±5.32°, 43.5°±4.25°, 3.13±0.24 mm, 1.45±0.22 mm, 1.36±0.28 mm, 0.93±0.20 mm, and 0.96±0.21 mm, respectively. The differences between the anterior chamber volume and the central and peripheral anterior chamber depths were statistically significant （Z=-5.466, -7.352, -2.614, -2.546, -2.203, -3.327, P<0.05）. Conclusion The anterior chamber volume and the central and peripheral anterior chamber depths decreased soon after LASIK was performed with the Allegro Oculyzer system. The change in the central anterior chamber depth was greater than that of the peripheral anterior chamber depth.