同型半胱氨酸与冠状动脉病变程度的关系

目的 探讨血浆同型半胱氨酸(Homocysteine,Hcy)与冠状动脉病变程度的关系。方法 检测157例行冠状动脉造影患者的血浆同型半胱氨酸,冠状动脉病变严重程度以积分计,以冠状动脉造影结果分为冠心病组和对照组。 结果 冠心病患者血浆Hcy水平显著高于对照组(t=3.23 ,P<0.01) ,三支病变者和二支病变者血浆Hcy水平 ,均不同程度显著高于对照组(t= -2.03,P<0.05;t= -2.57,P<0.05),而与单支病变者血浆Hcy水平无明显差别(P>0.05)。从单因素相关分析看 ,Hcy与冠状动脉病变严重程度积分、冠状动脉病变支数、年龄呈正相关关系(r=0.26、0.25、0.31 ,均P<0.01)。logistic回归分析提示Hcy、年龄、高血压、糖尿病是冠心病的危险因素。 结论 Hcy与冠状动脉病变程度可能有直接关系 ,Hcy可能是冠心病新的独立的危险因素。     

彩超、增强磁共振动脉造影对颅外颈动脉狭窄的术前评估

目的 评价彩超、增强磁共振动脉造影(CEMRA)对颅外颈动脉狭窄的术前评估价值。方法 回顾分析了93例因颅外颈动脉狭窄而接受介入治疗患者的术前彩超、CEMRA检查结果。结果 超声检查可判断狭窄性质和狭窄程度，CEMRA能显示颈动脉全程，显示多发狭窄。但两者对狭窄程度都有过高评估的倾向，对斑块溃疡难以显示。结论 就目前彩超和磁共振机器的性能，尚无法替代DSA检查。必须有机地结合彩超、CEMRA和DSA检查，以多侧面、全方位地了解狭窄的颈动脉，制定合理的治疗方案。     

高龄冠状动脉硬化性心脏病的外科治疗

目的：探讨高龄冠状动脉硬化性心脏病(冠心病)患者外科治疗的特点。方法：对35例70岁以上冠心病患者外科治疗方法的选择、术前和术中的注意事项以及术后处理的特点进行回顾性分析。结果：本组病人无手术中死亡，1例术后3d死于严重的低心排综合征，其余患者术后恢复顺利。结论：合理的手术方法、做好术前准备、完善的手术技术及正确的术后管理，高龄冠心病患者的冠脉旁路移植术与一般患者相比死亡率无明显增加，且可明显改善患者症状，减轻心绞痛，提高生活质量。     

Coronary stenting for coronary artery narrowing in a heart transplant recipient

Transplant atherosclerotic coronary disease remains the leading cause of death in heart transplant recipients. We report the first case of coronary stent implantation in a heart graft for epicardial focal stenosis. Due to the lower rate of restenosis after stenting in the native coronary artery, we suggest that coronary stenting be considered an acceptable, first intention therapeutic option instead of angioplasty alone whenever possible.     

血液流变学因素对缺血心肌冠脉流量的影响

选用长白猪８只于麻醉下开胸，于在体猪心上探讨心肌缺血时冠脉仍保留有部分扩张储备，而未被充分利用的机理。实验结果表明：降低左冠状动脉前降支（ＬＡＤ）内压至４．６７ｋＰａ时，由ＬＡＤ分别输入腺苷、山莨菪碱、生理盐水（２ｍｌ／ｍｉｎ），皆能诱发出明显的ＬＡＤ流量增加（Ｐ＜０．０５）。在维持ＬＡＤ内压不变，并持续分别输入上述三种溶液的同时，从ＬＡＤ远端取血测血液流变学指标，结果显示，输入生理盐水和山莨菪碱使红细胞压积降低，血浆粘度和全血粘度下降；心肌缺血时，冠脉内输注药物所诱发出的“冠脉扩张储备”部分是由于此种给药方式所引起的血液稀释及血液粘度下降的结果。它提示在冠脉狭窄时，血液粘度对狭窄远端的心肌血供可能是一个相当重要的因素，降低血液粘度可能并不亚于扩血管药物的作用。     

冠心病行为模式与心理状态的相关性探讨

目的为探讨Ａ型行为在冠心病（ＣｏｒｏｎａｒｙＨｅａｒｔＤｉｓｅａｓｅ，ＣＨＤ）中的作用及与心理状态的相关性。方法对１１４例ＣＨＤ及３７例非ＣＨＤ应用心理测验方法对照调查。结果发现Ａ型行为的人易患ＣＨＤ。ＣＨＤＡ型行为者在焦虑、抑郁、人际关系、认识、敌对性症状因子分较ＣＨＤ非Ａ型行为者有明显增高。ＣＨＤ非Ａ型行为者也具有一些特有的心理症状。结论ＣＨＤ病人的行为模式与病后的某些心理表现呈正相关。     

THE CHANGES OF DEFORMABILITY OF ERYTHROCYTES AND 2.3-DPG IN RED BLOOD CELL AND BLOOD IN PATIENTS WITH CORONARY ARTERY STENOSIS

The purpose of this paper is to study the changes of deformabilityof erythrocytes and 2.3-DPG(2.3-diphosphoglycerate acid)in the patients with coro-nary artery stenosis and the effects of some factors on them.It is showed that:de-formability of crythrocyte and 2.3-DPG were inversely proportional to the degreeof the lesions of coronary vessels(P<0.01);there was a significant decrease of de-formability of erythrocytes after using contract agents(P<0.01);Salvia increaseddeformability and 2.3-DPG significantly(P<0.01).In conclusion,our data suggestthat the possible existence of microcirculation dysfunction in coronary artery dis-eases with parallelism to the impairement deformability of erythrocytcs and Salviabca good drug to action in deformability and 2.3 DPG in patients.     

Hepatic falciform ligament artery: angiographic anatomy and clinical importance

Summary The hepatic falciform ligament artery (HFLA) was evaluated by angiography and also by dissections. Based on the findings, the mechanism of the post-chemoembolization skin rash was studied. A total of 340 liver cirrhosis patients who underwent hepatic artery chemoembolization for hepatocellular carcinoma were reviewed in terms of the angiographic incidence of the HFLA, variations in its origin, and the incidence of skin rash. The HFLA was demonstrated in 26 (7.6%) of the 340 patients on angiography. Two HFLAs were observed in one patient. The origin was the middle hepatic artery (A4) in 16 cases, the superior branch of the middle hepatic artery in three, the inferior branch of the middle hepatic artery in two, the inferior branch of the left hepatic artery (A3) in three, and the confluence of A3 and A4 in three cases. There were no patients who developed post-chemoembolization skin rash. Two cadavers were dissected to investigate the anastomosis between the HFLA and the subcutaneous artery. Two different anastomoses were found: (1) direct and (2) via the ensiform branch of the internal thoracic artery. These were located at the lower and upper part of the falciform ligament, respectively. The distribution of a chemotherapeutic agent through these anastomoses is the likely cause of post-chemoembolization skin rash. If prophylactic embolization of the proximal portion of the HFLA using a metallic coil is performed, the skin rash will be prevented.

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L'artère du ligament rond du foie : anatomie angiographique et implication clinique

Résumé L'artère du ligament falciforme hépatique (ALFH) fut étudiée par des angiographies et des dissections. D'après les résultats, le mécanisme d'un rash cutané après chimio-embolisation est discuté. Un total de 340 patients présentant une cirrhose hépatique ayant eu une chimio-embolisation de l'artère hépatique pour un carcinome hépato-cellulaire fut revu en fonction de l'incidence angiographie de l'ALFH, les variations d'origine de l'ALFH, et l'incidence d'un rash cutané. L'ALFH fut objectivée angiographiquement chez 26 (7,6%) des 340 patients. Deux ALFH furent objectivées chez un patient. L'origine des ALFH était située sur l'artère hépatique moyenne (A4) dans 16 cas, la branche supérieure de l'artère hépatique moyenne dans 3 cas, la branche inférieure de l'artère hépatique moyenne dans 2 cas, la branche inférieure de l'artère hépatique gauche (A3) dans 3 cas, et la confluence A3 et A4 dans 3 cas. Aucun patient ne développa un rash cutané après chimio-embolisation. Deux cadavres furent disséqués pour étudier les anastomoses entre l'ALFH et les artères sous-cutanées. Deux types d'anastomoses entre l'ALFH et des artères sous-cutanées furent individualisés directement et par l'intermédiaire de l'artère xiphoïde et de l'artère thoracique interne. Celles-ci étaient respectivement situées à la partie inférieure et à la partie supérieure du ligament falciforme. La distribution de l'agent chimiothérapique par ces anastomoses est vraisemblablement la cause des rash cutanés après chimio-embolisation. Dans le cas d'une embolisation prophylactique de la portion proximale de l'ALFH par utilisation d'un coil métallique le rash cutané pourrait être prévenu.

     

Life satisfaction in patients with chest pain subsequently diagnosed as coronary heart disease – connection through depressive symptoms?

The aim of this study was to investigate factors associated with life dissatisfaction in symptomatic patients (n = 144) with chest pain subsequently diagnosed as coronary heart disease (CHD) by coronary angiography. Life dissatisfaction was assessed with a four-item life satisfaction scale (LS), depression with the 21-item Beck Depression Inventory (BDI) and other psychiatric symptoms with the symptom check list (SCL). DSM-III-R Axis I and Axis II psychiatric diagnoses were performed by means of the Structured Clinical Interview. All assessments took place one day before angiography. Twenty-four per cent of CHD patients were dissatisfied with their lives. Life dissatisfaction was associated with being unmarried. Dissatisfied patients had Axis I mental disorders and Axis II personality disorders more frequently than others. Psychiatric and depressive symptoms according to the SCL and BDI, respectively, were also higher among dissatisfied patients. In multiple logistic regression analyses, mental disorders were related to life dissatisfaction when age, sex, employment status, New York Heart Association class, duration of chest pain symptoms and work load were controlled in the model. Married subjects had a lower probability of being dissatisfied with their lives than other subjects (Odds Ratio, OR: 0.23). When BDI scores were included in the model, the only factor independently associated with life dissatisfaction was the severity of depressive symptoms (OR: 1.81). To conclude, life dissatisfaction is not primarily determined by the severity of CHD but by the existence of depressive symptoms.     

周围神经小间隙动脉套桥接与外膜缝合比较研究

将大鼠的腓总神经切断后，进行如下４组实验：Ａ．原位３ｍｍ间隙动脉套桥接，Ｂ．原位断端外膜缝合，Ｃ远侧断端旋转１８０°３ｍｍ间隙动脉套桥接，Ｄ远侧端旋转１８０°外膜缝合。术后１２周的电生理学，组织学评价显示，Ｂ组神经再生效果最佳，Ａ、Ｃ两组接近Ｂ组，而Ｄ组较差。