动脉硬化性高血压病人护理上的指导

高血压病人逐渐增多,目前为止,高血压发病占据心血管疾病的首位,并有向年轻化发展的势态.高血压已经引起人们的关注.因动脉硬化而致的高血压更被人们所认识.因为由于动脉硬化性高血压引起的心脑血管的突发事件,属实给人类带来很多麻烦和不幸,使一部分高血压患者达剑了谈虎色变的程度,产生焦虑和忧郁心理,不但使高血压得不到彻底治疗,反而会加重高血压的产生.     

大剂量X射线辐照对离体大鼠脊髓神经元凋亡的影响

目的:研究X射线辐照对大鼠原代脊髓神经元细胞的损伤效应。方法:制备SD大鼠脊髓原代神经元细胞,神经元标志物神经元核抗原(Neu N)免疫荧光染色鉴定其纯度。给予0、3、6和9 Gy等距离X射线辐照,二甲基噻唑-二苯基四氮唑溴盐(MTT)比色法检测神经元存活率,乳酸脱氢酶(LDH)漏出率评价细胞膜完整性。Western Blot检测DNA损伤反应蛋白-聚(ADP核糖)聚合酶1(PARP1)完整型和裂解型蛋白的表达水平以及胞浆胞核蛋白中凋亡诱导因子(AIF)的表达变化。结果:大鼠脊髓原代90%Neu N染色阳性,提示神经元纯度达90%以上。原代神经元细胞接受0、3、6和9 Gy等距离X射线辐照后48 h,9 Gy辐照使得细胞存活率显著降低(P 0. 05)及LDH漏出率升高(P 0. 05)。6 Gy辐照后神经元细胞中完整型PARP1表达显著升高(P 0. 05),而9 Gy辐照后PARP1水解明显加剧(P 0. 01),提示凋亡增加。6 Gy及以上剂量辐照后神经元细胞核蛋白中AIF显著增多(P 0. 05)。结论:大剂量X射线辐照破坏了大鼠脊髓神经元细胞膜完整性,引起DNA损伤,诱导了caspase依赖及非caspase依赖的细胞凋亡。     

ENTRESTO对心力衰竭大鼠血清cAMP、BNP、Gal-3及生存时间的影响

目的 研究ENTRESTO对心力衰竭大鼠血清cAMP、BNP、Gal-3及生存时间的影响.方法 将SD雄性大鼠采用结扎冠状动脉左前降支近端的方法建立心肌梗死后心力衰竭大鼠模型,将其随机分为4组:正常组、建模组及低、高剂量实验组(sacubitril/缬沙坦,49/51 mg,97/103 mg),每组8只,灌胃给药.正常组及建模组给予同等剂量蒸馏水.分别于给药后3、9、18 h取大鼠静脉血,采用化学发光法测定BNP;采用ELISA检测法测定cAMP、Gal-3;观察小鼠生存时间.结果 建模组大鼠个时段血清Gal-3、BNP含量较其他组最高,差异具有统计学意义(P<0.05),经ENTRESTO治疗后,低、高剂量组大鼠血清Gal-3、BNP水平均有不同程度下降,且高剂量组大鼠Gal-3、BNP水平低于低剂量组,高于正常组(P<0.05).建模组大鼠个时段血清cAMP含量较其他组最低,差异差异具有统计学意义(P<0.05),经ENTREST治疗后,低、高剂量组大鼠血清cAMP水平均有不同程度升高,且高剂量组大鼠cAMP水平高于低剂量组,低于正常组,差异具有统计学意义(P<0.05).建模组大鼠最早出现死亡个体,且最早全部死亡;经生存分析得知,与低、高剂量组对比,差异显著,具有统计学差异(P<0.05).结论 ENTRESTO能够降低心力衰竭大鼠血清中的 Gal-3、BNP水平,升高cAMP水平,延长心力衰竭大鼠生存时间.     

肌注猪苓多糖引起过敏反应二例报告

猪苓多糖能调节机体免疫功能,对乙肝、肿瘤等病有一定疗效。本品为中药猪苓提取的多糖物质,系注射用粉剂。我站于2001年12月下旬使用该制剂治疗乙型肝炎中引起过敏反应2例,现报告如下。     

慢性心力衰竭患者心脏再同步治疗疗效观察

Objective This study was designed to evaluate the clinical outcome of cardiac resynchro-nization therapy(CRT) during short and mid-long term follow-up. Methods Consecutive patients treated with CRT between 1999 and 2008 were registered. Clinical information was collected from baseline and last follow-up. Clinical information included survival, chnical cardiac function, echocardiography parameters and QRS wave width from surface ECG. Results Ninety-five patients who were treated with CRT successfully were included. These patients were divided into two groups: those with only short term follow-up and those with mid-long term follow-up. In the short term follow-up group,survival was 89.1% with follow-up of(18±10) month(median = 18 months). Survival was 66.6% in mid-long term group with follow-up of(57±17) months (median = 54 moths). While clinical cardiac function was significantly improved in both groups the intrinsic QRS wave width did not show significant change. Those patients' medical therapy for chronic heart failure has been changed dur-ing the period of follow-up. Conclusion CRT can improve clinical cardiac function in parts of patients with chronic heart failure and increased survival during mid-long term and short term follow-up. However, there re-mains a need for more sensitive indicators.     

心脏再同步化治疗中经胸心外膜起搏导线的植入技术

目的探讨经胸心外膜左心室导线植入在慢性充血性心力衰竭心脏再同步化治疗中的意义。方法对1例经静脉植入左心室导线因冠状静脉窦开口畸形而放弃的患者行经胸植入左心室心外膜导线植入。结果右心房、右心室心内膜起搏导线植入及两根心外膜起搏导线缝合均顺利,术后未出现严重并发症。术后2周后临床症状逐渐改善,NYHA心功能分级从术前Ⅲ、Ⅳ级提高至Ⅱ级,LVEDD从72mm减至66mm,优化程控起搏器后超声心动图描记术检查室间隔基底部与左心室侧壁间失同步性改善,第3天心外膜起搏导线阈值从术中的2.0V降为0.5V且稳定。已随访12周临床症状、心功能改善,组织多普勒显像示左心室内恢复同步化。结论心脏再同步化治疗经胸心外膜左心室导线植入是安全、可行的,特别是对经静脉途径失败的患者,是可选择的方法之一;术中左心室导线的定位及术后的综合处理十分重要。     

慢性心力衰竭患者心脏再同步治疗疗效观察

Objective This study was designed to evaluate the clinical outcome of cardiac resynchro-nization therapy(CRT) during short and mid-long term follow-up. Methods Consecutive patients treated with CRT between 1999 and 2008 were registered. Clinical information was collected from baseline and last follow-up. Clinical information included survival, chnical cardiac function, echocardiography parameters and QRS wave width from surface ECG. Results Ninety-five patients who were treated with CRT successfully were included. These patients were divided into two groups: those with only short term follow-up and those with mid-long term follow-up. In the short term follow-up group,survival was 89.1% with follow-up of(18±10) month(median = 18 months). Survival was 66.6% in mid-long term group with follow-up of(57±17) months (median = 54 moths). While clinical cardiac function was significantly improved in both groups the intrinsic QRS wave width did not show significant change. Those patients' medical therapy for chronic heart failure has been changed dur-ing the period of follow-up. Conclusion CRT can improve clinical cardiac function in parts of patients with chronic heart failure and increased survival during mid-long term and short term follow-up. However, there re-mains a need for more sensitive indicators.     

p55PIK和血管内皮生长因子在乳腺癌患者中的表达及意义

目的探讨乳腺癌患者磷脂酰肌醇-3-激酶亚基p55γ(p55γof phosphatidylinositol 3-kinase, p55PIK)、血管内皮生长因子(vascular endothelial growth factor, VEGF)水平变化及临床意义。方法 73例乳腺癌患者为乳腺癌组,59例乳腺癌前病变患者为癌前病变组,52例乳腺增生患者为乳腺增生组。采用免疫组织化学法检测3组患者手术切除组织p55PIK、VEGF蛋白阳性表达率并比较分析。对乳腺癌组患者随访30个月,采用Kaplan-Meier生存曲线分析p55PIK、VEGF阳性表达与乳腺癌患者预后的关系,采用log-rank法比较生存差异。结果乳腺癌组p55PIK和VEGF阳性表达率(57.53%、71.23%)明显高于癌前病变组(35.59%、50.85%)和乳腺增生组(15.38%、26.92%)(P0.05),癌前病变组高于乳腺增生组(P0.05);乳腺癌组p55PIK阳性患者病死率(38.10%)高于p55PIK阴性患者(12.90%)(P0.05),VEGF阳性患者病死率(34.62%)高于VEGF阴性患者(9.52%)(P0.05)。结论 p55PIK、VEGF阳性表达与乳腺癌的发生、发展有关,有可能成为乳腺癌临床治疗和预后的新靶点。     

面神经的角神经三维可视化研究

目的 通过三维可视化技术,验证前期解剖学研究结果,并为失神经支配手术提供一定的理论依据.方法 取自愿捐献的甲醛固定的成人尸头,切取内眦角内侧全层软组织长3 cm、宽1 cm,以皮肤表面2平行刀痕为定位线,连续横断石蜡切片,片厚10 μm,切片间距0.25 mm,共切取120张切片.采用HE组织化学染色,高分辨率扫描仪获取二维数码图像后进行三维重建.结果 ①真实再现了角神经的三维立体结构及角神经与内眦动静脉的三维立体行径,且重建结构不但能单独或搭配显示,并可从任意角度显示.②证实了角神经显微解剖学研究的正确性.③角神经毗邻关系的三维重建技术可以应用到临床.结论 基于组织学和计算机技术,可以三维重建角神经的毗邻关系,为角神经的失神经支配手术提供更加准确的可行性依据.     

大骨瓣开颅手术治疗额颞部脑挫裂伤的体会

<正>2005-01—2010-06,我科采用标准外伤大骨瓣开颅手术治疗额颞部脑挫裂伤160例,取得较好疗效,现总结如下。1资料及方法1.1一般资料男117例,女43例;年龄19～70岁,平均43.6岁。受伤原因:车祸伤110例,坠落伤37例,暴力打击8例,跌伤5例,按受伤机制分类:减速性损伤143例,复合损伤7例,加速