2003-2007年西安市大骨节病监测结果分析

大骨节病是以四肢透明软骨变性坏死为主要病理特征的地方性变形性骨关节病,该病致畸性很高,严重制约了病区社会生产力和经济的发展,使病区居民吴现因病致贫、因贫致病的恶性循环.     

心房颤动患者射频消融术后运动耐力现状及影响因素分析

背景　运动耐力水平低下与心血管疾病所致死亡风险相关,对于心房颤动患者而言运动耐力可能是影响其生活质量和临床预后的重要因素。即使成功行射频消融术,患者运动耐力水平依然不容乐观,且针对其现状及影响因素的调查研究较少。目的　探讨心房颤动患者射频消融术后运动耐力现状及其影响因素。方法　采用便利抽样法,选取2018年5月-2019年6月在南京医科大学第一附属医院心内科就诊的189例完成射频消融术的心房颤动患者为研究对象,采用自制一般资料调查表收集患者的一般资料,运用心肺运动试验（CPET）评估患者运动耐力。运动耐力的影响因素采用多元线性回归分析。结果　心房颤动患者射频消融术后最大摄氧量（VO2max）平均为（19.7±6.1）ml?kg-1?min-1。Weber心功能分级A级85例（45.0%）、B级45例（23.8%）、C级52例（27.5%）、D级7例（3.7%）。不同性别、年龄、文化程度、吸烟、饮酒、运动习惯、术前美国纽约心脏病协会（NYHA）心功能分级、术前心房颤动症状（EHRA）分级、体质指数（BMI）心房颤动患者射频消融术后VO2max比较,差异均有统计学意义（P<0.05）。多元线性回归分析结果显示,运动习惯〔β=3.956,95%CI（2.746,5.269）〕、术前EHRA分级〔β=-4.651,95%CI（-5.318,-3.983）〕、BMI〔β=-0.224,95%CI（-0.383,-0.066）〕是心房颤动患者射频消融术后运动耐力的影响因素（P<0.05）。结论　心房颤动患者即使射频消融术成功,短期内仍存在不同程度的运动耐力下降,提示临床应结合患者运动习惯、术前EHRA分级及BMI等采取相应干预措施以促进其运动耐力提升,进一步改善生活质量。     

弥漫性轴索损伤患者早期肠内添加ω-3脂肪酸对T细胞亚群及预后的影响

目的观察早期肠内添加ω-3脂肪酸对于弥漫性轴索损伤患者的治疗效果。方法根据入院顺序,将弥漫性轴索损伤患者随机分成两组：实验组和对照组,每组20例患者。根据病情需要,在对所有患者行常规对症支持治疗的同时,分别行早期肠内免疫营养和早期常规肠内营养,进行等热量、等氮量的营养支持。在入院时、伤后7天、15天测定T细胞亚群、淋巴细胞总数。统计感染并发症的发生率。并统计分析比较两组患者伤后3月的GOS预后评分。结果与对照组比较,实验组T细胞亚群绝对数、淋巴细胞总数明显回升,感染并发症发生率下降,伤后3月的GOS预后评分明显增高（P〈0.05）。结论应用免疫营养支持不仅能改善弥漫性轴索损伤患者的营养状况,还能增强患者免疫功能,降低感染率,改善预后。     

自发性2型糖尿病动物模型KKAy小鼠肾脏损害的特征与演变

 摘要: 目的 观察自发性2型糖尿病动物模型KKAy小鼠糖尿病早期肾损害的特征和演变,旨在探讨其在糖尿病肾病研究中的应用价值。方法 选择8周龄雄性KKAy小鼠和C57BL/6小鼠各20只,分别于8周龄、20周龄测定血糖、尿微量白蛋白、尿肌酐,并留取肾脏标本,于光镜及电镜下观察其肾脏病理特点。结果 ①不同周龄KKAy小鼠体重、随机血糖均高于对照组C57BL/6小鼠(P<0.05)。② 20周龄KKAy小鼠尿白蛋白排泄率显著高于8周龄KKAy小鼠和对照组C57BL/6小鼠(P<0.05)。③20周龄KKAy小鼠,光镜下肾小球面积增大, 肾小球毛细血管基底膜（GBM）增厚,系膜基质增生,可见硬化结节;电镜下肾小球基底膜增厚,足突部分扁平、融合。结论 20周龄KKAy小鼠出现肥胖、高血糖、尿白蛋白排泄率增加及典型的糖尿病肾病病理改变,是研究2型糖尿病早期肾损害的理想动物模型。     

食管造影及温度监测指导环肺静脉消融治疗心房颤动

Objective Because of the severe consequences of an atrial esophageal fistula,it is vital to avoid this complication. The most safe way is to avoid ablating the segment of esophagus behind left atrium (LA). What we do is to image the relationship of esophagus to posterior LA wall and real-time esophageal tem-perature monitoring to ablate the posterior LA wall. Methods Sixty-four patients with paroxysmal atrial fibrilla-tion (PAF) were enrolled to pulmonary veins (PV) isolation. Swallowing a radiocontrast agent at the same time when imaging of LA to observe the relationship of esophagus to posterior LA wall and according to the different relationship between the segment of esophagus behind LA and PV, the esophagus were divided into type Ⅰ , type Ⅱ and type Ⅲ. A esophageal temperature probe was inserted and advanced into the esophagus directly posterior to the LA. Three steps ablation strategy and real-time esophageal temperature monitoring were applied to guide the PV isolation. The procedure was interrupted when the esophageal temperature was 39℃ until] the tempera-ture renormalized and ended when PV were isolated. Results There were 48 type ⅠI , 11 type Ⅱ and 5 type Ⅲ esophagus in the 64 patients. After three steps ablation,all PV isolations were completed. Only 18.8% of the patients needed to ablate the posterior LA close to the esophagus. Conclusion Only one PV ostiolum close to the posterior LA wall in most PAF patients and many of them can achieve complete PV isolation without ablating the posterior LA close to esophagus which could minimize the risk of esophageal injury dramatically.     

食管造影及温度监测指导环肺静脉消融治疗心房颤动

Objective Because of the severe consequences of an atrial esophageal fistula,it is vital to avoid this complication. The most safe way is to avoid ablating the segment of esophagus behind left atrium (LA). What we do is to image the relationship of esophagus to posterior LA wall and real-time esophageal tem-perature monitoring to ablate the posterior LA wall. Methods Sixty-four patients with paroxysmal atrial fibrilla-tion (PAF) were enrolled to pulmonary veins (PV) isolation. Swallowing a radiocontrast agent at the same time when imaging of LA to observe the relationship of esophagus to posterior LA wall and according to the different relationship between the segment of esophagus behind LA and PV, the esophagus were divided into type Ⅰ , type Ⅱ and type Ⅲ. A esophageal temperature probe was inserted and advanced into the esophagus directly posterior to the LA. Three steps ablation strategy and real-time esophageal temperature monitoring were applied to guide the PV isolation. The procedure was interrupted when the esophageal temperature was 39℃ until] the tempera-ture renormalized and ended when PV were isolated. Results There were 48 type ⅠI , 11 type Ⅱ and 5 type Ⅲ esophagus in the 64 patients. After three steps ablation,all PV isolations were completed. Only 18.8% of the patients needed to ablate the posterior LA close to the esophagus. Conclusion Only one PV ostiolum close to the posterior LA wall in most PAF patients and many of them can achieve complete PV isolation without ablating the posterior LA close to esophagus which could minimize the risk of esophageal injury dramatically.     

小脑脑桥角颅咽管瘤一例

患者 女,54岁.因右耳鸣、听力下降6个月,加重伴头痛、口角歪斜2个月入院.查体:右面部痛觉减退,右眼球外展受限,右侧周围性面瘫,右侧听力下降,右侧软腭降低,悬雍垂偏左,咽反射减弱,伸舌偏右,左侧上下肢轻瘫试验阳性,肢体肌张力正常,病理征阴性,右侧指鼻试验阳性,闭目难立征阳性,易向右侧偏倒,肢体深浅感觉正常.     

食管造影及温度监测指导环肺静脉消融治疗心房颤动

Objective Because of the severe consequences of an atrial esophageal fistula,it is vital to avoid this complication. The most safe way is to avoid ablating the segment of esophagus behind left atrium (LA). What we do is to image the relationship of esophagus to posterior LA wall and real-time esophageal tem-perature monitoring to ablate the posterior LA wall. Methods Sixty-four patients with paroxysmal atrial fibrilla-tion (PAF) were enrolled to pulmonary veins (PV) isolation. Swallowing a radiocontrast agent at the same time when imaging of LA to observe the relationship of esophagus to posterior LA wall and according to the different relationship between the segment of esophagus behind LA and PV, the esophagus were divided into type Ⅰ , type Ⅱ and type Ⅲ. A esophageal temperature probe was inserted and advanced into the esophagus directly posterior to the LA. Three steps ablation strategy and real-time esophageal temperature monitoring were applied to guide the PV isolation. The procedure was interrupted when the esophageal temperature was 39℃ until] the tempera-ture renormalized and ended when PV were isolated. Results There were 48 type ⅠI , 11 type Ⅱ and 5 type Ⅲ esophagus in the 64 patients. After three steps ablation,all PV isolations were completed. Only 18.8% of the patients needed to ablate the posterior LA close to the esophagus. Conclusion Only one PV ostiolum close to the posterior LA wall in most PAF patients and many of them can achieve complete PV isolation without ablating the posterior LA close to esophagus which could minimize the risk of esophageal injury dramatically.