实时心肌声学造影评价2型糖尿病患者心肌微循环的研究

目的应用经静脉实时心肌声学造影，观察2型糖尿病患者心肌微循环灌注的情况。方法选择射血分数大于50％，无冠心病病史，负荷超声或者冠状动脉造影正常，无瓣膜病变，无心房颤动和其他严重心律失常，无先天性心脏病，并排除合并高血压病、肾病、甲状腺功能减退的38例患者作为研究对象；正常对照组20例。经体检、心电图和超声心动图检查无心脏疾患，无高血压病、肾病及甲状腺功能减退病史。均进行实时心肌声学造影，图像存储。结果2型糖尿病患者心肌造影剂灌注的峰值强度A与反映心肌血流速度的k值较正常对照组低（P〈0．01），反映心肌血流量的A·k乘积也明显低于正常对照组（P〈0．01）。结论实时心肌声学造影技术可定量评价2型糖尿病患者心肌微循环灌注的改变。     

老年支气管哮喘患者高血浓度茶碱致心律失常的研究

目的　本文分析了 2 0 6例老年支气管哮喘患者 ,探讨其血茶碱浓度与心律失常的关系。方法　通过静脉使用氨茶碱 ,每天总量为 0 5～ 1 0 g。测定茶碱血浆浓度同时进行心电图检查 ,从而比较不同血浆浓度患者心电图的心律失常表现。 结果　发现诱发各种心律失常与茶碱浓度升高有着明显关系 ,在较低治疗血浆浓度 (A组 )组对心脏的副作用绝大部分为窦性心动过速 (占心律失常总发生率的 80 % )。而高血浓度茶碱组 (D组 )的房早、房纤、房扑、室早的发生率占心律失常总发生率的 5 2 6 %。当高血浓度茶碱恢复至 1 0mg/L以下时 ,各种心律失常有相当部分会消失。结论　老年哮喘患者在应用氨茶碱制剂 ,特别是静脉使用时 ,要密切监测血浆茶碱浓度 ,临床上应减少静脉注射较大剂量 (>0 5 g/d)氨茶碱 ,避免严重心律失常发生     

医科院校学科考试方法的调查与思考

学科考试方法的改革是当前医科院校教学改革的一项重要内容。调查表明 ,教师和学生双方对考试方法的意见是比较客观的。考试方法的改革必须根据考试目的、内容、规模、对象以及课程教学特点等多方面因素 ,科学选择 ,灵活运用     

与MDS发病相关的某些因素的研究现状

骨髓增生异常综合征（ＭＤＳ）是一组造血系统的恶性疾病。多种癌基因激活、抑癌基因失活，以及细胞凋亡增加、端粒酶激活、微卫星序列不稳定性等可能与ＭＤＳ发病有关。本文综述了这些因素在ＭＤＳ中的研究现状     

应用逆转录-聚合酶链反应方法检测孕妇外周血中胎儿ε/γ血红蛋白基因

目的：探索检测孕妇外周血中胎儿特异血红蛋白基因表达的方法。方法：提取孕妇全血mRNA,经体外逆转录后,用逆转录-聚合酶链反应（RT-PCR）方法,应用ε/γ特异引物引导扩增胎儿特异血红蛋白基因片段,经琼脂糖凝胶电泳后,在凝胶成像系统下观察。结果：在7名妊娠妇女中,6名扩增出ε/γ基因片段,1名为阴性。结论：应用RT-PCR方法可直接从孕妇全血中扩增出胎儿特异血红蛋白基因片段,孕妇全血中微量的胎儿mRNA已基本满足体外逆转录及扩增的要求。利用孕妇外周血进行的无创性产前诊断具有可行性。     

肺表面活性物质预防极低体重儿RDS的临床观察

新生儿呼吸窘迫综合征（RDS）又称肺透明膜病，是早产儿尤其是极低体重儿的主要并发症之一，是由于早产儿肺泡Ⅱ型细胞分泌肺表面活性物质不足所引起，病死率极高。临床表现为生后不久即出现进行性呼吸困难和呼吸衰竭。肺表面活性物质（PS）治疗已取得了很好的疗效，本文就我院在2003—2006年对收治的19例极低体重儿使用PS取得了很好的疗效，现报告如下。     

泪道内镜下治疗泪道阻塞性疾病的初步观察

Objective To evaluate the therapeutic efficacy of lacrimal endoscope treatment for lacrimal passage obstruction, and to compare the effectiveness of endoscopically controlled laser surgery and micro-drill surgery for lacrimal passage obstruction. Methods It was a prospective random controlled trial. Eighty nine patients (104 eyes) with lacrimal passage obstruction, including presaccal canalicular obstruction (PSCO) and nasolacrimal duct obstruction (NLDO), were collected from September 2006 to December 2006 in Department of Ophthalmology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology. Patients were examined by endoscopy of the lacrimal drainage system under local anesthesia to detect the obstruction and changes of lacrimal mucous membrane. The obstructions were treated with laser or microdrill. Irrigation was performed to prove the recanalization of the lacrimal passage followed by injected ointment with 0.3% tobramycin and 0.1% dexamethasone into the lacrimal passage. All patients were followed up after the operation for 9-12 months. The difference between the laser and the microdrill treatment was observed. Chi-square test was used to evaluate the curative effect and complications differences between these two groups. Results The obstruction scene in the lacrimal passage of 89 patients could be observed effectively. All obstructions (104/104 eyes) were eliminated after the operation. Through the follow-up, the cure rate reached 78.85% (82/104 eyes). The cure rate of PSCO group and NLDO group, reached 77.78% (42/54 eyes) and 80.00% (40/50 eyes), respectively (χ2=0.077,P=0.782). The cure rate of laser group and micro-drill group, was 80.43% (37/46 eyes) and 77.59% (45/58 eyes), respectively (χ2=0.125,P=0.724). The cure rate of laser treatment was 89.66% (26/29 eyes) in the PSCO group and 64.71% (11/17 eyes) in the NLDO group (P=0.040). The cure rate of micro-drill treatment was 64.00% (16/25 eyes) in the PSCO group and 87.88% (29/33 eyes) in the NLDO group (χ2=4.664,P=0.031). Hemorrhage and palpebral edema occurred in 10.87% (5/46 eyes) and 4.35% (2/46 eyes) after laser treatment, respectively. Percentage of hemorrhage and palpebral edema after the micro-drill treatment was 55.17% (32/58 eyes) (compared to the laser group, χ2=21.969,P=0.000) and 6.90% (4/58 eyes) (compared to the laser group, χ2=0.017 ,P=0.896). Conclusions Lacrimal passage obstruction can be observed and treated directly through the endoscopy of lacrimal drainage system. Choosing an appropriate surgical procedure according to the locations of the obstruction can be helpful for improving the effectiveness of the operation.     

腹腔镜胆囊切除术中对胆囊管结石的判断及处理(附63例报告)

腹腔镜胆囊切除术（1aparoscopic cholecystectomy，LC）现已普遍开展。由于胆囊管结石的隐蔽性，手术中常容易遗漏或忽视导致再次手术。术中正确判断胆囊管结石并妥善处理，对患者术后生活质量及减少并发症起着重要作用。我院自1998年10月至2007年10月对63例合并胆囊管结石的患者实施LC，61例成功，无一例发生严重并发症，现报告如下。     

光学相干断层扫描对氩激光治疗糖尿病性黄斑水肿的疗效观察

目的应用光学相干断层扫描观察氩激光治疗糖尿病性黄斑水肿的临床疗效。方法对糖尿病性黄斑水肿患者行氩激光光凝术。在光凝前、光凝后3个月分别进行扫描获取光学相干断层扫描图像,记录黄斑中心凹视网膜厚度,作统计学分析。结果平均随访(3.0±0.6)个月。光凝前及光凝后3个月黄斑中心凹区视网膜厚度平均值分别为(397±102)μm和(204±90)μm,差异有统计学意义。结论光学相干断层扫描检测能较准确定量测算黄斑区视网膜厚度,可对比观察氩激光光凝前后视网膜厚度变化,进而判断氩激光光凝的疗效。     

薯蓣皂苷对缺氧/复氧心肌细胞损伤的抗氧化作用研究

目的评价薯蓣皂苷对心肌细胞的抗氧化保护作用。方法对培养的乳鼠心肌细胞造成缺氧/复氧损伤模型,比较正常对照组、缺氧/复氧损伤组、以及薯蓣皂苷各组(10ml/L、30ml/L、100ml/L)培养液中超氧化物歧化酶(SOD)、丙二醛(MDA)和一氧化氮(NO)含量。结果缺氧/复氧损伤组SOD活性明显降低,MDA和NO含量较正常显著升高;而薯蓣皂苷中、高剂量组上述指标都有不同程度的改善。结论薯蓣皂苷对缺氧/复氧造成的心肌细胞损伤具有保护作用,并呈现剂量依赖关系,作用机制与增强细胞抗氧化作用、减轻自由基和脂质过氧化物导致的细胞膜损伤有关。