非体外循环下双向腔肺分流术

目的探讨在非体外循环下行双向腔肺分流术治疗复杂先天性心脏病的手术适应证、外科技巧、术后处理和疗效。方法在非体外循环下行双向格林手术6例。3例建立上腔静脉-右心房临时转流,自上腔静脉入右房处横断上腔静脉,封闭近心端,不阻断肺动脉的情况下应用可吸收线端侧吻合远心端与右肺动脉,前壁用自体心包片加宽。3例利用双上腔互为旁路行双侧双向腔肺分流术。结果全组无手术死亡,无并发症发生。手术时间缩短,不用输血,呼吸机辅助呼吸时间3.5~45h,肺动脉压由术前的(15.20±3.34)mmHg升高到(18.40±4.67)mmHg,末梢动脉血氧饱和度(SO2)由术前0.76±0.06升高到0.92±0.04,胸液量130~640ml。结论对于难以解剖根治或一期生理矫治的肺血少的复杂先天性心脏病,只要把握好手术适应证,注意手术操作,加强术后管理,在非体外循环下行双向腔肺分流术是一种很好的选择。     

双向Glenn术治疗紫绀型先心病的围术期麻醉管理体会

目的总结在体外循环下行双向Glenn分流术治疗紫绀型复杂先天性心脏病的临床麻醉处理经验。方法2012年8月至2013年2月,我院5例在体外循环下完成紫绀型复杂先心病作双向Glenn分流术患者,麻醉均采用静脉复合气管插管七氟醚吸入全身麻醉,麻醉诱导采用静脉注射依托咪酯0.1-0.15mg/kg,咪达唑仑0.05-0.08mg/kg,维库溴铵0.1-0.15mg/kg,舒芬太尼0.5-1.5μg/kg。右侧颈内及右股静脉置入双腔静脉导管,测CVP,左侧桡动脉穿刺测血压。麻醉维持用舒芬太尼0.05-1μg/kg,维库溴铵0.05-0.08mg/kg静脉注射。结果术后早期动脉血氧饱和度(90±3)%较术前(76±5)%显著上升(P<0.01)。本组手术循环、麻醉处理稳定,无并发症、死亡。结论麻醉处理得当,维持循环平稳,能保障手术顺利完成,有助于术后康复。     

非体外循环下双向格林术19例

目的 :总结常温非体外循环下双向格林分流术 (Glenn术 )治疗复杂先天性心脏病的体会。方法 :1999年 7月至 2 0 0 3年8月 ,对复杂性先天性心脏病患者 19例行双向Glenn术。其中 17例建立上腔静脉 -右心房旁路行单侧双向Glenn术 ,2例利用双上腔静脉互为旁路行双侧双向Glenn术。结果 :全组无住院死亡 ,术后并发乳糜胸 1例 ,远期无肺动、静脉瘘发生 ,动脉血氧饱和度从术前 ( 78± 11) %上升至术后 ( 92± 6) % ,活动耐力显著增加。结论 :对于难以解剖根治或一期生理矫治的肺血少型复杂先天性心脏病 ,非体外循环下行Glenn术是一种安全、可靠的手术方法。在吻合口前壁用自体心包片加宽 ,可获得良好的吻合口通畅效果     

改良Blalock-Taussig分流术在危重紫绀型先天性心脏病中的应用

目的　探讨改良Blalock Taussig分流术在危重紫绀型先天性心脏病中的应用,并对手术效果进行评价。方法　运用回顾性分析法,总结2 0 0 0年10月—2 0 0 4年4月本院2 5例患儿行改良Blalock Taussig分流术的临床经验。其中男15例,女10例,年龄3d～3岁,平均(3.0 7±3.4 3)月,新生儿8例,体重1.5～12kg ,平均(4.14±1.84 )kg。结果　术后死亡2例,死亡率8% (2 / 2 5 ) ,患儿动脉血氧饱和度由术前4 0 %～70 % (5 8.8%±10 .1% )上升至术后75 %～85 % (78.4 %±4 .3% ) ,有明显改善(P <0 .0 5 )。随访6～32月,平均14 .8月,紫绀明显减轻,活动耐量增加。6例患儿已行二期手术。结论　改良Blalock Taussig分流术作为姑息性手术可改善缺氧,促进肺血管发育,为二期施行双心室矫治及双向腔肺分流术或房坦手术(Fontan)赢得时机,减少死亡率。     

非体外循环下双向格林分流术

目的　应用非体外循环下双向格林分流术治疗复杂先天性心脏病 ,评价其疗效。方法　 2 0 0 2年4～ 7月 ,我院行非体外循环下双向格林分流术治疗单心室等复杂先天性心脏病 5例 ,其中单侧双向格林分流术3例 ,双侧双向格林分流术 2例。术前患者均经血气分析、血常规、超声心动图等检查。氧饱和度为 (78.7± 3.0 ) %。结果　所有患者无一例死亡 ,均顺利出院。术后血氧饱和度升高至 (93.9± 0 .9) % ,紫绀症状改善。结论　非体外循环下双向格林分流术的手术方法安全、并发症少、术后恢复快且住院费用少     

非体外循环下冠脉搭桥手术的麻醉处理

目的 :探讨非体外循环下CABG手术的麻醉处理中有关的问题。方法 :回顾并总结了 2 0 0 0年实施的非体外循环下CABG手术的麻醉共 5 3例。结果 :本组手术时间为 10 5～ 4 85 (2 6 7± 90 )分钟。芬太尼总用量为 0 .5～3.6mg(31.3± 7.6 μg Kg) ,异丙酚总用量为 2 0 0～ 2 4 90mg(15 .3± 8.1mg Kg)。术后拔管时间为 10～ 36 0 0 0分钟 (16 4 5±5 6 87)。本组除 1例因术后严重心衰死亡外 ,余均康复出院。结论 :非体外循环下CABG麻醉的关键在于确保麻醉平稳、避免加重心肌缺血、维持和改善心肌的氧供需平衡 ,以及密切监测心肌缺氧情况及心功能状态     

体外循环非心脏手术的麻醉(附8例病例分析)

目的　总结体外循环非心脏手术病人的术前评估与麻醉。方法　回顾性分析了 8例病人的 9次体外循环行非心脏手术的麻醉情况 ,其中 6次经左或右股动、静脉、1次右经锁骨下动、静脉建立部分体外循环 ,2次常规体外循环。结果　该组病人平均体外循环时间 96～ 1 84 (1 31± 31 )min ,平均手术时间 4～ 9.5 (5 .9± 1 .8)h ,平均出血量 6 0 0～ 35 0 0 (1 35 0± 96 7)ml,平均输血量 4 0 0～ 30 0 0 (95 0± 886 )ml,平均尿量 4 0 0～ 1 80 0 (1 0 0 1± 4 5 0 )ml,术后平均呼吸支持时间 4 .5～ 96 (2 8.5± 30 .8)h。 1例病人术后 4 2d死于多器官功能不全综合征。结论　体外循环用于呼吸道难于维持、循环功能难于稳定或特殊要求的病人具有明显优点 ,加强麻醉前评估和麻醉管理有利于麻醉、手术成功进行     

非体外循环下冠状动脉搭桥术的麻醉管理

目的:探讨非体外循环下冠状动脉搭桥的麻醉管理方法。方法:16例冠状动脉狭窄病人分别在全麻下采用体外循环(CCABG组)和非体外循环(OPCAB组)下行冠状动脉搭桥术,麻醉方法采用咪唑安定、芬太尼、异丙酚、安氟醚静吸复合麻醉,术中通过心血管活性药物控制血压、心率。对OPCAB搭桥前后血流动力学变化进行比较,并对OPCAB和CCABG手术时间,术后恢复情况,输血情况进行比较。结果:OPCAB术的麻醉能够维持病人的血流动力学平稳,手术时间(120±32min),术后呼吸支持时间(6.5±3.6h),ICU停留时间(24.3±8.5h)及输血量(2.5±0.5u)均小于CCABG组。结论:OPCAB手术的麻醉效果满意,血流动力学稳定,能够满足手术要求,并相对于体外循环下手术的病人更早恢复,更省费用,具有明显的优势。     

非体外循环冠状动脉搭桥术的围术期管理

目的　探讨非体外循环冠状动脉搭桥术的围术期管理。方法　回顾性分析 2 2例冠心病施行非体外循环冠状动脉搭桥术的围术期管理措施。结果　 2 2例患者围术期血流动力学稳定 ,无一例改为体外循环下手术 ;平均麻醉时间( 16 0± 40 )min ;平均输血量 ( 2 5 0± 85 )ml;术后 12h平均胸液引流量 ( 118± 5 8)ml。结论　非体外循环冠状动脉搭桥术的围术期管理的关键是加强监测、维持体温正常、合理使用正性肌力及血管扩张药物、维持血流动力学和内环境的稳定、防止心律失常的发生。     

非体外循环下双向格林分流术的临床应用

目的 评价非体外循环双向格林分流术的手术效果.方法 2007年3月-2010年11月,复杂先天性心脏病患儿25例接受非体外循环下双向格林分流术.分析术前、术后的经皮血氧饱和度、McGoon比率、Nakata指数.结果 术后7d血氧饱和度和平均肺动脉压力较术前有所升高(P＜0.05).术后14个月McGoon比率、Nakata指数较术前有所升高(P＜0.05).全组无死亡病例,所有患儿顺利出院.结论 非体外循环下双向格林分流术是治疗复杂的难以一期根治的先天性心脏病安全可靠的术式,手术效果明确.     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Electro-Acupuncture Combined with the Trigger Point Needle-Embedding for Treatment of Primary Trigeminal Neuralgia in 31 Cases

In recent years, the author of this essay has applied electro-acupuncture combined with the trigger point needle-embedding for treatment of primary trigeminal neuralgia in 31 cases, yielding satis- factory results as reported in the following.     

Investigation of Matrix Metalloproteinase -1, 2 and tissue inhibitor of matrix metalloproteinases-1 in Endometriosis

Objective： To explore the role of matrix metalloproteinase-1,2 （MMP-1, MMP-2） and tissue inhibitor of matrix metalloproteinases-1 （TIMP-1） in endometriosis. Methods： The eutopic and ectopic endometria from 40 subjects suffering from endometriosis and regular.endometria from 40 subjects （excluding endometriosis） were collected and examined by in situ hybridization technology and western blot assay. Results： Both expressions of MMP-1 and -2 were stronger in ectopic endometrium and eutopic endometrium than in normal endometrium. On the contrary, the expression of TIMP-1 in ectopic endometrium and eutopic endometrium was lower. The differences were significant （P 〈 0.01 ）. Moreover, there was no relationship among the expressions of MMP-1, 2 and TIMP-1 in ectopic endometrium. Conclusion： The expressions of MMP-1, 2 and TIMP-1 lose balance and lack of periodic changes in ectopic endometrium , which explains the biological invasive behavior of endometriosis. It was suggested-that regulating the balance between the MMPs and TIMP-1 should be an ideal therapeutic target to endometriosis.     

Shi Da-zhuo (史大卓) —An outstanding cardiologist of integrative medicine

Prof. SHI Da-zhuo, Ph.D., male, was born on March 20, 1960. Prof. SHI entered the Ph.D. program in 1990 at the China Academy of Chinese Medical Sciences under the supervision of Prof. CHEN Ke-ji, majoring in the treatment of cardiovascular diseases. After receiving his Ph.D. degree in 1993, Prof. SHI started working at the Cardiovascular Center in Xiyuan Hospital affiliated to China Academy of Chinese Medical sciences.     

Persist in and Carry Forward the Integrative Medical Research——Speech at the 6th National General Congress of Chinese Association of Integrative Medicine by Academician CHEN Zhu,Minister of Ministry of Health

The 6th National General Congress of Chinese Association of Integrative Medicine （CALM） was convened at 19-20, April 2008 in Beijing. Academician CHEN Zhu, the minister of Ministry of Health indicated at the congress that the integration of Chinese and Western medicine is very well in keeping with the situation of our country and the general rule of development in medical science; and as a good integration of Chinese medicine and Western medicine, it is mutually beneficial and advantageous to both of them. Seeing the creativity shown in integrative medical investigation in theoretic and methodological sides, we should and must persist in and develop it.