动脉粥样硬化性肾动脉狭窄和急性冠脉综合征的关系

急性冠脉综合征一直是冠心病领域的热点，在冠脉造影时代越来越多的肾动脉狭窄被确诊。它们在发病机制、发病率、症状特点、诊断方法及预后等方面的关系，值得关注；两病的结局分别为器官功能的衰竭，最终导致心肾综合征，严重影响预后，已成为一个重要的公共卫生课题。本文对急性冠脉综合征和动脉粥样硬化性肾动脉狭窄之间的关系进行综述。     

3例急性冠脉综合征患者CTA、冠脉造影及OCT对比

目的了解急性冠脉综合征患者冠脉CTA、冠脉造影、OCT的表现。方法急性冠脉综合征患者3例,在行冠脉造影前均行64排CT(Somatom Definition)冠脉CTA检查,明确罪犯病变;常规冠状动脉造影后行OCT检查(Lightlab),分别分析冠脉CT、冠脉造影和OCT影像学结果。结果冠脉CTA均提示为软斑块,斑块最低CT值均小于100Hu,1例伴有轻度钙化,斑块负荷较重,均呈正性重构;OCT示2例有极薄的纤维帽(分别为50μm和40μm),纤维帽后有大的脂核。结论冠脉CTA对于血管壁较宏观的观察较有优势,冠脉造影可以动态观察血管的情况,OCT可细致观察血管壁、斑块和血栓。     

HELLP综合征合并急性肾功能衰竭10例分析

目的探讨HELLP综合征合并急性肾功能衰竭(ARF)的临床特点、诊断、治疗和孕产妇及新生儿预后。方法对我院2005年1月-2008年12月以来HELLP综合征合并ARF的10例患者临床资料进行回顾性分析。结果多为妊娠期高血压疾病的并发症,以血压升高、恶心、呕吐、水肿、皮下淤斑或黏膜出血、少尿或无尿为特点,乳酸脱氢酶、转氨酶、血小板、血肌酐等均为诊断及监测疾病变化及预后的指标;在常规治疗HELLP的基础上及时终止妊娠、行血液净化治疗,是防止病情恶化降低孕产妇及围产儿死亡率的关键。结论HELLP综合征合并ARF发病急而凶险,早期诊断、综合治疗、及时终止妊娠及血液净化治疗是改善孕产妇及新生儿预后的关键。     

冠脉介入围手术期的监护

1　临床资料1998年 4月至 2 0 0 0年 4月间行冠脉介入手术 194例 ,其中男 118例 ,女 76例 ,年龄 2 7～ 81岁 ,平均年龄 5 9± 18岁。其中 :心绞痛型 13 6例 ,心肌梗塞型 2 6例 ,隐匿型 2 2例 ,冠脉狭窄大于 70 %并予冠脉内球囊成形及支架植入术者 99例。2　方法护士长、组长、经管护士参加术前讨论 ,拟定围手术期护理诊断、护理计划 ,使专科护士独具紧急情况下的应急及配合抢救能力。3　围手术期监护3 1　术前护理3 1 1　因患者及家属对冠脉诊治手术缺乏了解 ,我们根据患者年龄、职业、生活习惯、受教育程度及心理状况 ,采取不同的方法进…     

肠道血管畸形致下消化道出血的激光手术治疗

1　激光器及临床资料临床资料 :我院从 1998～ 2 0 0 1年共收治 35例肠道血管畸形致下消化道出血患者 ,男 2 3例 ,女 12例 ,年龄从 15～ 6 7岁 ,5 0岁以上占 6 5 3%。临床症状有反复间歇性黑便历史 ,少数伴有呕血。血量不等 ,个别病例呈急性大量出血 ,出血量 >5 0 0ｍｌ,有3例就诊时有休克表现。术前检查 :Ｈｂ <70ｇ/Ｌ ,大便隐血 。35例中 ,病变位于空肠 10例 ,回肠 15例 ,右半结肠 5例 ,左半结肠 3例 ,乙状结肠 2例。全部病人均通过剖腹探查、术中血管造影、肠镜检查得到确诊。全部病人采用Ｎｄ:ＹＡＧ激光手术治疗 ,术后恢复顺利。追…     

半导体激光、磁疗综合治疗急性乳腺炎的疗效观察

目的：观察半导体激光、磁疗综合治疗急性乳腺炎的临床疗效。方法：搜集被专科确诊的急性乳腺炎患者118例,随机分为治疗组和对照组。两组均常规应用抗生素,治疗组常规抗生素用药的基础上加用半导体激光、磁疗综合治疗后联合手法排乳,对照组常规抗生素用药的基础上联合手法排乳。结果：治疗组一疗程后治愈率达85%,显效率96.7%,对照组一疗程后治愈率达51.7%,显效率72.4%。两组疗效有显著性差异（P〈0.05）。结论：急性乳腺炎在常规则抗生素治疗的基础上加用半导体激光、磁疗综合治疗急性乳腺炎有明显临床疗效,对哺乳期急性乳腺炎的妇女尤其适用,值得临床推广。     

CT冠状动脉造影与单纯冠状血管造影术的回顾性研究

目的探讨CT冠状动脉造影替代单纯常规冠状血管造影术的可行性。方法选取2007年6月16日-2008年6月17日在我院心内科行单纯CCA并最大狭窄处≤50%的患者共568例,其中1个月内曾在我院行CTCA检查的患者102人,对比CTCA与CCA的结果。结果80例为单纯CCA检查,19例为支架植入术后复查,3例为冠脉旁路移植术后复查;CTCA诊断8例偏差,诊断符合率为92.2%;其中19例支架植入术后复查患者,CTCA诊断3例偏差,诊断符合率为84.2%。结论CTCA可较准确的鉴别无需再血管化治疗的患者,包括支架植入术后复查的患者。     

局部糖皮质激素联合氦氖激光对急性化脓性中耳炎的疗效观察

目的:观察局部糖皮质激素联合氦氖激光治疗急性化脓性中耳炎的临床疗效。方法:将临床确诊的81例(81耳)急性化脓性中耳炎患者随机分成实验组和对照组。其中,实验组(40例)在给予左氧氟沙星滴耳液5ml+与布地奈德混悬液2ml混合均匀后滴耳的同时配合氦氖激光局部照射及全身抗生素治疗;对照组(41例)则仅给予左氧氟沙星滴耳液滴耳并联合氦氖激光局部照射及全身抗生素(同实验组)治疗。10日为一疗程,观察两组疗效。结果:1、实验组总有效率为95%,对照组总有效率为82.8%,两组间有统计学意义。2、两组治愈时间分别是7.6±1.5天和10.6±1.6天,经统计学分析,两组间有统计学意义(P0.05)。结论:局部糖皮质激素联合氦氖激光治疗急性化脓性中耳炎较常规治疗方法有更好的疗效,且可明显缩短病程。该治疗方法简单可行,疗效高,值得推广和应用。     

腹腔内灌注压对重症急性胰腺炎患者预后的影响

目的了解腹腔内灌注压变化对重症急性胰腺炎患者预后的影响,并比较腹内压、腹腔灌注压及APACHE-Ⅱ评分对重症急性胰腺炎患者死亡率的评价作用。方法选取2007年12月-2009年6月入住我院急诊重症监护室的36例重症急性胰腺炎(SAP)患者,每日监测腹内压(IAP),计算腹腔内灌注压(APP)并记录临床数据进行APACHE-Ⅱ评分。结果36例患者中23例(64%)存在腹内高压(IAH),IAH患者具有更高的院内死亡率(56.5%),APP<7.98kPa的患者死亡率高于APP≥7.98kPa的患者(90.9%vs12%,P<0.01)。IAP与APACHE-Ⅱ评分存在正相关(r=0.938,P<0.01),而APP与IAP及APACHE-Ⅱ评分存在明显负相关(r=-0.972,-0.906,P<0.01)。通过受试者工作特征曲线比较,APP指标ROC曲线下面积最大(94.5%)。结论SAP患者入院时存在IAH或APP<7.98kPa死亡率明显增高。APP作为独立指标对SAP患者预后的评价优于APACHE-Ⅱ评分及IAP。     

半导体激光联合电针、中频电治疗及护理颞下颌关节紊乱综合症的疗效观察

目的:观察半导体激光联合电针及中频电治疗颞下颌关节紊乱综合征的效果。方法:将56例符合诊断标准的颞下颌关节紊乱综合征患者分为观察组和对照组,各28例,对照组使用中频电治疗,观察组在对照组治疗的基础上加用半导体激光和电针治疗,两组采用相同护理措施,10d后进行疗效比较。结果:对照组治愈10例,显效3例,好转7例,无效8例,总有效率71.4%;观察组治愈19例,显效5例,好转2例,无效2例,总有效率92.9%;观察组临床疗效明显优于对照组(P0.05)。结论:半导体激光联合电针、中频电治疗及护理颞颌关节紊乱综合征临床疗效显著,具有消炎,止痛,改善颞颌关节和恢复咀嚼肌功能的作用,且优于单纯中频电治疗。     

Modeling sound generation in stenosed coronary arteries

Acoustic measurements obtained from sensitive microphones placed on the chest are being used in a procedure to noninvasively diagnose coronary artery disease. Utilizing specially developed signal processing techniques, the spectral content of isolated diastolic heart sounds has been estimated and usually shows an increase in high-frequency components in patients with occlusive coronary arteries. In order to establish a theory for the origin of these spectral features, a sound source model has been developed which combines an incremental network model of the left coronary artery tree with a transfer function model describing arterial chamber resonant characteristics. The network model predicts flow in both normal and stenosed coronary arteries. From this flow information, the arterial chamber transfer function model predicts the development of acoustic signals from the chamber resonant characteristics. The transfer function of a segment of coronary artery demonstrates two resonance frequencies. These resonance frequencies depend upon the length and diameter of the chamber segment, as well as upon the distal hydraulic impedance loading the segment. The lower resonance frequency can be excited by the usual flow fluctuations (low frequency) in the coronary artery. In cases of stenosis, the wideband spectral characteristics of the turbulence produced by the stenosis excites both the low and high resonance frequencies. In a small sample of patients, the spectra obtained from isolated diastolic acoustic signals recorded by a chest microphone agree well with those predicted by this theory.     

Bayesian statistics as applied to hypertension diagnosis

The Bayesian approach was applied to a specific case of medical diagnosis, i.e. essential hypertension and five types of secondary hypertension (fibrodysplasic renal artery stenosis, atheromatous renal artery stenosis, Conn's syndrome, renal cystic disease, and pheochromocytoma). Only blood pressures, general information and general biochemical data are taken into account. Nineteen items were finally selected through statistical investigation of the experimental data as being both discriminative and independent. The marginal density distributions of every item, and then joint density distribution functions were determined within six types of hypertension. The frequency of a given hypertension type within the hypertensive patients was used as prior probability of this state. The loss matrix was established by medical arguments. The expected loss corresponding to six possible decisions was calculated for all cases. Both the ratio of secondary hypertensions that could be inferred from this set of data (not including the results of complementary tests) and that of correct essential hypertension diagnosis provided to be satisfactory     

In silico investigation of electrically silent acute cardiac ischemia in the human ventricles

Acute cardiac ischemia, which is caused by the occlusion of a coronary artery, often leads to lethal ventricular arrhythmias or heart failure. The early diagnosis of this pathology is based on changes of the electrocardiogram (ECG), i.e., mainly shifts of the ST segment. However, the underlying mechanisms responsible for these shifts are not completely understood. Furthermore, clinical observations indicate that some acute ischemia cases can hardly be detected using standard 12-lead ECG only. Therefore, multiscale computer simulations of cardiac ischemia using realistic models of human ventricles were carried out in this work. For this purpose, the transmembrane voltage distributions in the heart and the corresponding body surface potentials were computed with varying transmural extent of the ischemic region at different ischemia stages. Some of the simulated ischemia cases were " electrically silent," i.e., they could hardly be identified in the 12-lead ECG.     

Myocardial electrical impedance responds to ischemia and reperfusion in humans

Myocardial electrical impedance (MEI) is correlated to ischemia and reperfusion of the heart muscle. The entire body of work with MEI to this point has been carried out in animal subjects in vivo and excised tissue samples. In this study, we measured MEI clinically for the first time in human patients who were undergoing off-pump coronary artery bypass (OPCAB) surgery. MEI was measured with a monitor designed in this laboratory and approved by the FDA for use on human subjects. Our patient population (n = 18) had a 70%-100% stenosis of the diseased coronary artery targeted for bypass. We measured MEI continuously during surgery and at 3, 6, 24, and 72 h postoperatively from two temporary pacing electrodes attached to the heart muscle. Absolute baseline impedance ranged from 173 to 729 ohms. MEI increased with occlusion of the diseased artery prior to bypass. The percent increase from baseline was inversely correlated to the percent stenosis of the diseased artery. MEI decreased below baseline immediately on reperfusion following bypass in all patients and continued decreasing over the measurement period. MEI is a reliable clinical indicator of ischemia and reperfusion in humans and may indicate the effectiveness of coronary artery surgery. The parameter may have monitoring and diagnostic value in heart disease in humans.     

美托洛尔对舒张性心力衰竭兔神经内分泌系统的影响

目的研究美托洛尔对舒张性心力衰竭兔神经内分泌系统的影响。方法雄性新西兰兔30只随机分为3组：手术组在右侧肾动脉上1cm处行腹主动脉缩窄术;手术治疗组从术后第1天起应用美托洛尔治疗;假手术组作为对照组。术后观察心衰的临床表现,定期复查超声心动图,并监测全身和心肌局部AngⅡ、ET-1、NE和NT—proBNP变化。结果手术治疗组的心衰发生率明显低于手术组,心室结构和功能达到显著改善,血清AngⅡ（25．57vs38．16,P〈0．01）、ET-1（21．14vs35．96,P〈0．01）和血清与心肌NE（97．90vs128．51,P〈0．01;11．77vs17．28,P〈0．05）、NT—proBNP（221．92vs305．76,P〈0．01;24．33vs30．53,P〈0．05）显著降低。结论美托洛尔可有效抑制DHF兔的全身和心肌局部神经内分泌系统激活.     

槐定碱对心力衰竭大鼠心肌细胞钙诱导钙释放的影响

目的:研究槐定碱对心力衰竭大鼠心肌细胞钙诱导钙释放的影响。方法:结扎大鼠冠状动脉左前降支制备心力衰竭模型,随机分为假手术组、心力衰竭组、槐定碱5 mg/kg、10 mg/kg和20 mg/kg剂量组。4周后酶解法分离各组大鼠心室肌细胞,采用膜片钳和激光扫描共聚焦显微镜同步实时记录系统记录心肌细胞的L-型钙电流(ICa.L)及胞浆内的钙瞬变。结果:心力衰竭组大鼠心肌细胞的ICa.L、钙火花发生率及钙瞬变峰值明显低于假手术组;槐定碱中剂量和高剂量组大鼠心肌细胞的ICa.L、钙火花发生率及钙瞬变峰值明显高于心力衰竭组;槐定碱低剂量组与心力衰竭组相比差异不显著。结论:一定浓度的槐定碱对改善心力衰竭大鼠心肌细胞钙诱导钙释放功能具有重要的作用。     

Displacement and velocity of the coronary arteries: cardiac and respiratory motion

This paper presents measurements of three-dimensional (3-D) displacements and velocities of the coronary arteries due to the myocardial beating motion and due to breathing. Data were acquired by reconstructing the coronary arteries and their motion from biplane angiograms in 10 patients. A parametric motion model was used to separate the cardiac and breathing motion fields. The arteries move consistently toward the left, inferior, and anterior during a cardiac contraction. The displacement and velocity of the right coronary artery during a cardiac contraction was larger than measured for the left coronary tree. Cardiac motion dominates the respiratory motion of the coronary arteries during spontaneous breathing. On inspiration, the arteries move caudally, but the motion in the left-right and anterior-posterior axes was variable. Spatial variation in respiratory displacement and velocity of the coronary arteries indicates that the breathing motion of the heart is more complex than a 3-D translation.     

Background millimeter radiation influence in cardiology on patients with metabolic and pre-metabolic syndrome

The effects of background millimeter radiations (BMR) in patients with coronary artery disease (CAD), hypertension and in subjects with Inherited real risk of CAD, were investigated through invariant statistic measures, typical of nonlinear dynamics analysis of biological systems. The experimental evidences show that BMR ameliorate the nonlinear complexity in biosystems, recognized sign of physiological behavior, by increasing both the rate of unpredictability of heart rate variability (HRV) in patients with metabolic syndrome and the fractal dimension of coronary microvessel oscillations in subjects with pre-metabolic syndrome, healing their genetic alteration and CAD Inherited real risk.