目的 探讨第一阶段射血分数(EF1)在冠心病患者经皮冠状动脉介入治疗(PCI)术后的早期变化.方法 回顾性分析行冠状动脉造影检查且行PCI术的40例冠心病患者(观察组)及同期排除重要脏器及心血管疾病的40例患者(对照组)经胸超声心动图检查数据.分析观察组患者术前与PCI术后第4天左心房内径(LAD)、左心室舒张末期内径(LVDd)、左心室收缩末期内径(LVDs)、左心室射血分数(LVEF)、E/E'比值和EF1变化.比较术前、术后观察组与对照组上述指标的变化.结果 观察组术前EF1低于对照组(P＜0.05).观察组术后EF1高于术前(P＜0.05),而与对照组比较无统计学差异(P＞0.05).观察组术前E/E'比值高于对照组(P＜0.05).观察组术后E/E'比值低于术前(P＜0.05),但仍高于对照组(P＜0.05).观察组术后与术前及与对照组LAD、LVDd、LVDs、LVEF比较差异均无统计学意义(P＞0.05).结论 EF1在冠心病PCI术后早期即出现较为显著的变化,EF1结合E/E'比值能够反映PCI术后早期心肌损伤恢复情况.

患者34岁,孕35+3周双胎妊娠,主因右上腹持续性疼痛14 h入院.BP 173/112 mmHg,产科超声未见异常.给予降压、解痉等治疗后无效且腹痛加剧,急诊行子宫下段剖宫产术,但术后腹痛无缓解,急诊腹部超声示肝包膜下153 mm×60 mm大片状低回声区,其内探及网格状及絮状等回声,CDFI示肝右叶门静脉分支血流纤细,可疑肝包膜下血肿,见图1.

目的 探讨经颅彩色多普勒超声(TCCD)联合二维斑点追踪技术(2D-STI)在颅脑损伤临床监测中的应用价值.方法 选取42例中重型颅脑损伤(TBI)患者,于术后第1、第3、第7天(T1、T3、T7)运用TCCD分别测量大脑中动脉(MCA)和颈内动脉颅外段(eICA)的时间平均峰值流速(TAPV)、搏动指数(PI)、离登指数(LR)评估脑血流参数;运用2D-STI检测左室整体纵向峰值应变(GLPS)评估心肌功能.结果 MCA-TAPV与LR在T3最低(P＜0.01,＜0.05);TBI术后T1脑充血的发生率最高(33.3％,14/42),T7最低为2.3％(P＜0.01);而T7脑血管痉挛发生率23.9％,较T1(2.3％,1/42)升高(P＜0.01).心尖部应变保持正常,基底及中间段的应变及GLPS逐渐下降,三点之间GLPS差异均具有统计学意义(P＜0.01).MCA-TAPV及LR与GLPS呈负相关性(P＜0.01,＜0.05).结论 对于中重症颅脑外伤患者,TCCD联合2D-STI同步监测脑血流动力学及心肌功能改变是检测脑心综合征的有效手段,有助于临床早期预防及治疗.

目的:探讨运用二维斑点追踪技术(2D-STI)评价乳腺癌患者接受化疗及后续放射治疗(RT)后早期左心功能改变.方法 :选取靖江市人民医院放疗科,2017年5月至2019年10月收治的,接受化疗及RT序贯疗法的30例乳腺浸润性导管癌(Ⅱ级)患者,平均年龄(49.4±8.7)岁,分别于RT前(T0)、RT结束首日(T1)、RT后6个月(T6)随访.常规超声心动图测量LVEF,LVDd、LAD、avg E/e'值、E/A及三尖瓣反流峰值速度(TR Vmax).使用QLAB软件2D-STI测量左心室心肌18节段纵向峰值应变、纵向峰值应变达峰时间,并得到左心室整体纵向峰值应变(GLPS)及纵向应变达峰时间标准差(TTPLS-SD),以牛眼图显示.结果 :T6与T0比较,GLPS绝对值由(-17.23±2.96)％下降为(-13.58±3.81)％(P=0.015);TTPLS-SD 由(34.62±16.48)ms延长为(53.44±13.34)ms,P = 0.008,变化差异有统计学意义.三个时间点对比GLPS绝对值与TTPLS-SD呈负相关(P均<0.01);其中在T1、T6 时,GLPS绝对值与TTPLS-SD 的r均>0.8,两者强相关.avg E/e'在[T1(10.49±0.39)、T6(9.51±0.37)分别与T0(7.58±0.01),P分别= 0.019、0.000]差异有统计意义.LAD在[T1(3.29±0.30)cm较T0(3.42±0.34)cm扩大(P= 0.019),T6(3.37±0.30)cm 与T0],差异无统计学意义.TR Vmax在[T6(2.03±0.62)m/s较T0(1.87±0.60)m/s,P=0.025]流速稍有增快.但LVEF、LVDd、E/A比值在随访中无明显变化.结论 :应用2D-STI测量左心室GLPS及TTPLS-SD可监测乳腺癌患者化疗及RT序贯治疗后的左心早期收缩功能变化,优于LVEF、LVDd、E/A比值;结合E/e'、LAD、TR Vmax观察舒张功能早期改变,可为临床监测乳癌治疗后心肌损害和预防性治疗决策提供更好的手段.

Ethnopharmacological relevance: Shenfu injection (SFI) is a well-known Chinese herbal medicine widely used in the treatment of septic shock in China. Aims: The aims of this study are to investigate the protective effects of SFI on sepsis-induced myocardial injury in mice and to identify the underlying mechanism of action. Materials and methods: Seventy-two male C57/B6J mice (5-6 weeks old) were randomly divided into five groups: control (NC), sham sepsis (sham), sepsis (LipopolysaccharideLPS), sepsis treated with a low dose SFI, and sepsis treated with a high dose SFI. Sepsis was induced in mice by intraperitoneal injection of LPS. Myocardial tissue samples were collected from different groups at 6 h, 12 h, and 24 h post-LPS injection. Myocardial injury was examined using hematoxylin-eosin (H&E) and TUNEL staining. Western-blot analysis was performed to determine the protein expression of B-cell lymphoma 2 (Bcl-2), BH3 interacting-domain death agonist (Bid), truncated-Bid (t-Bid) and caspase-9 in all the groups. Moreover, the structural changes in the mitochondria of cardiomyocytes were also observed by transmission electron microscopy. Results: H&E staining revealed structural damage, local necrosis, interstitial edema, inflammatory cell infiltration and vacuolar changes in the myocardial tissue in the sepsis (LPS) group; almost intact myocardial tissue was observed in the high dose SFI group with improvements in interstitial edema and inflammatory cell infiltration. We observed that LPS-induced cardiomyocyte apoptosis was significantly improved with high dose SFI as compared with sepsis (LPS) group (P < 0.05). LPS was found to decrease the protein expression of Bcl-2 and increase the level of Bid, t-Bid and caspase-9. Treatment with SFI significantly increased the Bcl-2 protein expression (P < 0.05) and decreased the protein expression of Bid, t-Bid and caspase-9 as compared with LPS group (P < 0.05). Markedly swollen myocardial mitochondria with partial vacuolation were observed in LPS treated mice while SFI treatment was found to significantly improve the LPS-induced morphological damage of the mitochondria. Conclusion: In conclusion, we demonstrate that SFI protects against sepsis-induced myocardial injury in mice through the suppression of myocardial apoptosis. It upregulates the protein expression of Bcl-2 and down regulates the protein expression of Bid, t-Bid and caspase-9, and alleviates sepsis-induced mitochondrial damage.

目的 观察大剂量生黄芪对呼吸机相关膈肌功能障碍的作用及对撤机的影响.方法 选取2016年1月至2017年12月江苏省靖江市中医院重症医学科58例因呼吸衰竭而行有创通气的患者,统一采用辅助通气模式,在机械通气6 h后随机分为2组,各29例.对照组以早期目标导向镇静方法予以浅镇静,气道管理;同时予氨溴索化痰,能全力胃肠营养支持,枯草杆菌肠球菌二联活菌肠溶胶囊防止肠道细菌的移位等.实验组在对照组治疗基础上加用生黄芪120 g、川芎10 g,每日1剂,分2次鼻饲,每次50 mL,疗程7 d.比较2组患者治疗前后的呼吸力学指标、膈肌功能以及撤机成功率.结果 实验组的最大吸气压力(MIP)、潮气量(Vt)、膈肌增厚分数(DTF)、膈肌活动度(DE)在治疗后明显高于对照组;DE对预后的判断价值较高(P=0.000);且实验组的呼吸机相关膈肌功能障碍发生率低于对照组(χ2=4.614,P=0.032),撤机成功率高.结论 大剂量生黄芪能够改善呼吸机相关膈肌功能障碍,改善预后.

目的 对EGFR-TKI治疗进展后不同治疗策略的生存期和疗效进行探讨.方法 以该院2016年1—12月接诊的67例EGFR-TKI治疗后出现进展且接受后续治疗的晚期肺腺癌患者为对象,对其实施放疗治疗的同时,给予不同的进展后首次治疗策略,8例为EGFR-TKI联合化疗组,8例为继续EGFR-TKI治疗组,51例为单纯化疗组,分析各组生存期与疗效.结果 67例患者在EGFR-TKI进展后未得到完全缓解,总客观缓解率(ORR)为2.99％,总疾病控制率(DCR)为50.75％;继续EGFR-TKI组DCR为75.00％,EGFR-TKI联合化疗组DCR为62.50％,单纯化疗组为45.10％差异有统计学意义(P<0.05);EGFR-TKI联合化疗组平均无进展生存期(PFS)为3.3个月,继续EGFR-TKI治疗组平均PFS为3.0个月,单纯化疗组平均PFS为2.0个月差异无统计学意义(P>0.05);EGFR-TKI联合化疗组平均总生存期(OS)为11.5个月,继续EGFR-TKI治疗组平均OS为6.9个月,单纯化疗组平均OS为8.8个月,BSC组平均OS为0.9个月差异有统计学意义(P<0.001).结论 初次EGFR-TKI治疗后,部分晚期肺腺癌患者耐药后仍然可在EGFR-TKI治疗中受益.

目的 探讨超声引导下聚桂醇硬化治疗卵巢内膜异位囊肿(OEC)的临床疗效.方法 对41例患者43个OEC根据血清CA125、CA199浓度分为轻度组(12例12个囊肿)和中重度组(29例31个囊肿),行超声引导聚桂醇硬化治疗术,按抽出液的1/10～1/5的比例注入聚桂醇注射液并保留囊内,观察治疗过程中患者的反应及耐受程度,术后1、3、6个月分别统计有效率、显效率及治愈率;比较轻度组与中重度组患者疗效的差异;术前、术后6个月检测CA125、CA199及卵泡刺激素(FSH)水平.结果 41例患者43个OEC均一次穿刺成功,患者耐受性良好,术中无刺激性疼痛.治疗后1个月、3个月、6个月复查,有效率分别为51％ (22/43)、12％ (5/43)、0(0/43),显效率分别为44％(19/43)、23％(10/43)、7％ (3/43),治愈率分别为5％(2/43)、65％ (28/43)、93％ (40/43).OEC患者聚桂醇硬化术后6个月,轻度组有效0个、显效1个、治愈11个,中重度组有效0个、显效3个、治愈28个.2组患者疗效比较,差异无统计学意义(Z=-0.135,P＞0.05).OEC患者血清CA125水平术前为(49.89±26.62) μg/L、术后为(25.46±6.10) μg/L,差异有统计学意义(t=5.250,P＜0.01);血清CA199术前为(45.17±22.15) μg/L、术后为(44.26±23.29) μg/L,FSH术前为(5.97±2.03) IU/L、术后为(6.07±1.97) IU/L,两者术前、术后间差异均无统计学意义(t=11.070、-1.095,P均＞0.05).结论 超声引导下聚桂醇注射液治疗子宫内膜异位囊肿,不良反应轻,患者耐受性好,疗效好,且可有效降低CA125水平,对卵巢功能无明显影响,在硬化治疗中有望成为无水乙醇的替代物.

Objective:To understand the curative effect of ultrasonic intervention hardener lauromacrogol in the treatment of ovarian cyst,to observe the change of the ovarian function.Methods:After cleaning cyst fluid guided by ultrasound,pour into appropriate 1%lauromacrogol injection and lien cyst,the reaction and tolerance degree of patients were observed in the process of the treatment.We tracked statistics efficiently for 6 months.The serum estradiol and progesterone levels before and after 1,3,6 months were compared.Results:28 cases of 30 cyst were puncture success on one time.1/10 to 1/5 proportion was injected to lauromacrogol injection and keeped the cyst.The maximum was 30mL.6 months after the treatment,the review effective rate was 100%.The serum estrogen and progesterone level postoperation 1 month were compared with preoperation,and the difference was statistically significant(P<0.05).Compared with the review of 3,6 months,the difference was no statistically significant.Conclusion:The ultrasonic intervention lauromacrogol injection in the treatment of ovarian cyst has obvious curative effect.Patients have no obvious symptoms.We should try to reduce the amount of lauromacrogol,and ensure the curative effect at the same time.

应激性血糖升高是ICU危重患者中普遍存在的一种现象,过高的血糖可能导致多器官功能的损害.高血糖对机体的损害主要通过两种方式体现,一是持续性的高血糖,二是较大的血糖波动幅度(也称血糖变异度).而较大的血糖波动比持续高血糖对糖尿病的慢性并发症有更大影响.血糖波动和高血糖状态相互促进,相辅相成,共同影响患者的预后.对于危重颅脑疾病患者,其主要起因可能是由于应激导致的神经内分泌失调有关.血糖波动加重了局部脑组织存在的缺血、缺氧现象,加重了乳酸中毒.因此,对危重颅脑疾病的患者,必须控制血糖的波动,而最好的控制方法,应该在降低血糖的同时,注重减少血糖的波动.

目的 探讨介入栓塞化疗联合射频消融治疗原发性肝癌的方法,疗效及前景.方法 20例肝癌患者经过一次或多次介入化疗栓塞仍有肿瘤残余,且均存在无法再栓塞的情况,然后在超声引导下进行射频消融术.术后观察AFP的动态变化、影像资料、评估肿瘤坏死率、以及患者的生存情况.结果 肿瘤完全坏死率达95%,肿瘤复发率10%,随访8月～1.5年,仅有2例出现了局部复发和远处转移.结论 介入栓塞化疗联合射频消融术治疗原发性肝癌是安全、有效的方法,其效果明显优于单纯的介入化疗栓塞,具有广阔的应用前景,值得推广.

Objective To evaluate the association between aorta atheromatous plague and the level of serum soluble adhesive molecules in cerebral infarction patients.Methods According to the results of aorta atheromatous plague explored with carotid artery ultrasound at hospitalization,87 patients [49 males,38 females,range 44 to 79 years old and average(59±18)years old] with cerebral infarction were divided into two main groups:Aorta atheromatous plague negative group and aorta atheromatous plague plaque positive group.Aorta atheromatous plague positive group were divided into two subgroups according to the results of microembolic signals(MES)detected by transcranial doppler(TCD),i.e.MES negative group and MES positive group.Serum soluble adhesive molecules levels were measured by radioimmunoassay at hospitalization and were compared between every two groups.In MES positive group,the patients were treated with low molecular heparin sodium(LWMH).The serum soluble adhesive molecules levels were measured before therapy and at the end of the 1st,2nd,4th week after treatment respectively.Results The levels of serum soluble adhesive molecules in all groups were beyond the reference.The levels of serum soluble adhesive molecules in MES negative group and MES positive group were higher(P<0.01)than which in aorta atheromatous plague negative group.Serum soluble adhesive molecules levels were higher in MES positive group than in MES negative group(P<0.05).In MES positive group,serum soluble adhesive molecules levels tended to decrease after the treatment with LWMH.It reached the lowest point at the end of the 2nd.week,and then it increased at the end of the 4th week.Conclusions The formation and cracking of the aorta atheromatous plague may be associated with the serum soluble adhesive molecules.The level of serum soluble adhesive molecules may be an index in monitoring the state of cerebral infarction.Applying anti-inflammation therapy routinely in older population will be beneficial to preventing and treating cerebral infarction.

Objective To study the relativity of carotid atherosclerosis plaque detected by Color Doppler Ultrasonography and ischemic cerebral vascular disease(ICVD).Methods The carotid atherosclerotic plaque was detected by Color Doppler Ultrasonography in 39 cases with transient ischemic attack(TIA),74 cases with cerebral embolism and 25 normal controls.The result was analyzed comparatively.Results The patients with ICVD had different varieties of carotid atherosclerotic plaques(P0.05).Conclusions Color Doppler Ultrasonography can detect the characteristic of carotid atherosclerotic plaques and has a significant diagnostic value in ICVD.