目的 分析在下肢动脉硬化闭塞症(arteriosclerosis obliterans,ASO)治疗中,采取血管腔内成形术干预的临床价值.方法 方便选取2019年9月—2021年9月间三明市第二医院收治的86例下肢动脉硬化闭塞症患者为研究对象,采取随机数表法将其分为两组,各43例.对照组实施非手术治疗干预,观察组则实施腔内血管成形术干预;对比观察在不同治疗方案下两组患者的康复效果、踝肱指数(ABI)、间歇性跛行距离、疼痛程度及血流动力学指标(血流峰速、血流量以及血管内径).结果 观察组治疗总有效率高于对照组(95.35％vs 79.07％),差异有统计学意义(χ2=5.108,P=0.024).观察组治疗后1、3个月的ABI指数高于对照组,差异有统计学意义(t=6.120、4.834,P<0.05);且观察组1、3个月的间歇性跛行距离长于对照组,差异有统计学意义(t=9.128、6.817,P<0.05).治疗,观察组治疗后1、3个月疼痛程度均低于对照组,差异有统计学意义(t=3.744、6.579,P<0.05).观察组治疗后血流峰速、血流量以及血管内径分别为(46.88±5.46)cm/s、(35.89±3.45)mL/(s·m2)、(1.35±0.34)mm,优于对照组的(39.35±5.34)cm/s、(27.25±3.60)mL/(s·m2)、(0.83±0.30)mm,差异有统计学意义(t=6.465、11.363、7.520,P<0.05).结论 在下肢动脉硬化闭塞症(ASO)治疗中,采取血管腔内成形术干预效果显著,可有助于改善患者血流动力学指标,提升其踝肱指数.

目的 探讨不同浓度的雷洛昔芬(RAL)对高糖高脂饲料饮食小鼠主动脉瓣生物学功能影响.方法 C57小鼠随机分成5组,每组10只.分别为:对照组(普通饲料喂养)、高糖高脂组(高糖高脂喂养)、RAL低剂量组(RAL 4.5 mg/kg+高糖高脂饮食)、RAL中剂量组(RAL 9.0 mg/kg+高糖高脂饮食)、RAL高剂量组(RAL 18.0 mg/kg+高糖高脂饮食),灌胃给药3个月.采用组织学苏木素-伊红(HE)染色和茜素红染色检测主动脉瓣脂肪化和钙化程度,免疫组织化学染色和RT-qPCR定量检测含半胱氨酸的天冬氨酸蛋白水解酶(Caspase)-3的相对表达水平.结果 与高糖高脂组相比,RAL低、中、高剂量组小鼠的主动脉瓣脂肪化和钙化明显得到了改善,Ccaspase-3蛋白和mRNA表达在给RAL后均较高糖高脂组有显著降低.结论 一定浓度的RAL具有抑制高糖高脂饮食小鼠主动脉瓣钙化凋亡病变的作用.

Objective To evaluate a new operation of Occlusion of trans-jugular venous minimal invasive surgery on atrial septal defect with curve-controllable sheath catheter. Methods From December 2015 to March 2016, 7 patients with atrial septal defect (ASD) underwent trans-jugular vein closure using the curve-controllable sheath catheter were analyzed retrospective. These patients were 23-47years old and weighed 39.6-64.5kg,male and female 2 and 5 cases. Results All patients were performed minimal invasive surgery successfully. The average procedure time was 22-40 minutes. The ventilator was used for 2-4.5h.The patients stayed in ICU for 6-32h,and the postoperative hospitalization stay was 2-3days. All patients survived and were discharged. The one week and 1, 3month follow up examination with the postoperative echocardiography and ECG indicate that no residual shunt, no occluder dislocation and noⅢstage atrioventricular block. Conclusion It is a new surgical method with simple operation, mild damage. It has advantages over traditional percutaneous and transtrhoracic closure of ASD.

Objective To explore a new, simple, safe and effective closed reduction technique for the treatment of unilateral locked facet of cervical spine(ULFCS), and observe its clinical effect. Methods From May 2009 to May 2013, a retrospective analysis was done on 12 consecutive cases of ULFCS who underwent closed reduction by a modified technique of the halo-vest method. After reduction, only anterior cervical decompression and internal fixation was performed. Results Twelve patients underwent modified halo-vest technique with successful closed reduction, which took a mean time of 65 min(40-110min). After close reduction, 8 patients were performed anterior cervical discectomy and interbody fusion and internal fixation,and the other patients with anterior cervical corpectomy with titanium mesh and bone graft and internal fixation. Aggravation of neurological damage was not observed. Conclusion These data demonstrated that modified Halo-Vest reduction technique can safely and effectively replace unilateral low cervical locked-facet. This technique can be widely used as an adjunctive mean for operation.

目的:观察冠心病(coronary heart disease,CHD)患者,行冠状动脉旁路移植术(coronary artery bypass graft,CABG)治疗前后,血清心肌营养素-1(cardiotrophin-1,CT-1)的变化及意义.方法:选择60例成功接受CABG的CHD患者,分别于术前、术后1d、1w测定血清CT-1浓度,于术前及术后1w行超声心动图(ultrasonic cardiogram,UCG)检查测定左心室射血分数(LVEF)、左心室舒张末期容积指数(LVEDVI)和左心室收缩末期容积指数(LVESVI).结果:①CHD患者术后1d CT-1较术前增高(P＜0.05);②CHD患者术后1w,CT-1明显降低(P＜0.05),且UCG各参数明显改善(P＜0.05).结论:CHD患者血清CT-1升高,且CT-I与心功能关系密切,检测CT-1对CHD患者的治疗和心功能的评价有一定价值.

>患者资料男性患者,49岁,因"车祸致头部流血伴头痛、胸闷2 h余"急诊来我院就诊。伤后曾短暂昏迷数分钟,醒后不能回忆受伤时情况,并感头痛、恶心,无呕吐、伴颈部疼痛、双上肢麻木、大小便未解。入院查体:神志清,额头有一长约15 cm的皮肤挫裂伤口,顶部见2处长约5 cm、6 cm的不规则伤口,左踝部有一不规则伤口,长约3 cm,有活动性出血。颈部有压痛,心脏体检未见明显异常,左肺可闻及湿性罗音。腹部体检无明显异常。四肢无畸形,双上肢感觉减退,左上肢肌力Ⅱ级,右上肢手指伸屈肌力为Ⅳ级,屈伸肘肌力正常,病理反射未引出。入院X线片示C 5-6 椎体骨折脱位;CT示右侧额、顶、颞部头皮血肿;左肺创伤性湿肺,颅内及腹部未见明显异常,C 1 后弓、C 2 椎板、棘突骨折,C 5-7 椎体骨折伴脱位,C 6 、C 7 双侧椎弓根骨折（图1）。入院后

目的 创建一个不切除左室心肌的左室减容手术,并对该实验方法进行评价.方法 10只成年犬通过起搏器快速起搏3周后,建立一个形态上类似于扩张性心肌病的心力衰竭的动物模型,然后对实验动物实施心肌缝缩左室减容手术(OLCVR),由3个部分组成:(1)沿左前降支纵行全层切开左室前壁至心尖部;(2)切开线左缘缝至心室内膜中隔部下1/3处;(3)切开线右缘与左室自由壁吻合.测定线性前负荷可变工作率(Mw),作为左室收缩功能的评价指标;左室舒张功能的指标由等容压力变数(Tau)和最高充盈率(PFR)决定.用心脏超声对左室功能进行评价.结果 术后左室扩张末期径显著降低,左室短缩率显著增高,Mw显著增高,差异有统计学意义,Tau 及PFR无显著改变.结论 OLCVR可以显著提高左室的收缩功能而不改变左室的舒张功能,此种方法有可能为治疗扩张性心肌病开辟一条新途径.

Objective To evaluate the safety and accuracy of pedicle screw internal fixation technique for the treatment of thoracolumbar burst fractures using computer assisted surgical navigation(CASN) system.Methods Clinical data of 56 patients with thoracolumbar burse fractures underwent pedicle screw fixation from January 2009 to January 2011 in the Second Affiliated Hospital of Shantou University Medical College were reviewed retrospectively.There were 26 cases in CASN group and 30 cases in conventional group which performed conventional operation.The safety and accuracy of pedicle screw insertion,operation time,estimate blood loss and clinical results between two groups were analyzed and compared.Results Out of 268 screws 248 were correctly inserted into the pedicles(92.5%).The accuracy of CASN group was 93.6% while in conventional group was 91.7%,there was no statistical difference between two groups(P >0.05).The operation time in CASN group was(2.4 ± 0.4) h while that in conventional group was(2.2 ± 0.7) h,there was no significant difference between two groups(P >0.05).The estimate blood loss in CASN group was(184 ± 49) mL while that in conventional group was(276 ± 81) mL,the difference between two groups had statistical significance(P <0.05).Dynamic flexion-extension X-ray radiographs showed that no abnormal activity in fixation segments,and no loosening or breakage of pedicle screws had been found.Conclusions Pedicle screw internal fixation with CASN system can improve the safety and accuracy of pedicle screw insertion and reduce the estimate blood loss,and obtain good therapeutic effects for patients with thoracolumbar burst fractures.

目的观察不同剂量阿托伐他汀对行冠状动脉旁路移植术(CABG)后的冠心病(CHD)患者血脂和心功能的影响。方法选择40例拟行CABG的CHD患者,随机分为常规治疗组(20例)和强化治疗组(20例),分别给予阿托伐他汀20、40 mg/d,用药自CABG术前及术后1个月,观察对两组血脂和心功能的影响。结果 (1)两组治疗前血脂水平比较差异无统计学意义(P>0.05);(2)术后1个月,两组总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)降低,强化治疗组降低更明显(均P<0.05);(3)术后1个月,强化治疗组左室收缩末期容积指数(LVESVI)、左室舒张末期容积(LVEDVI)指数明显低于常规治疗组(P<0.05),强化治疗组左室射血分数(LVEF)明显高于常规治疗组(P<0.05)。结论 CHD患者CABG术前及术后应用阿托伐他汀可显著降低血脂水平,强化阿托伐他汀治疗降脂效果更明显,且较常规阿托伐他汀治疗而言,治疗能更好地改善CHD患者CABG治疗后的心功能。

患者,男,50岁.4 d前在当地医院行胃镜检查时开始出现气促,不能平卧,后症状加重,尿量减少,并出现颜面及双下肢浮肿,于2011年8月3日到我院急诊就诊,查血常规:WBC 11.87×109·L-1,Plt 11×109·L-1;肾功能BUN 13.6 mmol/L,Cr 151 μmol/L;hsCRP 88.25 mg/L;LDH 904 U/L;凝血四项PT、APTT延长;栓溶二聚体 4 056.12ng/mL;B型钠尿钛前体pro-BNP 4 812.00 pg/mL.

目的:观察中西医结合疗法治疗高能量肱骨干骨折的临床疗效.方法:将60例患者随机分为治疗组和对照组各30例,对照组采用微创钢板固定技术治疗及常规术后处理,治疗组在对照组治疗基础上加以中药内服与熏洗.观察2组术后肿胀、疼痛、并发症情况及骨折愈合时间.结果:术后3天,2组两侧上臂周径差值、VAS评分及骨折愈合时间比较,差异均有显著性意义(P＜0.05),治疗组优于对照组.2组并发症情况比较,差异无显著性意义(P＞0.05)结论:中西医结合疗法治疗高能量肱骨干骨折疗效优于单纯西医治疗,值得临床推广.

BACKGROUND:There is controversial in choosing the treatment method for the treatment of traumatic subaxial cervical fracture-dislocation and spinal cord injury. <br> OBJECTIVE:To evaluate the clinical effect of implant internal fixation and Halo-vest external fixation on the stability after treatment of subaxial cervical fracture-dislocation. <br> METHODS:A retrospective analysis was conducted on 17 patients with subaxial cervical fracture-dislocation in the Department of Orthopedics, the Second Affiliated Hospital of Shantou University Medical Col ege between January 2009 to December 2011, including 13 male patients and 4 female patients, the age was ranged from 21-65 years, average 41.6 years. There were six cases of high fal ing injury, three cases of crush injury and eight cases of traffic accident injury. The hospitalization time after injury was 2 hours to 5 days, average 2.5 days. Al the patients received Halo-vest external fixation under local anesthesia, then distraction gradual y, and received anterior decompression graft and titanium screw fixation under reduction. The treatment effect was evaluated <br> through Frankel classification and imaging examination. <br> RESULTS AND CONCLUSION:Al the patients were fol owed-up for 12-24 months, average 15.4 months. Normal anteraposterior X-ray film showed fracture reduction, the cervical vertebra restored to the normal <br> sequence and physiological curvature;CT showed graft fusion without internal fixation fracture and loosing; <br> according to Frankel classification, marked effect (decreased for 2 grade) in five cases, effective (decreased for 1 <br> grade) in 10 cases, and ineffective in two cases. Implant internal fixation combined with Halo-vest external fixation is&nbsp;safe and reliable in the instability fixation of subaxial cervical fracture-dislocation, and can better restore the spinal sagittal alignment.

目的 探讨mEH 基因T612C、A691G位点SNP及ApoE基因型在中国汉族人群中的分布,并探讨华法林维持剂量与其相关性.方法 共选取52例换瓣术后患者以及68例健康汉族个体.瓣膜置换术后个体根据国际化标准比值(INR)控制在1.5～2.2,调整华法林维持剂量,采用PCR-RFLP技术检测ApoE基因型、Pyrosequencing法检测mEH T612C及 A691G SNP.结果 (1)在120个受测试人群中,mEH T612C等位基因频率分别为74.6%和25.4%;而mEH A691G分别为66.7%、33.3%,换瓣人群中mEH T612C的纯合子比杂合子和野生型的所需华法林剂量要高,分别为(5.5±2.9)mg/d、(4.8±2.2)mg/d、(4.0±2.6)mg/d,三者之间剂量比较有显著性差异(P<0.05).(2)在120个受测试人群中,ApoE基因型等位基因E2,E3,E4的频率分别为44.2%、35.8%、20.0%;换瓣人群中各基因型所需华法林的剂量分别为(4.5±2.7)mg/d、(4.7±2.4)mg/d、(4.4±2.6)mg/d,三者之间差异无统计学意义(P＞0.05).结论 mEH基因T612C、A691G位点 SNP能解释部分个体之间华法林维持剂量的差异,ApoE基因型的差异不能解释华法林维持剂量的差异.

Objective: To observe the effect of L-arginine on the intimal hyperplasia of autografted vein and todiscuss mechanism.Meth ods:(1) Autogenous vein graftsmodelwas established in 60 rabbits.Animals received either simvastatin(10 mg/kg/day) and L-argi nine(100 mg/kg/day) were injeted into the ear veins.The control group given normal saline.(2) Thirty-three CAD patients undergo ing OPCAB were divided into groups treatment(n=16)and control(n=17).The treatment group were given with graft-protecting liquid concluding L-Arginine but the control without L-Arginine.Compare two groups with the rate of surgery triumph.Results:(1) The stenosis of grafted veins: 4 weeks later,the jugular veins intima /media membrane of all the operative group swere significantly thicker than The normal control group.There were significant differences between every two group(P < 0.05).(2)The rate of surgery tri umph Conclusion have no significant difference(P>0.05),but ICAM-1,ET-1,VCAM-l levels were significant difference than before(P< 0.05),and significant difference than the control.Conclusion:(1) The intima /media membrane of hare’s external jugular vein has thick ened after grafting.(2) Simvastatin can lessen the thickness of arterialized veins intima /media membrane and lighten the stenosis of the bridging vein.(3) graft-protecting liquid concluding L-Arginine could improve endothelial function,put off the development of coro nary artery disease.

目的 观察左旋精氨酸(L-Arg) 对自体移植静脉内膜增生的影响,探讨其作用机制.方法 60 只新西兰兔,随机分为左旋精氨酸实验组、生理盐水对照组.术前3 d 开始采用灌胃法给予辛伐他汀(10 mg/Kg 溶于10 ml 生理盐水),经耳缘静脉给予左旋精氨酸(100 mg/kg),对照组给与等量生理盐水,每天一次,直至术后取材.所有动物术日建立自体静脉旁路移植模型:于术后1、2、4、6 周及8 周取材.观测新生内膜与中膜面积比(IPM) 、细胞间黏附分子(ICAM21)及细胞周期素A(Cyclin A) 的表达,统计学分析各组间差异.结果 移植4 周后,各组静脉均有内膜及中膜较正常颈静脉明显增厚表现,左旋精氨酸组内膜及中膜增厚较对照组轻.两组静脉桥的管腔狭窄程度进行比较存在明显差异.结论 (1) 兔静脉移植至股动脉后内膜及中膜增厚.(2) 左旋精氨酸联合降脂药物能抑制移植静脉内膜及中膜增生,减少静脉桥狭窄.

目的 评价氨甲环酸(TA)在减少体外循环心脏手术后出血的效果.方法 2009年3月至2011年10月间接受体外循环心脏手术者160例,随机分为氨甲环酸组(TA组,80例)和对照组(80例),在体外循环术中,TA组静脉注射TA,对照组注射等量的0.9%生理盐水.比较两组在肝素化前、鱼精蛋白中和肝素后和术后24h三个时间点血小板数量、凝血指标及血浆D-D二聚体水平,同时比较术后6h、24h纵隔心包引流量及术后输血量.结果 体外循环术后24h TA组的总失血量(250±117)ml,显著少于对照组的(840±353)ml,且术中、术后输血量TA组显著少于对照组.术后对照组的血浆D-D二聚体水平显著增加.而TA组的D-D二聚体水平无显著变化.结论 与对照组相比,TA可以发挥抗纤溶作用,并能够有效地降低体外循环术后出血.

目的 总结12例瓣膜置换术后患者的再次急诊换瓣及围术期急救处理经验.方法 对2005-03～2011-01瓣膜置换后行急诊再次瓣膜手术的病例进行回顾性研究.术前心功能Ⅱ级2例,Ⅲ级9例,Ⅳ级1例.再次手术行二尖瓣置换(MVR)9例,瓣膜置换+三尖瓣成形(TVP)11例,主动脉瓣置换(AVR)2例,二尖瓣+主动脉瓣双瓣置换(DVR)1例.结果 无一例住院死亡,随访存活患者心功能明显改善.结论 急诊再次换瓣手术应恰当掌握手术时机,及时、准确诊断,果断抉择手术时机;急诊手术是解决人工瓣膜急性功能障碍的最有效手段,合理选择术式及良好围术期处理是进一步提高手术疗效的关键.

随着现阶段外科技术的提高,老年冠心病患者接受外科治疗的越来越多,然而年龄仍然是影响手术病死率和疗效的重要因素之一.老年患者多合并高血压、糖尿病、肾功能不全等并发症,围手术期病死率和并发症发生率相对较高.现对我科收治的65例年龄≥70岁的冠心病患者行冠状动脉旁路移植术(CABG)疗效,总结分析如下.

目的 探讨心脏瓣膜置换术后孕妇适合的抗凝方案以及华法林对妊娠和分娩过程的影响.方法 回顾性分析经治的22例心脏瓣膜置换术后妊娠患者的临床表现、处理及结局.心脏机械瓣膜置换术后均采用口服华法林抗凝.其中12例(组1,华法林组)妊娠期继续口服低剂量(<5mg/d)华法林抗凝治疗,10例(组2,低分子肝素组)孕妇确诊早孕后即用低分子肝素皮下注射,至孕12周后恢复华法林口服抗凝治疗,至分娩前2周改用低分子肝素皮下注射剂,比较两组的妊娠结局.结果 22例心脏瓣膜置换术后妊娠患者经过合理抗凝,适时剖宫产分娩,无胎儿畸形发生.组1母体并发症2例(16.67%),与组2的1例(10.00%)比较无显著性差异(直接概率P=0.43).组1围产儿并发症2例(16.67%),与组2(0例)比较无显著性差异(直接概率P=0.29).两组新生儿出生体重比较有显著性差异(t=1.50,P<0.05).结论 妊娠期间口服华法林能有效防止血栓形成,未增加胎儿畸形等围产不良结局发生的风险.

Objective To study the clinical effectiveness of patients with coronary artery disease(CAD)combined with obstructive sleep apnea syndrome(OSAS)undergoing off pump coronary arteries bypass grafting(OPCABG).Methods Thirty-three CAD patients combined with OSAS undergoing OPCABG were divided into groups treatment(n=16)and control(n=17).The treatment group were given with(blood vessel)graft-protecting liquid concluding L-Arginine but the control without L-Arginine.Compare two groups with the rate of surgery triumph.the changes of plasma concentration of serum soluble intercellular adhesion molecule-1(sICAM-1)and endothelin-1(ET-1)and vascular cell adhesion molecule-1(VCAM-1) were detected.Results The rate of surgery triumph Conclusion have no significant difference(P0.05),but ICAM-1,ET-1,VCAM-l levels were significant difference than before(P0.05),and significant difference than the control.Conclusion blood vessel graft-protecting liquid concluding L-Arginine could improve endothelial function,put off the development of coronary artery disease.