先天性心脏病新技术——介入导管术

近20年间,伴随着科学技术的发展以及医疗水平的提高,介入导管术治疗先天性心脏病逐渐成为主要选择。该项技术微创、疗效好、安全、并发症少、住院时间短,深受患者青旺火。本文讨论该项技术的主要适应范围以及今后的发展趋势,同时指出医疗技术的创新必须遵守的哲学性原则。     

先天性心脏病新技术——介入导管术

近20年间,伴随着科学技术的发展以及医疗水平的提高,介入导管术治疗先天性心脏病逐渐成为主要选择.该项技术微创、疗效好、安全、并发症少、住院时间短,深受患者青睐.本文讨论该项技术的主要适应范围以及今后的发展趋势,同时指出医疗技术的创新必须遵守的哲学性原则.     

医疗机器人的研究进展及伦理学思考

随着现代科技的日新月异,医疗机器人被广泛应用于医疗行业,大大推动了医学的发展,并成为机器人研究领域的热门方向之一。在简要介绍国内外医疗机器人研究进展及应用现状的基础上,本文指出该项技术存在的医疗责任追究机制不完善、缺少法律保障和规范、对医疗岗位冲击、无法体现对患者人文关怀等伦理问题;提出积极发展和推广医疗机器人技术的同时,推动人们对医疗机器人观念的更新,进一步制定和完善相关法律法规是解决该项技术伦理问题的关键。     

关于3D打印技术应用在环境艺术设计中的思考

通过对3D打印技术原理与发展趋势的介绍认识,从环境艺术设计专业的实际出发,结合案例,分析该项技术应用在环境艺术设计专业中的优点及重要性,进一步探讨3D打印技术在环境艺术设计中未来的运用与发展。     

心理平衡的自我测定

下面四个方面的问题各有若干项目,你可根据自己最近一周内的实际感觉,在各项题前标上1—5。其中“1”表示自觉无该项症状;“2”表示自觉有该项问题,但发生不频繁或不严重;“3”表示自觉有该项症状,程度为轻到中度;“4”表示自觉常有该项症状,其程度为中到严     

中美辅助生殖技术伦理规范的比较研究

人类辅助生殖技术给不孕不育症患者带来了福音,但在一定程度上改变了人类的自然生殖过程,同时也为医务工作人员在实施该项技术的过程中增添了新的伦理困惑.通过比较研究,拟从伦理法规制定机构、单一精子供应上限、精子库精源、受者范围、捐献目的、捐献方式等对中美两国在人类辅助生殖技术方面伦理规范的差异进行阐述,为我国提高此项技术的伦理审查能力、增强政策研究、保证伦理监督的公平和客观提供科学合理的借鉴.     

植入前组织配型孕育“救星同胞”的伦理思考

应用植入前遗传学诊断技术在胚胎植入母体子宫前,对人类白细胞组织相容性抗原配型检测,选择与现存患儿相同HLA配型的胚胎进行受孕,孕育一个组织配型相同的脐带血干细胞供者。在某种意义上说,该项技术的应用是创造人来获得移植组织,由此引发系列伦理争议。讨论孕育"救星同胞"这一医学实践内在需要的伦理规范。     

经支气管镜介入治疗的现状与思考

经支气管镜介入治疗已逐渐成为治疗中央气道病变的新手段。为使该项技术在我国规范化开展,呼吸科医生必须严格掌握其治疗适应证,明确治疗目的并正确选择治疗方法。本文还介绍了不同类型的支气管结核在内镜下的治疗方法以及支气管镜下实施肺减容治疗重度肺气肿这项新型技术,同时指出了我国在支气管镜介入治疗方面的不足和建议。     

腹腔镜下零缺血免缝合钬激光肾部分切除术的临床应用价值

评价腹腔镜下零缺血免缝合钬激光肾部分切除术的临床应用价值,探讨该项技术在缩短术中肾脏缺血时间、减少肾脏组织损伤范围等方面的有效性及安全性。"零缺血"技术即术中不阻断肾动脉,"免缝合"技术即不用传统的缝线方式缝合肾脏创面止血,而是通过钬激光烧灼创面达到止血目的。根据笔者所在医院初期开展的腹腔镜下零缺血免缝合钬激光肾部分切除术及参考国内外相关文献报道情况,"零缺血"技术可最大程度减少肾脏热缺血时间,避免肾功损害,"免缝合"技术可有效减少肾脏组织损伤范围,"钬激光"应用于肾部分切除术,一方面可进行术中止血,避免对肾脏创面的缝合,另一方面相比传统的缝线缝合方式,钬激光对肾脏组织的损伤范围更小。将"零缺血"、"免缝合"、"钬激光"三种技术同时用于腹腔镜肾部分切除术,可最大程度避免术中肾功损害、减少肾脏组织的损伤范围。在掌握适应证的前提下,该项技术安全可靠,可以明显减少手术时间,缩短术中肾脏热缺血时间,减少肾脏组织的损伤范围。     

HUGO伦理委员会关于克隆的声明

前言“克隆”这个术语在一般意义上用来指用无性生殖产生个体有机体或细胞的遗传拷贝,涉及一系列技术,包括胚胎分裂;将体细胞核转移到去核卵;以及用细胞培养建立来源于一个体细胞的细胞系。克隆的类型也可按照所说的有机体和该项技术用于的目的而加以区分。例如,人的...     

冠心病的外科治疗

首例成功的冠状动脉旁路移植术（CABG）手术完成于1960年,随着体外循环技术的成熟,CABG手术得以不断发展。20世纪90年代,以非体外循环下冠脉旁路移植术（0PCAB）为代表的微创冠脉搭桥手术逐渐应用于临床,并取得满意的临床效果。尽管冠脉介入技术（PCI）以其创伤小的优点在冠心病的治疗方面蓬勃发展,但是CABG在远期通畅性方面仍然占据优势地位,因此CABG仍然是冠心病治疗的效果确定的一种方法。     

稳定型冠心病治疗方案的临床抉择

由于医疗技术水平的发展,稳定型冠心痛的治疗方案在不断地更新与变化。以往,经皮冠状动脉介入术被广泛应用到稳定型冠心痛的治疗上。但最近的COURAGE试验（the clinical outcomes utilizing revascularization and aggressive drug evaluation trial）使得这一治疗手段的合理性和必要性被质疑。我们必须重新考虑稳定型冠心病治疗方案的临床抉择。     

冠心病介入治疗过度应用的分析和对策

介入治疗是冠心病治疗的重要进展和手段之一,可以改善急性心肌梗死患者的生存率.但目前也出现了过度使用的问题.冠心病本身的特点、医生对冠心病治疗认识不全面和现行医疗制度的不合理部分是其产生原因;建立正确的冠心病诊治策略,深入改革医疗体制,加强医师职业道德培养,同时注意辩证分析过度医疗才能科学合理的应用介入治疗造福冠心病患者.     

家族性高胆固醇血症基因治疗的思考

家族性高胆固醇血症是最典型的常染色体显性遗传性疾病,是早发冠心痛的主要病因。随着目前人类基因组学的研究进展,基因治疗有望解决患者遗传基因缺陷,从根本上治疗家族性高胆固醇血症。期待在不久的将来,当人类娴熟的应用基因治疗技术时可以从根本上治愈多种基因相关疾病。推动人类医疗事业的巨大发展。     

平板运动试验结合颈动脉斑块检测诊断冠心病

探讨平板运动试验(TET)结合颈动脉斑块检测在诊断冠心病的临床意义。对166例疑诊冠心病患者进行冠状动脉造影(CAG),TET,颈动脉斑块检查,以CAG的诊断结果为金标准,分析TET,颈动脉斑块检查,TET结合颈动脉斑块检查诊断冠心病的敏感度、特异度。比较三者诊断冠心病的敏感度、特异度。三者敏感度分别为71.4%、64.3%、96.0%。特异度分别为65%、60.0%、82.4%。后者较前两者敏感度、特异度P<0.05。TET结合颈动脉斑块检查可显著提高冠心病的诊断率,不失为CAG前的筛选方法。     

2004 CAROLYN SHERIF AWARD ADDRESS: HEART DISEASE AND GENDER INEQUITY

Individual patient records from the National Hospital Discharge Survey for 1988 and 1998 comprising approximately 10 million cases were the basis for a binary logistic regression model to predict coronary artery bypass graft. Patterns in 1988 and in 1998 indicated a dramatic and pernicious gender discrepancy in medical decisions involving bypass surgery. Overall, men were twice as likely to have bypass as were women with comparable medical profiles. This result was particularly evident for women in their 40s and 50s, when angina was a primary diagnosis, and in the presence of any comorbid condition (e.g., diabetes or hypertension). Failure to pursue proactive case management of women with heart disease costs women's lives.     

左主干或多支冠脉病变的选择:PCI或CABG?

近年来,PCI技术越来越多地实践于左主干和多支冠脉病变,但与CABG相比,其疗效一直受到质疑。本文对近年来PCI和CABG的疗效比较做一总结,发现对于左主干和冠脉多支病变,CABG仍优于PCI。但随着生产力水平的发展和社会需求越来越高的双重作用下,两项技术都必然会有新的发展,两者疗效的比较还会继续,我们将拭目以待。     

Can physical activity be used as a tool to reduce depression in patients after a cardiac event? What is the evidence? A systematic literature study

A reduction in the incidence of cardiovascular diseases (CVD) has been reported in the Western world, but post‐infarction depression often occurs and is related to poor medical outcomes. The aim of this study was to examine the scientific literature by a systematic review, in order to find evidence for whether physical activity can be a tool to reduce depression in patients who have suffered a cardiac event. Three databases were systematically searched (PubMed, CINAHL, and Cochrane), and the GRADE protocol was used in combination with a revised Amstar‐protocol for the systematic review. Scientific reports fitting the area were scarce. Finally, ten studies were included in this study: one meta‐analysis, five randomized controlled trials, and four clinical trials. The results showed low to moderate evidence for the use of low to moderate levels of exercise as a tool to reduce depression in post‐coronary artery event patients. This study concluded positive effects of physical activity as a tool to reduce depression in post‐coronary artery event patients. Physiotherapists could be further involved in increasing physical activity after cardiac events. More studies are needed in the area.     

Effects of transient coronary artery occlusion on canine intrinsic cardiac neuronal activity

In order to further elucidate the regulatory function of canine epicardial neurons, the effects of transient coronary artery occlusion on their spontaneous activity was studied. Fifty-eight individual, spontaneously active units were identified by means of their action potential configurations in specific loci of atrial and ventricular epicardial fat of 10 anesthetized dogs. The activity of 49 of the units was modified by one minute of coronary artery occlusion. Twenty-four of the 49 responding units exhibited increased activity and 37 decreased activity during coronary artery occlusions. Activity changes were sometimes, but not always, associated with decreased left ventricular intramyocardial systolic pressure. During reperfusion, the activity of 6 units was increased compared to control levels, even though ventricular pressures remained the same. Following acute decentralization, 48% of previously active units generated spontaneous activity; the activity of 89% of these was altered during coronary artery occlusion despite the fact that overall cardiodynamics were unchanged. Following hexamethonium administration, the activity generated by 9 of 10 spontaneously active units was modified by coronary artery occlusion. It is concluded that transient coronary artery occlusion can modify the activity generated by intrinsic cardiac neurons, such modification involving central and peripheral neuronal interactions.     

心脏冠状动脉多层CT检查——临床上我们是否应用得当?

心脏冠状动脉多层CT扫描目前在对心脏进行整体扫描进而发现冠状动脉狭窄或冠状动脉钙化方面应用较多,但从经济费用-临床效益比值考虑,是否所有患者均需进行此项检查值得商榷。为降低患者就诊成本,我们认为,对于年轻非糖尿病患者可先根据Framingham冠心病危险量表进行测算患者未来10年出现冠心病的危险度,如果根据此量表计算的患者未来10年出现冠心病的危险度10%的中度以上危险度的患者,才应该给予心脏冠状动脉多层CT扫描检查以了解其是否需要进一步深入治疗。