目的探讨纤维支气管镜（纤支镜）在体外循环术后机械通气患者中的应用。 方法回顾性分析2014年1～12月行纤支镜检查76例体外循环术后机械通气患者的临床资料，男45例、女31例，年龄21～71（42.8±6.3）岁。其中行二尖瓣置换术35例，主动脉瓣置换术11例，二尖瓣置换术+主动脉瓣置换术17例，冠状动脉旁路移植术5例，升主动脉+主动脉全弓或半弓人工血管置换术8例。术前心功能Ⅱ级25例、Ⅲ级39例、Ⅳ级12例。术前合并中、重度肺动脉高压13例，感染性心内膜炎5例。 结果76例患者中气道大量分泌物59例，气道严重充血、水肿明显9例，痰痂阻塞气管导管3例，血痂阻塞气管导管2例，导管部分闭塞2例，气道轻微渗血1例。59例经纤支镜检查吸出气道分泌物后，肺部湿啰音较检查前明显减轻，呼吸状态明显好转；其余17例也经纤支镜检查进行准确诊断和有效处理。本组患者在纤支镜检查中顺利完成痰液标本采集共31例，未发生缺氧、心律失常和出血等操作并发症。 结论体外循环术后机械通气患者行纤支镜检查，在维持呼吸道通畅、正确指导抗生素应用、辅助诊断治疗中有积极作用。
ObjectiveTo investigate whether lysyl oxidase(LOX) has significant relation to persistent atrial fibrillation(AF) with mitral valvular diseases. MethodsWe included 184 consecutive lone mitral valvular disease patients who needed surgery in our hospital between March 2012 and February 2014. Patients who had persistent AF formed the AF group, and those who still kept sinus rhythm(SR) comprised the SR group. In the AF group, patients were separated into two groups by the subgroup of mitral valvular disease(mitral stenosis and mitral regurgitation), then formed a MS+AF group and a MR+AF group. There were 97 patients with 44 males and 53 females at age of 52.76±11.35 years in the AF group and 90 patients with 48 males and 42 females at age of 47.95±14.22 years in the SR group. Blood specimens were obtained from patients for the first time peripheral venous blood after admitted to hospital. LOX levels were measured by ELISA test kits of LOX. ResultsAF was diagnosed in 51.87%(97/187) of lone mitral valvular disease patients. Mitral stenosis patients were easy to have AF(60.31% vs. 34.43%, P<0.05). The plasma level of LOX was significantly higher in the AF group than that in the SR group(73.78±25.42 IU/L vs. 51.05±18.96 IU/L，P<0.05). In the AF group, the LOX level in the mitral stenosis group was higher than that in the mitral regurgitation group(84.21±32.15 IU/L vs. 59.74±35.21 IU/L， P<0.05). Mitral stenosis patients more frequently had a history of stroke than mitral regurgitation patients did. AF correlated significantly with the level of LOX(r=0.124， P=0.036) and left atrial dimension(r=0.531，P=0.042). ConclusionWe validate and extend the hypothesis that increasing LOX level predicts an increasing risk of AF in mitral valvular diseases. Lysine oxidase is a potential diagnostic biomarker for AF. It is expressed significantly in mitral stenosis patients with AF especially.
ObjectiveTo evaluate the mid-term recovery of cardiac function after heart valve replacement and concomitant bipolar radiofrequency ablation for atrial fibrillation (AF). Methods Clinical data of 191 patients with heart valve disease and AF in the same surgical team of Xinqiao Hospital from January 2011 Jan to December 2013 was retrospectively analyzed. Heart valve replacement was performed for a control group (n=93), which includes 31 males and 62 females with their age of 48.33±7.55 years and AF duration of 4.80±2.03 years. Valve replacement and concomitant bipolar radiofrequency ablation was performed for a synchronism ablation group (n=98), which includes 27 males and 71 females with their age of 46.95±7.70 years and AF duration of 5.06±2.26 years. The echocardiogram, electrocardiogram and complications at hospitalization, 6 months, 1 year and 2 year after operation were analyzed. ResultsNo in-hospital death occurred. There were statistical differences in aortic cross-clamp time, cardiopulmonary bypass time, tricuspid ring, ICU stay, total volume of postoperative drainage between the two groups. All the patients were followed up for 2 years. Two years postoperatively, in the synchronism ablation group, 85 patients (86.73%) were followed up, 1 patient with cerebral embolism, 2 patients with cerebral hemorrhage. In the control group, 85 patients (91.40%) were followed up, 4 patients with cerebral embolism, 2 patients with cerebral hemorrhage. There were no death, cardiac rupture, and permanent cardiac pacemaker implantation in the two groups during the follow-up. One year and 2 years postoperative fractional shortening of the synchronism ablation group was significantly higher than those of the control group (37.18%±5.35% vs. 34.72%±6.40%, P=0.007; 37.95%±7.99% vs. 35.18%±5.15%, P=0.008). One year and 2 years postoperative left ventricular ejection fraction of the synchronism ablation group was significantly higher than that of the control group (66.27%±6.99% vs. 63.33%±8.14%, P=0.012). The rate of self-feeling cardiac function improvement in 1 year and 2 years after surgery of the synchronism ablation group was significantly higher than that of the control group (85.39% vs. 72.94%, P=0.005; 84.71% vs. 68.24%, P=0.005). ConclusionCardiac function of the mid-term after the valve replacement and concomitant bipolar radiofrequency ablation for atrial fibrillation obviously improves.