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find Author "唐汉博" 4 results
  • 心脏搏动下经右心室微创封堵婴幼儿肌部室间隔缺损

    目的探讨心脏搏动下经右心室微创封堵婴幼儿肌部室间隔缺损的临床效果。 方法回顾性分析2010年1月至2013年1月兰州大学第一医院心血管外科39例肌部室间隔缺损患儿行心脏搏动下经右心室微创封堵肌部室间隔缺损的临床资料,其中男26例、女13例,年龄10个月至3岁,体重6~15kg。应用经胸超声心动图进行术后随访,观察封堵器的位置,有无移位、有无残余分流、塑型情况及毗邻瓣膜是否开闭等。观察各瓣膜反流情况、各瓣膜口血流及房室腔的变化,心脏功能、肺动脉高压恢复情况等。 结果39例患儿中36例(92.3%)植入封堵器成功封堵,有3例患儿(7.7%)经食管彩色超声心动图(TEE)诊断不适宜行封堵治疗,其中1例由于右心室流出道有异常肌束,2例由于边缘过短不适宜行封堵手术,而改为体外循环下心内直视手术。36例患儿随访6个月以上,经胸超声心动图显示无封堵器脱落、移位,无溶血和房室传导阻滞,人工瓣膜表面光滑,无异物。心脏明显缩小,心功能正常,无神经系统并发症发生。其中3例术后存在轻微的残余分流,随访6个月均消失。 结论心脏搏动下经右心室微创封堵肌部室间隔缺损是肌部室间隔缺损一种较优的治疗选择,在经食管彩色超声心动图引导下手术是镶嵌治疗成功的关键,超声科医生与外科医生的合作是手术成功的基础。

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  • The Equipment and the Working Model of Pakistan International Medical Rescue Team in Wenchuan Earthquake

    Objective To analyze the equipment and the working model of Pakistan international medical rescue team in Wenchuan earthquake in order to provide the first hand references for our medical rescue. Methods We analyzed the aim, the staff composition, the medical equipment, the logistic material and the working model of the Pakistan international medical rescue team by working with the Pakistan team, and summarized its strengths and weaknesses. Result The main aim of the Pakistan international medical rescue team is to search, rescue and treat the wounded and sick in mass casualty incident. The team consisted of 28 staffs, including 2 leaders (the executive leader was an epidemic expert, and the vise leader was an administrative officer), 6 clinical doctors, 2 nurses, 3 medical technicians, 10 field search and rescue staffs and 5 logistics staffs. The medical equipment included a field ambulance, 7 field tents and 2 marine satellite phones. The medical equipment and instruments include an X-ray table, a B-ultrasound scanner, an ECG tester, a set of surgery operation equipment and 2 sets of ICU instruments. The main medicines included antibiotics, analgesics and for trauma treatment. Narcotic drugs and surgical supplies supported 200 patients; fluid infusion and drugs were enough for 500 patients; other laboratory reagents were enough for 500 patients; oral drugs, disinfection cotton and bandages were for 3 000 patients. Logistics materials contained a set of cooking appliances, 2 sets of toilet facilities and enough rice, flour and water for the whole team for two weeks. The field tent hospital was built in one day. In the field tent hospital, 1 256 patients were treated, 14 surgeries were performed, 236 X-ray and B-ultrasound examinations as well as 314 biochemical examinations were conducted within 10 days. Conclusion With complete disciplines and rational structure, the configuration of the Pakistan team is fitful for its aim, and it balances the function of search, rescue and public health. Apart from equipment and instruments enough for 300-500 patients rescue, the team also considers both its own survival and environmental protection. The outcome would be better if they could arrive at the spot in the first week after the earthquake happened.

    Release date:2016-09-07 02:13 Export PDF Favorites Scan
  • Efficacy of Early Surgery for Infective Endocarditis: A Meta-analysis

    ObjectiveTo systematically review the short term and long term efficacy of early surgery for infective endocarditis (IE) patients. MethodsWe searched PubMed, EMbase, The Cochrane Library, CBM, WanFang Data and CNKI databases for cohort studies concerning the efficacy of early surgery for IE patients from inception to October 2014. Two reviewers independently screened literature, extracted data and assessed the risk bias of included studies. Then meta-analysis was performed by using RevMan 5.3 software. ResultsSixteen cohort studies including 8 141 patients were included. The results of meta-analysis showed that early surgery could reduce the short term mortality (OR=0.57, 95%CI 0.42 to 0.77, P=0.000 4) and long term mortality (OR=0.57, 95%CI 0.43 to 0.77, P=0.000 7) in IE patients. Subgroup analysis showed that early surgery could significantly reduce the short term mortality and long term mortality in patients with native valve endocarditis (NVE). ConclusionEarly surgery can reduce IE patients' short term mortality and long term mortality. Due to the limited quality and quantity of the included studies, more large-scale high-quality studies are needed to verify the above conclusion.

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  • Comparison on Clinical Outcomes Between China-made CL-V Bileaflet Prosthesis and St. Jude Bileaflet Prosthesis

    Abstract: Objective To evaluate early clinical outcomes and short-term follow-up results of CL-V bileaflet prosthesis. Methods From April 2004 to May 2010, 38 patients with valvular heart diseases underwent mechanical heart valve replacement. Eighteen patients received CL-V bileaflet valve replacement (CL group) including 8 males and 10 females with their mean age of (47.4±6.2)years and mean body weight of (64.7±11.9) kg. Preoperatively,15 patients were in New York Heart Association (NYHA) classⅢ, and 2 patients were in NYHA classⅣ. Mitral valve replacement (MVR) was performed in 16 patients, mitral and aortic valve replacement(DVR) in 2 patients. A total of 20 CL-V bileaflet prostheses were implanted. Twenty patients received St. Jude bileaflet valve replacement (SJM group)including 9 males and 11 females with their mean age of (49.7±7.6) years and mean body weight of (66.1±11.1) kg. Preoperatively, 15 patients were in NYHA classⅢ, and 3 patients were in NYHA classⅣ. MVR was performed in 17 patients,aortic valve replacement (AVR) in 1 patient, and DVR in 2 patients. A total of 22 St. Jude bileaflet prostheses were implanted. Clinical outcomes, hear function, hemodynamics and blood compatibility were measured on the 7th postoperative day and 6 months during follow-up and compared between the two groups. Results There was no early mortality (<30 d) or postoperative complication in either group. Follow-up rate was 100% and the mean follow-up duration was 19.8 (6-61)months. At 6 months after surgery, those patients who were preoperatively in NYHA classⅢ orⅣall improved to classⅠ orⅡ. In CL group, cardiothoracic ratio was 0.51±0.05, left atrium diameter (44.5±7.8) mm, left ventricular end diastolic diameter (LVEDD,46.6±4.1) mm, LVEF 65.3%±7.7%,and LVFS 35.0%±7.1%. In SJM group, cardiothoracic ratio was 0.51±0.06, left atrium diameter (45.8±9.6) mm, LVEDD (46.2±9.8) mm, LVEF 64.1%±9.0%,and LVFS 34.9%±4.7%, which were not statistically different from those parameters of CL group respectively (P>0.05). At 6 months after surgery, transthoracic echocardiography was used to compare hemodynamics of bileaflet prostheses with same size 27 mm in the two groups. Prosthetic transvalvular gradient was (5.1±0.9)mm Hg in CL group and (5.8±0.8) mm Hg in SJM group, and effective orifice area was (2.3±0.3)cm2 in CL group and(2.5±0.2)cm2 in SJM group,which were not statistically significant between the two groups (P>0.05) respectively. In both groups, the level ofhemoglobin, lactate dehydrogenase and platelet at 6 months postoperatively were all within normal range and not statistically from those respective preoperative parameters(P>0.05). Hemolytic reaction and hemolytic anemia were not found. During early and short-term follow-up, there was no thromboembolic complications or anticoagulation-related severe bleeding events in the two groups with same anticoagulation intensity target (target INR value 1.5 to 2.5). Conclusion Early clinical outcomes and short-term follow-up results of CL-V bileaflet prostheses are similar to those of St. Jude bileaflet prostheses. Postoperative patients have good clinical outcomes, hemodynamics and blood compatibility. Patients’ heart function significantly improve during short-term follow-up without valve-related complication. Mid-term and Long-term follow-up are further needed to demonstrate its good performance.

    Release date:2016-08-30 05:50 Export PDF Favorites Scan
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