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find Keyword "心源性" 14 results
  • 急性心肌梗死合并心源性休克手术治疗六例

    摘要: 目的 总结急诊冠状动脉旁路移植术(CABG)救治急性心肌梗死(AMI)合并心源性休克(CS)患者的早期临床结果和经验,以评估手术疗效。 方法 自2006年10月至2008年10月中国海洋大学附属青岛市市立医院共对6例急性心肌梗死合并心源性休克患者施行急诊CABG,其中男4例,女2例;年龄62~78岁(68.3±7.9岁);从发生休克距开始手术时间为1~7 h(4.1±3.1 h);冠状动脉狭窄90%以上病变支数1~3支(2.5±1.3支)。1例采用非体外循环(offpump CABG)技术,5例采用体外循环心脏停跳(onpump CABG)技术,心肌保护采用顺行性灌注结合经冠状静脉窦逆行灌注心肌保护方式。 结果 每例患者平均移植血管3支(1~4支),安装主动脉内球囊反搏(IABP)3例。 1例患者术后第3 d死于循环衰竭合并肾功能衰竭,病死率16.67%(1/6), 5例治愈出院。围手术期发生呼吸功能不全2例,急性肾功能不全1例。出院3个月后随访,心功能分级(NYHA)Ⅲ级3例,Ⅱ级2例;1年后随访心功能Ⅲ级1例,Ⅱ级2例,Ⅰ级2例。 结论 急诊CABG可以有效提高急性心肌梗死合并心源性休克患者的生存率。

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  • The Optimal Timing and Operation Pattern of Emergent Coronary Artery Bypass Grafting after Acute Myocardial Infarction

    Objective To summarize the efficacy and clinical experiences of emergent coronary artery bypass grafting (E-CABG) in patients with acute myocardial infarction (AMI) and to discuss the operative opportunity and procedures. Methods We retrospectively analyzed the clinical data of 21 patients with AMI undergoing E-CABG in Sun Yatsen Cardiovascular Disease Hospital between June 1999 and December 2009. Among the patients, there were 14 males and 7 females with their age ranged from 24 to 81 years (63.9±12.4 years). Six patients were operated within 6 hours after the onset of AMI, 7 patients were operated from 6 hours to 3 days after the onset of AMI, and 8 patients were operated from 3 days to 30 days after the onset of AMI. Eight patients had the cardiogenic shock after AMI, one had rupture of ventricular septum and cardiogenic shock, two had rupture of coronary artery after percutaneous transluminal coronary angioplasty, eight had unstable angina and frequent ventricular arrhythmia, one had ventricular fibrillation and cardiac arrest, and one had cardiac trauma. Ten patients were treated with intraaortic balloon pump (IABP). Conventional CABG was performed for 12 patients, off-pump CABG for 5 patients, and on-pump-beating CABG for 4 patients. Results Five patients died after E-CABG with a mortality of 23.8% which was obviously higher than the overall CABG mortality (23.8% vs. 3.1%, χ2=21.184, P<0.05). There were respectively 2, 2 and 1 deaths with a mortality of 33.3%, 28.6% and 12.5% respectively for operations within 6 hours, 6 hours to 3 days and 3 to 30 days after the onset of AMI. The mortality of those patients who were operated within 3 days after AMI was obviously lower (P<0.05). The primary causes of death were low cardiac output syndrome, perioperative acute myocardial infarction after CABG and sapremia. There was one death each for patients operated with off-pump and on-pump-beating CABG. Sixteeen patients were discharged from the hospital. The follow-up was from 6 months to 10 years. There were 6 late deaths among which 5 died of cardiac failure accompanied by pulmonary infection, one died of noncardiac factor. Ten patients survived at present, and the quality of life among 5 patients was unsatisfactory. Conclusion The mortality of E-CABG is obviously higher in patients operated within 3 days of AMI. With the support of IABP, if the operation can be carried out 3 days after the onset of AMI, the surgical success rate will be greatly improved by adopting proper offpump and onpumpbeating procedures.

    Release date:2016-08-30 05:57 Export PDF Favorites Scan
  • 心源性脑栓塞患者的心瓣膜置换术

    摘要: 目的 [HTSS]探讨心源性脑栓塞患者行心瓣膜置换术的手术时机、疗效,总结围手术期处理经验。 方法 回顾性分析1999年6月至2008年10月42例心源性脑栓塞患者接受心瓣膜置换术的临床资料,男25例,女17例;年龄28~64岁,平均年龄45.5岁;病程0.5~30.0年。风湿性心脏病31 例,感染性心内膜炎11 例;行二尖瓣置换术27例,主动脉瓣置换术11例,二尖瓣和主动脉瓣联合瓣膜置换术4例;同期行三尖瓣成形术18例,左心房血栓清除术22例。 结果 术后早期(30 d内)死亡4例,手术死亡率9.52%;其中死于鱼精蛋白过敏、严重肺部感染、急性肾功能衰竭、脑出血和广泛脑栓塞各1例;其余患者均顺利出院,术后平均住院时间为12.5 d。随访35例,随访时间2~112个月,随访期间死亡5例,其中1例术后1个月余因头部外伤致颅内出血死亡,1例3年后死于脑出血,1例5年后死于肺癌, 2例6年后死于心力衰竭;其余患者生存状况良好。失访3例。 结论 心源性脑栓塞患者行心瓣膜置换术效果良好,应根据心瓣膜病变程度、心功能状况以及脑栓塞的程度决定手术时机。脑栓塞后有以下情况者可尽早手术治疗:(1)急性心力衰竭、心功能Ⅳ级,经内科保守治疗效果不佳;(2)梗塞灶小,偏瘫轻,或偏瘫后恢复快;(3)伴左心房血栓或心瓣膜赘生物,短期内可能再次栓塞者。加强围手术期处理是手术成功的重要因素。

    Release date:2016-08-30 06:02 Export PDF Favorites Scan
  • 左冠状动脉开口于右乏式窦引发青少年运动中猝死尸体剖检一例

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  • 急性心肌梗死伴心源性休克患者应用主动脉内球囊反搏治疗的观察及护理

    【摘要】 目的 探讨使用主动脉内球囊反搏治疗过程中护理措施对改善患者预后的影响。 方法 选择我科2008年9月〖CD3/5〗2009年5月使用主动脉内球囊反搏治疗急性心肌梗死伴心源性休克的9例患者,对治疗过程进行了观察及全面合理的护理。 结果 主动脉内球囊反搏治疗患者,取得了满意的效果。 结论 主动脉内球囊反搏患者病情复杂危重,使用过程中需辅以全面合理的护理措施,防止并发症发生,对改善患者预后有益。

    Release date:2016-09-08 09:45 Export PDF Favorites Scan
  • Diagnostic Value of MSCT and MRI for Stasis Cirrhosis

    Objective To investigate multi-slice spiral CT (MSCT) and MRI features of stasis cirrhosis and the diagnostic value of MSCT and MRI. Methods MSCT and MRI findings of 35 patients with stasis cirrhosis were studied. The size of liver and spleen, the diameter of hepatic vein (HV), enhancement pattern of liver parenchyma, contrast medium reflux in inferior vena cava (IVC) and (or) HV, ascites, number of varices and correlated abnormalities were reviewed. Results The volume index of liver and spleen of 35 patients was 4434.95 cm3 and 621.92 cm3 respectively. The mean diameter of HV of 27 patients (77.1%) was 3.61 cm and HV of other 8 patients (22.9%) were too small to show. Number of patients showed waves of borderline, inhomogeneous pattern of parenchymal contrast enhancement, contrast medium reflux in IVC and (or) HV, varices and ascites was 5 (14.3%), 29 (82.9%), 20 (57.1%), 16 (45.7%), and 6 (17.1%), respectively. Correlated abnormalities included cardiac enlargement 〔4 cases (11.4%)〕, pericardium thickening 〔11 cases (31.4%)〕, and pericardial effusion 〔2 cases (5.7%)〕. Conclusions Stasis cirrhosis mainly demonstrate liver enlargement, inhomogeneous pattern of parenchymal contrast enhancement, contrast medium reflux in IVC and (or) HV, and slight portal hypertension. MSCT and MRI play invaluable roles in diagnosis, differential diagnosis and etiological diagnosis of stasis cirrhosis.

    Release date:2016-09-08 11:04 Export PDF Favorites Scan
  • 心源性脑栓塞护理分析

    目的探讨心源性脑栓塞的护理措施及要点。 方法对2013年6月-2014年3月急诊入院的74例心源性脑栓塞患者,采取严密监测、对症护理、侧重重点、分步处置的护理对策。对神经系统早期以处置意识障碍、预防神经系统症状加重为主;中期以避免并发呼吸系统、泌尿系统、皮肤系统并发症的护理及心理护理为主;后期以饮食和功能康复训练为主;其心脏护理贯穿于整个护理过程中。 结果74例患者在救治基础上均得到精心周全的护理,康复或好转后直接出院57例(其中出院择期等待心脏手术25例),安全转科治疗心脏原发病7例,死亡10例,平均住院13.7 d。 结论心源性脑栓塞护理涉及心脑两方面,问题交织复杂。护理目标和护理措施要掌握规律性,即对心血管的护理要贯穿始终,以心力衰竭纠正与否来确定护理重点;而对神经性的护理则应注意阶段性和掌握侧重点。

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  • Application of Noninvasive Positive Pressure Ventilation in Patients with Acute Left Heart Failure

    Objective To investigate the effects of noninvasive positive pressure ventilation (NPPV) on patients with acute left heart failure. Methods Twenty patients with acute left heart failure diagnosed between September 2013 and July 2014 were randomized into treatment group (n=10) and control group (n=10). Both groups used conventional sedations, diuretics and drugs that strengthened the heart and dilated the vessels, while early use of NPPV was applied in the experimental group. Arterial blood gas analysis [pH value, pressure of arterial carbon dioxide (PaCO2), and pressure of arterial oxygen (PaO2)], heart rate (HR), respiration, duration of Intensive Care Unit (ICU) stay and invasive mechanical ventilation, duration of overall mechanical ventilation, and success case numbers before and two hours after treatment were observed and analyzed. Results For the control group, two hours after treatment, PaO2 was (67.0±8.5) mm Hg (1 mm Hg=0.133 kPa), HR was (124±10) times/min, Respiration was (34±4) times/min, the duration of ICU stay was (6.0±1.1) days, invasive ventilation was for (32.0±3.1) hours, and the total time of mechanical ventilation was (32.0±3.1) hours. Those indexes for the treatment group two hours after treatment were: PaO2, (82.3±8.9) mm Hg; HR, (98±11) times/min; respiration, (24±4) times/min; the duration of ICU stay, (4.0±0.8) days; invasive ventilation time, (16.0±1.3) hours; the total time of mechanical ventilation, (26.0±1.8) hours. All the differences for each index between the two groups were statistically significant (P < 0.05). Conclusion Early application of NPPV can rapidly relieve clinical symptoms and reduce the medical cost for patients with acute left heart failure.

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  • 如何治疗主动脉瓣狭窄合并体外膜肺氧合支持下的心源性休克

    背景:患者,男,77 岁。因活动后呼吸困难及劳累性胸痛入院,完善相关检查后发现存在重度主动脉瓣狭窄及严重冠状动脉狭窄,随后行经导管冠状动脉介入治疗至右冠狭窄处植入支架。术后,患者突发心源性休克和心脏骤停,复苏后依赖于静脉-动脉体外膜肺氧合支持。检查:心电图,经胸廓的超声心动图,冠状动脉造影,计算机断层血管摄影。诊断:严重主动脉瓣狭窄合并心源性休克。治疗:为稳定患者血流动力学状态,早日拔除体外膜肺,患者被转运至导管室实施急诊经导管主动脉瓣置换术。

    Release date:2018-02-26 05:32 Export PDF Favorites Scan
  • A case report of emergency transcatheter aortic valve replacement in a patient with cardiogenic shock caused by severe aortic stenosis

    Aortic stenosis accounts for a large proportion of valvular heart disease in China. This article described an unusual case of severe aortic stenosis with severe cardiopulmonary decompensation treated by emergency transcatheter aortic valve replacement. Preoperative assessment was performed by transesophageal echocardiography. The extracorporeal membrane oxygenation team was informed to be ready. During the operation, no obvious perivalve leakage was observed after valve released. The transvalvular pressure gradient decreased to 7 mm Hg (1 mm Hg=0.133 kPa).The patient’s symptoms were completely relieved after the operation, and no adverse events occurred during the hospitalization. After discharge, color Doppler echocardiography showed that stenosis was eliminated, cardiac function was improved, no significant perivalvular leakage was observed, and pulmonary hypertension reduced to moderate. The success of this operation confirmed the efficacy of emergency transcatheter aortic valve replacement, and showed that after a rigorous evaluation, emergency transcatheter aortic valve replacement may be a reasonable choice for patients with severe aortic valve stenosis.

    Release date:2020-05-26 02:34 Export PDF Favorites Scan
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