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find Keyword "心脏不停跳" 20 results
  • Clinical Outcomes of Plication of Left Ventricular Aneurysm During Off-pump Coronary Artery Bypass Grafting

      Abstract: Objective To evaluate clinical outcomes of plication of left ventricular aneurysm during off-pump coronary artery bypass grafting (OPCAB). Methods A total of 114 patients who underwent coronary artery bypass grafting (CABG) and concomitant surgical treatment for left ventricular aneurysm from January 2007 to January 2011 in Beijing Anzhen Hospital were included in this study. All the patients were divided into 2 groups according to the different surgical procedures they received. In groupⅠ, there were 76 patients including 57 males and 19 females with their average age of (63.4±7.8) years who underwent CABG and left ventricular aneurysmectomy under cardiopulmonary bypass on the  non-beating heart. In groupⅡ, there were 38 patients including 32 males and 6 females with their average age of (60.6±8.9) years who underwent OPCAB and plication of the left ventricular aneurysm on the beating heart. Preoperative data were not statistically different between the 2 groups except that the percentage of the left ventricular aneurysm to the left ventricle  of groupⅠwas significantly larger than that of groupⅡ(42.2%±13.6% vs. 26.5%±12.3%, t=5.499, P=0.000). Postoperative clinical outcomes and morbidities were compared between the 2 groups, and all the patients were followed up for 6 months. Results There was 2 in-hospital death in groupⅠ, one for postoperative refractory ventricular arrhythmia, and the other for severe pneumonia. There was 1 in-hospital death in groupⅡ because of perioperative myocardial infarction. Postoperative thoracic drainage, incidence of reexploration for bleeding, mechanical ventilation time and incidence of  intra-aortic balloon pump (IABP) implantation were not statistically different between the 2 groups (P>0.05). To compare  their echocardiography outcomes at early postoperative stage and 6 months after discharge with preoperative values, left ventricular end-diastolic dimensions (LVEDD) at early postoperative stage and 6 months after discharge were both signific antly decreased than preoperative value in both groups [groupⅠ: (54.0±7.8) mm amp; (56.0±8.1) mm vs. (59.6±6.6) mm,  groupⅡ: (52.0±7.2) mm amp; (53.6±5.3) mm vs. (57.9±5.4) mm], and left ventricular ejection fraction (LVEF) at early  postoperative stage and 6 months after discharge were both significantly higher than preoperative value in both groups  (groupⅠ:43.5%±3.2% amp; 55.7%±3.7% vs. 38.0%±7.4%, groupⅡ:44.7%±2.8% amp; 57.0%±3.5% vs. 41.0%±6.6%), but there was no statistical difference in LVEDD and LVEF between the 2 groups(P>0.05). Conclusion Plication of  left ventricular aneurysm during OPCAB is a safe and effective surgical procedure, and possibly more appropriate for patients  with a smaller left ventricular aneurysm.

    Release date:2016-08-30 05:28 Export PDF Favorites Scan
  • Application of Lower Sternal Incision with On-pump, Beating Heart Intracardiac Procedures in Mitral Valve Replacement

    Abstract: Objective To explore the application of lower sternal incision with on-pump, beating heart intracardiac procedures in mitral valve replacement (MVR). Methods We retrospectively analyzed clinical data of 42 patients (minimal incision group) with valvular heart diseases who underwent MVR via lower sternal incision under the beating heart condition in Xinqiao Hospital of the Third Military Medical University from January 2011 to December 2011. There were 16 male and 26 female patients with their average age of 42.3±12.7 years in the minimal incision group. We also randomly selected 42 patients with valvular heart diseases who underwent MVR via routine midline sternotomy during the same period in our department as the control group. There were 18 male and 24 female patients with their average age of 43.8±13.1 years in the control group. Operation time, cardiopulmonary bypass time, major complications, chest drainage  in postoperative 24 hours, skin incision length and average postoperative hospital stay were observed and compared  between the two groups. Results There was no major perioperative complication such as in-hospital death. There was no reexploration for postoperative bleeding, complete atrioventricular block, embolism or perivalvular leakage in the minimal incision group. There was no statistical difference in cardiopulmonary bypass time, operation time, or the incidence of  reexploration for postoperative bleeding, wound infection and perivalvular leakage between the two groups(P>0.05). The skin incision length in the minimal incision group was shortened by 5.2 cm compared to that in the control group (7.9±1.4 cm vs. 13.1±3.3 cm, P=0.000). Chest drainage in postoperative 24 hours in the minimal incision group was significantly less than that of the control group (183.6±40.2 ml vs. 273.4±59.9 ml, P=0.000). Postoperative hospital stay in the minimal incision group was significantly shorter than that of the control group (8.1±1.3 d vs. 10.6±2.1 d, P=0.000). Forty patients in the minimal incision group were followed up for 3-15 months and 2 patients were lost during follow-up. Four patients had postoperative wound pain, and the majority of patients didn’t have significant wound scar formation but a satisfactory quality of life. Thirty-eight patients in the control group were followed up for 3-15 months, 4 patients were lost during follow-up, and 17 patients had postoperative wound pain. Conclusion Lower sternal incision with beating heart can reduce the surgical injury, simplify the operation procedure and improve the therapeutic efficacy. It is a safe, effective and esthetic surgical approach for MVR.

    Release date:2016-08-30 05:28 Export PDF Favorites Scan
  • 冠状动脉旁路移植术治疗左主干分叉病变

    目的 探讨冠状动脉左主干分叉病变的外科治疗方法,总结其临床经验。 方法 1999年3月至2008年4月我院共收治29例冠状动脉左主干分叉病变患者,在体外循环心脏不停跳下行冠状动脉旁路移植术(CABG),观察体外循环时间、术后呼吸机辅助时间、 ICU时间、住院时间、围术期以及随访情况。 结果 体外循环时间为482±15.5 min,术后呼吸机辅助时间14.2±4.6 h,住ICU时间3.3±0.8 d,住院时间18.0±2.7 d,无围术期心肌梗死发生。本组患者随访7~98个月 (29.0±19.2个月),25例心绞痛症状完全消失,2例心绞痛症状缓解,3例于术后3年、4年和8年分别死于脑血管病变、心脏骤停及肺癌。超声心动图检查提示:左心室收缩功能获得不同程度的改善。 结论 冠状动脉左主干分叉病变应用体外循环心脏不停跳CABG可以取得良好的治疗效果。

    Release date:2016-08-30 06:06 Export PDF Favorites Scan
  • 左主干完全闭塞的外科治疗

    目的 探讨冠状动脉左主干完全闭塞的外科治疗方法,总结其临床经验。 方法 1998年3月~2006年11月我院共收治6例冠状动脉左主干完全闭塞患者,在体外循环心脏不停跳下行冠状动脉旁路移植术(CABG),观察体外循环时间、术后呼吸机辅助时间、ICU时间、住院时间、围术期以及随访情况。 结果 体外循环时间为88.2±15.5min,术后呼吸机辅助时间14.2±4.6h,住ICU时间3.3±0.8d,住院时间18.0±2.7d,无围术期心肌梗死发生。6例均随访,随访时间29.0±19.2个月,心绞痛症状均消失,无1例死亡。超声心动图检查提示左心室收缩功能得到不同程度的改善。 结论 冠状动脉左主干完全闭塞患者施行体外循环心脏不停跳CABG,可以取得良好的临床疗效。

    Release date:2016-08-30 06:08 Export PDF Favorites Scan
  • 右腋下垂直小切口心脏不停跳心内直视手术135例

    目的 探讨右腋下垂直小切口心脏不停跳手术治疗先天性心脏病的方法。 方法 2003年11月~2006年6月,采用右腋下小切口在心脏不停跳下施行心脏手术135例;其中室间隔缺损(VSD)68例,房间隔缺损(ASD)61例(ASD合并左上腔静脉4例),VSD+ASD 5例,冠状动静脉瘘1例。 结果 全组无手术死亡。平均住院时间8d。术后发生右肺不张2例,右侧气胸1例,切口液化2例。术后随访122例,随访时间1个月~2年,除2例VSD患者术后发生残余漏外,其余患者均恢复良好。 结论 对单纯ASD、VSD患者选择右腋下垂直小切口,在心脏不停跳下施行心内直视手术,安全可靠、手术时间短、创伤轻、恢复快、切口美观。

    Release date:2016-08-30 06:15 Export PDF Favorites Scan
  • 心脏不停跳手术中心肌NF-κB转录活性、ICAM-1的表达及其临床意义

    目的 探讨心脏不停跳与心脏停搏手术对心肌核转录因子κB(NF-κB)转录活性、细胞间黏附分子-1(ICAM-1)表达水平的影响及其临床意义。方法 将40例先天性心脏病患者随机分为两组,每组20例。组Ⅰ:行心脏不停跳心内直视手术;组Ⅱ:行常规体外循环手术(灌注冷晶体心脏停搏液)。两组患者均于心内操作前、后取右心房壁心肌组织检测NF-κB转录活性、ICAM-1表达水平,用透射电子显微镜观察心肌超微结构;分别于术前、主动脉开放或心内操作完成后1、24、48和72h测定两组心肌肌钙蛋白I(cTnI)、肌酸激酶同工酶MB(CK-MB),并对其结果进行比较。结果术后组Ⅰ NF-κB转录活性、ICAM-1表达水平较术前无显著变化,组Ⅱ NF-κB转录活性较术前升高(Plt;0.01);术后NF-κB转录活性组Ⅱ显著高于组Ⅰ(Plt;0.01)。术后两组血清cTnI、CK-MB水平较术前均有不同程度升高(Plt;0.01),主动脉开放后/心内操作完成后各时点,组Ⅱ均显著高于组Ⅰ(Plt;0.01)。透射电子显微镜观察,组Ⅰ术后心肌超微结构无明显变化,组Ⅱ心肌损伤变化显著。结论 心脏不停跳下心内直视手术术后短期内心肌NF-κB转录活性、ICAM-1表达水平无明显变化,减轻了心肌缺血-再灌注损伤及由NF-κB激活而引起的心肌炎性反应,有较好的心肌保护效果。

    Release date:2016-08-30 06:23 Export PDF Favorites Scan
  • 心脏不停跳手术患者心肌线粒体变化的观察

    目的 观察心脏不停跳手术患者心肌线粒体形态及量化计分情况 ,探讨其对心肌的保护效果。 方法 16例二尖瓣置换术患者按不同的术式分为心脏不停跳组和心脏停搏组。分别于上、下腔静脉 (心脏不停跳组 )或主动脉 (心脏停搏组 )阻断前 ,阻断 6 0 min和开放后 2 0 min取心肌标本 ,在透射电子显微镜下观察线粒体形态并进行量化计分。 结果 上、下腔静脉或主动脉阻断前两组心肌线粒体计分差别无统计学意义 (Pgt;0 .0 5 ) ;阻断 6 0 min和开放后 2 0 min心脏停搏组心肌线粒体计分均高于心脏不停跳组 (Plt;0 .0 1) ,心脏不停跳组心肌超微结构优于心脏停搏组。结论 浅低温心脏不停跳手术可减轻心肌缺血 -再灌注损伤 ,有较好的心肌保护作用。

    Release date:2016-08-30 06:24 Export PDF Favorites Scan
  • 心脏不停跳与冷晶体停搏在常见先心病矫治术中对肌钙蛋白I的影响

    目的 探讨常见先天性心脏病矫治术中心脏不停跳与心脏停搏两种术式对心肌肌钙蛋白 I(c Tn I)的影响及其心肌保护的效果。 方法  36例先天性心脏病矫治术患者按入院顺序以奇偶数随机分为心脏不停跳组 (组II)和冷晶体停搏组 (组I)两组 ,每组 18例。分别于术前、主动脉开放后 (组 为缝合右心房壁后 ) 1、2 4、4 8、72和 96 h取患者中心静脉血 ,测定 c Tn I、肌酸激酶 (CK)、肌酸激酶同工酶 (CK- MB)、乳酸脱氢酶 (L DH) ,并用透射电子显微镜观察两组各前 10例患者心内操作前、后心肌超微结构。 结果 两组术后血清 c Tn I、CK、CK- MB和 L DH水平均不同程度升高。两组 c Tn I均于术后 1h达峰值 ,主动脉开放后各时点组II显著高于组I(t=- 32 3.0 4 ,Plt;0 .0 1) ;组ICK-MB术后 2 4 h达峰值 ,组II术后 1h达峰值 ,主动脉开放后各时点组II显著高于组I(t=- 72 .5 3,Plt;0 .0 1) ;CK、L DH变化趋势与 CK- MB相似。组I术后心肌超微结构变化轻微 ,组II明显改变 ,...更多其受损程度分级较术前重。 结论 常见先天性心脏病矫治术中心脏不停跳可明显减轻心肌缺血、缺氧及再灌注损伤 ,减少 c Tn I的释放 ,较冷晶体停搏术有良好的心肌保护效果。

    Release date:2016-08-30 06:24 Export PDF Favorites Scan
  • 大型室间隔缺损伴肺动脉高压的外科治疗

    目的 总结 5 9例大型室间隔缺损 ( VSD)伴肺动脉高压在心脏不停跳下行 VSD修补术的经验。 方法 5 9例大型 VSD伴肺动脉高压患者均在浅低温心脏不停跳下行 VSD修补术。结果手术死亡1例 ,其余患者术后无低心排血量综合征、严重心律失常 ,发现残余漏 4例和III°房室传导阻滞 2例 ,均治愈出院。术后随访未发现残余漏 ,无其他并发症和晚期死亡。 结论 在心脏不停跳下行大型 VSD修补术 ,能更好地保护心肺功能 ,术中能避免残余漏和 °房室传导阻滞的发生 ,临床效果良好。

    Release date:2016-08-30 06:27 Export PDF Favorites Scan
  • 胸骨正中小切口在心脏直视手术中的应用

    目的 介绍胸骨正中小切口在心脏手术中的应用效果. 方法 风湿性心瓣膜病或先天性心脏病患者40例,分别在常规体外循环或常温心脏不停跳下行心内直视术.做胸骨下端正中小切口,长5~9cm,保留胸骨柄的连续性. 结果 手术均顺利进行,术后无严重并发症发生,循环稳定,恢复快,瘢痕隐蔽.心脏不停跳手术患者,术后辅助呼吸和使用正性肌力药物的时间明显缩短. 结论 胸骨正中小切口可以安全的应用于多种常规和心脏不停跳心内直视手术,适应范围广、创伤小、手术效果好和美容效果佳.

    Release date:2016-08-30 06:31 Export PDF Favorites Scan
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