随着人口的老龄化，越来越多的有症状或无症状的冠心病患者需接受非心脏外科手术。接受非心脏外科手术而死亡的患者大约有50%是由于心脏并发症所致［1］。围手术期发生的心脏并发症大约5%～10%为心肌梗死，主要发生于术后头3天，其病死率很高，可达32%～69%［2，3］。术后发生心肌梗死或不稳定型心绞痛的患者发生心血管问题的几率增加20倍［4］。因此，如何评估非心脏外科手术患者的心脏危险性，如何预防围手术期心脏并发症的发生，已成为外科医生十分关注的一个问题。
Objective To assess the value of pulmonary ventilation test in evaluating the prognosis of cardiac surgery patients. Methods Data were collected retrospectively from consecutive patients with coronary heart disease or valvular disease, who were prepared for cardiac surgery in Zhongshan Hospital from January 2007 to December 2008. The main outcome indices were mortality of surgery, the prolonging time of using artificial airway ( ≥3 days) , and the prolonging time in intensive care units ( ICU) ( ≥5 days) . Then the relationship between the poor outcome and ventilation disorder was analyzed. Results In the 422 cases,the incidence of ventilation disorder was 55% , included 27. 5% restrictive ventilation disorder, 15. 6% obstructive ventilation disorder, and 11. 8% mixed ventilation disorder. And the severity of pulmonaryventilation disorder was mild of 34. 6% , moderate of 15. 2% , and severe of 5. 2% . Among the 42 patients who gave up surgery,50% were due to ventilation dysfunction, and the patients were prone to give up surgery with the deterioration of pulmonary function( P lt; 0. 001) . But comparing with the patients with normal pulmonary function, the risk of poor outcome after surgery did not significantly increase in the patients with ventilation disorder ( P gt; 0. 05 ) . The logistic regression analysis indicated that cardiopulmonary bypass ( CPB) was an absolute risk factor ( P lt; 0. 05) . Conclusions The incidence of ventilation disorder in patients with cardiac disease is quite high. Severe pulmonary ventilation disorder is the significant cause of giving up surgery, but may be not the absolute contraindication of cardiac surgery.
Abstract： Objective To evaluate prediction validation of Sino System for Coronary Operative Risk Evaluation （SinoSCORE） on in-hospital mortality in adult heart surgery patients in West China Hospital.?Methods?We included clinical records of 2 088 consecutive adult patients undergoing heart surgery in West China Hospital from January 2010 to May 2012, who were also included in Chinese Adult Cardiac Surgical Registry.We compared the difference of preoperative risk factors for the patients between Chinese Adult Cardiac Surgical Registry and West China Hospital. SinoSCORE was used to predict in-hospital mortality of each patient and to evaluate the discrimination and calibration of SinoSCORE for the patients.?Results?Among the 2 088 patients in West China Hospital, there were 168 patients （8.05%） undergoing coronary artery bypass grafting （CABG）, 1 884 patients （90.23%） undergoing heart valve surgery, and 36 patients （1.72%） undergoing other surgical procedures. There was statistical difference in the risk factors including hyperlipemia, stroke, cardiovascular surgery history, and kidney disease between the two units.The observed in-hospital mortality was 2.25% （47/2 088）. The predicted in-hospital mortality calculated by SinoSCORE was 2.35% （49/2 088） with 95% confidence interval 2.18 to 2.47. SinoSCORE was able to predict in-hospital mortality of the patients with good discrimination （Hosmer Lemeshow test: χ2=3.164, P=0.582） and calibration （area under the receiver operating characteristic curve of 0.751 with 95% confidence interval 0.719 to 0.924）. Conclusion SinoSCORE is an accurate predictor in predicting in-hospital mortality in adult heart surgery patients who are mainly from southwest China
Objective To study palliative surgical strategies for patients with complex congenital heart diseases， and improve their clinical outcomes and survival rate.?Methods We retrospectively analyzed clinical data of 95 patients with complex congenital heart diseases who underwent palliative surgical repair in Union Hospital of Tongji Medical College，Huazhong University of Science and Technology from January 2004 to May 2011. There were 68 male patients and 27female patients with their age ranging from 1 month to 37 years. Modified Blalock-Taussig shunt （B-T shunt） was performed in 12 patients， modified Brock’s procedure in 23 patients， bidirectional Glenn procedure in 55 patients and pulmonary artery banding in 5 patients. Surgical strategies and influential factors of treatment outcomes were analyzed.?Results There were 10 in-hospital death with the overall mortality of 10.5% （10/95）. All the surviving patients were discharged successfully. Main postoperative complications included low cardiac output syndrome， hypoxemia and pneumonia. All the surviving patients were followed up for 5 months to 6 years， and in New York Heart Association （NYHA） functional class ⅠorⅡduring follow-up. During follow-up， nine patients after modified Brock’s procedure received radical repair， and 6 patients after bidirectional Glenn procedure received total cavopulmonary connection.?Conclusion A considerable numberof patients with complex congenital heart diseases may miss their best timing for surgical repair， which significantlyinfluences their surgical outcomes. We need to choose best palliative surgical strategy for these patients according to their pulmonary artery development condition， heart malformation characteristics and final treatment goal.
Abstract: Objective To summarize the clinical experiences of treatment of pulmonary artery dissection, in order to improve the diagnosis and treatment of the disease. Methods We retrospectively analyzed the clinical data of 4 patients including 3 males and 1 female with pulmonary artery dissection who were treated in Fu Wai Hospital between October 1996 and May 2009. Their age ranged from 17 to 45 years with an average age of 31 years. One patient with pulmonary artery dissection with aortic root aneurysm and chronic type Ⅱ aortic dissection was treated with Bentall’s surgery, total arch replacement and pulmonary artery angioplasty under deep hypothermic circulatory arrest. One patient with pulmonary artery dissection with patent ductus arteriosus (PDA) and severe pulmonary hypertension after a failed PDA transcatheter closure was treated with conservative strategy. For the one patient with pulmonary artery dissection with ventricular septal defect (VSD) and severe pulmonary arterial hypertension, VSD was repaired under cardiopulmonary bypass while left pulmonary artery dissection was left untreated. And conservative treatment was carried out for another patient with pulmonary artery dissection with VSD, PDA and Eisenmenger’s syndrome. Results Three patients recovered and 1 patient died of acute pericardial tamponade due to rupture of the dissection within 60 hours after onset of dissection. Followup was done in 3 cases with 1 lost. The followup time was 3 months and 4 years respectively. The New York Heart Association was class Ⅰ and Ⅱ. Conclusion Dissection of the pulmonary artery is a rare disease with a tendency of rupture and bad prognosis. Symptoms of pulmonary artery dissection are nonspecific, which can cause missed diagnosis. In patients with chronic pulmonary hypertension, the sudden seizure of chest pain, exertional dyspnea, and cyanosis, or worsened hemodynamics and cardiac shock may indicate pulmonary artery dissection which can be easily detected with echocardiography, CT scan and magnetic resonance imaging. Corrective surgery or conservative treatment can prevent rupture and possible death based on different causes of pulmonary artery dissection.
Objective To summarize the immediate and intermediate outcomes of surgical correction on patients with tetralogy of Fallot and absent pulmonary valve (TOF/PVAB). Methods From January 1996 to August 2009, 14 patients，including 5 males and 9 females, aged 3.4±3.4 years (0.2-11.0 years) with an average weight of 12.0±6.3 kg (4-26 kg), underwent complete surgical correction in Beijing Fu Wai Cardiovascular Hospital. The right ventricular outflow tract was reconstructed with valved conduit in 4 patients, and monocusp with transannular patch was used in 10 patients. Six patients underwent pulmonary artery wall reduction, and 2 patients underwent both pulmonary artery plication and wall reduction. Results There were 2 (14.3%) perioperative deaths. Both were low bodyweight infants. One died of low cardiac output and respiratory failure, and the other died of central nervous system complications. Ten patients were followed up for an average time of 8.3±4.3 years (0.6-13.0 years). All patients followed up survived. The echocardiogram found pulmonary valvular dysfunction in 4 patients. The patients’ cardiac function were classified as New York Heart Association(NYHA) Ⅰ to Ⅱ. There was no late death or reoperation. Conclusion The immediate and intermediate outcomes of surgical correction of TOF/PVAB are good, but the function of pulmonary valves and conduit should be followed-up closely.