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find Keyword "心脏直视手术" 11 results
  • Clinical Diagnosis and Surgical Therapy for Blood Culture-Negative Infective Endocarditis

    Objective To investigate clinical diagnosis,timing of surgery and perioperative therapeutic strategies for blood culture-negative infective endocarditis (IE). Methods Clinical data of 240 IE patients who were admitted tWuhan Asia Heart Hospital between July 2008 and July 2012 were retrospectively analyzed. According to their blood cultureresults,all the patients were divided into blood culture-negative group and blood culture-positive group. In the blood culture-negative group,there were 158 patients including 88 male and 70 female patients with their age of 51.3±10.1 years. In the blood culture-positive group,there were 82 patients including 45 male and 37 female patients with their age of 48.9±9.8 years. All the patients underwent surgical treatment,and the surgical procedures included complete vegetations excision,debridement of infected valves,removal of necrotic tissue around the annulus,and concomitant heart valve replacement or intracardiac repair. Postoperatively,all the patients received routine monitoring in ICU,cardiac glycosides,diuretics,other symptomatic treatment and adequate dosages of antibiotics for 4-6 weeks. Results Four patients died postoperatively in this study including 1 patient for low cardiac output syndrome and 3 patients for multiple organ dysfunction syndrome,1 patient in the blood culture-positive group and 3 patients in the blood culture-negative group respectively. There was no statistical difference in surgical mortality between the 2 groups (χ2=0.15,P=0.70). All the other patients were discharged successfully and followed up for 6 to 36 months with the median follow-up time of 22 months. During follow-up, 2 patients died including 1 patient for cerebral infarction 2 years after surgery and another patient for cerebral hemorrhage 3 yearsafter surgery. Conclusion Patients with blood culture-negative IE should receive adequate dosage and duration of broad-spectrum antibiotics to control the infection rapidly, and aggressive surgical therapy to decrease in-hospital mortality and improve their quality of life and prognosis.

    Release date:2016-08-30 05:47 Export PDF Favorites Scan
  • 右侧腋下小切口先天性心脏病直视手术的临床应用

    目的 总结右侧腋下小切口心脏直视手术临床应用的经验。 方法 回顾性分析2010年5月至2011年8月大坪医院采用右侧腋下小切口施行心脏直视手术83例先天性心脏病患者的临床资料,其中男27例,女56例;年龄7个月~59 (8.0±9.1)岁;行房间隔缺损修补术21例(心脏不停跳18例、同期行三尖瓣成形术3例、二尖瓣成形术1例),行室间隔缺损修补术60例(同期行右心室流出道疏通术4例),完全性肺静脉异位引流矫治术1例,右心室双出口矫治术1例。 结果 全组患者均顺利完成手术,体外循环时间21 ~ 185 (66.9±32.3) min,升主动脉阻断时间5 ~ 122 (32.5±25.5) min。 早期死亡1例(1.2%),死亡原因为低心排血量。门诊随访80例,失访3例。无残余漏、Ⅲ○房室传导阻滞等并发症发生。 结论 右侧腋下小切口选择性应用于先天性心脏病直视手术,安全可靠、创伤小,切口美观;但应强调适应证的合理选择、充分的术野显露、可靠的体外循环以及术中准确的手术操作。

    Release date:2016-08-30 05:50 Export PDF Favorites Scan
  • 经胸骨正中切口心脏手术后并发乳糜胸的治疗

    摘要: 目的 探讨经胸骨正中切口心脏直视手术后发生乳糜胸的可能机制和治疗经验,以减少术后乳糜胸的发生。 方法 回顾分析1996年10月至2006年1月收治的18例经胸骨正中切口径路行心脏直视手术后发生乳糜胸患者的临床资料,其中男12例,女6例;年龄2个月~79岁,平均年龄144岁。所有患者均采用在禁食基础上的保守治疗,包括胸腔闭式引流、静脉高营养、强心、利尿等综合措施。 结果 住院时间7~130 d,胸腔引流时间4~35 d。全组死亡2例,其中死于心律失常、心搏骤停1例;因肺部感染、再次插管,死于多器官功能衰竭1例。随访14例,随访时间2~10年,失访2例。随访期间无乳糜胸复发或需二次手术者。 结论 经胸骨正中切口径路行心脏直视手术后发生乳糜胸可能与手术时损伤较小的淋巴侧枝有关,采用禁食、胸腔闭式引流、静脉高营养等保守治疗效果满意。

    Release date:2016-08-30 06:01 Export PDF Favorites Scan
  • 右腋下小切口心脏直视手术3 012例的临床应用

    目的 总结右腋下小切口在心脏直视手术中应用的临床经验。 方法 2001年11月至2008年7月我们采用右腋下小切口施行心脏直视手术3 012例,男1 834例,女1 178例;年龄8个月~78岁,平均年龄124岁。行室间隔缺损修补术1 999例(干下型109例),房间隔缺损修补术677例(同期行三尖瓣或二尖瓣成形术107例、行部分型肺静脉畸形引流29例),法洛三联症矫治术43例,法洛四联症矫治术35例,右室双腔心矫治术33例,房室管畸形矫治、肺动脉瓣狭窄交界切开、右心室流出道狭窄疏通、三尖瓣下移畸形行11/2心室矫治或三尖瓣置换术等共123例,二尖瓣成形术28例,二尖瓣置换术74例。 结果 全组均顺利完成手术,早期死亡5例(0.17%),死亡原因分别为灌注肺、鱼精蛋白严重过敏、术中损伤左冠状动脉、低心排血量及脑血栓昏迷。二次开胸止血8例(0.26%),切口感染6例(0.20%),肺不张、灌注肺、低心排血量、感染性心内膜炎、急性肾功能衰竭(ARF)等并发症24例(0.79%);ARF患者均经连续床旁血液滤过治疗痊愈,其余患者经对症支持治疗痊愈。通过门诊复查、电话等形式随访1~82个月,共随访2 765例,失访247例;3例室间隔缺损出现小型残余漏,2例二尖瓣成形术后出现轻中度二尖瓣关闭不全,1例Ebstein畸形行三尖瓣成形术后出现轻中度三尖瓣关闭不全,其他患者无异常。 结论 右腋下小切口应用于心脏直视手术,有创伤小、失血少、切口美观等优点,但应严格掌握手术适应证。

    Release date:2016-08-30 06:02 Export PDF Favorites Scan
  • Expression Change and Its Implication of Cell Adhesion Molecules CD11b/CD18, sPselectin in Perioperative Period of Cardiopulmonary Bypass

    Abstract: Objective To observe the significance of the changes of cell adhesion molecules (CAM) CD11b/CD18 and sPselectin during the perioperative period of open heart surgery under cardiopulmonary bypass (CPB), and investigate the roles of CD11b/CD18 and sPselectin in systemic inflammatory response triggered by CPB. Methods Thirty patients including 18 males and 12 females, age ranged from 29 to 55 years (45.3±8.1 years) having undergone valvular replacement for rheumatic heart disease in our hospital were selected as the subjects of this research. After anesthesia induction, radial arterial blood sample was collected at six different time points including the time prior to skin incision, and 30 min, 1 h, 6 h, 12 h and 24 h following the start of CPB. The expression levels of CD11b/CD18 were tested by flow cytometry, and concentration of sP-selectin in the plasma was measured with enzymelinked immunosorbent assay(ELISA). Results The expression of CD11b/CD18 was elevated at 30min after CPB, and it reached the peak (581.44±215.26) at 6 h after CPB with significant differences (Plt;0.05). Its expression started to drop at 12 h after CPB, but it was still higher than the expression level before CPB. The expression returned under the level before CPB at 24 h after CPB with insignificance differences (Pgt;0.05). The expression of sPselectin in the peripheral blood started to rise evidently at 30 min after CPB, reaching the peak (51.44±10.06 ng/ml) with significant differences (Plt;0.05). Its expression level decreased at 12 h after CPB and fell back below the level before CPB with insignificant differences (Pgt;0.05). Conclusion CPB can cause the expression of CD11b/CD18 and sPselectin to rise in the peripheral blood, which may play an important role in the systemic inflammatory response triggered by CPB.

    Release date:2016-08-30 06:02 Export PDF Favorites Scan
  • 体外循环心脏直视手术后并发精神障碍的临床分析

    目的 探讨体外循环心脏直视手术后并发精神障碍的病因和防治措施,以减少术后精神障碍并发症的发生。 方法 对1998年1月至2007年5月收治的45例体外循环心脏直视术后发生精神障碍患者的临床资料进行回顾性分析,分析其危险因素、临床表现、防治措施和预后。 结果 45例患者经积极治疗,精神症状大多在4d内痊愈,且无复发。术后死亡2例,其中1例双瓣膜置换术患者术后3d死于低心排血量,1例于冠状动脉旁路移植术后8d死于以肾功能衰竭为主的多器官功能衰竭。随访29例,随访率67.4%(29/43),随访时间2~43个月(21.5±7.8个月),无精神障碍复发者;失访14例。 结论 体外循环心脏直视手术后精神障碍的发生是由于病理生理、环境、个体因素等多种因素作用的结果,应采取综合防治措施。

    Release date:2016-08-30 06:04 Export PDF Favorites Scan
  • 心内直视下射频消融改良迷宫术治疗心房颤动

    目的 总结心内直视下射频消融改良迷宫手术治疗心房颤动的临床经验。 方法 2005年5月~2006年8月在心内直视手术同期采用射频消融改良迷宫手术治疗心房颤动30例,术前诊断风湿性心脏病26例,二尖瓣关闭不全3例,冠心病1例。手术采用Cardioblate TM冲洗式射频消融系统,每例患者分别应用单极系统和双极系统,按照迷宫手术线路分别于左、右心房行心内膜射频消融手术,并切除左、右心耳,同期完成相应的心脏手术。 结果 手术均顺利完成,射频消融手术时间30.5±12.6 min。术后死亡1例,其余29例顺利出院。术后当天21例患者(70.0%)转为窦性心律。29例患者出院后随访7.6±4.8个月,24例(82.8%)为窦性心律,5例(17.2%)为心房颤动或房室结性心律。 结论 心内直视下射频消融改良迷宫手术治疗心房颤动简单、有效,具有良好的临床应用前景。

    Release date:2016-08-30 06:16 Export PDF Favorites Scan
  • Protective effects of Cimetidine on Immune Function of Patients after Cardiac Surgery with Cardiopulmonary Bypass

    Objective To investigate the protection effects of cimetidine for the immune function of patients underwent cardiac operation under cardiopulmonary bypass (CPB). Methods From Jan. 2004 to Jan. 2005, thirty patients suffered from rheumatic cardiac valvular disease received cardiac valve replacement in our hospital, and were divided into cimetidine group and control group.The effects of cimetidine on cellular immune, fluid immune and erythrocytic immune were observed 1d before operation, 1, 3, 5, 7 and 14d after operation. Results After operation,CD3,CD4,CD4/CD8, NK cell activity, Interleukin-2(IL-2), RBC-C3bRR and RBC-ICR in cimetidine group were significantly higher than those in the control group(Plt;0.01). In cimetidine group,those index began to recover on the postoperative 3 to 5 days, and return to normal level on the postoperative 7 days (Pgt;0.05). In control group, 7 and 14 days respectively. Conclusion The protective effects of cimetidine on immune function of openheart operative patients are significant.

    Release date:2016-08-30 06:15 Export PDF Favorites Scan
  • 心脏直视手术围术期尿微量蛋白变化的临床观察

    目的 观察心脏直视手术围术期尿微量蛋白的变化并分析其临床意义.方法 40例心脏直视手术患者按疾病种类不同分为两组,组Ⅰ:风湿性心脏病瓣膜置换术患者(n=20);组Ⅱ:非紫绀型先天性心脏病患者(n=20).采用速率散射比浊法分别于术前1天,手术结束时,术后1天,术后3天和术后5天测定微白蛋白、转铁蛋白、免疫球蛋白G和α1-微球蛋白的浓度变化.结果 两组术后微白蛋白、转铁蛋白、免疫球蛋白G和α1-微球蛋白的浓度均明显升高(P<0.05或P<0.01),到达峰值后逐渐下降.两组比较,组Ⅰ术后改变较明显,持续时间也较长(P<0.05或P<0.01).结论 心脏直视术后存在不同程度的肾脏损害,风湿性心脏病瓣膜置换术患者术后的肾脏损害较重.尿微量蛋白测定可以敏感、准确地发现心脏直视术后亚临床肾脏损害.

    Release date:2016-08-30 06:35 Export PDF Favorites Scan
  • Right Axillary Straight Mini-thoracotomy in Open Heart Surgery in Infants

    ObjectiveTo summarize our experience of right axillary straight mini-thoracotomy for surgical treatment of common congenital heart diseases in infants. MethodsWe conducted a retrospective analysis of 369 infants undergoing open heart surgery through right axillary straight mini-thoracotomy in the 153th Central Hospital of People's Liberation Army from April 2009 to April 2013. There were 191 males and 178 females with their mean age of 8.2±3.1 months (range, 3-12 months)and body weight of 7.8±4.5 kg (rang, 4.5-11.2 kg). Surgical procedures included ventricular septal defect (VSD)repair in 290 patients, atrial septal defect (ASD)repair in 16 patients, VSD and ASD repair in 34 patients, VSD repair and mitral valvuloplasty in 4 patients, valvotomy for pulmonary valve stenosis (PVS)in 9 patients, ASD repair and valvotomy for PVS in 6 patients, correction of partial anomalous pulmonary venous connection in 4 patients, and correction of partial atrioventricular canal defect in 6 patients. ResultsSix patients (1.6%)died postoperatively. Postoperative complications included right atelectasis in 3 patients, right pneumothorax in 2 patients, pneumonia in 16 patients, incision fat liquefaction in 12 patients, third-degree atrioventricular block in 1 patient, cerebral air embolism in 1 patient, and reexploration for bleeding in 3 patients. A total of 295 patients were followed up for 6 to 12 months after discharge. Residual VSD shunt was found in 4 patients, and mild mitral regurgitation was found in 2 patients. ConclusionClinical outcomes of right axillary straight mini-thoracotomy during open heart surgery are satisfactory for infants with common congenital heart diseases, but strict indications and skillful surgical techniques are needed.

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