【摘要】目的 探讨肝硬变门静脉高压症患者术前肝脏备功能的评估方法。方法 用Logistic多元回归法分析了78例门静脉高压症行断流术患者术后出现肝功能不全的相关因素，从中筛选与肝功不全关系最密切的危险因子。结果 术后发生肝功不全影响最大的因素依次为： 肝性脑病（EN）、血浆吲哚氰绿潴留试验（ICGR15 min）及门静脉充血指数（PCI）等，而术前的血清总胆红素（TBIL）、白蛋白（A）、凝血酶原时间（PT）、门静脉内径（dp）、门静脉流速（Vp）及门静脉流量（Qp）等因素，在多元回归中所占比例不大。结论 综合分析术前患者临床指标和肝功能实验室检查有助于评价肝硬变患者肝储备功能，预测手术风险及术后转归。
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.
ObjectiveTo analyze the surgical procedures and clinical effects of surgical treatment for patients with hypertrophic obstructive cardiomyopathy (HOCM). MethodsWe retrospectively analyzed the clinical data of sixty-five consecutive patients with HOCM who underwent modified Morrow procedure in Wuhan Asia Heart Hospital between June 2010 and December 2013. There were 40 males and 25 females with mean age of 48.4±11.5 years (ranged 18-70 years). ResultsThere was no in-hospital mortality. There was no valve injury or ventricular septal perforation occurred during operation. Postoperative LVOT gradient, interventricular septum (IVS), left ventricular end-diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF) and mitral regurgitation (MR) were significantly lower than preoperative values (P<0.05). Complete atrioventricular block occurred in 3 patients, complete left bundle branch block occurred in 7 patients, and left anterior division block occurred in 3 patients. All patients were followed up for 6-35 months. During the following-up time, the clinical symptoms diminished in 55 patients and ameliorated significantly in other 10 patients. All patients had a NewYork Heart Association functional class Ⅰ/Ⅱ during the follow-up. ConclusionSurgical septal myectomy can eliminate obstruction of left ventricular outflow tract and relief symptoms obviously. The early and mid-term outcomes are satisfactory.
ObjectiveTo discuss the effect of Cabrol in treatment of Stanford type A aortic dissection.MethodsThe clinical data of patients whom were diagnosed with type A aortic dissection of Stanford in our hospital from January 2013 to January 2018 were retrospectively analyzed. All of 40 patients underwent Cabrol surgical procedure. There were 31 males and 9 females aged 26–75 (48.8±3.3) years. The surgical treatment effect of the patients was evaluated, mainly including the aortic index, the changes in cardiac function before and after operation, and the postoperative follow-up.ResultsAll the 40 patients completed the operation successfully. The diameter of ascending aorta and aortic sinus in postoperative patients were smaller than those before operation (P<0.05). Postoperative left ventricular ejection fraction and cardiac output increased, central venous pressure and left ventricular end-diastolic dimension decreased, and cardiac function indexes were significantly different from those before the operation (P<0.05). Seven patients suffered complications in postoperative follow-up including one stenting leakage, three neurological diseases and three acute renal failure. Two patients died postoperatively.ConclusionCabrol’s operation is effective in the treatment of Stanford type A aortic dissection, which can significantly improve the cardiac function of patients, simplify the anastomosis of coronary artery ostia and decrease amount of bleeding.
目的 探讨胆道镜在探查十二指肠损伤中的临床价值。方法 回顾性分析我院2001年3月至2011年2月期间收治的28例十二指肠损伤患者应用胆道镜探查的临床资料。结果 开腹后直视十二指肠球部损伤7例，胆道镜探查发现其中3例合并水平部损伤，2例合并降部与水平部交界处损伤。直视下未见十二指肠损伤患者中胆道镜探查发现十二指肠损伤21例，其中降部5例，水平部6例，降部与水平部交界处3例，升部2例，十二指肠多处伤5例。按Lucas分级，Ⅰ级4例，Ⅱ级12例，Ⅲ级7例，Ⅳ级5例。Ⅰ级损伤患者中3例在胆道镜下未见血肿继续增大，局部损伤未行处理；1例血肿压迫十二指肠导致肠腔狭窄，在胆道镜引导下避开肠系膜血管，切开肠系膜行血肿清除及止血术。Ⅱ级损伤患者中6例在胆道镜引导下避开肠系膜血管切开肠系膜行全层缝合。其他病例分别采用十二指肠破口空肠Roux-en-Y吻合术（Ⅱ级3例，Ⅲ级1例）、十二指肠空肠端端吻合术（Ⅱ级1例，Ⅲ级3例）、十二指肠空肠Roux-en-Y吻合术（Ⅱ级2例，Ⅲ级2例，Ⅳ级1例）、Graham简化术（Ⅲ级1例，Ⅳ级4例），术后通过空肠切口处放置十二指肠内引流。术后发生并发症12例，其中肠瘘2例，胰瘘2例，肠梗阻3例，腹腔脓肿2例，胰腺脓肿3例。死亡3例，治愈25例。结论 在十二指肠损伤患者中应用胆道镜探查，可以确切诊断十二指肠受损情况，防止漏诊，也可以在胆道镜引导下行相应部位的处理。
ObjectiveTo systematically review the effects of enteral feeding pump and intermittent bolus nasogastric feeding on gastric retention, diarrhea, regurgitation, and other complications of patients who received enteral nutrition treatment. MethodsWe electronically searched databases including PubMed (1980-2013.9), Wiley Online Library (1990-2013.9), Elsevier (1990-2013.9), CNKI (1990-2013.9), VIP (1989-2013.9) and WanFang Data (1990-2013.9), to collect randomized controlled trials (RCTs) about enteral feeding pump and intermittent bolus nasogastric feeding. Two reviewers independently screened the literature according to the inclusion and exclusion criteria, extracted the data, and assessed the methodological quality of the included studies, and then meta-analysis was performed using RevMan 5.2.6 software. ResultsA total of 16 trials involving 1 263 patients were finally included. The results of meta-analysis indicated that enteral feeding pump was better than intermittent bolus nasogastric feeding in the incidences of gastric retention (OR=0.27, 95%CI 0.16 to 0.45, P < 0.000 01), diarrhea (OR=0.24, 95%CI 0.16 to 0.34, P < 0.000 01), regurgitation (OR=0.26, 95%CI 0.11 to 0.65, P=0.004), aspiration (OR=0.19, 95%CI 0.11 to 0.32, P < 0.000 01), aspiration pneumonia (OR=0.40, 95%CI 0.23 to 0.68, P=0.000 7), and abdominal distension (OR=0.24, 95%CI 0.10 to 0.57, P=0.001), with significant differences. However, they were alike in the incidence of tub obstruction (OR=0.43, 95%CI 0.14 to 1.29, P=0.13). ConclusionAccording to existing relevant RCTs, enteral feeding pump is better than intermittent bolus nasogastric feeding in reducing enteral nutrition complications to some extent. However, due to the low methodological quality of the included studies, more large-scale, multicentre high quality RCTs are still needed to verify the aforementioned conclusion.
ObjectiveTo explore the clinical value of modified Soave procedure with stapler for the treatment of Hirschsprung disease. MethodsThe clinical data of 26 patients with Hirschsprung disease adimitted in No.477 hospital from January 2002 to December 2010 were analyzed retrospectively. All the patients underwent modified Soave operation with rectal mucosa and proximal intestine stapled end-to-end. ResultsAll operations were successful without anastomotic leakage, aponeurosis of investment infection, and colonitis. Increased stool frequency presented in two cases, which were cured with astringents on day 15 and 30 after operation, respectively. Mild fecal contamination was in one case. All cases were followed up between 3 months to 60 months, with an average 32 months, without incontinence and constiptation. ConclusionModified Soave procedure with stapler is safe and effective for the treatment of Hirschsprung disease in elder children and adult.