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find Author "汪曾炜" 21 results
  • 双极射频消融迷宫术后同步电复律治疗心房颤动

    目的 总结双极射频消融迷宫术(CoxⅣ)术后同步电复律治疗心房颤动(AF)的临床经验。 方法 2006年7月至2009年7月沈阳军区总医院对223例AF患者行CoxⅣ治疗,其中13例患者(包括男4例,女9例;年龄41~69岁;风湿性心脏病7例,退行性心瓣膜病5例,继发孔型房间隔缺损合并三尖瓣关闭不全1例)于出院后仍为AF而药物转复不佳,行同步电复律治疗。电复律后观察心率和心律情况,监测生命体征,出院后继续口服胺碘酮200 mg,1次/天,定期门诊随访。 结果 CoxⅣ手术后6个月内行同步电复律4例,即刻转复窦性心律3例;6个月以上行同步电复律9例,即刻转复窦性心律4例、AF 2例、交界性心律3例。CoxⅣ术后1年以上行电复律3例,转复窦性心律2例。13例均获随访,随访时间6个月~1年。随访期间窦性心律8例(61.54%)、AF4例(30.77%)、交界性心律1例(7.69%)。7例电复律后即刻转复为窦性心律的患者中有1例复发,窦性心律维持率为85.71%(6/7);6例即刻未转复为窦性心律患者中有2例转为窦性心律。窦性心律患者复律后左心房内径(LAD)较复律前明显减小(39.00±5.15 mm vs. 54.50±3.63 mm, t=6.958, P=0.000),而AF患者LAD在复律前后无明显改变(51.00±5.72 mm vs. 48.00±5.89 mm,t=0.731,P=0.493)。 结论 CoxⅣ手术后电复律治疗AF安全有效,成功率高,是CoxⅣ术后控制AF的重要治疗手段。复律时机以术后6个月以内为宜,即刻转复窦性心律成功率较高,维持率也高。LAD明显缩小者电复律效果较好。

    Release date:2016-08-30 05:57 Export PDF Favorites Scan
  • 老年瓣膜病患者心瓣膜置换术的临床分析

    目的 总结老年瓣膜病患者行心瓣膜置换术的经验,以提高手术效果。 方法 回顾性分析2000年1月至2009年4月沈阳军区总医院收治74例老年瓣膜病患者行心瓣膜置换术的临床资料,其中男51例,女23例;年龄60~74岁。术前经心电图、胸部X线片、彩色超声心动图、主动脉根部造影和左心室选择性造影检查诊断,均经手术证实,单纯二尖瓣病变45例;单纯主动脉瓣病变13例,其中7例为先天性二叶主动脉瓣畸形导致退行性改变;主动脉瓣和二尖瓣联合病变16例。均在全身麻醉体外循环下行心瓣膜置换术。 结果 全组无手术死亡,围术期死亡2例。74例患者体外循环时间58.0~136.5 min,主动脉阻断时间36.0~102.0 min。生存患者均无明显并发症,术后9~32 d顺利出院。 结论 心瓣膜置换术是治疗老年瓣膜病的安全方法,对左心房增大者进行减容并对三尖瓣关闭不全者进行良好处理,可获得满意的临床效果。

    Release date:2016-08-30 05:57 Export PDF Favorites Scan
  • Experimental Study on the Isolation, Culture and Identification of Mesenchymal Stem Cells from Human Bone Marrow in Vitro

    Objective To observe the morphology and growing status of mesenchymal stem cells(MSCs) of human bone marrow in vitro, in order to confirm that MSCs of human bone marrow are ideal seed cells and provide basic theory for further MSCs research. Methods The methods of density gradient centrifugation with lymphocyte separation medium for human and adherent filtration were used to isolate and purify MSCs of human bone marrow. We observed the cellular growth status and morphology of the primary MSCs and the surface antigens of second passage MSCs were tested. Results The primary culture cells fused into monolayer after 14-16 d. The passage cells kept the same morphological characteristics of primary culture cells. Ultrastructure of the second passage MSCs showed that the shape of nuclei was irregular, there were multiple nucleoli in some of the nuclei, and morphological differentiation of intracytoplasm organelles was immature. The growth curve of the first, fifth and tenth passage cells showed a logarithmic growth at day 3, a peak growth at day 5, and no clones occurred after tenth passage. Cloning efficiency of first passage, fifth passage and tenth passage was respectively 25.83%±2.93%, 14.67%±1.63% and 4.67%±0.52%. Test of MSCs phenotypic characteristics showed a high homogeneity among the cells and surface antigen profiles were positive for CD29, CD44 and negative for CD34, CD45. Conclusion The methods of density gradient centrifugation with lymphocyte separation medium for human and adherent filtration are simple, economic and efficient to isolate and purify MSCs from human bone marrow. With a high proliferating ability in vitro, MSCs from human bone marrow are ideal seed cells for tissue engineers.

    Release date:2016-08-30 05:59 Export PDF Favorites Scan
  • The Long Effect of Nonpulsatile Flow on Changes of Structure and Function in Pulmonary Microcirculation

    Objective To investigate the long effect of nonpulsatile flow on changes of structure and function in pulmonary microcirculation and to identify the pulmonary reconstruction under this blood perfusion. Methods Canine models with nonpulsatile flow in the right lung was established, and sacrificed 6 months later. Compare endothelial nitric oxide synthase (eNOS) in vascular endothelium, apoptosis in smooth muscle cell with immunohistochemistry by streptavidinbioepidermmultienzyme complex methodes, and observe structural changes in pulmonary arterioles with optical microscope. Results The expression of eNOS in the right nonpulsatile flow perfusing lung was weaker as compared to the left lung (10 846.7±177.8 vs. 13 136.1±189.6;t=2.240, P=0.040), the fas was ber as compared to the left lung(14 254.1±217.1 vs. 11 976.7±195.7; t=2.160, P=0.040). The ratio of wall thichness/vessel diameter in the right lung(13.64%±12.80% vs. 14.96%±13.10%) and wall area/vessel area(46.40%±11.70% vs. 47.80%±12.20%) was lower as compared to the left lung(Plt;0.05). Conclusion Longterm nonpulsatile flow can decrease the expression of eNOS, contract the muscles in capillary net, and increase pulmonary vascular resistance. Moreover it canincrease the arteriole apoptosis, leading to vascular structure remodeling.

    Release date:2016-08-30 06:05 Export PDF Favorites Scan
  • Surgical Technique and Outcomes for Supracardiac Total Anomalous Pulmonary Venous Connection

    Objective To summarize the surgical experience of supracardiac total anomalous pulmonary venous connection(S-TAPVC) and study the surgical technique and outcomes for S -TAPVC. Methods Eightysix patients with S-TAPVC underwent the surgical repair from May 1985 to December 2007. There were 49 males and 37 females. The patients aged from 7 months to 35 years (mean 9.6 years) and weighed from 4.9 kg to 68.0 kg (mean 23.8 kg). The patients were divided into three groups by the approach for the anastomosis. There were 20 patients in groupⅠthrough the right atrium incision, 49 patients in group Ⅱ through the right and left atrium incisions and 17 patients in group Ⅲ through the top of the left atrium incision. The interrupt continuous anastomosis between the common pulmonary venous and the left atrium was used in all patients. The enlarged atrial septal defect(ASD) was repaired with autopericardium. The vertical vein was ligated if the postoperative left atrial pressure was less than 15 mm Hg. But the vertical vein was opened or just partialy ligated if the postoperative left atrial pressure was more than 15 mm Hg. Results There was no early operative death. The postoperative left atrial pressure in three groups were 9.3±3.2 mm Hg, 9.9±2.9 mm Hg and 11.6±3.8 mm Hg, respectively. The cases with open or just partly ligated vertical vein in three groups were 0 case (0%), 7 cases (14.3%) and 2 cases (11.8%), respectively. The cases of arrhythmia in three groups were 5 cases (25.0%), 15 cases (30.6%)and 1 case (5.9%). The severely low cardiac output syndrome occurred in 2 patients and reoperation for bleeding in 2 patients. The morbidity of arrhythmia in group Ⅲ was less than in group Ⅱ(P=0.042). Conclusion The outcome of surgical repair for S -TAPVC is satisfactory. The anastomosis through the top of the left atrium incision has low occurrence of arrhythmia. The anastomosis through the right and left atrium incision is easy to expose and to perform surgery, especial for old children and adult patients.

    Release date:2016-08-30 06:05 Export PDF Favorites Scan
  • The Effect of Ischemic Preconditioning on Myocardial Ischemic Reperfusion of Elderly Rats

    Objective To investigate the effect of ischemic preconditioning(IPC) on myocardial ischemic reperfusion injury(I/R) of elderly rats. Methods Fiftysix Wistar rats, of which there were 28 aged from 21-23months(elderly rat) and 28 aged from 4-5months(young rat), were used to build isolated heart perfusion Langendorff model. The rats were divided into 7 groups with random number table(8 in each group): adult control group, adult I/R group, adult IPC group, elderly control group, elderly I/R group, elderly IPC group and elderly enhanced IPC group. The control group underwent a 90-min perfusion without any intervention; the I/R group underwent a 30-min equilibration period, then a 30-min ischemia and a 30-min reperfusion; the IPC group underwent a 10-min equilibration period, then a 5-min ischemia for twice and a 5-min reperfusion, after that a 30-min ischemia and [CM(158-3mm]a 30-min reperfusion; the enhanced IPC group underwent a 10-min equilibration period, then a 5-min ischemia for 4-times and a 5-min reperfusion, after that a 30-min ischemia and a 30-min reperfusion. The recovery rates of cardiac output(CO), left ventricular developed pressure (LVDP), the maximum rising and descending rate of left ventricular pressure (±dp/dtmax) after a 30-min reperfusion were compared among groups. The activity of creatine kinase (CK) in coronary outflow, the level of malonyldialdehyde (MDA) and superoxide dismutase (SOD) before ischemia and after a 30min reperfusion were detected. The myocardial infarction areas were compared among groups. Results After a 30min reperfusion, compared with adult I/R group, in adult IPC group CK reduced significantly(89.48±18.72 U/L vs. 115.76±16.72 U/L,q=6.061,Plt;0.01),the level of MDA decreased significantly(9.53±3.44 nmol/ml vs. 16.84±2.29 nmol/ml,q=7.732,Plt;0.01),the level of SOD increased significantly(584.7±122.62 U/ml vs. 429.46±85.24 U/ml,q=4.754,Plt;0.01),the recovery rates of CO,LVDP,+dp/dtmax and -dp/dtmax increased ignificantly(78.69%±9.68% vs. 65.10%±8.63%,83.61%±8.46% vs. 67.23±8.68%,81.68±8.68% vs. 67.89%±6.89%,89.79%±7.78% vs. 66.79%±8.46%,Plt;0.01), the myocardial infarction areas reduced significantly (5.25%±4.33% vs. 14.75%±8.02%,q=7.458,Plt;0.01)。There was no statistical significance between elderly IPC group and elderly I/R group in the above indexes(Pgt;0.05).However, There was statistical significances between elderly enhanced IPC group and I/R group. CK reduced significantly (88.60±28.32 U/L vs. 105.76±9.64 U/L,q=5.620,Plt;0.01),the level of MDA decreased significantly(8.38±3.36 nmol/ml vs. 16.80±3.06 nmol/ml,q=7.500,Plt;0.01),the level of SOD increased significantly(558.87±78.66 U/ml vs. 433.75±86.65 U/ml,q=7.335,Plt;0.01),the recovery rates of CO,LVDP,+dp/dtmax and -dp/dtmax increased significantly (77.99%±10.02% vs. 66.26%±9.78%,85.59%±6.67% vs. 73.90%±6.66%,83.87%±9.98% vs. 68.90%±8.68%,86.01%±766% vs. 70.39%±7.98%,Plt;0.01), the myocardial infarction areas reduced significantly (795%±6.32% vs. 1568%±10.36%,q=8.680, Plt;0.01). 〖WTHZ〗Conclusion The protective effect of IPC on I/R elderly rat hearts has weakened. The enhanced IPC is able to regain the protective effect of IPC on elderly rat hearts.

    Release date:2016-08-30 06:06 Export PDF Favorites Scan
  • 老年患者二尖瓣置换同期行冠状动脉旁路移植术的临床分析

    目的 总结老年二尖瓣疾病合并冠心病患者心瓣膜置换术同期行冠状动脉旁路移植术(CABG)的经验,以提高临床效果。 方法 2002年7月至2004年7月我科共30例老年二尖瓣疾病患者二尖瓣置换术同期行CABG。年龄66.0±9.1岁(60~73岁), 4例为风湿性瓣膜病变,26例为二尖瓣瓣膜退行性病变。术前心功能分级(NYHA):Ⅰ级3例,Ⅱ级5例,Ⅲ级17例,Ⅳ级5例。共移植旁路血管71支,使用左侧乳内动脉24例,其余均为大隐静脉。置换机械瓣27例,置换生物瓣3例;行三尖瓣De Vega成形术17例。 结果 术后早期死亡1例(3.3%)。随访29例,平均随访时间13个月,心功能均有明显改善,Ⅰ级18例,Ⅱ级10例,Ⅲ级1例,可从事简单的运动及正常家务劳动,生活质量满意。 结论 老年二尖瓣疾病患者二尖瓣置换术同期行CABG的危险性较大,充分的术前准备,正确的手术方案,术中良好的心肌保护及严密的术后处理是手术成功的重要因素。

    Release date:2016-08-30 06:08 Export PDF Favorites Scan
  • 慢性缩窄性心包炎的外科治疗

    目的 总结慢性缩窄性心包炎的外科治疗经验。方法 78例患者术前均被明确诊断为慢性缩窄性心包炎,均在全身麻醉下经胸部正中切口行心包剥脱术。结果 术后中心静脉压6.5~14.0mmHg(1kPa=7.5mmHg),平均8mmHg。死亡1例,再次开胸止血2例,发生低心排血量综合征3例。术后病理检查:心包纤维结缔组织增生、玻璃样变性60例,呈于酪样结核病变18例(伴结核肉芽肿形成7例)。随访65例,随访时间3个月~10年,心功能(NYHA)均为I级,无心包缩窄复发和死亡。结论 手术是治疗慢性缩窄性心包炎惟一有效的方法,胸部正中切口是较佳的手术径路,心包切除范围应根据具体病情而定,力争将心包彻底松解切除。

    Release date:2016-08-30 06:23 Export PDF Favorites Scan
  • Changes of the Level of G Protein in Newborn Guinea-pig Myocardium Undergoing Global Ischemic Reperfusion

    ObjectiveTo study the changes of levels of α subunits of stimulatory (Gsα) and inhibitory guanine nucleotide binding protein (Giα) in newborn guinea pig (0 2 days old) myocardium undergoing global ischemic reperfusion, and influences on the changes by St.Thomas Ⅱ and cold blood cardioplegic solution.MethodsThirty newborn guinea pigs were randomly assigned to three groups. GroupⅠ ( n = 10): the newborn hearts suffered by hypothermic global ischemia; group Ⅱ( n =10): the newborn hearts arrested by St. Thomas Ⅱ , and group Ⅲ ( n = 10): the newborn hearts arrested by cold blood cardioplegic solution. Levels of Gsα and Giα were investigated with Western blot analysis.ResultsNo differences of levels of Gsα and Giα were found in three groups before ischemia ( P gt;0.05). The level of Gsα after ischemia was significantly decreased than before ischemia in groupⅠand group Ⅱ ( P lt; 0 01), whereas no pronounced changes in group Ⅲ ( P gt;0.05) were noted after ischemia. The level of Gsα in group Ⅲ was not significantly changed after reperfusion compared with before ischemia( P gt;0 05), and it was much higher than those in groupⅠand group Ⅱ ( P lt; 0 01). Level of Giα was found not markedly changed in group Ⅲ after reperfusion compared with that before ischemia, but was notable higher in groupⅠand group Ⅱ( P lt;0.01). ConclusionsSignificant decrease of level of Gsα, whereas marked increase of level of Giα are found in myocardium of newborn guinea pig undergoing hypothermic (20℃) ischemic reperfusion. No impact of St. Thomas Ⅱ on these changes is verified, but recovery to the level of Gsα and Giα before ischemia is achieved by cold blood cardioplegic solution after ischemia and reperfusion. Unbalance between Gsα and Giα is the one of the mechanisms of ischemic reperfusion injury for immature myocardium.

    Release date:2016-08-30 06:24 Export PDF Favorites Scan
  • 心脏肿瘤的外科治疗

    目的总结心脏肿瘤的发生部位、肿瘤性质、诊断和外科治疗方法。方法1979年1月至2003年6月对195例心脏肿瘤患者行手术治疗,其中良性肿瘤186例(95.38%)、恶性肿瘤9例(4.62%);完整切除肿瘤188例,大部分或部分切除肿瘤7例。结果手术死亡5例,死亡率2.56%(5/195);手术成功190例(97.44%),术后随访3个月至15年,随访率96.84%(184/190),6例粘液瘤患者于术后4个月~2年内复发,4例恶性肿瘤分别于术后5个月~2年内死亡。结论心脏肿瘤以粘液瘤多见,彻底切除肿瘤是防止心脏肿瘤复发的关键,心脏恶性肿瘤手术近远期效果差;近10年心脏肿瘤呈逐年增加的趋势。

    Release date:2016-08-30 06:25 Export PDF Favorites Scan
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