Search

巨大心脏患者术后气管软化塌陷二例

急诊支气管动脉栓塞术治疗气管镜活检后大咯血一例

Embosphere 微粒球栓塞大咯血出血靶血管的疗效和安全性研究

目的 观察 Embosphere 微粒球作为栓塞材料治疗大咯血的近远期疗效和安全性。 方法 纳入 2013 年 7 月至 2016 年 3 月收治的 82 例大咯血患者，采用 Embosphere 微粒球为主要的栓塞材料，栓塞支气管动脉以及其他出血靶血管，观察 24 h 内咯血有无停止，7 d 内有无咯血反复，以及围手术期的不良反应。术后随访 1 年观察咯血有无反复。 结果 患者术后 24 h 内咯血停止 78 例，明显减少 3 例，无效 1 例；7 d 内有 1 例出现反复。近期有效率 97.6%（80/82）。随访 1 年，咯血复发 4 例，远期有效率 92.7%（76/82）。围手术期的不良反应主要为胸痛、胸闷和发热，未发生严重并发症。 结论 Embosphere 微粒球经出血靶血管栓塞治疗大咯血的近期和中远期疗效确切，无严重的不良反应，值得临床推广应用。

Surgical Treatment Experience of Emergency Surgery in Treating Rheumatic Valves Patients with Preoperative Ventricular Electrical Storm

目的探讨成人风湿性心脏瓣膜病术前并发心室电风暴（恶性室性心动过速、心室颤动）行急诊手术的疗效及体会。 方法回顾性分析2004年10月至2014年10月我院成人心脏瓣膜入院后突发恶性室性心动过速、心室颤动的患者6例，其中男2例，女4例，年龄35.0～64.0岁，平均49.8岁。6例患者均为风湿性心脏瓣膜病，二尖瓣中重度狭窄并主动脉瓣及三尖瓣中重度关闭不全2例，二尖瓣中重度关闭不全并三尖瓣中重度关闭不全4例，恶性心律失常发作后立即予艾司洛尔等药物控制，病情基本稳定后急诊手术。其中，行双瓣膜置换+三尖瓣成形术2例，行二尖瓣置换+三尖瓣成形术4例。 结果无围术期患者死亡，术后无心功能显著恶化、无多脏器功能衰竭、无恶性室性心律失常。术后1～2周24 h动态心电图提示室性早搏大于1 000次的2例，室性早搏500～1 000次1例，小于500次的患者3例，短阵室性心动过速2次的患者2例，短阵室性心动过速3次的患者1例。所有6例患者均安全出院，随访6个月至10年，无患者死亡。 结论急诊外科手术联合β受体阻滞剂在治疗成人心脏瓣膜疾病术前突发的反复恶性室性心动过速、心室颤动安全有效。

The therapeutic effect and mid-term follow-up of 154 patients of multiple valvular surgery through right anterolateral intercostal thoracotomy: A retrospective cohort study

ObjectiveTo investigate the therapeutic effect, safety and effectiveness of multiple valvular surgery through right anterolateral intercostal thoracotomy, as well as the mid-term follow-up results and surgeon's learning curve.MethodsThe clinical data of 154 patients with multiple valvular disease were performed minimally invasive cardiac surgery in the Department of Cardiovascular Surgery, The First Affiliated Hospital of Air Force Medical University, from 2015 to 2019 were retrospectively analyzed. There were 103 males and 51 females, aged 23-68 years. Closed cardiopulmonary bypass was established through femoral artery and femoral vein, and the thoracic cavity was entered through a 6 cm transverse incision in the fourth intercostal space on the right side of sternum. Baseline and perioperative characteristics and postoperative outcomes were reviewed.ResultsThere was no perioperative death. The average cardiopulmonary bypass time was 159.3±39.4 min, and the aortic clamping time was 102.3±20.3 min. One patient underwent thoracotomy during the operation, and two patients underwent second thoracotomy for hemostasis. During the follow-up period of 10-55 months, 1 patient died, 2 patients developed mild perivalvular regurgitation, 6 patients developed moderate tricuspid regurgitation, and no serious cardiovascular events occurred in the rest of the patients.ConclusionOur findings demonstrate that multiple valvular surgery through right anterolateral intercostal thoracotomy is safe, and in an acceptable risk of complication. The early and middle follow-up results are satisfactory. The minimally invasive cardiac surgery can also meet the requirements of cosmetology, and is conducive to the recovery of patients' mental and physical health. This method is worthy of application in medical centers with rich experience in routine cardiac surgery.