目的 通过对连枷胸两种不同治疗方法的比较，探讨该病的优化治疗方案。 方法 将2005年1月－2012年11月收治的80例枷胸患者按入选标准分为：保守组40例，通过胸部外固定和（或）呼吸机内固定等方法治疗；手术组40例，采用镍钛记忆合金环抱式接骨器手术内固定骨折的肋骨，比较两种治疗方法和疗效及并发症情况。 结果 保守组和手术组各死亡3例，原因为呼吸道感染致呼吸衰竭，两组无差异，但ICU停留和住院天数、机械通气时间、呼吸道感染等并发症手术组明显低于保守组（P＜0.01）。手术组无胸壁畸形，而保守组有18例，两组比较差异有统计学意义（P＜0.01）。出院3个月后，手术组患者部分肺功能指标显著优于保守组（P＜0.01）。 结论 手术治疗连枷胸可迅速稳定胸壁，消除反常呼吸和激烈疼痛对呼吸的影响，还可减轻连枷胸对患者远期肺功能的影响，具有较高的临床应用价值。
ObjectiveTo investigate the distribution of uridine diphosphate-glucuronosyltransferase 1A1 (UGT1A1) gene polymorphisms in esophageal carcinoma (EC) patients, and their relationship with adverse effects (delayed diarrhea and neutropenia) of Irinotecan. MethodsForty-eight patients with esophageal squamous carcinoma who were admitted to Sichuan Provincial People's Hospital between January and October 2012 were recruited in the study. There were 37 male and 11 female patients with their age of 56 (25-38) years. Formalin-fixed, paraffin-embedded samples were collected from those EC patients and genomic DNA was extracted. UGT1A1 polymorphisms were detected by PCR and DNA sequencing. Three genetic loci were investigated including UGT1A1* 28 (TA6 > TA7), UGT1A1* 6 (211G > A) and UGT1A1* 93 (-3156G > A). Adverse effects (delayed diarrhea and neutropenia) of patients with different UGT1A1 polymorphisms after Irinotecan treatment were recorded. The relationship between UGT1A1 polymorphisms and Irinotecan-induced adverse effects was analyzed. ResultsUGT1A1 polymorphisms were detected in 10 out of 48 (20.8%) EC patients. UGT1A1* 93 (-3156G > A)polymorphisms were most common with the polymorphism rate of 16.7% (8/48), followed by GT1A1* 6 (211G > A) polymorphisms with the polymorphism rate of 4.2% (2/48). The incidences of grade 3~4 diarrhea and grade 3~4 neutropenia after Irinotecan treatment in the patients with UGT1A1 polymorphisms were 60.0% and 40.0% respectively, which were significantly higher than those of the patients with wild type UGT1A1 (21.1% and 15.8% respectively, P < 0.05). UGT1A1 polymorphism rates were 45.5% (5/11) in female patients and 13.5% (5/37) in male patients, which were significantly different (P < 0.05). ConclusionsIn EC patients, 2 polymorphism loci including UGT1A1* 93 (-3156G > A) and GT1A1* 6 (211G > A) can effectively predict adverse effects caused by Irinotecan treatment. UGT1A1 polymorphism rate of male patients is significantly lower than that of female patients.
【摘要】 目的 探讨活动期感染性心内膜炎（infectiue endocarditis，IE）患者心脏手术的最佳时期。 方法 回顾分析1999年9月-2009年9月行外科治疗的92例IE患者的临床资料。IE诊断标准为修订的Duke标准。采用SPSS 12.0软件包，分析了年龄、性别、是否是院内感染IE、合并症（糖尿病、慢性阻塞性肿疾病、癌症）、病原菌、手术时间等因素与手术并发症及6个月病死率的关系。 结果 56例患者在确诊为IE后7 d内手术，36例患者在确诊7 d后，并抗生素治疗完成后手术。葡萄球菌为主要感染菌株，与栓塞、脓肿及感染性休克显著相关。最常见的手术指征是重度的瓣膜关闭不全合并心功能不全。6个月的病死率为12%。早期手术与晚期手术比较，病死率增高。单因素分析显示，与6个月病死率相关的因素包括葡萄球菌感染和感染性休克。多因素分析显示感染性休克为6个月内死亡的预测因子。感染性休克的患者尽管行了早期手术，病死率仍为67%。严重瓣膜关闭不全的患者，若未出现心衰，无手术（早期或晚期）死亡。 结论 手术患者的预后由是否发生过感染性休克决定。晚期手术组患者结果好于早期手术组，但结果的差异可能并不是手术的时期不同，而是感染性心内膜炎的严重程度不同造成的。对于有重度瓣膜返流但无心衰的患者，早期手术可能在缩短住院时间，预防心衰发生上有帮助。【Abstract】 Objective To discuss the optimal time of cardiac operations in patients with infective endocarditis (IE). Methods We analyzed the clinical data of 92 patients with IE diagnosed by the modified Duke criteria between September 1999 and September 2009. SPSS 12.0 was used to analyze predictors of 6-month mortality, including age, sex, nosocomial origin of infection, comorbid conditions (diabetes, chromic obstructive pulmonary disease, cancer), the causative microorganisms, the timing of cardiac operation, and the complications. Results Fifty-six patients underwent operation within the first 7 days after diagnosis of infective endocarditis, and 36 received operation at the completion of antibiotic treatment 7 days after the diagnosis. Staphylococci predominated and were significantly associated with embolism, abscess, and septic shock. The most frequent indication for operation was severe regurgitation with heart failure. The 6-month mortality was 12%. Early operation showed an increased mortality compared with late operation. Univariate analysis showed that factors associated with 6-month mortality included staphylococci infection and septic shock. Multivariate analysis revealed that septic shock was a predictor of 6-month mortality. Despite early operation for patients with septic shock, 67% of them died. No death occurred to patients with severe regurgitation but without heart failure after undergoing (early or late) operations. Conclusions The prognosis for surgically treated patients is determined by the occurrence of septic shock. The outcome in patients undergoing late operations is favorable compared with patients undergoing early operations. This difference is probably not due to the timing of the surgical intervention but to the severity of infective endocarditis. In patients with severe regurgitation without heart failure, early operation may offer benefits in shortening the length of hospitalization and preventing development of heart failure.
目的 总结68例二尖瓣成形术的临床经验，评估其术后临床效果。 方法 回顾分析2001年12月－2011年12月进行二尖瓣成形术治疗的68例二尖瓣关闭不全患者的临床资料。成形术的方法为：人工瓣环植入、双孔成形、后瓣矩形切除、赘生物切除及心包补片修复、腱索转移等。术中采用注水实验和经食管超声心动图检查评估成形效果。 结果 68例患者中手术死亡2例，二次开胸止血1例，肺部感染3例。全部患者术中注水实验和食管超声心动图检查显示成形效果满意。存活66例患者随访6个月，术后10 d、6个月彩色多普勒超声心动图检查：左心房内径、左心室舒张末内径缩小。术后6个月彩色多普勒超声心动图检查：无或微量反流33例，轻度反流27例，轻～中度反流5例，中度反流1例。 结论 根据二尖瓣关闭不全的特征，选择相应的二尖瓣成形技术，可以取的较好的临床效果。