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find Author "袁宏声" 17 results
  • 心瓣膜置换时采用盐水冲洗射频改良迷宫手术治疗心房颤动

    目的介绍心瓣膜置换时采用盐水冲洗射频改良迷宫手术治疗心房颤动(AF)的技术要点。方法对74例心瓣膜疾病合并AF患者行心瓣膜置换时采用盐水冲洗射频改良迷宫手术治疗AF,射频能量25~30W,盐水冲洗速度180~240ml/h。首先完成右心房主要的切口和消融,在心脏停搏后进行左心房消融,继后处理心瓣膜。心脏复跳后再完成右心房剩余的消融和缝合切口。结果本组患者体外循环时间102±26rain,主动脉阻断时间58土22min,射频消融时间12±5min。住院死亡2例,其中死于机械瓣膜故障1例,多器官功能衰竭1例。术后随访70例,随访时间1.0~3.5年,随访过程中突然死亡2例。60例患者恢复窦性心律(85.7%,60/70)。结论心瓣膜疾病合并持续AF的患者在行心瓣膜置换术时,同期行盐水冲洗的射频改良迷宫手术是合理及有效的。

    Release date:2016-08-30 06:23 Export PDF Favorites Scan
  • Radiofrequency Modified Maze Procedure for Atrial Fibrillation in Patients with Mitral Valve Diseases

    Abstract: Objective To summarize the experiences of radiofrequency modified maze procedure for atrial fibrillation (AF) in patients with mitral valve diseases. Methods From May 2003 to December 2008, 122 patients, including 31 males and 91 females, with permanent AF underwent radiofrequency modified maze procedure as a combined operation with mitral valve replacement. Their age ranged from 23 to 65 years old (47±10 years). The duration of AF varied from 0.5 to 32.0 years (6.5±5.7 years). There were 57 cases of stenosis, 7 cases of regurgitation and 58 cases of both stenosis and regurgitation. Ablation lines were made with Cardioblate (Medtronic, monopolar, 25.30 W, 180.240 ml/h). After rightsided maze procedure was finished, aorta was crossclamped and cold crystalloid or blood cardioplegia were delivered for myocardial protection. Left atrial incision was performed through the interatrial groove or interatrial septum. The ablation lines were created to encircle the orifices of the left and right pulmonary veins respectively. The ablation lines were also performed from the left encircling line to the posterior mitral valve annulus and to the orifice of left atrial appendage respectively. An ablation line was used to connect the circumferential line of left and right pulmonary veins. The left atrial appendage was tied and concomitant operations were performed. Amiodarone was given to the patients after operation and regular follow-up was done. Results There were four perioperative deaths including 2 cases of multiple organ failure, 1 case of mechanic valve obstruction and 1 sudden death. Follow-up was done to 115 patients for 1.5-7.0 years (4.8±2.6 years) with three cases lost. During the followup period, four patients died, including 3 sudden deaths and 1 case of prosthetic obstruction. Eightyseven patients (78.4%, 87/111) recovered to sinus rhythm; 22 patients still had AF; 1 patient had atrial flutter; and 1 patient required a permanent pacemaker one year after the operation. Diameter of left atrium after operation (0.5-7.0 years) was decreased compared with that before operation(44.90±7.50 mm vs. 54.30±10.80 mm,t=10.641,P=0.000). Conclution Radiofrequency modified maze procedure for AF in patients with mitral valve disease is relatively safe. But heart rhythm instability, tachyarrhythmia and recurrent AF are not rare for those patients. Therefore, the surgical indication of AF should be individualized.

    Release date:2016-08-30 06:02 Export PDF Favorites Scan
  • 60岁以上心瓣膜病患者的外科治疗与随访

    目的 总结≥60岁心瓣膜病患者的外科治疗经验及随访结果,以提高手术疗效。 方法 2000年7月至2008年12月, 86例≥60岁的心瓣膜病患者接受了心瓣膜置换术治疗,其中男43例,女43例;年龄60~74岁,平均年龄63.8岁。二尖瓣病变55例,主动脉瓣病变9例,二尖瓣及主动脉瓣双瓣膜病变21例,三尖瓣病变1例;风湿性心瓣膜病65例,退行性心瓣膜病21例。心房颤动59例,窦性心律27例。心功能分级(NYHA)Ⅲ级79例,Ⅳ级7例。行二尖瓣置换术55例,双瓣膜置换术21例,主动脉瓣置换术9例,二尖瓣置换术后三尖瓣置换术1例;同期行三尖瓣成形术16例,改良射频迷宫术8例,左心房血栓清除术7例。 结果 围术期因心律失常死亡1例。术后有3例患者因胸骨哆开而再次行胸骨固定术,1例患者因瓣周漏而再次行心瓣膜置换术,3例患者因呼吸功能不全行气管切开术。85例患者均治愈出院。术后左心房内径(51.1±13.8 mm vs.56.2±17.2 mm,P=0.001)和右心房内径(48.8±9.6 mm vs. 52.1±13.9 mm,P=0.012)较术前明显缩小,左心室、右心室内径、射血分数和缩短分数与术前比较差异均无统计学意义(Pgt;0.05)。随访84例,随访时间2~96个月(24±22个月),失访1例。随访期间有1例患者于术后5个月因抗凝强度不足发生左心房血栓,经治疗后血栓消失;另1例术后6年因抗凝强度不足发生脑梗死,经住院治疗肢体偏瘫未能恢复。 结论 只要适当把握手术指征和手术时机,注重术前准备及围术期处理,对≥60岁患者行心瓣膜置换术效果良好。术后与抗凝有关的主要问题为抗凝不足。对这些患者术后应加强国际标准化比率(INR)监测及持续的心功能调整。

    Release date:2016-08-30 06:06 Export PDF Favorites Scan
  • Clinical Characteristics and Management of Patients with Severe Tricuspid Regurgitation after Mitral Valve Surgery

    Objective To summarize the clinical characteristics and management experiences of patients with severe tricuspid regurgitation (TR) after mitral valve surgery. Methods Thirty patients were followed up and reviewed for this report. There were 1 male and 29 female patients whose ages ranged from 32 to 65 years (47.1±92 years). A total of 28 patients had atrial fibrillation and 2 patients were in sinus rhythm. There were 13 patients of mild TR, 10 patients of moderate TR and 7 patients of severe TR at the first mitral valve surgery. Five patients received the tricuspid annuloplasty of De Vega procedure at the same time, 2 patients received Kay procedure. The predominant presentation of patients included: abdominal discomfort (93.3%, 28/30), edema (66.7%,20/30), palpitation (56.7%, 17/30), and ascites (20%, 6/30). Results Nine patients underwent the secondary surgery for severe TR. The secondary surgery included tricuspid valve replacement (6 cases), mitral and tricuspid valve replacement (2 cases) and Kay procedure (1 case). Eight patients were recovered and discharged and 1 patient died from the bleeding of right atrial incision and low output syndrome. Twentyone patients received medical management and were followed up. One case was lost during followup. Conclusion Surgery or medical management should be based on the clinical characteristics of patients with severe TR after mitral valve surgery. It should be based on the features of tricuspid valve and the clinical experience of surgeon to perform tricuspid annuloplasty or replacement.

    Release date:2016-08-30 06:08 Export PDF Favorites Scan
  • 针灸致迟发性心脏压塞一例

    Release date:2016-08-30 06:23 Export PDF Favorites Scan
  • 右心室流出道血管瘤一例

    Release date:2016-08-30 06:23 Export PDF Favorites Scan
  • 心瓣膜置换术患者围术期尿NAG/Cr变化及乌司他丁对肾的保护作用

    目的 了解心瓣膜置换术患者围术期尿 N-乙酰 - β- D-氨基葡萄糖苷酶 (NAG) /肌酐 (Cr)的变化 ,观察乌司他丁对肾的保护作用。 方法  5 3例心瓣膜置换术患者用抽签法随机分为两组。实验组 :2 3例 ,给乌司他丁 2 0 0 0 0U/ kg,分 3次静脉注射 ;对照组 :30例 ,静脉注射生理盐水 2 0 m l。分别于术前 30 min,主动脉阻断前 5 min,主动脉开放后 5 min,手术结束 ,术后第 1、3、5 d检测尿 NAG/ Cr值、血尿素氮 (BU N)和血 Cr等指标。 结果 两组患者的尿NAG/ Cr值均于手术开始后升高 ,于主动脉开放后 5 min和手术结束时达到高峰 ;主动脉开放后 5 min、手术结束时和术后第 1d,实验组患者尿 NAG/ Cr值明显低于对照组 (Plt;0 .0 5 )。尿 NAG/ Cr值与体外循环 (CPB)时间、主动脉阻断时间和 TM- 5 0 (平均灌注压低于 5 0 mm Hg的时间压力积分 )呈正相关 (r=0 .5 6 0 ,0 .4 93,0 .5 0 5 ;Plt;0 .0 5 )。 结论 CPB...更多时间、主动脉阻断时间和 TM- 5 0可影响尿 NAG/ Cr,乌司他丁对心瓣膜置换术患者围术期的肾损伤有一定的保护作用。

    Release date:2016-08-30 06:24 Export PDF Favorites Scan
  • Intraoperative Saline-irrigated Radiofrequency Modified Maze Procedure for Chronic Atrial Fibrillation in Mitral Valve Diseases

    Objective To report the preliminary results of intraoperative saline-irrigated radiofrequency modified maze procedure for chronic atrial fibrillation (AF) in mitral valve diseases. Methods From May 2003 to April 2004 forty-one patients underwent intraoperative saline-irrigated modified maze procedure. The patients included 13 male and 28 female. Their age ranged from 27-65 years (46±10 years). The duration of AF varied from 5 months to 15 years (4.5±3.6 years).The left atrial diameter varied from 37-93 mm (54±11mm). There were mitral stenosis 20, mitral regurgitation 1 and mitral stenosis with regurgitation 20 cases. Cardiopulmonary bypass (CPB) was established as usual. Ablation lines were made with Cardioblate (Medtronic, 25-30 W, 180-240ml/h). Having finished right-sided maze procedure, the aorta was cross-clamped and cold crystalloid or blood cardioplegia were used for myocardial protection. Left atrial incision was performed through the interatrial groove. The ablation lines were created to encircle the orifices of the left and right pulmonary veins respectively. The ablation lines were also performed from the left encircling line to the posterior mitral valvular annulus and to the orifice of left atrial appendage respectively. A ablation line was used to connect left and right pulmonary veins circumferential line. Concomitant procedures were performed (there were double valve replacement 10 cases, mitral valve replacement 31 cases, tricuspid annuloplasty 6 cases, removing the left atrial thrombi 6 cases). Results CPB time varied from 71-160 min (105±24 min) and cross-clamping time varied from 32-106 min (62±20 min). The ablation time varied from 4-22 min (11±4 min). One patient died during hospitalization and the death was caused by acute mechanic valve obstruction. During follow-up at discharge and 3 months 35% patients (14/40) were free of AF and the others were not. But at 6 months 67% patients (10/15) were free of AF. Conclusion The intraoperative saline-irrigated radiofrequency modified maze procedure is comparatively simpler and its efficacy is satisfactory.

    Release date:2016-08-30 06:25 Export PDF Favorites Scan
  • 心脏机械瓣置换术后使用维生素K1过敏反应一例

    Release date:2016-08-30 06:24 Export PDF Favorites Scan
  • 二尖瓣置换术后内源性机械瓣功能障碍救治成功一例

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