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以脾梗死为首发的感染性心内膜炎误诊一例

胸骨粉碎性骨折压迫右心室流出道一例

Self-management of Anticoagulation Monitoring for Patients Following Mechanical Heart Valve Replacement: A non-randomized Controlled Trial

Objective To discuss the application value in increasing the frequency of monitoring and ensuring the safety of anticoagulation therapy in patient self-monitoring (PST) and self-management (PSM) of portable coagulometer. Method This non-randomized prospective controlled study was conducted in 100 patients receiving oral warfarin anticoagulation therapy after heart valve replacement and met the inclusion criteria in our hospital between March 2013 and April 2014 year. All the patients were divided into three groups including an outpatient follow-up group(outpatient group), a self-monitoring group and a self-management group. Meanwhile, the patients in the outpatient group visited professional institutions, performed international normalized ratio (INR) testing with central lab and adjusted the dosage of orally administered warfarin by the doctors. And the other two groups performed INR testing with CoaguChek XS portable coagulometer by themselves, and the patients in the self-management group performed management by themselves. The follow-up time was 6 months. The dates of time in therapeutic range (TTR), fraction of time in therapeutic range (FTTR) and anticoagulation complications in the three groups were analyzed and compared. Results There was no significant difference in the INR results obtained from the follow-up time among the three groups (P=0.845) . TTR value of INR of the outpatient group, the self-monitoring group, and the self-management group was 45.9% (4368.0 days/9517.0 days), 61.2% (6057.0 days/9897.0 days), and 65.4% (2833.8 days/4333.0 days), respectively with a statistical difference among the three groups (P<0.001) . FTTR value of INR obtained from the outpatient group, the self-monitoring group, and the self-management group was 48.3% (99 times/205 times), 60.7% (164 times/270 times), and 64.9% (100 times/154 times) respectively. There was a statistical difference in the FTTR between the outpatient group and the self-monitoring group (P=0.007) , and also between the outpatient group and the self-monitoring group (P=0.002) . But there was no statistical difference between the self-monitoring group and the self-management group (P=0.392) . There were not any major bleeding and thrombosis complications in all study. And there was no statistical difference in the total complications, thrombosis, and bleeding complications rates between the outpatient group and the self-monitoring group, and also between the outpatient group and the self-management group (P>0.05) . Conclusions The patients receiving oral anticoagulation after heart valve replacement or their care providers were able to perform PST and PSM. The use of portable coagulometer for self-monitoring and self-management can increase the frequency of anticoagulation monitoring and achieve better INR target value control. PST and PSM could achieve higher quality of anticoagulation management and life and without increasing the risk of oral anticoagulation than the traditional monitoring method. The monitoring frequency of once a month is reasonable for the patients receiving oral anticoagulation more than half a year after heart valve replacement.

应用全 3D 经食管超声心动图精确引导房间隔缺损经皮封堵治疗的可行性研究

目的探讨应用全 3D 经食管超声心动图（TEE）在精确引导房间隔缺损（ASD）经皮封堵治疗中的应用。方法纳入 2017 年 7 月至 2018 年 6 月间诊断 ASD，并于我院行全 3D-TEE 引导经皮介入封堵患者 17 例，男 4 例、女 13 例，平均年龄（27.1±8.0）岁。手术过程采用全 3D-TEE 引导经皮 ASD 封堵技术。记录手术时间、成功率、3D 超声图像质量、封堵器更换率及手术相关并发症等。结果经 TEE 示房间隔缺损直径（15.8±2.7）mm，3D-TEE 测量房间隔缺损前后径（17.4±2.4）mm，上下径（17.9±5.3）mm，缺损周长折算径（18.0±3.5）mm。手术成功率 100.0%，平均 ASD 封堵器型号（23.1±3.5）mm，无封堵器脱落，明显残余分流，心内结构损伤等严重不良事件，平均导管操作时间（30.7±5.5）min，封堵器换伞率 11.8%（2/17）。15（88.2%）例患者图像佳并采用全 3D-TEE 引导。结论应用全 3D-TEE 精确引导房间隔缺损经皮封堵治疗安全、有效，具有无辐射及引导精准的优势。