目的总结心脏大血管穿透伤的临床特点、早期诊断和救治经验，提高抢救成功率。 方法回顾性分析2007年7月至2014年6月我院26例心脏大血管穿透伤患者的临床资料，男23例、女3例，年龄16～71（22.0±8.4）岁。其中刀刺伤25例，钢锥刺伤1例；心脏穿透伤23例，升主动脉刀刺伤2例，主肺动脉刀刺伤1例；心脏压塞型7例，失血休克型8例，心脏压塞+失血休克型2例，亚临床型9例。26例就诊后30 min至3 h急诊在全身麻醉下行开胸手术治疗，侧开胸手术20例，前正中开胸手术6例，其中2例在体外循环下手术。 结果全组死亡2例，均为失血休克型，1例69岁右心室贯通伤和右冠状动脉主干损伤男性患者术中死于低心排血量综合征，1例38岁右心室前壁穿透伤男性患者术后死于纵隔感染导致的多器官功能衰竭，其余患者痊愈出院，救治成功率达92.3%。18例随访1个月至7年，无后遗症发生。 结论迅速明确伤情，及时诊断，急诊开胸探查是提高心脏大血管穿透伤抢救成功率的关键。
ObjectiveTo investigate the efficacy of intravenous infusion of recombinant human brain natriuretic peptide in rheumatic heart valves patients with cardiorenal syndrome preoperatively, the function and operational results before and after treatment were compared. MethodsA randomized, single-blind, and controlled study was conducted in 60 patients characterized of rheumatic heart valves patients in our hospital from March 2012 through March 2015. There were 24 males and 36 females at average age of 52.1±8.9 years (ranged from 35-73 years). Their left ventricular ejection fraction was less than 40% and plasma creatinine was mildly or moderately raised. They were recruited into an experiment group and a control group by random digital table. The control group received continuous intravenous Dopamine and Nitroglycerin based anti-heart failure treatment (n=30). The experimental group received additional recombinant human brain natriuretic peptide for 48 hours without bolus (at a dose of 0.006 μg·kg-1·min-1, n=30). The levels of the biomarkers for cardiac and renal function between before and after treatment were compared. ResultsIn the experiment group, treatment with recombinant human brain natriuretic peptide for 48 hours had lower level of plasma NT-proBNP than the baseline level with a statistical difference (88.6±55.1 pg/ml vs. 55.0±47.6 pg/ml, P=0.014), lower level of high sensitivity creative reaction protein than the baseline level with a statistical difference (2.79±1.27 mg/l vs. 1.39±0.79 mg/l, P=0.000), more 24 hours urine output than the baseline level with a statistical difference (1 464.0±348.3 ml vs. 1 223.0±279.9 ml, P=0.005), lower level of serum cystatin-C than the baseline level with a statistical difference (0.25±0.14 mg/l vs. 0.08±0.07 mg/l, P=0.000), higher inotrope requirement within three days after operation (2.52±1.30 mg·kg-1·min-1 vs.3.36±1.15 mg·kg-1·min-1, P=0.011), less ICU stay days (4.5±1.2 days vs. 5.3±1.6 days, P=0.03). There were no statistical differences between the experiment group and the control group after treatment in cardiac function class, left ventricular ejection fraction, left ventricular end-diastolic diameter, creatinine, chest tube drainage volume, and intra-aortic balloon pumping use. ConclusionIntravenous injection of recombinant human brain natriuretic peptide in the patients with rheumatic valve disease combined with cardiorenal syndrome before operation can decrease systemic inflammation reaction and cardiac and renal function injury, and enhance operational recovery.
Objective To evaluate the clinical effectiveness of valve-sparing aortic root replacement (VSARR) in the treatment of patients with dilated aortic root after operation for tetralogy of Fallot (TOF). Methods A retrospective analysis was conducted on clinical data of TOF patients with aortic root dilation who underwent VSARR in our hospital from 2016 to 2022. Results Finally 14 patients were collected, including 8 males and 6 females, with a median age of 22 years ranging from 12-48 years. Among them, 5 patients had severe aortic valve regurgitation, 4 moderate regurgitation, and 5 mild or no regurgitation. Six patients had sinus of valsalva dilation, and 8 significant dilation of the ascending aorta. One patient had residual shunt due to ventricular septal defect, and 9 severe pulmonary valve regurgitation. The David procedure was performed in 10 patients, Yacoub procedure in 2 patients, and Florida sleeve in 2 patients. There was no perioperative mortality in the group. The median follow-up time was 2.9 years (ranging from 0.4 to 6.0 years). One patient had mild aortic valve regurgitation, and the rest had minimal or no regurgitation. One patient had mild stenosis of the left ventricular outflow tract, and the rest patients had no obvious stenosis. Conclusion VSARR is a satisfactory treatment for aortic root dilation in patients with TOF, with no significant increase in the incidence of left ventricular outflow tract stenosis or aortic regurgitation during mid-term follow-up.
ObjectiveTo summarize the application experience of off-pump total arterial coronary artery bypass grafting with left internal thoracic artery and bilateral radial arteries, and evaluate its safety and efficacy. MethodsThe clinical data of the patients with severe multiple coronary arteries stenosis undergoing off-pump total arterial coronary artery bypass grafting with left internal thoracic artery and bilateral radial arteries in the Affiliated Hospital of University of Electronic Science and Technology ＆ Sichuan Provincial People’s Hospital from November 2020 to April 2023 were retrospectively analyzed. Results Finally 24 patients were enrolled. There were 23 males and 1 female. The mean age was 53.63±4.33 years. The cardiac function class was from grade Ⅱ to Ⅲ according to New York Heart Association. There were 3.17±0.38 distal anastomoses. Y graft in 12 patients and sequential graft in 4 patients were performed. Coronary endarterectomy in 1 patient, intraaortic balloon pump (IABP) catheter implantation in 10 patients, and thymoma resection in 1 patient were also performed simultaneously. The operation time was 308.13±30.39 mi. The ventilator support time was 15.42±7.42 h, and the intensive care unit stay time was 46.08±27.32 h. The postoperative hospital stay time was 11.71±1.90 d. There were no death, but acute renal failure in 1 patient and cerebral infarction in 1 patient were found after operation. The postoperative left ventricular end diastolic diameter by echocardiogram before discharge was significantly reduced, the postoperative left ventricular ejection fraction and short axis shortening rate were significantly increased, compared to preoperative ones (P≤0.05). All arterial grafts were patent suggested through coronary artery computed tomography angiography (CTA) examination before discharge. All patients were followed up for 14.58±8.75 months. No angina recurrence and death were found. All arterial grafts were still patent in 16 patients suggested through coronary artery CTA or angiography examination at 1 year after operation. Conclusion Off-pump total artery coronary artery bypass grafting with left internal thoracic artery and bilateral radial arteries for patient with severe multiple coronary arteries stenosis is safe and effective. For high-risk patient, IABP assistance during operation is recommended.