单纯经胸超声心动图引导下经皮行卵圆孔未闭封堵术的学习曲线及可行性研究

目的研究单纯经胸超声心动图(TTE)引导下, 经皮行卵圆孔未闭(PFO)封堵术的学习曲线及成功率、安全性。方法回顾性研究乐山市人民医院心脏大血管外科2021年4月至2022年4月收治的具有PFO封堵适应证的患者, 单纯经TTE引导封堵前100例, 其中男25例, 女75例, 年龄(48.22±10.44)岁。统计患者术前基线资料:性别、年龄、身高、体质量、体质量指数、经食管超声心动图卵圆孔未闭的隧道长度及孔径大小、经颅多普勒增强试验右向左分流大小、合并房间隔膨胀瘤等。分析所有患者手术时间、成功率、并发症等情况。结果随着病例积累, 手术时间逐渐缩短, 积累到50例左右, 手术时间有明显的缩短, 学习曲线在50例以后趋于平稳, 差异有统计学意义(P<0.05)。在学习曲线内的手术病例的成功率、并发症与完成学习曲线后的手术病例比较, 差异无统计学意义(P>0.05)。结论经TTE引导下经皮行PFO封堵术学习曲线较长, 约需50例, 学习曲线过程中的成功率、安全性高, 此术式值得推广。     

急性缺血性卒中患者颈动脉斑块超声观察

目的观察急性缺血性卒中患者的颈动脉斑块分布、管腔狭窄程度及不稳定斑块的危险因素。方法经头颅MRI证实的急性缺血性卒中患者909例为AIS组,选取同期非脑卒中住院患者885例为对照组,比较2组颈动脉斑块的分布及管腔狭窄程度。根据狭窄程度将AIS组分为狭窄率≥50%亚组及50%亚组,比较2亚组稳定性斑块与不稳定性斑块的检出率。比较AIS组不稳定斑块和非不稳定斑块患者的临床资料,以有统计学意义的指标为自变量,行多因素Logistic回归分析。结果 AIS组颈动脉多发斑块和不稳定斑块的检出率及管腔狭窄程度均显著高于对照组(P均0.001)。颈动脉狭窄率≥50%亚组的不稳定斑块检出率显著高于狭窄率50%亚组(P0.001)。单因素分析显示年龄、男性、糖尿病、血脂异常、吸烟及饮酒是AIS颈动脉不稳定斑块的危险因素(P均0.05);多因素分析显示年龄、糖尿病、血脂异常及吸烟是AIS颈动脉不稳定性斑块的独立危险因素(P均0.05)。结论颈动脉不稳定斑块、狭窄程度与AIS发生密切相关;年龄、糖尿病、血脂异常和吸烟是颈动脉不稳定斑块的独立危险因素。     

单纯经胸超声心动图引导下经皮行卵圆孔未闭封堵术的学习曲线及可行性研究北大核心CSCD

目的:研究单纯经胸超声心动图(TTE)引导下,经皮行卵圆孔未闭(PFO)封堵术的学习曲线及成功率、安全性。方法:回顾性研究乐山市人民医院心脏大血管外科2021年4月至2022年4月收治的具有PFO封堵适应证的患者,单纯经TTE引导封堵前100例,其中男25例,女75例,年龄(48.22±10.44)岁。统计患者术前基线资料:性别、年龄、身高、体质量、体质量指数、经食管超声心动图卵圆孔未闭的隧道长度及孔径大小、经颅多普勒增强试验右向左分流大小、合并房间隔膨胀瘤等。分析所有患者手术时间、成功率、并发症等情况。结果:随着病例积累,手术时间逐渐缩短,积累到50例左右,手术时间有明显的缩短,学习曲线在50例以后趋于平稳,差异有统计学意义( P<0.05)。在学习曲线内的手术病例的成功率、并发症与完成学习曲线后的手术病例比较,差异无统计学意义( P>0.05)。 结论:经TTE引导下经皮行PFO封堵术学习曲线较长,约需50例,学习曲线过程中的成功率、安全性高,此术式值得推广。     

超声心动图检查参数预测早产儿动脉导管早期自然关闭

目的探讨超声心动图参数预测早产儿动脉导管早期自然关闭的价值。方法对165例早产儿分别于出生后24h、72h及7天行超声心动图检查,将7天内动脉导管未自然关闭者归为动脉导管未闭(PDA)组(n=37),7天内自然关闭者为对照组(n=128)。对出生后24h首次超声检查参数进行统计学分析,对差异有统计学意义的参数行多因素Logistic逐步回归分析。结果 PDA组左心房收缩末期内径/主动脉根部内径、分流束最细处动脉导管宽度、肺动脉压均高于对照组(P均0.05),最大分流速度、降主动脉与肺动脉压差(ΔPs)、卵圆孔分流速度均小于对照组(P均0.05)。多因素Logistic逐步回归分析结果显示,24h首次超声心动图参数中,仅ΔPs与动脉导管早期自然关闭相关(P=0.02)。结论超声心动图检查参数预测早产儿动脉导管早期自然关闭具有重要意义,ΔPs与动脉导管早期自然关闭相关。     

阿曲库铵在不同心内分流病人的时效比较

阿曲库铵(atracurium)是一种中等作用时效的非去极化肌松药。本文就阿曲库铵在不同心内分流病人的时效进行观察,现将结果总结如下。 资料与方法 一般资料 30例择期手术病人按心内分流情况分为三组,每组10例。A组为左向右分流病人,主要为室间隔缺损(VSD)和房间隔缺损(ASD),术前彩超检查无肺动脉高压,无右向左分流。B组为右向左分流的法乐氏四联症(TOF)病人。C组为无心内分流的普胸手术(如漏斗胸)病人。三组病人的年龄6～12岁,体重18～40kg,组间无统计学差异。术前肝、肾功能检查亦均在正常范围之内。术前用药为苯巴比妥钠2mg/kg、东莨菪碱0．1～0．3mg肌注。     

卵圆孔封堵术后残余分流的影响因素分析

目的 探讨卵圆孔封堵术后6个月经颅多普勒超声发泡试验（C-TCD）检查存在残余右向左分流（right to left shunt,RLS）的影响因素。方法 选取2019年1月至2022年3月在本院行卵圆孔封堵术的卵圆孔未闭（patent foramen ovale,PFO）患者77例，术后随访复查C-TCD检查，术后6个月有残余RLS的患者分入RLS组，无残余RLS的患者分入NRLS组，对比分析两组患者的临床资料。采用Logistic回归分析卵圆孔封堵术后残余RLS的影响因素。结果 与NRLS组相比，RLS组患者PFO更大、体重更轻、BMI值更低，差异有统计学意义（P<0.05）。两组相比，性别比，年龄，身高，是否吸烟、喝酒，既往疾病史，术前大量RLS，是否合并房间隔瘤，植入封堵器型号无统计学差异（P>0.05）。二元Logistic回归分析结果显示，PFO大小是术后残留RLS的危险因素（比值比3.509,95%可信区间1.199～10.269,P<0.05）。结论 PFO大小是卵圆孔封堵术后残留RLS的危险因素，因而PFO大小较大的患者术后应积极配合复查，如术后残留...     

卵圆孔未闭伴偏头痛患者平均红细胞血红蛋白浓度与右向左分流的相关性分析

目的 观察并分析卵圆孔未闭合(PFO)并偏头痛患者的平均红细胞血红蛋白浓度(MCHC)与右向左分流(RLS)的关系.方法 回顾性分析2019-09—2021-04连续就诊于郑州大学第一附属医院确诊为PFO合并偏头痛的130例患者的临床资料.患者头痛影响测定(HIT-6)评分均>55分,根据RLS的分流量分为少量RLS组...     

术前ASA分级及手术范围对胃癌根治术患者预后的影响

目的:探讨术前ASA分级及手术范围对不同年龄胃癌根治术后患者预后的影响。方法:回顾性分析188例首次行胃癌根治术的患者资料,根据ASA分级、手术范围、年龄,分别将患者区分为ASA高值(分级≥3)与ASA低值(分级3)患者、胃全切与胃部分切除患者、中青年(60岁)与老年(≥60岁)患者,比较不同因素分组的患者术后生存时间。结果:生存分析结果显示,ASA高值组术后生存时间短于ASA低值组(P0.05);中青年患者中,胃部分切除者生存时间长于全胃切除者(P0.05);老年患者中,胃部分切除者生存时间与全胃切除组生存时间差异无统计学意义(P0.05);ASA高值患者中,胃部份切除者生存时间与全胃切除者生存时间差异无统计学意义(P0.05);而ASA低值患者中,胃部分切除患者生存时间长于全胃切除患者(P0.05)。结论:ASA分级可作为胃癌根治术患者预后判断的指标,对中青年及术前ASA分级低患者应严格掌握手术范围,尽量避免不必要的大范围手术。     

鱼精蛋白致右→左心内分流

作者报告一例鱼精蛋白引起卵圆孔未闭(PFO)病人肺血管收缩导致急性右→左房内分流。患者男性,64岁,80kg,体外循环下行冠状动脉搭桥和室间隔缺损修补术。转流前超声心动图检查发现有一个很小右→左分     

老年冠心病患者经桡动脉途径同时接受冠状动脉、肾动脉和下肢动脉造影的安全性及有效性探讨

目的探讨老年冠心病患者经桡动脉途径冠脉造影同时行下肢动脉及肾动脉造影的方法并分析其安全性及有效性。方法收集可疑冠心病伴外周动脉粥样硬化的老年患者275例(年龄≥60岁)行选择性冠脉造影同时行肾动脉及下肢动脉造影。按介入途径分为左桡动脉组(124例)及右桡动脉组(151例),各组再按年龄段分为三个不同亚组:低龄老年亚组(60~69岁),中龄老年亚组(70~79岁),高龄老年亚组(≥80岁),分别以左、右桡动脉途径运用TIG共用造影管(100cm)及MP A1造影管(125cm)依次行冠脉、双侧下肢动脉和肾动脉造影,比较桡动脉穿刺成功率、造影操作时间、对比剂用量、X线曝光时间及造影完成率等,并分析这些指标与年龄的相关性。结果左、右桡动脉组的穿刺成功率及对比剂用量差异无统计学意义,而左桡动脉组造影操作时间、X线暴露时间均低于右桡动脉组,造影完成率亦明显高于右桡动脉组;左、右桡动脉组造影操作时间均与年龄呈正相关,而X线曝光时间与年龄无相关性。结论老年患者经左桡动脉途径冠脉造影同时行下肢动脉及肾动脉造影完成率高,安全有效,可作为首选路径。     

Outcomes after resection of cholangiocellular carcinoma

BACKGROUND: Cholangiocellular carcinoma (CCC) is a rare primary liver malignancy that arises from intrahepatic bile duct canaliculi and presents as a liver mass. Our purpose is to report operative morbidity and mortality and to determine long-term survival after resection for CCC. METHODS: Retrospective review of 31 consecutive patients who underwent resection during a 20-year period. RESULTS: Thirty-day hospital mortality was 3%, and postoperative morbidity was 38%. Kaplan-Meier 5-year survival was 35%; mean survival was 37 months; absolute 5-year survival was 33%. Mean survival in stages I, II, IIIA, and IIIC were 57, 33, 26, and 14 months, respectively (P = 0.03 comparing I to >I). Recurrence occurred in 18 patients; 89% were in the liver. Carbohydrate antigen 19-9 >100 U/mL was found to be an indicator of poor prognosis (P = 0.009). CONCLUSIONS: Resection for CCC can be performed with acceptable morbidity and mortality rates and results in good survival and cure. Hepatic recurrence is common. Carbohydrate antigen 19-9 may be useful in determining prognosis.     

Percutaneous Endovascular Management of a Splenic Artery Aneurysm

Splenic artery aneurysms are extremely rare lesions. Elective repair of these aneurysms is justified only if the aneurysm’s size is greater than 2 cm and the predicted peri-operative mortality is below 0.5%. Percutaneous techniques minimise the peri-operative morbidity and mortality rates and offer a safe and effective treatment option. We report a coil-embolisation of a 5.1 cm splenic artery aneurysm and a short review of the literature concerning the endovascular treatment options.     

Vacuum-assisted closure improves the incorporation of artificial dermis in soft tissue defects: Terudermis(®) and Pelnac(®)

As a dermal scaffold, artificial dermal substitutes allow the body to accomplish its own tissue regeneration through infiltration of cells and neovascularisation. However, they show not only rather lower take rates compared to autologous skin grafts alone, but they also require more time for sufficient vascular ingrowth to overlay the skin graft. To accelerate this overlaying, we applied vacuum‐assisted closure negative‐pressure settings over the artificial dermis: Terudermis^® and Pelnac^® grafts. Fourteen patients with complex tissue defects were treated, including bone exposure in two cases, tendon exposure in seven cases and soft tissue defects in five cases. Nine cases had combined wound infections. The time interval between the first artificial dermis graft and the second split‐thickness skin graft over it was 7·64 days on average. Dermal substitutes took place completely in all cases and there were no graft failures.     

Assessment and management of the predicted difficult airway in babies and children

Although it is essential to take a history and examine every child prior to airway management, preoperative anticipation of a difficult airway is not totally reliable and therefore it is wise to be prepared for the unexpected difficult airway. Information about the airway can be gained from previous medical records, current history, physical examination and other tests. A natural consequence of airway assessment is development of an airway plan. Important anatomical and physiological features may be identified in an airway assessment which can then have a direct influence on the subsequent airway plan. Managing the predicted difficult airway is usually elective. This allows proper preparation of equipment, assistants, expertise and the environment required for the airway plan. This article will discuss paediatric airway assessment, outline those features that contribute to airway difficulty, and identify indications and risk factors associated with various airway techniques. Key objectives for an airway management plan are to maintain oxygenation and avoid trauma. This involves adopting techniques that avoid hypoxia and provide a high success rate with minimum attempts.     

Assessment and management of the predicted difficult airway in babies and children

Although it is essential to take a history and examine every child prior to airway management, preoperative anticipation of a difficult airway is not totally reliable and therefore it is wise to be prepared for the unexpected difficult airway. Information about the airway can be gained from previous medical records, current history, physical examination and other tests. A natural consequence of airway assessment is development of an airway plan. Important anatomical and physiological features may be identified in an airway assessment which can then have a direct influence on the subsequent airway plan. Managing the predicted difficult airway is usually elective. This allows proper preparation of equipment, assistants, expertise and the environment required for the airway plan. This article will discuss paediatric airway assessment, outline those features that contribute to airway difficulty, and identify indications and risk factors associated with various airway techniques. Key objectives for an airway management plan are to maintain oxygenation and avoid trauma. This involves adopting techniques that avoid hypoxia and provide a high success rate with minimum attempts.