VSD结合多种皮瓣在小腿及足部创伤中的临床应用

目的介绍小腿及足部大面积皮肤软组织缺损或合并开放性骨折的创面修复方法。方法根据病例创伤大、污染重的特点,一期均选用VSD负压吸引7～10d。待创面清洁后,选用腓肠肌皮瓣、腓肠神经营养血管皮瓣、内踝上皮瓣、小腿内侧皮瓣或游离胸脐皮瓣等给予修复。结果仅有1例腓肠神经营养血管皮瓣远端出现部分坏死,后经过换药伤口愈合,其余病例创面均一期愈合,并且无发生深部感染或创伤性骨髓炎病例。结论VSD结合多种皮瓣在小腿及足部创伤中有较好的临床效果。     

VSD封闭负压吸引术治疗手足创伤性软组织缺损的临床观察

目的探讨VSD负压封闭式负压吸引技术治疗手足软组织缺损的治疗效果。方法应用VSD负压封闭引流治疗创伤组织缺损18例患者。其中手部软组织缺损12例(其中单纯骨外露6例,肌腱外露2例,二者兼有4例),足部软组织缺损6例(其中单纯骨外露2例,合并肌腱外露4例)。结果 17例采用一期VSD覆盖创面,二期结合真皮下毛细血管网皮片或全厚皮片移植创面修复术治疗后,创面全部愈合;1例采用二次VSD覆盖创面,结合真皮下毛细血管网皮片移植创面修复术治疗后,创面全部愈合(该例患者为糖尿病患者)。结论 VSD负压封闭引流治疗手足创伤软组织缺损,操作简便,疗效显著。     

超声心动图在房间隔缺损及室间隔缺损封堵术中的应用价值

目的探讨超声心动图在房间隔缺损及室间隔缺损封堵术中的应用价值。方法应用超声心动图对准备行房间隔缺损（ASD）、室间隔缺损（VSD）封堵术患者进行术前筛选、术中监测、引导封堵伞释放,术后随访,评价疗效。结果ASD、VSD封堵器放置成功。术后即刻超声检查,3例ASD均无残余分流。9例VSD患者中,2例可见少量残余分流,封堵器位置正常,功能良好。术后3个月复查,2例VSD残余分流完全消失,但1例ASD患者,心电图显示左前分支阻滞及偶发房早。结论超声心动图在术前病例选择、术中引导、术后疗效评价,提高手术成功率,减少并发症等方面具有重要应用价值。     

绑鞋带技术联合VSD技术治疗创伤性四肢皮肤软组织缺损创面的效果

目的 研究绑鞋带技术联合负压封闭引流（VSD）技术治疗创伤性四肢皮肤软组织缺损创面的效 果。方法 选取2021年8月-2022年12月我院诊治的40例创伤性四肢皮肤软组织缺损创面患者为研究对象, 采用随机数字表法分为对照组和试验组,各组20例。对照组采用VSD技术治疗,试验组在对照组基础上 应用绑鞋带技术,比较两组一期愈合率、临床手术指标、植皮率、换药次数、并发症发生率。结果 试验 组一期愈合率为95.00%,高于对照组的75.00%（P ＜0.05）;试验组手术时间、术中出血量与对照组比较, 差异无统计学意义（P ＞0.05）,但试验组创伤愈合时间、住院时间均短于对照组（P ＜0.05）;试验组植 皮率高于对照组,换药次数少于对照组（P ＜0.05）;试验组并发症发生率为10.00%,低于对照组的25.00% （P＜0.05）。结论 创伤性四肢皮肤软组织缺损创面患者应用绑鞋带技术联合VSD技术治疗可实现良好的 治疗效果,不仅可提高一期愈合率,缩短创伤愈合和住院时间,还能提高植皮率,减少换药次数,降低并 发症发生率,是一种有效、可行的治疗方法。     

室间隔缺损介入封堵入路术式研究

目的分析室间隔缺损(VSD)经导管介入封堵术传统术式失败的原因,总结左侧入路的临床经验。方法根据超声心动图选择符合介入治疗条件的VSD 25例行传统术式封堵,VSD直径为2~12(7±6)mm。传统术式建立动静脉轨道,输送系统从右室侧进入左心室。左侧入路术式封堵者无需建立动静脉轨道,仅将导丝经缺损送达右心室、肺动脉,沿导丝将输送鞘管送至右心室,将封堵器送至缺损部位进行封堵。结果其中传统术式成功20例,失败5例,均因为输送鞘不能通过缺损,改行左侧入路后4例成功,1例失败。VSD传统术式封堵成功率为80%(20/25),总体封堵成功率为96%(24/25),介入封堵后即刻存在少量残余分流3例(12.5%),21例(87.5%)无分流,1例(4%)三尖瓣少量返流,1例(4%)术中出现一过性房室传导阻滞。结论针对部分VSD患者,传统术式失败时,可尝试进行经左室入路介入封堵VSD,初步表明经左室入路介入封堵VSD安全有效,对部分合适的患者,如直接选用经左室入路,有可能缩短手术时间和X线暴露时间。     

Regression of Right Ventricular Pressure in Ventricular Septal Defect in Infancy: A Longitudinal Color-Flow Doppler Echocardiographic Study

To determine the course of right ventricular pressure (RVP) in patients with isolated ventricular septal defect (VSD) and factors influencing it, unselected 148 infants were followed-up longitudinally with color-Doppler echocardiography from a median age of 1 month for 201 patient-years. The patients were divided into three groups by absolute echographic size of VSD: group I, ≤4.0 mm; group II, >4 to ≤7 mm; group III, >7 mm. Sixty percent belonged to group I. Muscular defects dominated in group I, perimembranous defects dominated in group II, and those with outlet extensions dominated in group III. Peak systolic RVP was obtained by Doppler-estimated difference between systolic brachial artery and peak gradient across the VSD. Initial RVP ranged between 15 and 95 mmHg and increased in parallel to the size of defect. According to the regression equations RVP decreased in general by 0.17 mmHg per month. This correlated significantly with the size of the defect. In group I, the rate of decrease was very fast and is best expressed by a log function of time (r=−0.67, r ²= 0.45). In groups II and III the rate of decrease was less steep and had a greater variability. RVP normalized in 100% in those of group I and in 90% of group II, at median ages of 0.17 and 0.33 years, respectively. Median Q _p:Q _s values were 1.5, 2.2, and 3.0 in groups I–III, respectively. The outcome depended on the size of VSD. Spontaneous closure was observed in 51% of group I, 10% of group II, and none of group III. The rate was higher in muscular defects. Congestive heart failure was present in 53% and 100% in groups II and III, respectively. Death rate was 2.03%, all in patients with large defects. It is concluded that the temporal course of RVP with time can be estimated fairly well by the regression equation presented in relation to the initial size of the VSD.