不同超滤方法用于婴幼儿先心病体外循环手术的围术期比较

目的比较不同超滤方法对于低体重先心病体外循环手术病人围术期的影响。方法回顾性分析我院采用改良超滤前后13例低体重(<15 kg)先心病体外循环手术病人的临床状况,其中常规超滤(CUF)组6例,常规超滤+改良超滤(CUF+MUF)组7例,对比指标包括转流时间;主动脉阻断时间;转流前后的血球压积及血红蛋白,术后引流量,术后呼吸机通气时间,ICU滞留时间,围术期红细胞悬液用量,呋塞米的使用情况。结果体外循环前后Hct、Hb和总细胞悬液用量无统计学差异(P>0.05);手术后呋塞米用量和胸腔引流量CUF+MUF组明显小于CUF组(P<0.05)。结论改良超滤技术可以改善婴幼儿体外循环心脏手术后病人的器官功能及预后。     

Brown Bowel Syndrome Secondary to Jejunoileal Bypass: The First Case Report

A 58-year-old woman with a surgical history of jejunoileal bypass in 1980 for weight reduction sought medical attention with multiple complaints. The patient had not been taking any nutritional supplements since her bypass surgery, 26 years previously. She was found to have osteomalacia, chronic diarrhea, secondary hyperparathyroidism, and hyperoxaluria with a frequent history of nephrolithiasis. Because of her severe osteodystrophy and metabolic complications, reversal of her jejunoileal bypass was recommended. Reversal of the jejunoileal bypass with a sleeve gastrectomy was performed. Laparotomy revealed brown discoloration of the entire alimentary limb with atrophy of the bypassed intestinal limb. Histologic examination of the resected small bowel demonstrated brown pigment deposits within smooth muscle cells of the bowel wall. The pigment stained positive with Fontana-Masson most likely representing lipofuscin. We report a case of brown bowel syndrome complicating jejunoileal bypass, the first case reported in the literature to the best of our knowledge.     

可达龙治疗冠状动脉旁路移植术后快速性心律失常的疗效观察

目的评价可达龙（盐酸胺碘酮）对非体外循环下冠状动脉旁路移植术（OPCAB）后快速性心律失常的疗效。方法可达龙静脉负荷量150mg（3～5mg／kg）于10min内注射，如有效，继续以1．0mg／min静脉泵入；6h后改为0．5mg／min维持。若首剂静脉注射后20min疗效不明显，可再次静脉注射75～150mg，然后静脉泵入维持。总量〈1200mg／d。为保持疗效，可于静脉用药第1天加用或改用口服。结果本组110例中，快速心房颤动59例，显效50例；室上性心动过速30例，显效25例；房扑12例，显效8例，总有效98例，有效率89．1％。结论可达龙为治疗OPCAB后快速性心律失常的有效药物，安全可靠，疗效肯定，不良反应少。     

Perigraft seroma following axillofemoral bypass: Report of three cases

One hundred and twenty-three axillofemoral or bifemoral bypasses were performed in the Department of Cardiovascular and Thoracic Surgery of the Catholic University of Louvain, Belgium between 1975 and 1986. Three cases of perigraft seroma were noted. A polytetrafluoroethylene (PTFE) graft had been inserted in all three cases. In one case, the seroma recurred rapidly after surgical drainage. The two others were not drained. In all three cases appearance remained unchanged throughout the observation period. The three bypasses are patent at 5, 14 and 24 months. Observation is advocated for this complication especially in high risk patients.     

冠状动脉搭桥术113例临床分析

目的:总结113例冠状动脉搭桥术的临床经验.方法:对我院进行冠状动脉搭桥术的113例患者进行临床分析结果:本组共行动脉搭桥吻合113支,静脉搭桥吻合249支.围术期并发症:低心排5例,死亡2例,围术期死亡率1.8%.结论:确切、准确的适应证选择、手术及适当的围术期处理是确保手术成功的关键.     

钙、镁及甲状旁腺激素在心肺转流期间的动态变化

目的 观察心肺转流（CPB）期间钙、镁及甲状旁腺激素（PTH）的变化。方法 静脉血标本取自16例心内直视手术病人，采用原子吸收光谱法、离子选择电极法及化学发光分析方法于CPB期间不同时间点检测总钙、离子钙、总镁及PTH的含量。结果 CPB开始后钙、镁及PTH均降低（P＜0.05），至CPB结束时降至最低点（P＜0.01）。钙离子于术后第1天回复至术前水平，而总钙及总镁含量于术后第1天仍低于术前水平（P＜0.05）。PTH于CPB后2小时升高，于术后第1天升术前的2.6倍（P＜0.01）。结论 CPB期间发生了明显的低钙、低镁血症。钙－镁－甲状旁腺轴反应基本正常，但呈滞后现象。     

大剂量抑肽酶在长时间体外循环中的应用

目的研究大剂量抑肽酶在长时间体外循环中对出血量、输血量及血小板的影响.方法选取两组病例各30例,一组应用抑肽酶作为实验组,另一组不用抑肽酶作为对照组,观察它们在CPB术中、术后总输血量、总引流量,分别记录其术前、术后血小板的变化.结果实验组总输血量、总引流量较对照组减少(均P＜0.05),差异有显著性;两组病例术后血小板均较术前减少(均P＜0.01),而两组病例术前、术后血小板比较无差异(均P＞0.05).结论在长时间CPB中应用大剂量抑肽酶能明显减少输血量,但对血小板数量无明显影响.     

‘Shunt shuffle’—a simple technique of introducing intracoronary shunts for off-pump coronary artery bypass

Intracoronary shunting is a useful method for maintaining distal perfusion as well as providing a bloodless field during off-pump coronary revascularization. Intracoronary shunts require insertion of both ends through a limited arteriotomy, which sometimes can be troublesome. We describe the ‘shunt shuffle’ as a simple technique, which allows rapid, atraumatic and easy insertion of intracoronary shunts.