非体外循环冠状动脉搭桥术治疗低射血分数的左主干并三支病变患者疗效分析

目的 探讨非体外循环冠状动脉搭桥术(OPCABG)治疗低左心室射血分数(LVEF)的左主干并三支病变患者的疗效.方法 2010年1- 12月我院收治低LVEF的左主干并三支病变的冠心病患者28例,均在全身麻醉下行OPCABG.分别于术前和术后3d进行血红蛋白(Hb)、血小板计数(PLT)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、尿素氮(BUN)、肌酐(Cr)的检测;术后3个月行心脏超声检查记录LVEF、左心室舒张末期内径(LVED)测定值,并与术前检查结果进行比较.结果 1例因肺感染死于呼吸衰竭,剔除其数据.术前和术后3 d27例患者Hb分别为(137.94±19.40)、(111.06±12.71)g/L,PLT分别为(210.43±48.26)、(148.40±52.20)×109/L,差异均有统计学意义(t值分别为5.239、4.869,P均＜0.01);术前和术后3 dALT分别为(27.66±11.51)、(29.02±16.40) U/L,AST分别为(26.55±10.12)、(27.75±8.14) U/L,BUN分别为(6.51±1.00)、(6.88±2.53) mmol/L,Cr分别为(96.35±15.25)、(95.11±24.38) μmol/L,差异均无统计学意义(t值分别为0.335、0.882、1.625、0.803,P均＞0.05).术前及术后3个月LVEF分别为(36.23±3.41)％、(47.23±5.13)％,LVED分别为(62.23±5.93)、(58.08±5.02)mm,术后3个月LVEF较术前提高(t=6.904,P＜0.01),LVED明显缩小(=2.790,P＜0.05).结论 OPCABG治疗低LVEF的左主干并三支病变患者早期效果满意,对患者全身重要器官影响有限.但远期疗效及预后还需进一步随访分析.     

双极射频消融治疗风湿性心脏病合并心房颤动

目的:评价双极射频消融治疗风湿性心脏病合并心房颤动(房颤)的有效性和安全性.方法:选取100例确诊为风湿性心脏病合并房颤的患者(患者的房颤类型均为持续性房颤或长期持续性房颤),在行瓣膜置换术的同期行单极或双极射频消融治疗房颤.其中单极组患者共40人(男性17名,女性23名),平均年龄(55.7±8.2)岁,房颤持续时间(67.6±45.5)月,平均左房直径(57.2±11.2)mm.双极射频消融组患者共60人(男性22人,女性38人),平均年龄为(57.1±8.9)岁,房颤持续时间为(67.0±34.3)月,平均左房直径(54.3±7.6)mm.术后规律随访6个月,记录临床事件、心电图及24 h动态心电图表现.结果:双极组术后6月房颤的消除率为83％,无手术相关并发症发生.单极组术后6月房颤的消除率为72％,术后3例患者需永久起搏器植入.结论:运用双极射频消融治疗风湿性心脏病并发的房颤是有效和安全的.     

左西孟旦乌司他丁与其联合用药对幼兔离体心脏的保护作用

Objective Levosimendan,a new calcium ion sensitizer,is currently used in the treatment of heart failure and as an option for patients with injury to the left heart or at high risk for surgery.The study tried to evaluate the effects of levosimendan and ulinastain for protecting myocardium from ischemia-reperfusion (I/R) injury to the isolated immature rabbit hearts and investigate the possible mechanism.Methods Fifty New Zealand long-ear white immature rabbits were anesthetized and heparinized.Their hearts were rapidly removed and mounted on modified Langendorff apparatus.A left ventricle pressure monitoring line was inserted through the left atrial and mitral valve.The hearts were equilibrated with oxygenated K-H solution at 37℃ for 10 minutes.The rabbit hearts were randomly divided into 5 groups with 10 hearts in each group.Hearts in group C were perfused with K-H solution,in group U were perfused with ulinastain (50000 U/kg),in group LI were perfused with Levosimendan 0.1 μmol/L,in group L2 were perfused with Levosimendan 0.3 μmol/L,and in group L + U were perfused with Ulinastain (50 000 U/kg) and Levosimendan 0.1μmol/L.The hearts were arrested with St-Thomas solution for 30 min.Hearts in each group underwent 30 min-reperfusion with the same solutions after 30 min-global myocardial ischemia.Heart rate ( HR) Jeft ventricular pressure ( LVP) and LVdp/dtMax were monitored.Effluent from coronary sinus was collected at time of ischemia /reperfusion for measuring the concentration of TNF-α,IL-6,CK and cTnI.Results LVP and LVdp/dt in group L1,L2 and L + U were better than those in group C and U.But the heart rates in group L2 were higher than in other groups.Concentrations of CK,cTnI,TNF-α and IL-6 in the effluent from coronary sinus at 0、10 and 30 min of reperfusion were significantly lower in group L + U than in the other groups.Conclusion Levosimendan may have the similar effects with ulinastain in reducing the reperfusion injury to the immature myocardium.The protective effect of levosimendan (0.1 μmol/L) in combination with ulinastain (50 000 U/kg) was better than that of levosimendan or ulinastain alone.     

22例冠状动脉旁路移植术同期双极射频消融治疗心房纤颤

2007年4月至2(308年7月,我们为22例冠心病合并阵发性房颤的病人在冠状动脉旁路移植术同期施行双极射频消融,取得了满意的效果. 资料和方法 22例中男15例,女7例;年龄50～73岁,平均(61.6±5.6)岁.其中合并高血压16例,糖尿病3例,有心肌梗死病史6例,吸烟史6例.     

左西孟旦乌司他丁与其联合用药对幼兔离体心脏的保护作用

Objective Levosimendan,a new calcium ion sensitizer,is currently used in the treatment of heart failure and as an option for patients with injury to the left heart or at high risk for surgery.The study tried to evaluate the effects of levosimendan and ulinastain for protecting myocardium from ischemia-reperfusion (I/R) injury to the isolated immature rabbit hearts and investigate the possible mechanism.Methods Fifty New Zealand long-ear white immature rabbits were anesthetized and heparinized.Their hearts were rapidly removed and mounted on modified Langendorff apparatus.A left ventricle pressure monitoring line was inserted through the left atrial and mitral valve.The hearts were equilibrated with oxygenated K-H solution at 37℃ for 10 minutes.The rabbit hearts were randomly divided into 5 groups with 10 hearts in each group.Hearts in group C were perfused with K-H solution,in group U were perfused with ulinastain (50000 U/kg),in group LI were perfused with Levosimendan 0.1 μmol/L,in group L2 were perfused with Levosimendan 0.3 μmol/L,and in group L + U were perfused with Ulinastain (50 000 U/kg) and Levosimendan 0.1μmol/L.The hearts were arrested with St-Thomas solution for 30 min.Hearts in each group underwent 30 min-reperfusion with the same solutions after 30 min-global myocardial ischemia.Heart rate ( HR) Jeft ventricular pressure ( LVP) and LVdp/dtMax were monitored.Effluent from coronary sinus was collected at time of ischemia /reperfusion for measuring the concentration of TNF-α,IL-6,CK and cTnI.Results LVP and LVdp/dt in group L1,L2 and L + U were better than those in group C and U.But the heart rates in group L2 were higher than in other groups.Concentrations of CK,cTnI,TNF-α and IL-6 in the effluent from coronary sinus at 0、10 and 30 min of reperfusion were significantly lower in group L + U than in the other groups.Conclusion Levosimendan may have the similar effects with ulinastain in reducing the reperfusion injury to the immature myocardium.The protective effect of levosimendan (0.1 μmol/L) in combination with ulinastain (50 000 U/kg) was better than that of levosimendan or ulinastain alone.     

Protective effects of levosimendan and ulinastain on the isolated rabbit heart

<正>Objective Levosimendan,a new calcium ion sensitizer,is currently used in the treatment of heart failure and as an option for patients with injury to the left heart or at high risk for surgery. The study tried to evaluate the effects of levosimendan and ulinastain for protecting myocardium from ischemia-reperfusion (I / R) injury to the     

冠状动脉旁路移植术中不同静脉剥脱方法的临床应用

大隐静脉(GSV)是冠状动脉旁路移植术(CABG)中最常用的移植血管.目前GSV的采集方法主要有切开剥脱法(OVH)、点式剥脱法(MIVH)和腔镜采集法(EVH).我院自2008年12月-2009年2月通过不同静脉采集方法获取GSV并完成了147例CABG,报告如下.     

22例冠状动脉旁路移植术同期双极射频消融治疗心房纤颤

2007年4月至2(308年7月,我们为22例冠心病合并阵发性房颤的病人在冠状动脉旁路移植术同期施行双极射频消融,取得了满意的效果. 资料和方法 22例中男15例,女7例;年龄50～73岁,平均(61.6±5.6)岁.其中合并高血压16例,糖尿病3例,有心肌梗死病史6例,吸烟史6例.