主动脉弓手术中单侧与双侧顺行脑灌注的疗效比较meta分析

摘要 目的 顺行脑灌注（ACP，antegrate cerebral perfusion）是主动脉弓部手术中最常使用的脑保护措施，然而双侧顺行脑灌注（BACP,bilateral antegrate cerebral perfusion）的疗效是否优于单侧顺行脑灌注（UACP,unilateral antegrate cerebral perfusion）一致是争论的焦点。此研究通过系统评价来比较两种技术的疗效为临床提供依据。方法 计算机检索Pubmed、the coherence library、EMbase、CNK和wanfang Data数据库，搜集主动脉弓部停循环手术，使用单侧与双侧插管顺行脑灌注并以短暂性神经功能障碍（TND，temporary neurologic dysfunction）、永久性神经功能障碍（PND，permanent neurologic dysfunction）以及术后死亡率为结局指标的队列研究，由2位研究员独立筛选文献、提取资料和评价纳入研究的偏倚风险,检索时限均为建库至2017年9月。采用RevMan 5.3软件进行Meta分析。结果 共包括2891例患者的9项队列研究被纳入分析，其中BACP组是1480例、UACP组1411例。Meta分析结果显示，在术后死亡率[RR=0.88,95%CI(0.71,1.08，p=0.22]、TND[RR=1.00,95%CI(0.81,1.24，p=0.99)]以及PND[RR=1.00,95%CI(0.81,1.24，p=0.99)]方面两组之间均无明显差异。结论 主动脉弓部手术中单侧插管与双侧插管顺行脑灌注在术后死亡率以及神经功能障碍方面无明显差异。     

主动脉瓣置换术后患者腹胀原因分析及不同减压方法的疗效比较

目的：分析主动脉瓣置换术后患者出现腹胀的原因，比较不同减压方法在主动脉瓣置换术后中重度腹胀患者中的疗效。方法：①选取2015年01月至2017年01月期间在我科行主动脉瓣置换术的患者，多因素Logistic regression分析腹胀的危险因素。②上述研究对象中术后出现中重度腹胀并需要胃肠减压的患者，随机分为2组，分别选用不同的减压方法：A组经鼻置入小肠减压管，B组经鼻置入普通胃管。比较2组患者腹胀缓解有效率以及缓解时间。结果：①498例主动脉瓣置换术后患者出现腹胀132例，发生率为26.5%。多因素Logistic regression分析显示术后持续镇静/肌松时间≥72h是腹胀的独立危险因素。② A组52例患者腹胀缓解41例，缓解有效率为78.8%，缓解时间为46.9±18.6h；B组51例患者腹胀缓解30例，缓解有效率为58.8%，缓解时间为55.2±21.4h。A组腹胀缓解有效率明显高于B组，且缓解时间明显短于B组，差异有统计学意义。结论：主动脉瓣置换术后患者持续镇静/肌松时间≥72h是腹胀的独立危险因素。小肠减压管在胃肠减压方面较普通胃管疗效更为显著，心脏术后患者出现腹胀需要胃肠减压时，可优先考虑使用。     

Low dose of methyltestosterone in ovariectomised rats improves baroreflex sensitivity without geno‐ and cytotoxicity

This study evaluated the effects of the isolated use of a low dose of methyltestosterone (MT) on cardiovascular reflexes and hormonal levels and its geno‐ and cytotoxic safety in ovariectomized rats. Female Wistar rats were divided into four groups (n = 6), respectively: SHAM (received vehicle methylcellulose 0.5%), SHAM + MT (received MT 0.05 mg/kg), OVX (received vehicle), and OVX + MT (received MT). Twenty‐one days after ovariectomy, treatment was given orally daily for 28 days. The Bezold–Jarisch reflex (BJR) was analyzed by measuring the bradycardic and hypotensive responses elicited by phenylbiguanide (PBG) administration. The baroreflex sensitivity (BRS) was evaluated by phenylephrine and sodium nitroprussite. Myocyte hypertrophy was determined by morphometric analysis of H&E stained slides. Biochemical data were analyzed, as well as micronucleus assay. MT improved BRS and increased testosterone values, but did not change estradiol in the OVX group. MT did not promote changes in mean arterial pressure, heart rate, BJR, serum concentrations of troponin I, weight and histopathology of the heart. MT was able to restore the BRS in OVX rats. The geno‐ and cytotoxic safety of the MT was demonstrated by the absence of an increase in the micronucleus (PCEMN) or change in the ratio between normochromatic erythrocytes and polychromatic erythrocytes (NCE/PCE).     

Iatrogenic life-threating condition in a patient with multiple rare disorders

Andersen–Tawil syndrome (long QT syndrome 7) is a rare inherited disorder, characterized by periodic paralysis, long QT, ventricular arrhythmias and skeletal abnormalities.A 52-year-old female with a history of long QT-syndrome, ICD implantation (secondary prevention of cardiac arrest) and systemic vasculitis was admitted due to an electrical storm caused by endocarditis. She was admitted again short after discharge due to multi-organ failure, which was caused probably by withdrawal of steroids and VKA. Characteristic dysmorphic features resulted in Andersen–Tawil syndrome suspicion.If patients have one rare disorder they should not be excluded from further diagnostics, and very detailed outpatient care.     

Pregnant intravenous drug user tricuspid valve infective endocarditis treated with a successful simultaneous valve replacement and Cesarean section

A 30‐year‐old female patient known to be an intravenous drug user (IVDU) was admitted to Bajcsy‐Zsilinszky Hospital Cardiology Intensive Care Unit at 29‐week gestation with severe sepsis and right heart failure. She had methicillin‐sensitive Staphylococcus aureus on blood culture. Echocardiography confirmed the diagnosis of tricuspid valve infective endocarditis (IE). She had acute deterioration and hemodynamic instability for which an emergency tricuspid valve replacement (TVR) with a simultaneous Cesarean section (CS) was performed simultaneously. Medical management is the standard treatment in IE of IVDU pregnant patients, but in case of life‐threatening complications, emergency TVR and CS are to be considered. This is the first reported case of IVDU IE treated with simultaneous TVR and CS.