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1.
房间隔缺损(ASD)患者常合并三尖瓣反流(TR)。严重TR会增加心血管疾病发病率和死亡率。随着心导管技术的发展,ASD介入封堵术已成为代替外科手术的一种有效治疗方法,三尖瓣的介入治疗也有了新的尝试。但目前对于ASD合并TR患者的研究较少,对于ASD合并TR的患者在ASD闭合后三尖瓣的变化情况以及严重TR的治疗策略仍存在争议。本文就ASD合并TR的机制、诊断以及治疗进行阐述。  相似文献   
2.
Background Nowadays, the number of pediatric patients receiving permanent pacemaker implantations is increasing. However, there is very little relevant, long-term follow-up analysis carried out in China. Methods Clinical information from pediatric patients who underwent epicardial permanent pacemaker implantation from January 1, 2005 to December 31, 2017 in Guangdong Provincial People's Hospital was collected. Eligible patients received 12-lead electrocardiograms and echocardiography preoperatively and postoperatively, as well as programming control during their follow-up. Meanwhile, complications were treated and analyzed. Results A total of98 pediatric patients with permanent epicardial pacing were included in the study, including 60 males and 38 females. The age of patients who underwent surgery for the first time ranged from 8 days to 14 years old( the median age of these patients was 3 years old). The weight of these patients ranged from 2.7 kg to 52 kg(the median weight of these patients was 12 kg). Three patients died while they were getting treatment. The follow-up was carried out on eighty-seven out of ninety-five patients(91.6%) and lasted 5 months to 13 years( average 3.79±3.06 years). One patient with single-chamber right ventricular pacing was found to have cardiac insufficiency in the second year after operation. There were 6 patients with cardiac insufficiency whose ejection fractions were less than 55%. All these patients had a single-chamber left ventricular pacing implant or double-chamber right atrial left ventricular pacing implant. Paired T-test was used to compare the preoperative LVEF with the last echocardiographic LVEF(45%±7% vs.67%±7%, P 0.05),which indicated statistical differences. Conclusion A permanent epicardial pacemaker is safe and effective and reasonable pacing mode can protect cardiac function.[S Chin J Cardiol 2019;20(1):10-14]  相似文献   
3.
目的探讨胎儿室间隔完整型严重肺动脉狭窄(critical pulmonary stenosis with intact ventricular septum,CPS/IVS)或室间隔完整型肺动脉闭锁(pulmonary atresia with intact ventricular septum,PA/IVS)的产前超声心动图诊断、右心室发育评估及宫内介入治疗的结局随访。方法回顾性分析广东省人民医院2016年9月至2018年12月6例产前超声心动图诊断为PA/IVS或CPS/IVS(1例诊断PA/IVS,5例为CPS/IVS)行胎儿肺动脉瓣球囊成形术(fetal pulmonary valvuloplasty,FPV)胎儿的产前超声心动图诊断、右心室发育评估及结局随访资料。结果 6例胎儿诊断孕周为(26.48±2.15)周。6例胎儿术前三尖瓣环/二尖瓣环比值(tricuspid valve annulus/mitral valve annulus,TV/MV)分别为0.53、0.82、0.71、0.85、0.77、0.71,右心室纵径/左心室纵径比值(right ventricle length/left ventricle length,RV/LV)分别为0.42、0.63、0.52、0.61、0.75、0.61,三尖瓣流入时间/心动周期长度比值(tricuspid valve inflow duration/cardiac cycle length,TVID/CCL)比值分别为0.26、0.35、0.39、0.44、0.44、0.35,肺动脉瓣环/主动脉瓣环(pulmonary valve annulus/aortic annulus,PV/AV)比值分别为0.85、1.03、0.85、0.86、1.20、0.78。动态观察2周后,6例胎儿右心室各指标未见明显增长,于(29.45±1.19)周行FPV术,均取得技术性成功(100%),无宫内死亡,孕妇及胎儿无严重并发症。FPV术后,6例胎儿术后1~2周内TV/MV、RV/LV、TVID/CCL明显增长,术后2~6周增长趋于稳定,而PV/AV则在术后2~4周增长较明显。6例患儿分娩胎龄为(37.74±1.17)周,出生体质量(3.04±0.24)kg,于生后(15.33±7.31)d完成行一期手术,其中2例行外科手术,4例12的严重感染所致的多器官功能衰竭。存活的5例患儿血氧饱和度95%,无右心衰竭症状。结论产前可通过超声评估CPS/IVS、PA/IVS胎儿右心室发育状况,筛选宫内介入治疗适应证,适时进行FPV,可促进右心室小梁部及三尖瓣发育,争取患儿生后实现双心室循环。  相似文献   
4.
目的总结儿童先天性心脏病(CHD)介入治疗并发症的发生率,并分析其发生原因。方法回顾性分析2011年1月至2013年12月间2 356例诊断为室间隔缺损(VSD)、房间隔缺损(ASD)、动脉导管未闭(PDA)、肺动脉瓣狭窄(PS),并行介入治疗的0~18岁CHD患儿,在介入治疗中及治疗后发生并发症的情况。结果 2 356例CHD患儿中159例发生并发症,发生率为6.75%;其中VSD组为11.40%(82/719),ASD组为7.50%(51/680),PDA组为3.09%(22/712),PS组为1.63%(4/245)。心律失常发生率为4.41%(102/2 356)。严重并发症发生率为2.71%(64/2 356),VSD组为3.62%(26/719),ASD组为2.21%(15/680),PDA组为2.53%(18/712),PS组为1.63%(4/245);术中严重并发症为0.51%(12/2 356),术后早发严重并发症为1.99%(47/2 356),迟发严重并发症为0.21%(5/2 356)。严重并发症经介入手术治疗0.13%(3/2 356),经外科手术治疗0.64%(15/2 356),经内科保守治疗1.95%(46/2 356);2例死亡,死亡率0.08%。结论 CHD介入治疗的并发症及死亡率低,但仍不容忽视。术前严格掌握适应证,术中按常规操作,术后进行规范的长期随访至关重要。  相似文献   
5.
目的:探讨内脏异位综合征合并肺动脉狭窄/闭锁患儿有无缝隙连接蛋白43(Connexin43,Cx43)基因突变。方法:选取47例内脏异位综合征合并肺动脉狭窄/闭锁患儿,45例无内脏异位的法洛氏四联症患儿以及30例无先天性心脏病的患儿,抽取外周血,采用PCR-SSCP和DNA测序技术检测有无Cx43胞质尾区基因突变。结果:所有样本DNA的PCR特异性扩增良好。对Cx43胞质尾区的PCR扩增产物进行SSCP分析和测序,未查找到单核苷酸多态性位点任何转换、颠换、缺失和插入的变异。结论:内脏异位综合征合并肺动脉狭窄/闭锁的患儿以及无内脏异位的法洛氏四联症患儿均无Cx43基因突变。  相似文献   
6.
目的:筛选青风藤等39味苗药对醛糖还原酶(AR)的抑制强度,为探索其疗效机制和寻找天然醛糖还原酶抑制剂(ARIs)奠定一定基础。方法:从牛晶状体中分离纯化AR,常规方法制备青风藤等39味苗药的石油醚、乙酸乙酯、正丁醇和水4个提取部位,采用分光光度法测定各药物不同提取部位对AR的抑制作用。结果:本实验筛选的39味苗药中,有17味药物一定提取部位具有不同程度的AR抑制作用。结论:青风藤等苗药提取部位中含有AR抑制成分,这可能是其临床单独或配伍治疗糖尿病及其后遗症的重要机制。  相似文献   
7.
Background The bidirectional Glenn shunt surgery is a palliative procedure for patients with complex congenital heart disease(CHD) who are not suitable for biventricular repair in early life. There is limited evidence of successful strategies for long-term hemodynamic stabilization. Furthermore, there have been no data on optimal hemodynamics that could be used as a reference for patients' follow-on management. Methods Sixty CHD patients, 44 male and 16 female, with bidirectional Glenn shunt surgery and cardiac catheterization were enrolled at our hospital between January 2014 and December 2016. Pre-and post Glenn shunt percutaneous oxygen saturation(SpO_2), 6-minute walk test(6 MWT), superior vena cava pressure(SVCP), pulmonary arterial pressure(PAP), pulmonary capillary wedge pressure(PCWP), pulmonary vascular resistance(PVR), small pulmonary vascular resistance(s PVR) were measured. Pre-and post-total cavopulmonary connection(TCPC) SpO_2, and in-hospital complications were monitored. The optimal hemodynamic cutoff values for TCPC patient selection were estimated by receive operating characteristic(ROC) curve analysis. Results SpO_2 was significantly increased by bidirectional Glenn shunt surgery(75.42 ± 9.62% to 86.98 ± 7.63%, P 0.001) from 82.70 ± 5.99% to 95.00 ±4.07% in the 47 patients with TCPC. Forty-two patients completed the 6 MWT with a mean distance of 362.7 ±75.0 m and a SpO_2 decrease from 81.80 ± 7.84% to 67.59 ± 1.82%(P 0.001). The △SpO_2 and 6-minute walk distance(6 MWD) in the 32 who underwent TCPC and ten of them did not reach statistical significance(17.22 ±13.82% vs. 13.87 ± 8.74%, P = 0.08 and 358.88 ± 78.97 m vs. 374.80 ± 62.55 m, P = 0.564]. After cardiac catheterization, 47 patients were selected for TCPC. The right pulmonary artery systolic pressure(s RPAP), mean right pulmonary artery pressure(m RPAP), mean left pulmonary artery pressure(m LPAP), PVR, and s PVR were significantly lower in the TCPC group than in the non-TCPC group. The differences in superior vena cava systolic blood pressure(s SVCP), mean superior vena cava pressure(m SVCP), and left pulmonary artery systolic pressure(s LPAP) were not significant. The optimal cutoff values for TCPC were s SVCP ≤ 20 mm Hg(P = 0.025),s RPAP ≤ 22 mm Hg(P = 0.0001, mRPAP ≤ 13 mm Hg(P =0.003), s LPAP ≤ 27 mm Hg(P =0.03), m LPAP ≤ 11 mm Hg(P = 0.01), PVR ≤ 4.3 Wood U/m~2(P 0.0001) and were significantly associated with TCPC selection,except for m SVCP ≤ 19 mm Hg(P = 0.06) and s PVR ≤ 2.0 wood U/m~2(P = 0.0531). One patient died because of low cardiac output after TCPC. In-hospital mortality was 2.1%. Conclusion The SpO_2 can be significantly improved after bidirectional Glenn shunt and TCPC surgery. The 6 MWT is an index of activity tolerance prior toTCPC. Hemodynamic values of s SVCP ≤ 20 mm Hg, s RPAP ≤ 22 mm Hg, m RPAP ≤ 13 mm Hg, s LPAP ≤ 27 mm Hg, m LPAP ≤ 11 mm Hg, and PVR ≤ 4.3 Wood U/m~2 can help identify post Glenn-shunt patients indicated for TCPC.  相似文献   
8.
目的 观察经皮冠状动脉介入术(PCI)前使用不同剂量阿托伐他汀对对比剂诱导的急性肾损伤的影响。方法 入选拟行冠状动脉造影检查及拟行PCI术的患者106例,随机分成2组:20 mg阿托伐他汀组及40 mg阿托伐他汀组;入院24 h内完成常规化验检查、心脏彩色超声检查及肾脏血管超声检查,术后48 h复查肾功能。所有患者手术前当日清晨、术后2 h及术后48 h均留取约5 mL中段尿,用胶乳增强免疫透射比浊法统一测定中性粒细胞明胶酶相关脂质运载蛋白(NGAL)。结果 PCI术后,40 mg阿托伐他汀组与20 mg阿托伐他汀组比较,血清肌酐(77.44±23.14 mmol/L比94.24±36.14 mmol/L,P=0.014)降低,尿酸(313.05±110.84 μmol/L比354.00±100.66 μmol/L,P=0.060)降低,肾小球滤过率估计值(92.24±24.74比75.31±31.34,P=0.009)增高; PCI术后,40 mg阿托伐他汀组与20 mg阿托伐他汀组比较,2 h NGAL(33.13±20.44 μg/L比50.67±46.95 μg/L,P=0.013)、48 h NGAL(27.56±18.64 μg/L比58.38±56.81 μg/L,P=0.001)减低;应用对比剂后,20 mg阿托伐他汀组发生对比剂急性肾损伤11例,发生率为20.75%,而40 mg阿托伐他汀组发生对比剂急性肾损伤5例,发生率为9.43%,两组相比差别有统计学意义(P<0.05)。结论 应用对比剂前3天,每天服用40 mg阿托伐他汀较每天服用20 mg阿托伐他汀更能减少对比剂诱导的急性肾损伤的发生。  相似文献   
9.
张智伟 《大家健康》2016,(11):177-177
目的:研究分析眼底病使用激光光凝治疗的临床效果。方法:2012年6月至2014年6月该院对120例眼底病患者进行了研究分析,将患者分成对照组和观察组,均有60例,观察组患者接受激光光凝治疗,对照组患者接受药物治疗,对患者进行半个月的回访,对比治疗效果和并发症几率。结果:观察组的临床治愈率是80%,对照组的治愈率是45%,观察组较高;观察组的有效率是97%,对照组的有效率是81%,观察组较高;观察组并发症几率9%,对照组23%,观察组较低,两组结果对比存在统计学差异(P <0.05)。结论:激光光凝治疗眼底病的临床效果突出,可以提升治愈率,降低并发症几率,应该在临床中推广使用。  相似文献   
10.
目的评价自主研究的新型房间隔封堵器的生物相容性,为动物实验提供依据。方法封堵器框架由生物可吸收聚左旋乳酸(poly-L-lactic acid,PLLA)单丝网编织成型。通过对PLLA单丝进行体外细胞毒性测试、体外溶血测试、全身急性毒性测试、肌肉植入实验,评价新型房间隔封堵器的生物相容性。结果 PLLA房间隔缺损封堵器无体外细胞毒性,体外溶血率0.9%,无急性全身毒性反应。通过分析样品植入肌肉1个月、3个月和6个月后组织病理,观察样品与组织之间的反应,未发现明显的组织损伤和组织增生。结论生物可吸收PLLA房间隔封堵器的生物相容性良好,可进行下一步的动物实验研究。  相似文献   
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