乳内动脉-冠状动脉旁路移植术53例

作者对１９９４年１月～１９９６年１２月本院所作的５３例乳内动脉（ＩＭＡ）－冠状动脉旁路移植术进行了总结。全部患者均为经内科治疗效果不满意者。其中４４例发生过一次以上的心肌梗塞；１６例合并室壁瘤形成。除１例为非体外循环行单纯左ＩＭＡ与左前降支吻合外，其余均行左ＩＭＡ吻合前降支及大隐静脉序惯“蛇形”桥。全组平均做冠脉吻合口４．２８支。同期左室室壁瘤切除４例。手术死亡４例。３５例随访６个月～１年半，其中３０例症状消失，５例症状减轻，活动量增加。随访结果提示，ＩＭＡ冠脉旁路移植术可取得满意疗效。作者还对ＩＭＡ冠脉旁路移植术的技术要点、适应证等进行了讨论。     

胸廓内动脉在冠状动脉旁路移植术中的应用

１９８８年～１９９１年施行胸廓内动脉搭桥术３８例。其中男３１例，女７例。年龄５４～７９岁。共搭桥１００根，平均每个病人搭桥２．６３根。包括大隐静脉桥５９根，胸廓内动脉桥４１根；其中左胸廓内动脉３７根，右胸廓内动脉４根。双侧胸廓内动脉搭桥３例，游离胸廓内动脉１例。平均主动脉阻断时间５２ｍｉｎ，体外循环转流８７ｍｉｎ。术后１例使用主动脉内气囊反搏仪，４例应用正性血管药物，１例行剖胸止血术。全部病人痊愈     

乳内动脉—冠状动脉和移植术53例

作者对１９９４年１月－１９９６年１２月本院所作的５３例乳内动脉（ＩＭＡ）－冠状动脉旁路移植术进行了总结。全部患者均为经内科治疗效果不满意者。其中４４例发生过一次以上的心肌梗塞;１６例合并室壁瘤形成。除１例为非体外循环单纯左ＩＭＡ与左前降支史合外,其余元首地左ＩＭＡＫ吻合前降支及大陷序惯“蛇形”桥。全组平均做冠脉吻合口４．２８支。同期左室壁瘤切除４例。３５例随访６个月－１年半,其中３０例症状消失,５     

间断缺血心停搏在冠脉搭桥术中的应用

１９９２～１９９３年间为１８０例冠脉病变的病人施行冠脉搭桥术，全部病人均采用核甙抑制剂利多氟嗪预处理和低温（２８℃）间断缺血心停搏进行术中心肌保护。平均每例病人作冠状动脉端吻合３～４个，每个吻合口用９分钟，主动脉阻断累加时间约２５分钟，体外循环时间９０分钟，术后医院死亡率１．６％（３／１８０），无术后心梗发生。作者认为，冠脉搭桥术的术中心肌保护可采用核甙抑制剂和间断缺血心停搏方法，而不用心肌停搏液。     

非体外循环双侧乳内动脉完全心肌血运重建

目的 评估非体外循环双侧乳内动脉完全心肌血运重建治疗的效果。方法 2000年10月至2004年8月，共行双侧乳内动脉“Y”形吻合冠状动脉旁路移植（冠脉搭桥）52例，年龄33～78岁，平均56岁。3支病变者42例（80．8％），左主干病变者10例（19．2％）。心功能分级Ⅱ级46例，Ⅲ级4例。脑CT检查示陈旧性脑梗者11例（21．2％），颈动脉病变者21例（40．4％）。制备双侧乳内动脉，将游离的右侧乳内动脉吻合于左侧乳内动脉成“Y”形。均在心脏不停跳下进行冠脉搭桥，左侧乳内动脉序贯吻合对角支、左前降支，右侧乳内动脉序贯吻合于中间支、回旋支（钝缘支、左室后支）、后降支。并应用Tranortie H1311流量计进行桥血管的流量测定。结果 全组52例共行冠脉搭桥171支，平均3．3支/人。全组病人无死亡。围术期心梗2例，应用IABP 1例，开胸止血1例。全组无脑部并发症，无胸骨纵隔感染。结论 非体外循环下双侧乳内动脉“Y”形冠状动脉搭桥是安全、有效的手术方式，可以实现全动脉化的完全心肌血运重建，手术近期效果满意，远期效果有待进一步的随访观察。     

常规使用原位乳内动脉行冠状动脉旁路术

乳内动脉（ＩＭＡ）是当前国际上公认的最好的搭桥移植物。尽管认为亚州人比西方人乳内动脉细小，我们于１９９７年４月至１９９８年５月，对４８例冠心病患者施行了冠状动脉旁路术（ＣＡＢＧ）。１．资料与方法：本组４８例中，男４６例，女２例；年龄３８～７３岁，平均...     

心脏瓣膜病巨大左室的外科治疗经验

１９８７年１月至１９９２年３月，我们为６５例心脏瓣膜病巨大左室（ＥＤＤ＞７０ｍｍ）病人施行了瓣膜替换术。术前平均ＥＤＤ７８．８ｍｍ，ＥＳＤ５７．３ｍｍ，ＦＳ０．２６。心功能ＩＩＩ级１６例，ＩＶ级４９例。手术方式：ＭＶＲ１６例，ＭＶＲ＋ＴＶＰ１０例，ＡＶＲ１１例，ＭＶＲ＋ＡＶＲ２１例，ＭＶＲ＋ＡＶＲ＋ＴＶＰ７例。术后早期发生心、肺、肾、肝等重要器官并发症２７例，死亡９例（１３．８％）。ＡＶＲ组（１８     

1110例冠状动脉搭桥术的早期结果

目的　回顾性总结１９９６ 年１ 月以来１１１０ 例冠状动脉搭桥术（ＣＡＢＧ） 的近期疗效,介绍冠心病搭桥术的体会和经验。　方法　体外循环下行ＣＡＢＧ１０４８ 例,非体外循环ＣＡＢＧ６０ 例。心肌保护均采用冷血含钾停跳液,体外循环时间１１５ ±３５ 分钟,主动脉阻断时间７２ ±２４ 分钟,单支搭桥１１０ 例,２ 支搭桥１４５ 例,３ 支搭桥４１５ 例（３７－３ ％） ,４ 支搭桥或４ 支以上４３９ 例（３９－５％） 。搭桥材料：左乳内动脉７５１ 例,大隐静脉８７７ 例,桡动脉１０１ 例,全动脉化７２ 例。合并手术：室壁瘤切除１１２ 例,室壁瘤折叠１４ 例,左室成形５ 例,瓣膜手术４８ 例,室间隔穿孔修补术５ 例。　结果　住院死亡９ 例,死亡率０－８１％ 。其余患者痊愈出院,心绞痛基本缓解。术后并发症：低心排１１ 例,主动脉球囊反搏７例,围术期心肌梗塞２ 例,脑部并发症３ 例,二次开胸止血４ 例。　结论　选择好靶血管和充分血管化是冠状动脉搭桥术的关键。另外要重视围术期处理。     

乳内动脉在冠状动脉旁路移植术中的应用

冠状动脉旁路移植术（ＣＡＢＧ）治疗缺血性心脏病已取得了良好的效果,较为常用的旁路材料多为自体大隐静脉（ＳＶ）,但远期效果不满意,而乳内动脉（ＩＭＡ）作为旁路材料的远期通畅率明显优于静脉。我院近２年来采用ＩＭＡ联合ＳＶ行ＣＡＢＧ９例,具有较好的临床效果。１　临床资料与方法１．１　一般资料　全组９例,男８例,女１例。年龄３５～５６岁,平均年龄４９．３岁。均有心绞痛发作,按ＣＣＳＳ分级,心绞痛Ⅱ级１例,Ⅲ级和Ⅳ级各４例;陈旧性心肌梗死５例,有高血压病４例,糖尿病２例。冠状动脉造影示单支血管病变１例,双…     

急诊冠脉搭桥治疗急性心梗近况

急诊冠脉搭桥治疗急性心梗近况秦斌综述程邦昌审校急性心肌梗塞（ＡＭＩ）指冠状血管内的机械性阻塞使心肌供血不足，导致细胞死亡；争取早期恢复冠脉灌注可以减少心肌细胞坏死〔１，２〕。Ｃｏｌｅｍａｎ等〔３〕认为在梗塞早期，急诊冠脉搭桥（ＥＣＡＢＧ）的疗效要优于...     

主动脉缩窄手术时上下肢血压的同步监测与控制

本文报告全麻下主动脉缩窄手术３５例，其中前１０例应用浅低温，后２５例改用常温。全组麻醉后行右侧桡动脉和右股动脉穿刺置管，同步监测术中挠动脉平均压（ＲＡＰ）与股动脉平均压（ＦＡＰ）的变化。为了防止降主动脉阻断期间上半身出现严重高血压和出血危险，本组采用了控制性低血压，使阻断期间ＲＡＰ不高于１２～１３ｋｐａ（９０～１００ｍｍＨｇ）。但为了防止下半身血压过低，ＦＡＰ最好不低于５．３～６．７ｋＰａ（４０～５０ｍｍＨｇ）。本文提示在主动脉缩窄根治术时实施上下肢血压的同步监测与调控，不仅有利于对上下肢血压梯度的了解，判定手术效果，还有助于防止并发症，尤其是肾和脊髓的缺血损伤。     

Comparison of alternative arterial anastomosis site during liver transplantation when the recipient’s hepatic artery is unusable

BackgroundFew studies have analyzed outcomes of liver transplantation (LT) when the recipient hepatic artery (HA) was not usable.MethodsWe retrospectively evaluated the outcomes of LT performed using the different alternative sites to HA.ResultsBetween 2002 and 2017, 1,677 LT were performed in our institution among which 141 (8.4%) with unusable recipient HA were analyzed. Four groups were defined according to the site of anastomosis: the splenic artery (SA group, n=26), coeliac trunk (CT group, n=12), aorta using or not the donor’s vessel (Ao group, n=91) and aorta using a vascular prosthesis (Ao-P group, n=12) as conduit. The median number of intraoperative red blood cell transfusions was significantly increased in the Ao and Ao-P groups (5, 5, 8.5 and 16 for SA, CT, Ao and Ao-P group respectively, P=0.002), as well as fresh frozen plasma (4.5, 2.5, 10, 17 for the SA, CT, Ao and Ao-P groups respectively, P=0.001). Hospitalization duration was also significantly increased in the Ao and Ao-P groups (15, 16, 24, 26.5 days for the SA, CT, Ao and Ao-P groups respectively, P<0.001). The occurrence of early allograft dysfunction (EAD) (P=0.07) or arterial complications (P=0.26) was not statistically different. Level of factor V, INR, bilirubin and creatinine during the 7^th postoperative days (POD) was significantly improved in the SA group. No difference was observed regarding graft (P=0.18) and patient (P=0.16) survival.ConclusionsIn case of unusable HA, intraoperative and postoperative outcomes are improved when using the SA or CT compared to aorta.     

Bland‐White‐Garland syndrome: Choice of surgical technique

An anomalous origin of the left coronary artery from the pulmonary artery (Bland‐White‐Garland syndrome) was diagnosed in a 48‐year‐old woman complaining of angina for 2 years. The patient underwent surgical repair with ligation of the left coronary artery at the ostium, and a left internal mammary artery (LIMA) to the left anterior descending (LAD) coronary artery bypass. Arterial pressure monitoring and blood gas analysis of pulmonary artery and LAD was carried out before and after ligation and after LIMA to LAD anastomosis. We demonstrated an increase in systolic blood pressure in the LAD with the ligation of the fistula which did not improve significantly with LIMA to LAD reperfusion. However, there was an increase in coronary diastolic pressure with a persistent diastolic gradient. Review of the available literature and comparative analysis of different procedures suggests that ligation of the ostium plus off‐pump LIMA to LAD grafting could be the procedure of choice in adults with this rare but potentially life‐threatening, congenital coronary anomaly.     

Penetration of the Optic Nerve and Falciform Ligament by an Internal Carotid Artery-Ophthalmic Artery Aneurysm: Case Reoport

We report a case of an internal carotid artery (ICA)-ophthalmic artery aneurysm with penetration of the optic nerve. In addition, this case penetrated the falciform ligament, which severely disturbed optic canal unroofing during surgery. This is the first reported case in which penetration of the optic nerve and falciform ligament has been shown. To remove the anterior clinoid process in this case, the ultrasonic bone curette was a useful tool.     

冠心病搭桥术后胸骨裂开的防治(附5例报道)

目的 探讨冠心病搭桥术后胸骨裂开及其合并感染的诊断、治疗和预防。方法 未感染者及时再手术重新固定,合并感染者及时彻底清创、有效引流、牢固固定。结果 本组治愈率100％,伤口愈合时间平均10天(7～14天),1例除外。二次术后平均拔除引流管时间7.4天(2～20天)。结论 伤口局部的症状、体征、全身表现和X线胸片对诊断和治疗有重要意义。早发现、早诊断,及时重新固定,合并感染者及时彻底清创、有效引流、牢固固定是治疗成功的关键,可以有效缩短住院时间。重视胸骨裂开的预防,可减少其发生率。     

Adrenomedullin Reduces Ischemic Brain Injury after Transient Middle Cerebral Artery Occlusion in Rats

Summary  Background. The effect of adrenomedullin, a vasodilatory peptide on transient middle cerebral artery (MCA) occlusion was investigated in rats.  Methods. Transient MCA occlusion for 2 hours was made by using the intra-arterial suture method, followed by reperfusion.  Findings. An intravenous infusion of adrenomedullin (1 μ g/kg/min) from one hour before ischemia to one hour after ischemia significantly reduced the infarct size and improved neurological deficits (p<0.05), without affecting systemic blood pressure or other physiological parameters. The infarct size was reduced with adrenomedullin by 25.4±12.7%, 31.3±5.8%, 31.6±6.1% respectively at the coronal level 6, 8 and 10 mm posterior from the frontal pole. Adrenomedullin also significantly inhibited the increase in myeloperoxidase (MPO) activity in the MCA area of the ischemic hemisphere after 22-hour reperfusion (control: 0.205±0.054 unit/g wet tissue, adrenomedullin group: 0.047±0.009 unit/g wet tissue, p<0.0001).  Interpretation. These data suggest that adrenomedullin reduces acute ischemic brain injury and one of is neuroprotective mechanisms may be derived from inhibition of the infiltration of neutrophils into the ischemic tissue.     

Surgical considerations in off-pump coronary artery bypass grafting

Off pump coronary artery bypass grafting remains an important technique particularly in the care of high-risk patients. Consistently successful adoption of this technique requires a cooperative team approach and standardization across all phases of patient care. This review describes our approach to off pump coronary surgery.     

家猪肝动脉内给予32磷-玻璃微球的毒性反应研究

目的　评估正常家猪肝动脉内给予３２ 磷玻璃微球（３２ＰＧＭＳ） 后的急性和亚急性毒性反应。方法　１０ 只健康家猪经皮肝动脉内接受人类治疗剂量的３２ＰＧＭＳ（５ 只猪）、惰性３１ＰＧＭＳ（５ 只猪） ；２ 只猪作全程空白对照。术后按第１ 、２、４ 、８ 或１６ 周分期处以安乐死，取不同部位的肝组织进行光镜、电镜检查和超微形态计量分析。结果　给药组１、２ 周肝细胞核异常率（Ｎａｂｎ） 和线粒体变异率（ Ｍｖａｒ） 与其他各组比较差异均有显著性（ Ｐ＜ ０．０１，Ｐ＜ ０ ．００１）；给药组第８ 周与第１６ 周比较Ｎａｂｎ 无统计学意义（ Ｐ＞０ ．２０）。给药后第１、２ 周异常肝细胞多见；第４ 周异常肝细胞减少，血窦内皮破坏明显；第８ 周异常肝细胞少见，血窦内皮修复；第１６ 周肝组织形态学表现正常。结论　３２ＰＧＭＳ肝动脉给药正常肝组织宏观吸收剂量不超过１９０Ｇｙ 只是引起临床上允许的肝内变化，肝脏组织损伤修复的时间约８ 周以上。