风湿性主动脉瓣、二尖瓣及三尖瓣联合病变的外科护理

目的 分析风湿性主动脉瓣、二尖瓣与三尖瓣联合瓣膜病变的外科治疗及术后护理结果.方法 自2001年7月～2005年8月,对72例风湿性主动脉瓣、二尖瓣与三尖瓣联合瓣膜病变的患者,施行适宜的三尖瓣手术方式及正确的围手术期护理.结果 术后早期死亡3例(死亡率4.29%),其余患者临床恢复满意.结论 对于多瓣膜联合病变的患者,施行适宜的三尖瓣手术方式和正确的围手术期护理,是提高疗效,降低死亡率的关键.     

131例主动脉瓣及二尖瓣联合瓣膜置换治疗风湿性多瓣膜病变

目的探讨提高主动脉瓣及二尖瓣联合瓣膜置换治疗风湿性多瓣膜病变疗效的方法。方法1998年7月至2005年11月8年间,对131例风湿性多瓣膜病变患者施行外科治疗。男54例,女77例,年龄21~63岁,平均42.5±4.5岁。术前心功能Ⅲ~Ⅳ级者112例(占85.50%)。21例同期行Devega法三尖瓣成形。结果痊愈124例(占94.66%),死亡7例,(占5.34%),手术后存活病人心功能明显改善。结论对于严重风湿性多瓣膜病变的患者,加强围术期处理,改善病人的营养状况,选择适当的手术时机,改善心肌保护,提高手术技巧,积极纠治三尖瓣关闭不全,可提高主动脉瓣及二尖瓣联合瓣膜置换的疗效。     

利用导管损伤制备钙化性主动脉瓣疾病小鼠模型的最优时间选择

目的 探讨利用导管损伤制备钙化性主动脉瓣疾病小鼠模型的最优时间。方法 通过向8周龄小鼠右颈总动脉插入导管,在超声引导下将导管送至主动脉瓣口处损伤主动脉瓣膜,对导管损伤主动脉瓣膜后不同时间段的C57BL6小鼠主动脉瓣膜进行比较,将小鼠分为对照组、造模后4周、造模后8周与造模后16周组,从适应性喂养至造模结束取材均给予普通饲料饮食。使用超声检测小鼠心脏短轴缩短率、主动脉瓣膜峰值流速及主动脉瓣口面积,使用苏木素-伊红染色观察小鼠主动脉瓣膜厚度变化及瓣膜组织结构变化,利用茜素红染色检测小鼠主动脉瓣膜钙盐沉积情况,使用免疫荧光方法检测瓣膜成骨相关蛋白碱性磷酸酶表达。结果 小鼠从造模8周后开始出现心脏短轴缩短率明显下降。导管损伤4周、8周、16周后小鼠主动脉瓣膜明显增厚（P=0.002）,4周、8周和16周比较无统计学差异;导管损伤4周、8周、16周后钙盐沉积明显增多（P<0.0001）,4周、8周和16周比较无统计学差异;4周、8周、16周后成骨相关蛋白ALP指标表达量明显升高（P=0.0016）。导管损伤4周、8周和16周ALP表达量相比无统计学差异。结论 在保证小鼠生存率的情况下,导管...     

主动脉瓣置换治疗主动脉瓣膜疾病的临床效果

目的研究主动脉瓣膜置换治疗主动脉瓣膜疾病的临床效果。方法选择2014年1月—2019年1月在皖南医学院弋矶山医院治疗的主动脉狭窄27例与主动脉关闭不全43例患者为研究对象,对主动脉狭窄与关闭不全的患者在全麻体外循环下行主动脉瓣置换手术,采用超声探明患者术前、术后主动脉瓣的情况。结果主动脉狭窄与主动脉关闭不全的患者均无死亡。在随访的6个月中,主动脉狭窄与关闭不全的患者均恢复良好,心功能均有明显改善(P <0.05)。结论主动脉瓣置换治疗主动脉瓣狭窄与主动脉瓣关闭不全有明显的效果,对缓解左心室扩大及恢复心功能有明显的临床疗效。     

Hypertension in aortic valve disease and its response to valve replacement.

We have investigated the prevalence of hypertension and the response of blood pressure to operation in 87 patients with lone aortic valve disease who underwent aortic valve replacement. In patients with aortic stenosis alone 26% were hypertensive pre-operatively (age and sex adjusted blood pressure greater than 160 systolic and or greater than 95 mmHg diastolic) and 24% were hypertensive post-operatively. In those with aortic regurgitation alone, hypertension was present in 65% before and 57% after valve replacement using the same criterion. For combined stenosis and regurgitation, the prevalence was 54% and 62%, respectively. The post-operative increase in systolic pressure in patients with aortic stenosis occurred mainly in those with a history of left ventricular failure. In those with aortic regurgitation or combined stenosis with regurgitation, diastolic pressure rose after valve replacement resulting in a prevalence of diastolic hypertension of 44% and 35%, respectively. Blood pressure changes were not predicted by the type of valve inserted nor its size. Our data show that despite severe symptomatic aortic valve disease, systolic hypertension was common in aortic stenosis and diastolic hypertension was found in aortic regurgitation. This underlines the importance of blood pressure monitoring in patients following aortic valve replacement.     

主动脉瓣狭窄为主联合瓣膜病左心室病理改变与术后恢复的关系

目的 探讨风湿性心脏病主动脉瓣狭窄为主双瓣膜置换手术患者左心室心肌病理改变和手术后恢复的关系.方法 本组患者32例,采用超声心动图对比分析手术前、术后3、6、12个月左心室舒张末内径(left ventricular end-diastolic diameter,LVEDD),左心室射血分数(ejection fraction,EF)、短轴缩短率(fractional shortening,FS),主动脉瓣跨瓣压差(pressure gradient,PG),室间隔厚度(interventricular septal,IVS),左心室后壁厚度(left ventricular posterior wall thickness,LVPW),左心室重量指数(left ventricular mass index,LVMI)等,评估心脏功能恢复情况.术中取患者二尖瓣乳头肌作Massion病理染色,应用多媒体彩色病理图文分析系统测量心肌胶原纤维含量,并与意外死亡成年人乳头肌进行比较.结果 无手术早期死亡,均痊愈出院.手术后随访10～20个月,恢复良好,心脏超声结果显示,PG较术前明显降低(P＜0.01),LVEDD和LVMI也有降低(P＜0.05);EF、FS较术前有改善(P＜0.05),IVS和LVPW与术前比较无差异(P＞0.05).病理结果显示,手术组左心室心肌肥厚明显,心肌细胞肥大,心肌细胞可见空泡样变,Masson染色显示心肌细胞间质胶原纤维增生明显.定量分析手术组左心室肌间质胶原纤维容积比为(18.11±4.32)%,血管周围胶原纤维面积比例为(1.42±0.80)%,正常组分别为(6.31±1.69)%和(0.87±0.31)%,差异均明显(P＜0.05).结论 胶原成分异常沉积所致心肌纤维化是本组风心病主动脉瓣狭窄为主双瓣膜置换手术患者心肌的主要病理改变之一.术后经心脏超声评估心脏功能有改善,但仍不十分满意,可能与左心室心肌纤维化严重有关.     

Systolic time intervals: a review of the method in the non-invasive investigation of cardiac function in health, disease and clinical pharmacology

Measurement of systolic time intervals is a valuable, non-invasive procedure to assess left ventricular performance, particularly when influenced by drugs. In this review, we discuss various factors affecting systolic time intervals, the therapeutic implications of the technique and its place among other non-invasive tests of cardiac function.     

Reoperation on aortic disease in patients with previous aortic valve surgery

Background Aortic valve replacement (AVR) is a safe and effective method in the treatment of aortic valve diseases.This study aimed to increase the understanding on re-treatment of aortic diseases afte...     

二尖瓣及主动脉瓣置换术后心电图变化及心房颤动的影响因素

目的研究二尖瓣及主动脉瓣置换术后病人心电图变化及心房颤动（atrial fibrillation,AF）的影响因素。方法选取行二尖瓣及主动脉瓣置换术病人130例作为研究对象,根据其术后是否发生AF进行分组,观察发生AF组与未发生AF组病人手术前后心电图变化情况,采用单因素与二元logistic回归分析导致发生AF的独立危险因素。结果单因素与二元logistic回归分析结果显示:心功能分级、术前肺动脉收缩压、同期行其他手术、机械通气时间、术后发生肺炎、病人年龄、术后脑钠肽水平是导致病人发生AF的影响因素与独立危险因素（P < 0.01）。AF组心电图指标中QRSd、QTc指标显著高于非AF组（P < 0.01）;QT指标显著低于非AF组（P < 0.01）。AF组病人术后心电图QRS波振幅变化中、S1、S2、S3、R5、R6显著低于非AF组（P < 0.01）。结论二尖瓣及主动脉瓣置换术后病人发生AF病人与未发生AF病人心电图会发生显著变化,心功能分级、术前肺动脉收缩压、同期行其他手术、机械通气时间、术后发生肺炎、病人年龄、术后脑钠肽水平是导致病人发生AF独立危险因素。     

Silent cerebral embolism in patients with rheumatic mitral valve disease

Electroencephalograms were recorded in 71 stroke-free patients suffering from mitral valve disease, complicated by atrial fibrillation in 33. The incidence of EEG abnormalities was not related either to the presence or absence of atrial fibrillation or to the type of valve lesion present, and did not differ significantly from the incidence observed in the general population. The findings suggest that occurrence of symptomatically silent emboli is not a feature of rheumatic mitral valve disease.