141例心脏手术同期施行双极射频迷宫手术治疗心房颤动

目的 探讨心脏手术同期施行双极射频迷宫手术治疗心房颤动(AF)的效果及其影响因素.方法 2006年7月到2008年5月在心脏手术同期施行双极射频迷宫手术141例,回顾性分析和随访,比较手术前后心律、超声心动图等各项指标及心功能变化.结果 术后早期死亡6例.出院135例中,随访129例(95.56%),失访6例.随访3个月～2年,平均(16.79±7.91)个月.随访者中1例1O个月死于心衰,余128例生存.心功能(NYHA)Ⅰ级120例(93.75%),Ⅱ级8例(6.25%).被随访者3个月、6个月和1年以上稳定窦性心律(sSR)分别为69.77%、72.36%和87.14%.超声显示左心房比术前明显缩小,sSR者均出现明显 A 峰波,左心房功能良好.结论 心脏直视手术同期施行双极射频迷宫手术治疗AF安全有效.随着术后时间延长,sSR逐渐增加,AF复发率逐渐降低.老年、AF病程超过5年、左心房内径>60 mm以及中到重度的三尖瓣关闭不全是影响双极射频迷宫手术疗效的危险因素.     

直肠癌保肛手术42例治疗体会

目的　探讨直肠癌的保肛手术方法 ,阐述其合理性。方法　按Dukes分期 ,以Heald等提出的“直肠系膜全切除”(TEM)的原则 ,DukesA期癌下缘切除肠管 >3cm ,B期 >4cm ,C期 >5cm ,术中应保证吻合无张力 ,吻合口部位血运良好。结果　DukesA期 9例 ;B期 2 1例 ;C期 12例。术后局部复发 3例 ,占 7.1% ;吻合口瘘 2例 ,占 5 %。结论　在合理选择适应证的前提下 ,直肠癌保肛手术不会增加术后复发和转移的机会     

心脏瓣膜手术同期微波消融治疗心房颤动的术后护理

对112例风湿性心脏病并发心房颤动(AF)患者行心脏瓣膜手术同期微波消融(RF)治疗,术后密切观察病情变化,做好起搏器的护理、血液循环的监护,胺碘酮的用药监测及并发症的护理等.结果 术后随访2～24个月,100例恢复窦性心律,12例AF复发,治愈率为89.3%.提示术后全方位高质量的护理可提高手术成功率,降低复发率.     

心脏瓣膜手术同期微波消融治疗心房颤动的术后护理

对112例风湿性心脏病并发心房颤动（AF）患者行心脏瓣膜手术同期微波消融（RF）治疗,术后密切观察病情变化,做好起搏器的护理、血液循环的监护、胺碘酮的用药监测及并发症的护理等。结果术后随访2～24个月,100例恢复窦性心律,12例AF复发,治愈率为89.3%。提示术后全方位高质量的护理可提高手术成功率,降低复发率。     

急性重症胰腺炎42例手术治疗体会

急性重症胰腺炎是一种常见且极为凶险的外科急腹症,病情危重,并发症多,死亡率高。目前死亡率仍在３０％～５０％［１］。我院外科自１９８５年１０月至１９９７年９月共收治急性重症胰腺炎４２例。由于医疗设备有限,对重症胰腺炎的诊断只能依靠病人的症状、体征及胰淀粉酶的测定,不能在ＣＴ监护下以非手术治疗渡过急性期。因此,我们强调早期诊断,早期手术的治疗措施,取得了较好的效果。１　临床资料４２例中,男性１８例,女性２４例,最大年龄７２岁,最小年龄１６岁,平均年龄５４岁。死亡９例,病死率２１．４％。早期手术４１例…     

手术治疗直肠前膨出42例临床体会

本文对110例排粪造影病例中明确诊断的42例以直肠前膨出(reclocele,RC)为主要原因的顽固性便秘病例进行了手术治疗,针对RC并存的异常病变,选择了以经阴道修补术为主的综合性术式,有效率达95.2%。通过三年随访,认为对已明确诊断为RC的顽固性便秘患者经保守治疗无效,采用手术治疗可取得良好疗效。     

AO-C型踝关节骨折42例手术治疗体会

自1994年5月至1998年1月我院共收治42例AO-C型踝关节骨折,现将治疗体会报告如下。 1 临床资料 1.1 一般资料 本组中男27例,女15例。年龄17～63岁。左侧24例,右侧18例,三踝骨折8例。开放骨折13例,陈旧骨折(8～13周)3例。伴下胫腓前韧带附丽点骨折2例,腓骨粉碎骨折8例,开放伴骨丢失2例,Maisonneuve骨折1例     

心脏直视手术中双极射频消融治疗心房颤动91例分析

目的 探讨心脏直视手术同期采用双极射频消融技术治疗心房颤动的方法和早、中期疗效.方法 2005年3月至2007年1月共91例心房颤动患者于心脏直视手术同期接受了双极射频消融手术治疗.阵发性心房颤动5例,持续性/永久性心房颤动86例.37例采用AtricureTM干式双极射频消融系统,54例采用CardioblateTM冲洗式双极射频消融系统.消融径线包括标准Cox-mazeⅢ手术、改良Cox Mini.maze手术和单纯左心房迷宫手术.结果 平均射频消融时间(14.1±6.7)min,未发生与消融有关的并发症.围手术期死亡3例.术后2例患者安装永久起搏器,1例患者发生脑卒中及下肢动脉栓塞.随访6～29个月,双极射频消融组在术后6、12及12个月以上的成功率均高于单极射频消融组.截至末次随访,阵发性心房颤动组的非心房颤动心律为100%,持续性/永久性心房颤动组为75.3%.AtricureTM组与CardioblateTM组间,以及3种射频消融路径组间的成功率无差异.结论 双极射频消融技术实施简便、安全,耗时短,疗效满意,是一种更为先进的手术方法.     

心可舒联合乙胺碘呋酮治疗冠心病快速心房纤颤45例

目的：探讨心可舒联合乙胺碘呋酮治疗冠心病快速心房纤颤的临床疗效。方法病例选自我院2011年12月~2013年12月收治的冠心病快速心房纤颤患者共90例,分为两组,其中对照组（n=45）单纯给予乙胺碘呋酮治疗,观察组（n=45）采取心可舒联合乙胺碘呋酮治疗,观察并比较两组临床治疗效果及不良反应发生情况。结果观察组总有效率为91.11%,显著高于对照组的77.78%,两组比较差异有统计学意义（P＜0.05）;观察组不良反应发生率为6.66%,显著低于对照组的26.67%,两组比较差异有统计学意义（P＜0.05）。结论心可舒联合乙胺碘呋酮治疗冠心病快速心房纤颤疗效确切,可有效控制心室率,改善临床症状,且不良反应发生率低,安全性好,具有较好的临床应用价值。     

Body mass index predicts new-onset atrial fibrillation after cardiac surgery

Objective: New-onset postoperative atrial fibrillation (POAF) after cardiac surgery is associated with increased morbidity and mortality. Since obesity is becoming increasingly prevalent, identifying body mass index (BMI) as a risk factor for POAF could be of importance. The aim of our study is to investigate the effect of BMI on POAF, independent of other risk factors. Methods: We analyzed data of 6788 men and 2560 women who underwent coronary artery bypass grafting, valve surgery, or a combination of both, and who had no history of atrial fibrillation. Men and women were analyzed separately because risk factors of POAF were expected to be distributed unequally over both sexes. Results: The independent effect of gender was analyzed in a combined model. POAF occurred in 2517/9348 (27%) of patients. Multivariate logistic regression analyses showed that BMI (odds ratio (OR) 1.03; 95% confidence interval (CI): 1.01–1.04; p < 0.001 in men and OR 1.03; 95% CI: 1.02–1.05; p < 0.001 in women), age (OR 1.06; 95% CI: 1.05–1.07; p < 0.001 in men and OR 1.05; 95% CI: 1.04–1.06; p < 0.001 in women), valve surgery compared to coronary surgery (e.g., mitral valve surgery compared to coronary artery bypass grafting: OR 3.4; 95% CI: 2.4–4.6; p < 0.001 in men and OR 2.9; 95% CI: 2.0–4.3; p < 0.001 in women) and male gender (OR 1.23; 95% CI: 1.09–1.38; p = 0.001) were the only independent risk factors for POAF, whereas chronic obstructive pulmonary disease, hypertension, off-pump coronary artery bypass grafting, extra corporal circulation time, and transfusion of blood products were not. Conclusion: Body mass index, age, undergoing valve surgery and male gender, are independent risk factors for POAF.     

慢性心房颤动合并二尖瓣病的迷宫手术

作者自１９９５年至１９９６年１０月共作２０例慢性心房颤动的迷宫手术和二尖瓣替换或修复术。术吣外膜标测结果左房多为扑（１４／２０）,右房则往往是颤动（１８／２０）。无早期死亡。２０例随访３个月以上,其中１４例随访在１年以上,经电生理检查均为窦性心率,房室同步活动,不能诱发房颤;经多普勒超声心动图检查,左和右心房输出功能正常。晚期死亡１例,手术后４年半月死于急性坏死性肝炎,对迷宫手术作了一些改进,术后     

改良线路心房直视迷宫式射频消融治疗心房颤动

目的：探讨风湿性心脏病合并心房颤动（房颤）病人,在瓣膜置换同时采用改良线路经心房直视迷品式射频消融治疗房颤的可行性及疗效。方法：66例风湿性心脏病二尖瓣病变合并房颤病人,在体外循环心内直视下经心房行迷宫式射频消融,同时行二尖瓣置换术,结果：无手术死亡,57例房颤消失,其中术后窦性心律54例（81．8％）,结性心律1例（1．5％）,心房扑动2例（3％）,9例（13．6％）仍为房颤,随访2－60个月,总随访率89．6％,窦性心律稳定,无远期死亡,结论：经心房内视改良线路迷宫式射频消融治疗房颤,方法简捷,安全有效,远期疗效稳定,值得进一步研究,推广。     

New onset postoperative atrial fibrillation and early anticoagulation after cardiac surgery

Objectives. New onset postoperative atrial fibrillation (POAF) after cardiac surgery is associated with increased risk for thromboembolic complications. Compliance with anticoagulation treatment is prerequisite for successful outcome after POAF. We hypothesized that a disciplined anticoagulation protocol initiated instantly after POAF secures a long-term outcome. Design. A total of 519 consecutive patients undergoing cardiac surgery were retrospectively analyzed. Patients received anticoagulation using warfarin whenever POAF lasted longer than five min. Postoperative outcome including mortality, myocardial infarction and stroke were compared with patients on sinus rhythm (non-POAF). Results. Mean age of the study cohort was 64.3?±?9.0 years and median follow-up time was 76 months. There were 177 (34%) POAF and 342 (66%) non-POAF patients. At discharge, 144 (81%) POAF patients complied with warfarin, while 82 (24%) non-POAF patients received warfarin for non-rhythm causes (p?p?=?.03). After adjustment for comorbidities, major adverse clinical events (MACE)- including a combination of late cardiovascular mortality, myocardial infarction, stroke and late atrial fibrillation- was independently associated with POAF (OR 2.73, 95%CI 1.69-4.45, p?Conclusions. POAF after cardiac surgery was associated with high risk of MACE. Early anticoagulation may be justified in POAF patients to secure a long-term outcome after cardiac surgery.     

CHADS2 score predicts atrial fibrillation following cardiac surgery

Background

Atrial fibrillation (AF) following cardiac surgery portends higher morbidity and increased health expenditure. Although many anatomic and patient risk factors have been identified, a simple clinical scoring system to identify high-risk patients is lacking. The CHADS₂ score is widely used to predict the risk of stroke in patients with AF. We assessed the utility of this scoring algorithm in predicting the development of de novo postoperative atrial fibrillation (POAF) in cardiac surgery patients.

Material and methods

A total of 2120 patients from 2008 to 2013 were identified for inclusion in our analysis. CHADS₂ scores were calculated, and patients grouped into low- (0), intermediate- (1) and high-risk (≥2) categories. A multivariate regression model was developed to account for known risk factors of AF.

Results

Of the 2120 patients, 344 (16.2%) patients developed de novo POAF during their primary hospitalization. Mean CHADS₂ scores for POAF patients and no POAF patients were 2.1 ± 1.2 and 1.7 ± 1.3 (P < 0.0001), respectively. CHADS₂ score was a significant predictor of AF on multivariate regression analysis (adjusted odds ratio, 1.26; 95% confidence interval, 1.14–1.40). As CHADS₂ score increased from 0 to 6, the probability of POAF increased from 11.1% to 32.7% (P < 0.0001). Compared with the low-risk group, the intermediate-risk and high-risk groups had a 1.73- and 2.58-fold increase in odds of developing POAF, respectively (P < 0.02 and P < 0.0001).

Conclusions

CHADS₂ score is a powerful and convenient predictor of developing POAF. We recommend its utilization in identifying high-risk patients that may benefit from pharmacologic prophylaxis.     

胸腔镜辅助下微创射频消融手术治疗心房颤动临床分析

目的 探讨胸腔镜辅助下微创射频消融手术治疗心房颤动的技术和早期疗效.方法 2006年12月至2007年10月,共有57例心房颤动患者接受了胸腔镜辅助下微创心脏手术,其中男性40例,女性17例,平均年龄56.4岁,术前心房颤动病史(5.7±4.5)年.本组阵发性心房颤动38例,持续性心房颤动7例,长期存在的持续性心房颤动12例;3例患者曾行导管消融治疗,2例已安置永久性起搏器.所有患者均在胸腔镜辅助下实施双侧肺静脉前庭射频消融隔离、心外膜部分去迷走神经化治疗、左心耳切闭(Wolf Mini-maze手术);并在消融前后行心外膜电生理标测.结果 本组患者平均手术时间3.5 h;术中发现左心房血栓1例,1例患者同期行心外膜的心脏同步化手术.无围手术期死亡;1例术后并发急性呼吸功能不全,1例并发急性心功能不全.共16例患者术后及随访期间行胸外直流电复律治疗;全组患者出院时、术后1、3及6个月窦性心律的比例分别为78.9%(45/57)、64.3%(36/56)、83.9%(47/56)和87.0%(20/23);术前阵发性心房颤动患者则为84.2%(32/38)、67.6%(25/37)、86.5%(32/37)和89.5%(17/19).全组随访1～10个月无血栓及栓塞事件发生.结论 胸腔镜辅助微创心脏外科手术主要适用于阵发性心房颤动患者,其早期疗效理想,创伤小,安全性高.     

Incidence and predictors of perioperative atrial fibrillation in burn intensive care unit patients following burn surgery

BackgroundAtrial fibrillation is a well-documented complication following cardiac surgery. It is associated with increased inpatient and long-term mortality. There have been few prior studies on perioperative atrial fibrillation following burn surgery in severely burned patients. The purpose of this study was to identify the incidence, predictors, and prognosis of perioperative atrial fibrillation after burn surgery in severely burned patients.MethodsPatients aged older than 18 years with 30% burned total body surface area (TBSA) were enrolled in this study. Patients who had a previous history of atrial fibrillation or atrial fibrillation on the preoperative electrocardiogram were excluded. ?We reviewed medical records retrospectively, and the data of 214 patients were studied.ResultsA total of 214 critically ill burned patients and 1132 operations were available for analysis during the 5-year study period; 12 (1.1%) patients were diagnosed with newly developed atrial fibrillation after a burn operation, of whom 4 patients showed paroxysmal atrial fibrillation (all related to surgical stimulation) and none changed to persistent atrial fibrillation. The incidence of perioperative atrial fibrillation was associated with TBSA%, full-thickness TBSA%, and hypertension. Multiple logistic regression analysis indicated that TBSA% (OR=13.851, P < 0.001) and full-thickness TBSA% (OR=15.223, P = 0.018) were independent predictors for developing perioperative atrial fibrillation. All of our patients had at least one risk factor, with blood volume variation or burn sepsis occurring most commonly. Perioperative atrial fibrillation developed after a median of 0 days after burn surgery. Three patients died, and the causes of death were noncardiovascular events such as sepsis and multiple organ failure.ConclusionAtrial fibrillation was a relatively rare complication among severely burned patients admitted to surgery and was associated with TBSA% and full thickness TBSA%. All of our patients exhibited at least one of the modifiable risk factors for atrial fibrillation, confirming the importance of optimization of electrolytes and fluid status and limitation of sympathetic activation.     

小剂量胺碘酮预防冠状动脉旁路移植术后心房纤颤

目的 评价小剂量胺碘酮对冠状动脉旁路移植术后心房纤颤的预防效果、耐受性和安全性。方法 对1998至1999年235例冠状动脉旁路移植术后病人进行回顾性研究分析，其中对照组155例予常规药物，试验组80例合用小剂量胺碘酮。结果 常规药物治疗组21．93％出现心房纤颤，而小剂量胺碘酮预防用药组10％出现心房纤颤(P=0．024)。小剂量胺碘酮致心律失常3例，无甲状腺及肺部并发症发生。结论 预防应用小剂量胺碘酮能明显降低术后心室率，减少心房纤颤发生率，延迟发作，缩短持续时间，促进心房纤颤转复，同时改善心功能。小剂量胺碘酮毒副作用低于大剂量胺碘酮，尤其适用于缺血性心脏病合并心肌梗死及左心功能不全者。     

Bariatric surgery reduces incidence of atrial fibrillation: a propensity score–matched analysis

Background

Obesity is associated with an increased risk of atrial fibrillation (AF). Bariatric surgery results insubstantial long-term weight loss and the amelioration of several chronic comorbidities. We hypothesized that weightreduction with bariatric surgery would reduce the long-term incidence of AF.