心内畸形合并降主动脉缩窄一期矫治1例

病儿 男，13岁。自幼发现心脏杂音，活动后心悸、胸闷2个月。查体口唇无发绀；血压：右上肢134／71mmHg（1mmHg=0．133kPa），左上肢109／63mmHg，右下肢99／56mmHg，左下肢91／67mmHg。胸骨左缘3、4肋间可闻及3／Ⅵ级收缩期喷射样杂音，主动脉瓣听诊区可闻及3／Ⅵ级舒张期哈气样杂音。心电图示左心室肥大伴劳损。心脏彩色超声和大血管磁共振（MRA）检查见干下型室间隔缺损（VSD）1．0cm，主动脉瓣右冠瓣脱垂伴中度关闭不全，降主动脉起始处内径缩窄，最窄处约0．6cm。     

动脉导管未闭合并感染性心内膜炎一例

患者 女，25岁。因反复发热3个月，胸痛2个月入院。3个月前反复出现发热，体温高达40℃，伴寒颤，乏力。在外院给予抗生素治疗，仍反复发热。2个月前出现左胸疼痛，呈刀割样，深呼吸加重。于2007年5月20日入院。入院查体：体温37．5℃，脉搏112次／分，贫血面容，眼结膜略苍白，颈静脉怒张，肝颈静脉回流征阳性。胸骨左缘第2肋间触及震颤，闻及连续性机械样杂音，心尖部可闻及2／6级收缩期吹风样杂音，胸骨左缘第4～5肋间可闻及3／6级吹风样杂音，闻及第3心音奔马律。肝大、肋下5cm。脾大，甲乙线5cm，甲丙线6cm，     

镶嵌治疗成人室间隔缺损合并动脉导管未闭、主动脉缩窄1例

病人男，3-4岁。发现心脏杂音17年，活动后心悸3个月。入院查体：上肢血压160/65mm hg（1 mm Hg=0．133kPa），下肢血压118／45 mm Hg只。胸骨左缘第4肋间可闻及3/Ⅵ级吹风样收缩期杂音，左缘第2肋间可闻及连续性机械样杂音。胸部X线正侧位片示双肺纹理增多，肺动脉段稍突出。心电图示T波改变。超声心动图示室间隔上部回声中断约5mm，左室壁向心性肥厚。     

房间隔缺损心包补片修补术后发现右心房间皮瘤一例

<正>临床资料患者,女,6年前因"活动后心悸、气促、咳嗽1个月余"来诊,查体心界稍向左扩大,心律齐,A2=P2,胸骨左缘第2、第3肋间可闻及2/6级柔和的收缩期吹风样杂音,胸骨左缘第4肋间闻及3/6级收缩期杂音。心脏彩色超声心动图提示右心房、右心室扩大,房间隔回声中断,缺损约29.4 mm;彩色多普勒探及经房间隔缺损左向右分流频谱,分流速度约0.88 m/s,三尖瓣口大量反流。患者在气管内插     

右侧并列心耳合并房间隔缺损、室间隔缺损一例

患者女。10岁。出生后发现心脏杂音，诊断为先天性心脏病收入院。入院后查体：心尖搏动位于第5肋间左锁骨中线外1．5cm．全心扩大，胸骨左缘第2～4肋间可闻及3／6级收缩期喷射性杂音，伴细震颤，P2亢进、固定分裂。胸部X线片示：全心扩大，双肺充血。肺动脉段明显突出。心脏超声心动图提示：房间隔缺损（ASD）29．7mm，室间隔缺损（VSD）11mm，肺动脉高压。     

肺动脉起源右冠状动脉合并室间隔缺损一例

肺动脉近端狭窄并起源于右冠状动脉十分罕见，现报告一例如下。患者男，５岁。哭闹及活动后口唇青紫５年，不喜蹲踞。查体：口唇及皮肤中度紫绀，轻度杵状指，胸骨左缘３、４肋间可闻及３／Ⅵ级收缩期杂音，胸骨左缘第２肋间可闻及２／Ⅵ级连续性机器样杂音，Ｐ２消失，肝...     

双向Glenn手术治疗成人先天性三尖瓣狭窄合并肺动脉瓣狭窄卵圆孔未闭一例

患者男,20岁.出生后不久发现心脏杂音,口唇、甲床紫绀,活动后心悸、气促,双下肢水肿.查体:血压100/60 mmHg,发育欠佳,口唇紫绀,颈静脉充盈明显,胸骨左缘第2、3肋间可闻及4/6级收缩期杂音, 胸骨左缘第5肋间可闻及舒张期杂音,肺动脉瓣区第2心音不亢进.肝肋下4cm,轻度杵状指、趾,甲床轻度紫绀.     

三房心合并二、三尖瓣关闭不全冠状静脉窦畸形一例

三房心合并二、三尖瓣关闭不全冠状静脉窦畸形一例石凤梧张天舒谢英奎周文秀陈立华患者男，１５岁。胸骨左缘第２、３肋间可闻及Ⅲ级收缩期吹风样杂音，胸骨左缘第４肋间可闻及Ⅱ级收缩期吹风样杂音，心尖部可闻及Ⅲ级收缩期吹风样杂音及Ⅱ级舒张期隆隆样杂音。１９９４年...     

室间隔缺损合并右室流出道室性早搏二例

病例1男，7岁。以发现心脏杂音7年为主诉入院，心脏听诊：胸骨左缘第3、4肋间闻及3／6级收缩期喷射性杂音，心律不齐，频发早搏。彩色超声心动图提示：室间隔膜部缺损（缺损6mm）。心电图示：频发室性早搏。24h动态心电图示：室性早搏总数20288次／24h；室性早搏二联律743阵／24h；室性早搏三联律518阵／24h，动态心电图及体表心电图证实为单形性右室流出道室性早搏。     

法洛四联症合并冠状动脉畸形及左侧膈疝一例

患者男，2．4岁，体重15kg。出生后6个月哭闹时出现口唇紫绀。此后，病情渐加重。查体：口唇、甲床中度紫绀，胸骨左缘第2～4肋间可闻及3／6级收缩期杂音；左肺未闻及呼吸音。心脏彩色超声心动图提示：主动脉骑跨于室间隔缺损之上，右心室肥厚，右心室流出道狭窄。临床诊断：法洛四联症。胸部CT、胸部x线片和钡剂灌肠均提示左侧先天性膈疝（图1）。脉搏血氧饱和度0．72。     

Aortic arch advancement: the optimal one-stage approach for surgical management of neonatal coarctation with arch hypoplasia

BACKGROUND: The optimal surgical treatment for neonatal coarctation with aortic arch hypoplasia (NCoAo/AAH) is controversial. Important long-term concerns include arch growth. We report our results obtained with a one-stage radical approach of coarctectomy and aortic arch advancement for NCoAo/AAH. METHODS: From June 1995 to December 2000, 65 newborns with NcoAo/AAH underwent coarctectomy and aortic arch advancement via a median sternotomy under deep hypothermic circulatory arrest. Patients were classified by diagnosis: group 1, isolated NCoAo/AAH (n = 13); group 2, NCoAo/AAH with ventricular septal defect (n = 20); and group 3, NCoAo/AAH with complex cardiac lesions (n = 32). RESULTS: The study population included 36 boys and 29 girls. Mean age was 13 +/- 1.7 days (range 1 to 43 days). Mild to moderate left ventricular outflow tract obstruction was present in 15 patients. Mean body weight was 3.4 +/- 0.1 kg (range 1.6 to 5 kg). Eight babies were premature. The mean Z value for the aortic arch was -4 +/- 0.3 (range -2 to -4.5) and for the isthmus -4.5 +/- 0.2 (range -3 to -7). Mean deep hypothermic circulatory arrest time was 28 +/- 2 minutes (range 14 to 60 minutes). Mean intensive care unit stay was 6 +/- 1 days (range 2 to 30 days). There were three early deaths (all in groups 2 and 3) and two late deaths (in group 3) (5-year actuarial survival, 91% +/- 7.9%). There was one recurrence (5-year actuarial freedom from recurrence, 98% +/- 4%). Peak Doppler velocity across the arch in the remaining patients was 1 +/- 0.1 m/s (range 0 to 2.2 m/s). CONCLUSIONS: Coarctectomy and aortic arch advancement is the optimal surgical method for management of NCoAo/AAH. It has low operative morbidity and mortality and a very low incidence of recoarctation or arch obstruction.     

Involvement of Spinal Cord Nuclear Factor kB Activation in A Rat Model of Persistent,Postoperative Pain Evoked by Skin/Muscle Incision and Retraction （SMIR）

Background： Persistent postoperative pain is common but the pathogenic mechanisms underlying it are under debate. Recent studies have implicated the activation of nuclear factor kappa B （NF-kB） in spinal for development of neuropathic and inflammatory pain. Aims： The aim of the present study was to investigate whether NF-kB also mediates hyperalgesia in persistent postoperative pain and potentially the pathogenesis of postoperative pain, by measuring NF-kB levels and assessing the anti-allodynic effect of NF-r.B inhibition by pyrrolidine dithiocarbamate （PDTC） in rats after skin/muscle incision and retraction （SMIR） injury. Methods： After rats received a SMIR surgery, mechanical allodynia were determined by von Frey filaments, and NF-kB p65 in the spinal cord was quantified to determine the level NF-KB expression at different time points after SMIR by western blotting. The NF-kB inhibitor PDTC was administered intrathecally at day 1 after surgery and then daily for 7 days to determine the role of NF-KB in postoperative pain, Results： A significant increase in level of NF-kB p65 was observed in the spinal cord from day 1 to day 7 after SMIR, Intrathecal injection of PDTC attenuated SMIR-induced mechanical allodynia from day 3 to day 12. Conclusions： SMIR-induced mechanical allodynia can be partially reversed by the NF-kB inhibitor. Our results suggest that NF-r.B activation in spinal cord plays a role in SMIR-induced mechanical allodyuia in rats. Therefore, NF-kB inhibition may be useful but not sufficient for the therapeutic control of postoperative pain,     

Local infiltration analgesia following total hip replacement: a review of current literature

Controlling postoperative pain after total hip replacement is important and controversy remains regarding different regimens.By reviewing 18 studies,we attempt to find whether local infiltration analgesia after total hip replacement has any effect on postoperative pain,length of hospital stay and opioid consumption.We conclude that local infiltration analgesia is an effective method for decreasing postoperative pain.     

动态血糖监测仪及胰岛素泵临床应用中的持续质量改进

目的探讨持续质量改进（CQI）对提高患者使用动态血糖监测系统（CGMS）、胰岛素泵（CSII）护理质量的作用。方法选择2007年4～12月305例糖尿病患者为对照组,按照常规方法在公司业务员指导下,讲授仪器的结构、工作原理和操作步骤。护士现场学习,护士长和骨干护士重点学习全部操作,然后在科室推广应用。以2008年4～12月308例糖尿病患者为观察组,以CQI理论为指导,制订内分泌专科分层次的培训计划,制定各种操作规范并由护士长全程监督控制。结果改进后护士理论、操作考核成绩比改进前显著提高（均P〈0．01）;观察组中使用CSII的患者对护士安装仪器、故障处理和观察巡视的满意度较对照组显著提高（P〈0．05,P〈0．01）;观察组使用CGMS者仪器电缆线折断、局部皮肤炎症发生率显著低于对照组（均P〈0．05）。结论持续质量改进有助于护士业务技能的提高,为糖尿病患者的治疗、监测提供保证,提高了护理质量。     

钢丝固定治疗胫骨髁间隆突骨折

2000年8月～2005年12月，我科采用钢丝固定治疗胫骨髁间隆突骨折患者30例，疗效满意。     

手法复位治疗全髋置换术后的关节脱位

2006年8月～2007年1月，笔者对15例行全髋置换术后脱位患者给予手法复位治疗，取得较满意效果。 1材料与方法 1．1病例资料本组15例，男5例，女10例，年龄63～81岁。患者均为全髋关节置换术后6～9个月出现患肢短缩，略有屈曲、大转子上移、外突、肢体内收、内旋。摄X线片均未见假体周围骨折（见图1A）。     

2009年心胸血管麻醉热点问题

全文汇总了2009年心胸血管麻醉领域权威性和学术性较高的临床研究资料．对去年本专业相关热点问题进行了概括性介绍。杂交手术室是心外科、心血管麻醉和心内科介入治疗三种专业人员进行经导管治疗的场所．经导管行主动脉瓣膜置换术的开展证明人们对腔内治疗技术变革的认同。通过药物预处理和缺血预处理实施的心肌保护具安全、有效的临床特点．因此它们是目前多项临床试验关注的重点。血管紧张素抑制、贫血以及内窥镜取大隐静脉技术可对冠状动脉旁路移植术（CABG）的预后造成不良影响。不停跳CABG与停跳cABG的临床预后对低风险患者等同．但后者有利于改善高风险患者预后。经皮冠状动脉介入治疗（PCI）能明显降低心肌梗死患者的病死率．然而主动脉内球囊反搏技术对此类患者的有效性证据却不尽如人意。普拉格雷已被批准用于PCI后的血小板抑制．但有可能被替卡格雷取代。PCl与CABG技术对冠脉血管多支病变患者临床预后的影响相似．但CABG对降低患者行再血管化治疗可能性．对耱尿病和年龄〉65岁患者术后生存率的提高更有益。羟乙基淀粉和N-乙酰半胱氨酸都能够增加心脏手术患者围术期出血量和输血量。Vll因子能够治疗致命性出血．但它的安全性有待进一步论证。具有够刺激血小板生成作用的血小板生成紊拟肽等药物可能在未来改善心脏手术后止血功能方面发挥作用。非诺多泮、心房利钠肽以及碳酸氢钠的肾保护作用有待进一步试验证实。强化胰岛素治疗并无改善临床预后作用．却明显增加低血糖的发生率。     

Surgery for aortic coarctation: a 30 years experience

Objective: A retrospective study to review the experience of a single center with surgery for aortic coarctation over a period of 30 years (1970–1999). Methods: Criteria for inclusion: (a) aortic coarctation, isolated or associated with congenital heart defect; (b) surgery between 1970 and 1999. Data recorded: (1) date of surgery; (2) age at surgery; (3) associated lesions; (4) surgical technique; (5) simultaneous surgical procedures; (6) early and late surgical results in term of: (a) deaths; (b) need for reoperation because of re-coarctation or other cardiac lesion; (c) residual/recurrent pressure gradient, evaluated at cuff/Doppler at rest; (d) systemic hypertension, requiring medical treatment. Results: One hundred and forty-one patients underwent surgery for aortic coarctation: 30 neonates, 29 infants, 45 children and 37 adults. Associated lesions were found in 8/37 (=21.6%) adults and in 73/104 (=70.1%) pediatric patients. There were no hospital deaths. During the follow-up there were one late death in the adults group (1/37=2.7%) and three late deaths in the pediatric group (3/104=2.9%), all unrelated with aortic coarctation. Re-operation because of re-coarctation occurred only in ten late survivors of the pediatric group (10/101=9.9%), 9/10 operated on before 1980 (P<0.00001). End-to-end anastomosis, enlarged to the aortic arch in neonates, was associated with the lowest incidence of re-coarctation (P<0.005). A significant (>20 mmHg at rest) pressure gradient was found in none of the adults, and in seven of the 91 pediatric patients (7/91=7.7%) late survivors. Three adults (3/36=8.3%) late survivors are on medical treatment to control systemic hypertension. Conclusions: The long-term results of our retrospective study confirm that surgery has to be considered the gold standard for the treatment of aortic coarctation. The interventional angioplasty techniques have to provide long-term outcome at least similar to the results obtained with surgery.