微创心脏外科的进展

微创心脏外科(m in im ally invasive card iac surg-ery)是最近10年来在心脏外科发展史上的一个新技术。它不同于50余年来经典的心脏外科,正中开胸、纵劈胸骨进行心外或采用体外循环的心内直视手术,而是采用小切口并借用各种特殊的手术工具进行某些心脏手术。最早也是最多使用小切口进行心脏手术的是冠状动脉旁路移植术,之后有利用股动脉、股静脉插管进行体外循环,使微创心脏外科也能满足某些心内直视手术,如心脏瓣膜外科、升主动脉外科和先天性心脏病手术的要求。医学工业为微创心脏外科的蓬勃发展产生了很多相关的专业领域。从暴露心脏采…     

微创心脏手术中排气研究

目的探讨微创心脏手术中的排气技术，并评价排气效果。方法选取复旦大学附属中山医院2011年6月至2013年6月收治的56例行微创心脏手术患者为微创组，男31例、女25例，年龄33～7l（57-3±7．2）岁；同期56例行常规胸骨正中切口心脏二尖瓣成形术患者为对照组，男27例、女29例，年龄51～69（53．7±6,8）岁。比较两组患者术后心腔内残留气泡量、心电图异常发生率、术后清醒时间、术后思维能力及脑部并发症发生率等指标。结果微创组心腔内残留气泡量少量占69．6％、中量占30．4％，对照组少量占73．2％、中量占26．8％，两组差异无统计学意义（P〉0．05）。微创组心电图异常发生率与对照组差异无统计学意义（32．1％VS．26．8％，P〉0．05）。微创组术后思维能力评价好85．7％、中12．5％、差1．8％，对照组好78．6％、中19．6％、差1．8％，两组差异无统计学意义（P〉0．05）。两组脑部并发症发生率差异无统计学意义（1．8％vs．1．8％，P〉0．05）。结论采取一系列心脏排气措施可使微创心脏手术的空气栓塞发生率与胸骨正中切口手术相似，在空气栓塞并发症方面无需承担更高的风险。     

Fundamentals of Anaesthesia, 2nd Edn.

The first edition of this basic textbook appeared in 1999. Itwas reprinted in 2000 and a second edition has now been publishedonly 3 years later. These facts alone vouch for its popularity. The basic format of the book is unchanged, with Section 1being devoted to clinical anaesthesia, including clinical anatomy.Section 2 covers physiology, with an extra chapter on neonatalphysiology, and new chapters on neurology and endocrinology.Section 3, pharmacology, has been updated and now     

Minimally Invasive Cardiac Surgery: Current Status and Perspective

Recently, the minimally invasive approach has become a growing aspect in the field of cardiac surgery with the goal of eliminating cardiopulmonary bypass (CPB) and/or median sternotomy. In coronary bypass surgery, the application of this approach is direct anastomosis, primarily of the left internal thoracic artery to the left descending coronary artery under a beating condition without the use of CPB through a small left thoracotomy minimally invasive direct coronary artery bypass (MIDCAB). In the repair of intracardiac lesions, CPB cannot be excluded, but a small right parasternal incision or small partial sternotomy (ministernotomy) has been applied for congenital defects and mitral and aortic valve lesions. With technological advances in CPB, these approaches may become more popular in the near future.     

Anaesthesia OSCE. 2nd Edn

Anaesthesia OSCE has been written as an aid for candidates preparingfor the Primary FRCA examination. The second edition of thisbook has been extensively revised with the addition of new material.In OSCEs, candidates are required to apply their knowledge toanswer questions clearly and concisely. This book enables themto practice answering realistic OSCE     

微创小切口心脏瓣膜手术134例

目的总结经微创小切口行心脏瓣膜手术的临床经验,探讨手术径路、方法、效果以及可能的危险因素。方法采用微创小切口行心脏瓣膜手术134例,其中经胸骨旁切口行主动脉瓣置换术5例,二尖瓣置换术2例;经右胸前外侧切口行二尖瓣手术46例,单纯三尖瓣手术15例;经胸骨上段小切口(反Z字形)行主动脉瓣置换术11例;经胸骨下段劈开加横断右半胸骨(倒L形)切口行二尖瓣手术55例。结果术后早期死亡3例,其中2例死于低心排血量综合征和右心功能不全,1例死于急性肝、肾功能衰竭。随访114例,随访时间2个月~7年,术后6个月患者的心功能均有不同程度的改善,切口疤痕隐蔽,复查心脏彩色超声心动图显示心瓣膜功能良好。结论微创小切口行心脏瓣膜手术可行,避免了完全劈开胸骨,维持胸廓的完整性,减少损伤,相对美观,有利于患者术后的恢复。     

Impact of Sarcopenia on Outcomes of Minimally Invasive Cardiac Surgery

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