婴儿完全性肺静脉异位连接外科治疗

目的 总结23例婴儿完全性肺静脉异位连接(total anomalous pulmonary venous connection,TAPVC)的外科治疗经验.方法 全组均在中度低温体外循环下进行手术,其中急诊手术6例.患儿平均年龄(5.7士3.6)个月,平均体重(5.85±1.5)kg.心上型11例采用双房径路矫治并结扎垂直静脉,用可吸收缝线吻合肺静脉共干与左心房后壁切口;心内型12例,仔细辨认合并三房心畸形,避免损伤传导系统.均采用心包补片修补扩大的房间隔缺损.结果 手术早期死亡2例(死亡率8.7%).18例随访2个月～3年,患儿心功能明显改善,生长发育正常.结论 TAPVC可由超声心动图确诊,应尽早手术矫治.对于新生儿或婴儿期反复出现肺炎、低氧血症、心衰等患儿,在临床症状相对改善的情况下应急诊手术;同时加强体外循环和监护室的密切协作,完善术后处理方法.     

慢性中重度缺血陛二尖瓣关闭不全的外科治疗及中期随访

Objective To compare the results of mitral valve reconstruction and replacement as treatments for moderate to severe ischemic mitral regurgitation(IMR), and report the mid-term outcome. Methods From June 2002 to May 2008, 83 pa-tients with moderate IMR(35 cases) and severe IMR (48 cases) underwent coronary artery bypass grafting(CABG) combined with mitral valvuloplasty (MVP) (n = 43) or mitral valve replacement (MVR) (n = 40). There were 49 males and 34 females with a mean age of (59.3±7.5) years(51 -77years). The procedures of MVP included annuloplasty with a Dacron or autologous per-icardium ring in 21cases, commissural annuloplasty in 9, quadrangular resection of the posterior leaflet in 9 and using St. Jude mitral annuloplasty ring in 4. In the cases underwent MVR, 28 patients received mechanical prostheses and 12 received biopros-theses. Results 30-day mortality rate was 2.3% for MVP and 5.0% for MVR (P >0.05). The 30-day complication rate was similar for the 2 groups but mechanical ventilation time was longer for MVR patients. Mild MR ocurred in 6 patients with MVP (P <0.05). Sevonty-six patients were followed by outpatient department visit or telephone for (20.2 ± 4.9) months (3 - 60 months). During the follow-up period, 7 patients with MVP had mild insufficiency but free off etber complications. All the valve prothesis functioned well. However, 3 cases had thromboembolic complications and 7 late deaths were recorded in MVR group. Five-year complication-free survival rate was 90% for MVP group and 61% for MVR. Conclusion MVP resulted in excellent durability and provided significant mid-term survival benefit over MVR. MVP should be the first choice for patients with chronic IMR.     

磁性靶向材料介导骨髓间充质干细胞经静脉移植修复梗死心肌

目的探讨用磁性靶向材料介导骨髓间充质干细胞（MSCs）经静脉移植时到达心肌梗死部位的程度以及对心肌梗死修复的影响。方法取体外扩增的第4代MSCs，先测定MSCs的表面标记，用含10μmol的5-氮杂胞苷诱导后，将MSCs细胞核DAPI（4，6-联脒-2-苯基吲哚）染色后备用移植。将28只SD大鼠分为3组，A组：10只，磁性靶向材料和MSCs接触结合后经大鼠尾静脉移植，将磁石接触心肌梗死部位皮肤表面30min后继续饲养；B组：9只，未与磁性靶向材料结合的MSCs经大鼠尾静脉移植；C组：9只，将MScs直接移植心肌梗死部位。于移植2d后检查MSCs在梗死部位聚集的情况，30d后检查心肌梗死部位的功能及形态的改变。结果在透射电子显微镜下观察可见3～5个磁性靶向材料分子和MSCs的细胞膜结合。A组MSCs归巢率为38％，B组6％，C组53％，A组和C组聚集MSC数目明显多于B组（P〈0．01）。A组和C组移植后左心室射血分数（LVEF）、左心室短轴缩短率（LVFS）较移植前明显改善（LVEF46％±6％VS．38％±8％，51％±5％ vs．35％±4％；LVFS28％±6％vs．20％±7％，32％±4％vs．20％±5％，P〈0．05）；光学显微镜下观察梗死心肌内均可找到标记DAPI的移植细胞。B组移植后左心室收缩功能各项指标无明显改善，光学显微镜下在梗死心肌内未找到标记了DAPI的移植细胞（MSCs归巢率为38％）。C组与A组结果比较差异无统计学意义，但实验过程中死亡率较高。结论磁性靶向材料介导MSCs经静脉移植方法能聚集更多的MSCs于梗死心肌部位，减小梗死区面积，有效改善心肌梗死后的心功能。     

心脏移植术后体外膜肺氧合支持一例

体外膜肺氧合(ECMO)是一种可暂时性替代心肺功能的新型抢救技术,已被成功用于多种心脏围手术期循环、呼吸支持.心脏移植术后ECMO支持国内报道罕见[1].我院于2006年12月15日为1例扩张性心肌病患者实施原位心脏移植,术后ECMO支持5 d使受者存活.现将本例报告如下.     

慢性中重度缺血陛二尖瓣关闭不全的外科治疗及中期随访

Objective To compare the results of mitral valve reconstruction and replacement as treatments for moderate to severe ischemic mitral regurgitation(IMR), and report the mid-term outcome. Methods From June 2002 to May 2008, 83 pa-tients with moderate IMR(35 cases) and severe IMR (48 cases) underwent coronary artery bypass grafting(CABG) combined with mitral valvuloplasty (MVP) (n = 43) or mitral valve replacement (MVR) (n = 40). There were 49 males and 34 females with a mean age of (59.3±7.5) years(51 -77years). The procedures of MVP included annuloplasty with a Dacron or autologous per-icardium ring in 21cases, commissural annuloplasty in 9, quadrangular resection of the posterior leaflet in 9 and using St. Jude mitral annuloplasty ring in 4. In the cases underwent MVR, 28 patients received mechanical prostheses and 12 received biopros-theses. Results 30-day mortality rate was 2.3% for MVP and 5.0% for MVR (P >0.05). The 30-day complication rate was similar for the 2 groups but mechanical ventilation time was longer for MVR patients. Mild MR ocurred in 6 patients with MVP (P <0.05). Sevonty-six patients were followed by outpatient department visit or telephone for (20.2 ± 4.9) months (3 - 60 months). During the follow-up period, 7 patients with MVP had mild insufficiency but free off etber complications. All the valve prothesis functioned well. However, 3 cases had thromboembolic complications and 7 late deaths were recorded in MVR group. Five-year complication-free survival rate was 90% for MVP group and 61% for MVR. Conclusion MVP resulted in excellent durability and provided significant mid-term survival benefit over MVR. MVP should be the first choice for patients with chronic IMR.     

经非右室切口室缺修补术83例报告

对83例经非右室切口空缺修补术进行总结,其中右房切口42例,主肺动脉切口35例,先经右室切口后补充右房切口6例。文中就非右室切口的适应证和注意事项进行了讨论。认为非右室切口在很好地掌握适应证的前提下,能更好地显露手术野,缩短手术时间,减少并发症和最大限度地保存心肌的功能。     

腺苷心肌保护液对离体大鼠心肌能量代谢及离子含量的影响

为观察腺苷心肌保护液对大鼠心肌ＡＴＰ及离子含量的影响, 采用离体大鼠工作心脏缺氧停搏１２０ ｍ ｉｎ, 采用高钾、高钾＋ 腺苷及腺苷停搏液进行心肌保护。发现停搏末含腺苷的两组ＡＴＰ含量明显高于高钾组, 且复灌后进一步恢复; 各离子含量均能保持平稳。高钾组复灌后细胞内Ｎａ＋ 、Ｃａ２＋ 明显增高伴Ｍｇ２＋ 的减少。结果表明： 腺苷心肌保护液能够改善心肌能量代谢, 维持停搏期间及复灌后细胞内离子含量的稳定, 对缺氧心肌发挥保护作用     

持续静-静脉血液滤过治疗心脏术后急性肾功能衰竭的疗效观察

目的探讨持续静-静脉血液滤过(CVVH)在心脏手术后急性肾功能衰竭中应用的临床意义。方法9例心脏术后急性肾功能衰竭患者采用CVVH治疗,比较透析前后血电解质和尿素氮,肌苷的变化,以及全身水肿情况和血流动力学的变化。结果7例存活,2例死亡,存活患者透析后尿素氮、肌苷和血钾均逐渐降低,水肿改善,而血流动力学无明显变化。结论CVVH是治疗心脏术后急性肾功能衰竭的一种有效,方便而安全的方法。     

连续性静脉-静脉血液滤过治疗心脏术后急性肾功能衰竭

目的:探讨连续性静脉-静脉血液滤过在心脏手术后急性肾功能衰竭中应用的临床意义。方法:19例术后急性肾功能衰竭患者,采用连续性静脉-静脉血液滤过治疗,比较治疗前后血电解质、尿素氮、肌酐的变化,以及全身水肿情况。结果:15例存活,4例死亡。存活患者血液滤过后尿素氮和肌酐均逐渐下降直至恢复正常,尿量分别于透析后2~11d恢复正常,透析后4~5h血钾可降至正常范围。所有患者透析后水肿得到明显改善。结论:连续性静脉-静脉血液滤过是治疗心脏术后急性肾功能衰竭的一种有效、方便而安全的方法。     

褪黑激素对心肌缺血再灌注损伤的保护作用

目的 :探讨褪黑激素增补于停搏液中对缺血再灌注离体鼠心的保护作用。方法 :将 2 4只Wistar大鼠随机分为褪黑激素组 ,对照组。离体鼠心在改良的Langendorff Neely灌注模型上 30min预灌注 ,12 0min停搏 ,30min再灌注。缺血前及再灌注期间测定血流动力学指标 ,心肌酶 (CPK ,LDH)、心肌超氧化物歧化酶(SOD)、过氧化脂质 (LPO)含量。电镜观察心肌超微结构。结果 :再灌注后 ,褪黑激素组心功能、心肌超微结构的改善明显优于对照组 ;CPK ,LDH ,LPO含量显著低于对照组 (P <0 .0 1) ;SOD含量显著高于对照组 (P <0 .0 1)。结论 :褪黑激素增补于停搏液中可显著减轻心肌缺血再灌注损伤 ,具有良好的心肌保护作用