改良腱索转移法治疗二尖瓣前叶脱垂(附16例临床分析)

Objective To introduce an operative technique for prolapse of the anterior leaflet of mitral valve. Methods From January 2002 through May 2005, chordal transfer and "edge-to-edge" technique was performed in 16 cases with serious mitral valve re- gurgitation due to prolapse of the anterior leaflet. The etiology was chordal rupture in 12 cases and chordtal elongation in 4. The mean regurgitation area yam (14.76±3.28) cn2. Left ventricular ejection fraction (LVEF) was 33% - 69% before operation. Among those patients, 5 were in NYHA function class Ⅲ and 11 in class Ⅳ. Operations were performed under general anesthesia and car- diopulmonary bypass. First, "edge to edge" technique was performed. The free edge of the prolapsed anterior leaflet was sutyred to corresponding posterior leaflet. Then quadrangular resection was performed to transfer segment of posterior leaflet with its attached chordae. At last, the posterior leaflet was approximated after quadrangular resetion. Echocardiography was performed in each patient before discharge and at the times of follow-up. Results All patients survived the operation. One patient nequired mitral valve re- placement due to anterior leaflet perforation 3 days after the operatiom. The rest were free from reoperation. At the time d follow-up, all these patients were in NYHA functional class Ⅰ. Echocardiography showed neither stenosis nor significant regurgitation of the mitral valve. The cross-sectional area of the mitral valve was 3.3 -4.8 cm2[mean(3.78±0.52)cm2]. The mean regurgitation area was (0.45±0.22) cm2. Both dimension of left atrium and left vantricule reduced significantly. The diameter of left atrium was (48.26± 11.12) mm pre-operation vs. (37.57±9.56) mm post-operation (P=0.028). The ead-diastolic diameter of the left ventricule was (61.43±8.24)mm pre-operation vs (42.35±10.79) mm post-operation (P = 0.008). Conctusion Chordal transfer and "edge- to-edge" technique provides good results for repair of anterior leaflet prolapse of mitral valve.     

门诊患者对宫颈癌筛查、人乳头瘤病毒疫苗认知情况的调查

目的:了解妇科门诊患者对宫颈癌筛查及人乳头瘤病毒(HPV)疫苗的认知情况,探讨宫颈癌机会性筛查在门诊应用的意义.方法:在中日友好医院妇科门诊就诊的患者接受宫颈癌机会性筛查同时填写调查问卷378张,按就诊目的分为动员组和非动员组,对问卷结果和细胞学检查结果进行统计分析.结果:有效问卷共368份,其中86.14%知道宫颈癌筛查的目的,仅45.81%的人听说过HPV.愿意接种HPV疫苗者占72.75%,愿意让女儿接种HPV疫苗者占75.15%.非动员组对HPV的认知与HPV疫苗的接受程度优于动员组.医护人员与医疗机构对患者接种疫苗的意愿影响最大,患者愿意接受政府和医疗机构提供的疫苗.细胞学检查结果5.74%的人检出异常细胞.结论:即使在受教育程度较高的都市女性中,HPV的认知程度仍较低,但HPV疫苗的接受率较高.宫颈癌筛查与HPV疫苗推广需要医疗机构的健康教育和政府的大力支持.在医院开展宫颈癌机会性筛查可以作为普查范围以外的有效补充.     

临床生命伦理分析的经验主义视角

在当今国际世界,生命伦理学已从20世纪中叶问世的新学科发展成一种国际性的“社会运动”。在临床生命伦理学实践中,西方学者最为关心的是临床生命伦理分析的方法论问题,简要地介绍分析当代欧洲临床生命伦理分析的经验主义视角,探讨生命伦理学与自然主义之间的互动,借助当代主流伦理学的发展,回答临床生命伦理分析中的“是”与“应当”问题,以期对我国的临床生命伦理理论和实践的发展提供借鉴。     

冠状动脉旁路移植术后1年内接受经皮冠状动脉介入治疗的临床特征与随访结果研究

目的:本研究旨在探讨冠状动脉旁路移植术(CABG)后1年内患者经皮冠状动脉介入治疗(PCI)的临床特征和随访结果.方法:分析总结既往在北京安贞医院接受CABG且随后1年内接受PCI的121例患者的临床数据,并进行随访.结果:患者平均年龄为60.71岁,男性占71.9％,合并糖尿病、高血压、高脂血症和吸烟史等冠心病危险因...     

应用桡动脉序贯吻合行冠状动脉旁路移植术的疗效

目的:探讨冠心病患者应用桡动脉序贯吻合法行冠状动脉旁路移植术(CABG)的疗效。方法:回顾性分析北京安贞医院2020年4月至2020年12月期间109例接受桡动脉或大隐静脉序贯吻合CABG术的冠心病患者临床资料,其中男86例,女23例;年龄39~79岁,平均(61.1±8.0)岁。根据移植血管材料分为桡动脉组(47例)...     

烟草危害与公共健康的伦理研究

烟草危害是当今世界的一个严重的公共健康问题.降低烟草危害和保护公共健康已经成为重要的伦理学课题.本文首先例举一些事实说明烟草对于公共健康的危害,进而从伦理角度分析这一危害,并且讨论了降低烟草危害的道德责任问题.     

老年青光眼伴视野缺损患者反刍性沉思现状及影响因素分析

目的:调查老年青光眼伴视野缺损患者反刍性沉思现状并分析其影响因素。方法:采用便利抽样法,选取2018年1月—2020年12月在浙江省荣军医院接受治疗的95例老年青光眼伴视野缺损患者为研究对象,采用一般资料调查表、简体中文版事件相关反刍性沉思问卷（C-ERRI）、青光眼患者自我行为管理问卷（GSMQ）对其进行调查。采用单...     

单侧多功能外固定架治疗四肢骨折并发症分析和防治

目的探讨单侧多功能外固定架(UMEFA)治疗四肢骨折并发症的防治。方法对四川省科学城医院骨科1996-2005年应用UMEFA的108例患者进行回顾性分析,随访6个月2年。结果9例针道感染,13例延迟愈合,7例早期螺钉松动,4例膝关节功能受限,2例钢针断裂,骨折成角移位3例,骨折均在术后316个月愈合。结论UMEFA是治疗严重四肢骨折较理想的固定器材,但因其本身性能的局限性和使用不当,会出现一些并发症,要予以正确预防、处理,减少并发症的发生。     

肠道子宫内膜异位症误诊2例分析并文献复习

目的:分析肠道子宫内膜异位症误诊常见原因及治疗方法。方法:报道2例肠道子宫内膜异位症,结合文献就其误诊原因及诊治进行分析。结果:肠道子宫内膜异位症临床表现多样,无特异性,易误诊为肠道肿瘤,诊断主要依靠组织病理检查。结论:提高对肠道子宫内膜异位症的认识,熟悉其发病原因、机理及临床特点,可减少误漏诊。     

改良腱索转移法治疗二尖瓣前叶脱垂(附16例临床分析)

Objective To introduce an operative technique for prolapse of the anterior leaflet of mitral valve. Methods From January 2002 through May 2005, chordal transfer and "edge-to-edge" technique was performed in 16 cases with serious mitral valve re- gurgitation due to prolapse of the anterior leaflet. The etiology was chordal rupture in 12 cases and chordtal elongation in 4. The mean regurgitation area yam (14.76±3.28) cn2. Left ventricular ejection fraction (LVEF) was 33% - 69% before operation. Among those patients, 5 were in NYHA function class Ⅲ and 11 in class Ⅳ. Operations were performed under general anesthesia and car- diopulmonary bypass. First, "edge to edge" technique was performed. The free edge of the prolapsed anterior leaflet was sutyred to corresponding posterior leaflet. Then quadrangular resection was performed to transfer segment of posterior leaflet with its attached chordae. At last, the posterior leaflet was approximated after quadrangular resetion. Echocardiography was performed in each patient before discharge and at the times of follow-up. Results All patients survived the operation. One patient nequired mitral valve re- placement due to anterior leaflet perforation 3 days after the operatiom. The rest were free from reoperation. At the time d follow-up, all these patients were in NYHA functional class Ⅰ. Echocardiography showed neither stenosis nor significant regurgitation of the mitral valve. The cross-sectional area of the mitral valve was 3.3 -4.8 cm2[mean(3.78±0.52)cm2]. The mean regurgitation area was (0.45±0.22) cm2. Both dimension of left atrium and left vantricule reduced significantly. The diameter of left atrium was (48.26± 11.12) mm pre-operation vs. (37.57±9.56) mm post-operation (P=0.028). The ead-diastolic diameter of the left ventricule was (61.43±8.24)mm pre-operation vs (42.35±10.79) mm post-operation (P = 0.008). Conctusion Chordal transfer and "edge- to-edge" technique provides good results for repair of anterior leaflet prolapse of mitral valve.