自制左心辅助引流管道行左心辅助2例

左心辅助循环是治疗术后严重低心排的最有力措施之一。１９９５年９月至１９９６年９月我们使用自制左心辅助引流管道进行床旁左心辅助循环，对２例冠状动脉搭桥术后低心排病人进行左心辅助，现报道如下。临床资料２例重症冠心病病人均为男性，年龄分别为５８、５５岁。均...     

心脏嗜铬细胞瘤--原位心脏移植一例

目的报道心脏移植治疗心脏嗜铬细胞瘤的诊治经验。方法患者，女，年龄48岁。因心脏嗜铬细胞瘤无法直接手术切除，于2005年6月2日在全身麻醉中度低温体外循环下行原位心脏移植术，冷缺血时间185min。受者手术主动脉阻断时间95min，辅助循环时间64min。结果患者术后恢复顺利，术后18d复查血浆去甲肾上腺素为1．339ng／ml，尿去甲肾上腺素108μg／24h，术后20d痊愈出院。结论对不能手术直接切除的心脏嗜铬细胞瘤患者，心脏移植是一种有效的治疗手段。     

12例左心室辅助临床应用体会

当心脏泵功能出现衰竭时，心室机械辅助装置的应用可以减轻心脏的前、后负荷并降低心肌的耗氧；提高舒张期血压，增加冠脉血流，促进侧支循环和改善心肌收缩力；有利于心脏泵机能的强化及损伤心肌的恢复，促进受损心室再重构，从而成为一种独特而有效的治疗心功能衰竭的手段。     

升主动脉成形术中期效果分析

Objective Reduction ascending aortoplasty is an alternative procdure to the replacement of the ascending aorts in case of ascending aorta dilation. However,its applicabikity is still under debate.This retrospective study was designed to evaluuate the midterm follow-up of unsupported ascending reduction aortoplasty for of the ascending aorta in petients with aortic valve dis- ease.Methods From October ,1996 to April,2007, a total of 54 patients with aortic valve disease and dilatation of the ascending aorta underwent unsupported reduction aortoplasty in combination with aortic valve replacement at our institution The diameter of the ascending aorta was measyred before and early after sugery and then later between 13 and 96 menths [mean (23 ±16)months] posto- perativeiy using echocardiography.Results Two patients were dead with thean overall perioperative mortality rate was of 3.7%. The reduction aortoplasty decreased the diameter of the aorta from (45.77±6.02) mm p～eope～afive]y to (34.67 ～4.81) mm early after surgery (P<0.01). During follow-up, the diameter d aorta increased from (34.67±4.81) mm early after surgery to (37.65± 6.35) mm after a mean follow-up of (23±16) months (P<0.01), including the diameters are greater than > 45 mm within 5 pa- tients. Aortic stenosis and an early postoperative diameter greater than 40 mm m'e independent risk factors for redilatation. Conchusion Because of the unsatisfied midterm follow-up redilation of unsupported reduction aortoplasty for dilation of the ascending aorta with aortic valve disease, this group of patients needs continued intimate fallow-up or even reoperation. The patients of stenosis is the surtable indication for RAA, and it is necessary to reduce the diameter of aorta to be lees than 40 mm to prevent redilation.     

涤纶血管胶原蛋白涂层的实验及临床研究

提取牛皮Ⅰ型胶原蛋白,以4mg/ml的胶原蛋白溶液涂层苏州涤纶人工血管,经过0.3％戊二醛交联,涤纶血管渗水量由383±28ml·min~(-1)/cm~2降至2.8±0.5ml·min~(-1)/cm~2。将胶原蛋白涂层涤纶血管移植犬腹主动脉下段,以白蛋白涂层涤纶血管移植为对照。在肝素化状态下均不渗血。术后30天和90天观察显示,胶原涂层涤纶血管内壁覆盖一层完整光滑的内膜,光镜显示为纤维结缔组织,表面有内皮细胞被覆并与自体动脉内膜延续。而白蛋白涂层涤纶血管血栓形成率高,内壁纤维素沉积。临床采用胶原涂层涤纶血管为4例马凡综合征病人行主动脉根部替换,术中涤纶血管不渗血,随访3个月无不良反应。本研究显示胶原涂层涤纶血管机械性能良好,不渗血,尤其能促进涤纶血管的愈合。作为主动脉移植材料可广泛应用于临床,若用于中小血管移植可望提高远期通畅率。     

心脏移植后采用他克莫司替代环孢素A治疗的体会

目的 探讨心脏移植后因排斥反应或环孢素A(CsA)不良反应而将CsA替换为他克莫司(FK506)的临床效果.方法 6例原位心脏移植患者中,5例因发生严重排斥反应或排斥反应不能控制、1例因CsA的肝毒性,而将CsA替换为FK506,其它免疫抑制剂不变,转换时间为术后(167.8±166.7)d,FK506的用量为(6.0±1.4)mg/d,维持其血药浓度在(14.7±5.6) μg/L.心内膜心肌活检(EMB)联合超声心动图监测排斥反应.结果 随访(17.1±6.0)个月,6例患者全部存活,2例心功能下降者在换用FK506后心功能恢复正常.换用FK506前,排斥反应评分为(2.50±0.42)分,换用FK506后,排斥反应评分降至(0.60±0.39)分(P＜0.01).1例患者转换为FK506后3周,出现发热及胸腔积液,经抗结核治疗1周后好转,半年后停止抗结核治疗,患者至今存活1年;转换为FK506后,4例患者因血糖升高(其中2例转换前血糖即升高)需用胰岛素治疗;换用FK506后,CsA所致的多毛消失,牙龈增生减轻.结论 心脏移植后采用CsA进行免疫抑制治疗者,若反复发生排斥反应或出现不能耐受的CsA不良反应,可将CsA替换为FK506,临床效果明显.     

升主动脉成形术中期效果分析

Objective Reduction ascending aortoplasty is an alternative procdure to the replacement of the ascending aorts in case of ascending aorta dilation. However,its applicabikity is still under debate.This retrospective study was designed to evaluuate the midterm follow-up of unsupported ascending reduction aortoplasty for of the ascending aorta in petients with aortic valve dis- ease.Methods From October ,1996 to April,2007, a total of 54 patients with aortic valve disease and dilatation of the ascending aorta underwent unsupported reduction aortoplasty in combination with aortic valve replacement at our institution The diameter of the ascending aorta was measyred before and early after sugery and then later between 13 and 96 menths [mean (23 ±16)months] posto- perativeiy using echocardiography.Results Two patients were dead with thean overall perioperative mortality rate was of 3.7%. The reduction aortoplasty decreased the diameter of the aorta from (45.77±6.02) mm p～eope～afive]y to (34.67 ～4.81) mm early after surgery (P<0.01). During follow-up, the diameter d aorta increased from (34.67±4.81) mm early after surgery to (37.65± 6.35) mm after a mean follow-up of (23±16) months (P<0.01), including the diameters are greater than > 45 mm within 5 pa- tients. Aortic stenosis and an early postoperative diameter greater than 40 mm m'e independent risk factors for redilatation. Conchusion Because of the unsatisfied midterm follow-up redilation of unsupported reduction aortoplasty for dilation of the ascending aorta with aortic valve disease, this group of patients needs continued intimate fallow-up or even reoperation. The patients of stenosis is the surtable indication for RAA, and it is necessary to reduce the diameter of aorta to be lees than 40 mm to prevent redilation.     

非体外冠状动脉旁路移植术后早期强化抗栓治疗对出血的影响

目的评价术后联合应用阿司匹林加氯吡格雷抗血小板治疗对非体外循环下冠状动脉旁路移植术（off-pump CABG,OPCAB）后出血的影响。方法2007年12月~2008年12月期间在我院成功接受OPCAB的患者130名,术后随机分配到阿司匹林组 （A组）和阿司匹林加氯吡格雷组（AC组）。两组采用不同的抗血小板治疗方案：A组59例,口服阿司匹林100mg/d;AC组71例,口服阿司匹林100mg＋氯吡格雷75mg/d。记录并比较两组患者术前基线资料、实验室检查结果、术中术后情况,以及两组患者术后胸腔引流量、血及血制品使用量。结果两组患者术前、术中的基线资料及实验室检查结果比较差异无统计学意义（P〉0.05）;A组和AC组胸腔引流总量比较差异无统计学意义（1000.76&#177;382.88ml vs 1057.96&#177;475.32ml,P=0458）。A组和AC组给予抗血小板药物后的胸腔引流量比较差异无统计学意义（463.13&#177;261.48ml vs 469.12&#177;249.45ml,P=0.914）。两组患者中均未发生围术期死亡、二次开胸止血或严重的胸外出血情况。结论OPCAB术后早期采用双联抗血小板治疗不会导致术后出血的显著增加。     

冠状动脉旁路移植术同期自体骨髓干细胞移植治疗晚期缺血性心脏病临床研究的早期结果

目的:评价自体骨髓单个核细胞移植对晚期冠心病陈旧性心肌梗死患者心功能改善的早期影响.方法:前瞻性设计入组需要外科治疗的晚期冠心病陈旧性心肌梗死患者20例.在冠状动脉旁路移植手术同期,采用随机双盲,平行对照的方法经冠状动脉桥血管移植自体骨髓单个核细胞,患者随机分为干细胞治疗组与对照组.应用磁共振成像评价治疗前后心功能的变化,同时评价不良事件的发生.结果:试验揭盲后干细胞治疗组9例,对照组11例.手术早期结果无死亡.随访6个月,患者均存活,随访期间无不良事件发生.磁共振成像检查,手术后2组患者左心室射血分数较术前明显提高,差异有统计学意义(P=0.006),而两组间差异无统计学意义.手术后节段左心室壁增厚率干细胞治疗组大十对照组(P=0.044).结论:冠状动脉旁路移植术同期自体骨髓单个核细胞经桥血管心肌内移植是安全的,治疗早期无不良反应.早期结果显示:节段左心窒壁增厚率的变化干细胞治疗组优于对照组.     

CABG同期行左室成形术和二尖瓣成形术治疗左室室壁瘤并发二尖瓣关闭不全的效果

目的 评价冠状动脉旁路移植术（CABG）同期行左室成形术和二尖瓣成形术治疗左室室壁瘤并发二尖瓣关闭不全的近远期临床效果。 方法 自2000年1月~2008年12月,我院共32例患者因左室室壁瘤并发缺血性二尖瓣关闭不全同期进行左室成形术+二尖瓣成形术。左室成形术手术方式包括:线性缝合16例（50%）;心内膜环缩成形术9例（28%）;心室内环状补片成形术7例（22%）。二尖瓣成形术入路包括:左室入路20例（62%）,右房-房间隔入路11例（34%）,房间沟入路1例（3%）。全部患者均同期行CABG。本研究回顾性分析了上述患者手术中及围手术期的临床资料,并进行了46~175个月随访。 结果 围手术期死亡1例（3%）。术后1年和5年生存率分别为97%和74%。随访期间,9%（3例）出现二尖瓣中量及以上返流,9%（3例）出现NYHA心功能Ⅲ~IV级。左室成形方式及二尖瓣成形入路对远期效果无显著影响。 结论 左室成形术同期行二尖瓣成形术是治疗左室室壁瘤并发二尖瓣关闭不全的有效方法,术后的近远期临床结果令人满意。