动脉调转术后中期主动脉瓣反流的危险因素分析

目的:研究完全性大动脉转位及Taussig.Bing型右心室双出口患者行动脉调转手术后,中期主动脉瓣反流的危险因素.方法:人选185例完全性大动脉转位及Taussig-Ring型右心室双出口实施动脉调转术,并存活出院的患者,其中男性140例,女性45例,平均年龄(13.83±27.76)个月.采用经胸彩色超声评估主动脉瓣反流情况,主动脉瓣反流危险因素采用多因素Logistic回归模型分析.结果:所有存活患者均进行超声随访,平均随访时间(34.72±22.49)个月.共计19例患者出现主动脉瓣反流,其中轻度反流16例,中度反流3例,免于主动脉瓣反流率为90%.患者术后1、3、5年免于主动脉瓣反流的比例分别为95%、91%、83%.多因素Logistic回归分析发现合并室间隔缺损(P=0.0218)、年龄>6个月(P=O.0083)、术后主动脉瓣z值>1(P<0.01)为术后中期主动脉瓣反流的危险因素.结论:动脉调转术后中期丰动脉瓣具有良好的功能,动脉调转手术是治疗完全性大动脉转位的理想术式.合并室间隔缺损、手术年龄>6个月及解剖肺动脉根部与主动脉远端不匹配是动脉调转术后中期主动脉瓣反流的危险因素.     

对比中美冠状动脉血运重建适宜性标准在中国人群中的适用性和科学性

目的:旨在对比中美冠状动脉血运重建适宜性标准(以下分别简称“中国标准”、“美国标准”)在中国人群中的适用性和科学性。方法:连续入选4家大型心脏中心行择期冠状动脉造影中至少一支冠状动脉狭窄≥50%的稳定性冠心病患者。研究首先比较中美标准对入选患者的推荐结果。之后按中国标准推荐,将两种标准推荐不一致的患者划分为适宜组、不适宜组和可能适宜组,并根据实际接受的治疗将各组人群进一步划分为血运重建患者和药物治疗患者进行分析。主要结局指标为1年主要不良心脑血管事件(MACCE),包括全因死亡、非致死性心肌梗死、脑卒中、再次血运重建和再发心绞痛入院。结果:2016年8月至2017年8月连续入选6165例稳定性冠心病患者。根据中国标准,1.3%(80/6165)未得到推荐;根据美国标准,46.2%(2851/6165)未得到推荐;47.0%(2900/6165)中美标准推荐不一致,其中95.0%(2756/2900)术前未行负荷试验。在中美标准推荐不一致的2900例患者中,911例根据中国标准适宜血运重建,血运重建与1年MACCE无显著相关性(校正后HR=0.91,95%CI:0.53~1.57,P=0.74);504例根据中国标准不适宜血运重建,血运重建与1年MACCE无显著相关性(校正后HR=1.15,95%CI:0.33~3.97,P=0.82)。结论:与美国标准相比,中国标准临床场景覆盖率更高,适用性更好。在中美标准推荐不一致的患者中,遵循中国标准推荐进行决策与1年预后的改善无显著相关性,中国标准对“未行负荷试验”患者的推荐可能仍需进一步论证和优化。     

心脏手术相关性急性肾损伤的研究进展

心脏手术相关性急性肾损伤（cardiacsurgery—associatedacutekidneyinjury,CSA-AKI）是指发生在心脏外科术后的急性肾功能损害,发生率根据诊断标准和手段,以及心脏手术类型的不同,低至5％,高达45％,通常接近30％。继脓毒症之后,体外循环（cardiopuhnoncuybypass,CPB）是肾损伤的第二位致病原因,与冠状动脉造影相关的对比剂肾病则位列第三。     

冷缺血时间及供者年龄对心脏移植受者预后的影响：单中心临床研究

目的:本研究旨在探讨心脏移植中冷缺血时间(cold ischemia time,CIT)及供者年龄对心脏移植受者院内及远期预后的影响。方法:回顾中国医学科学院阜外医院2015～2020年首次行原位心脏移植的518例受者,并根据供心CIT将其分为<4 h组(n=225),4 h≤CIT <6 h组(n=171)及CIT≥6 h组(n=122),每组再根据供者年龄<40岁和≥40岁分为两个亚组。记录受者、供者基本资料与受者术中及术后应用机械辅助的情况,统计院内死亡率以及随访生存率。结果:供者平均年龄(35.5±11.1)岁(5～58岁),平均CIT(4.6±1.7) h(0.9～11.3 h)。CIT <4 h组、4 h≤CIT <6 h组与CIT≥6 h组院内死亡率差异无统计学意义(4.4%vs. 4.7%vs. 6.6%,P=0.70),术中或术后应用机械辅助的受者比例差异也无统计学意义(20.4%vs. 21.6%vs. 30.3%,P=0.93)。亚组分析中,不同CIT组的亚组院内死亡率差异无统计学意义;4 h≤CIT <6 h组中供者≥40岁的...     

睡眠呼吸暂停综合征18例误漏诊分析

睡眠呼吸暂停综合征(SAS)由于在睡眠期间发病,因而常被患者所忽略,如果医生对此认识不足,往往造成误漏诊。1994年6月～1999年9月我院收治SAS52例,误漏诊18例,误漏诊率达34.6%,现报告如下。1　临床资料1.1　一般资料　18例中,男13例,女5例;年龄37～72岁,平均57岁。1.2　临床表现     

大动脉转位患者动脉调转术后死亡的危险因素分析

Objective To analyze the in-hospital mortality and factors affecting in-hospital mortality for patients with transposition of the great arteries (TGA) undergoing arterial switch operation (ASO).Methods Between January 2004 and December 2007, ASO was performed in 169 patients [129 male, 40 female; mean age (11.71± 26. 3) months] with TGA. The patients were divided in intact ventricular septum group( n = 56): TGA with intact ventricular septum and ventricular septal defect group (n = 113 ):TGA with ventricular septal defect. Multiple logistic regression analysis was performed to identify the risk factors of in-hospital mortality. Results The overall in-hospital mortality was 11.24% (19/169). The yearly in-hospital mortality was similar between intact ventricular septum group and ventricular septal defect group. With the improvement of perioperative treatment, the in-hospital mortality decreased from 16.67% in 2004 to 3.92% in 2007. The multivariate analysis revealed that body weight ≤3 kg( OR:4. 571, P =0. 0409), complicating ventricular septal defect( OR:4. 444,P =0. 0406), complex TGA( OR:4. 321 ,P =0. 0140), coronary anomalies( OR:4. 867,P =0. 0104) and non-type A coronary arteries( OR:3. 045,P =0. 0243) were independent predictors for poor early postoperative survival. Conclusion Body weight ≤3 kg,complicating ventricular septal defect, complex TGA, coronary anomalies are independent predictors for increased in-hospital mortality in patients with transposition of TGA and undergoing arterial switch operation.     

Ross术后中远期主动脉瓣反流的危险因素分析

Objective To analyze the risk factors of the postoperative mid- and long-term aortic valvular regurgitation after ROSS procedure(pulmanary valve homograft transplantation). Methods Between March 1998 and July 2007,47 patients[25male, 22 female, mean age (13.31±5.79) years, ronge 1-34 years] with aortic valvular disease underwent the Ross procedure at our insti tution. There were 6 patients suffering fron rheumatic heart disease and 41 patients suffering from congenital heart disease. The aver age aortic blood flow velocity was (4.67±3.47) m/s, the average pressure gradient across aortic valve (88.26±58.06)mm Hg, LVEDD (45.53 ±10.78) mm, EF 0.69±0.08. All the patients were followed up in out-patient departement by ultrasonic cardio gram. Multiple logistic regression analysis was performed to find out the risk factors of the postive aortic valvular regurgitation. Results There was no poetoperative death in hospital. The mean follow-up periods was (36.15±22.1) months, rasnge from 12 to 110 months and none long-dated death. Compared with the data recorded in hospital, the diamenters of the aortic sinus and aortic annu lus enlarged significantly, respectively from (26.16±5.10) mm to (32.37±6.84) tam and from (19.41 ～3.98) mm to (23.45± 5.86) mm. The average flow velocity d the homograft (new aortic valve) was(1.39±0.48) m/s, graclient pressure (8.17+6.16) mm Hg. Mild aortic regurgitstion was present in 5 patients (10.6%), moderate aortic tegmgitafion in 2 pmieats (4.3%) and aevere aortic regurgitation in 1 petient (2.1%). The rate of free from regurgitation was 82.9%. Multiple logistic analyses identified the per esence of bicuspid aortic valve, enlargement of aortic annulus and age above 14 years as the risk factors for posterative aortic regurg itation. Conclusion The Ross procedure is a safe and effective procedure with good clinical results in mid-and long-term follow-up. However, the presence of bicuspid aortic valve, enlargement of aortic annulus and age above 14 years preoperatively were identified as the risk factors for postoperative aortic regurgitation.     

酗酒致支气管肺部损害15例分析

1992年～ 1 998年我院急诊收治酗酒患者 2 46例 ,其中引起支气管肺部损害 1 5例 ,报道如下。1　临床资料1 .1　一般资料　本组 1 5例 ,男 1 3例 ,女 2例 ,年龄 1 7～ 6 2岁 ,平均 30岁 ,长期酗酒 3例 ,偶尔饮酒过量 1 2例 ,酗酒量按酒精计算为 5 0～ 375 g,就诊时间为饮酒后 2 0 min～36 h。1 .2　临床表现　急性气管、支气管炎 3例 ,咳嗽剧烈 ,或干咳 ,或咯脓痰 ,肺部听诊呼吸音粗 ,时有干罗音 ,胸片示正常或纹理增多。支气管哮喘 4例 ,其中 3例既往有支气管哮喘或慢性支气管炎、肺气肿病史 ,1例无明显其它原因致哮喘发作史。低通气状态 4…