左右冠状动脉肺动脉瘘一例

患者女性,39岁,主因"发现心脏杂音38年,发作性胸闷、胸痛3年,加重1个月"收入院.患者38年前查体时发现心脏杂音,诊断为"心脏病",未予诊治.     

含乌司他丁肺保护液在心肺转流术中的肺保护作用

Objective To evaluate protective effects of hypothermic pulmonary protective solution with uli-nastatin on lung function during cardiopulmouary bypass (CPB) in the patients with congenital heart disease(CHD) and pulmonary hypertenion. Method Fifty-four children,who had CHD of left-to-fight shunts with moderate-se-rious pulmonary hypertension, were enrolled. They had been performed with the radical operation under CPB from September 2005 to December 2006 in the Department of Cardiovascular Surgery, Children' s Hospital of Zhejiang University. Moderate-serious pulmonary hypertension was defined as pulmonary-to-systolic pressure ratio > 0.45(Pp/Ps > 0.45). Fifty-four children were randomly divided into three groups. Patients in group A (n = 18)didn't receive pulmonary protective solution, and scrved as control; patients in group B (n = 18) were adminis-tered with pulmonary protective solution without ulinastatin;patients in group C (n = 18) were administered with pulmonary protective solution with ulinastatin. The serum concentrations of MDA and MPO were measured at five different time points:pre-operation, 0 h, 3 h, 6 h and 24 h in the intensive care unit (ICU) (T1～5). Patients'lung functions were monitored at T1 - T4. The time of mechanical ventilation was recorded. Results No one died in this study. The mean time of mechanical ventilation was shorter in the group B and group C than that in the group A. The MDA and MPO levels were lower in group B compared with group A at T4. The MDA level at T3-T5 and the MPO level at T4 was lower in group C than those in group A. There were no significant in MDA and MPO levels between group B and group C at five time point.A-aDO2 was lower in groups B and C than those in group A at T3 and T4, whereas at T4, A-aDO2 was lower in group C than that in group B. Cdyn was higher in group B at T3and group C at T3 - T4 than those in group A. Cdyn was lower in groups C than that in group B at T4.Condusions Lung perfusion with hypothermic protective solution during CPB can all lung injury and promote recovery after operation, especialy with ulinastatin.     

瘤颈栓塞治疗颅内动脉瘤破裂的单臂研究

目的探讨动脉瘤颈部血管内弹簧圈栓塞术(ECE)治疗具有血泡形成颅内动脉瘤破裂(RICABF)的有效性和安全性。方法回顾性分析86例RICABF患者临床资料,包括继发性破裂/出血率,颈内动脉瘤栓塞率,残余/复发性动脉瘤,术中事件和栓塞后并发症,以及格拉斯哥结局量表(扩展)(GOS-E)的改善。结果动脉瘤完全闭塞72个(72/86,83.7%),颈部残留12个(12/86,14.0%),残留动脉瘤2个(2/86,2.3%)。术后GOS-E评分3分3例(3.5%),4分10例(11.6%),5分73例(84.9%)。所有患者行随访血管造影(平均9.0个月)。复发3例(3/86,3.5%)。没有报告提示动脉瘤破裂或出血。结论瘤颈部ECE是RICABF的有效且安全的治疗方式,其长期有效性和安全性需要在前瞻性和比较性研究中进行调查。     

冠心病合并糖尿病患者置入BP-DES 2年临床预后分析:单中心、大样本数据研究

目的 探讨糖尿病(DM)与非DM的冠心病患者置入生物可降解聚合物药物洗脱支架(biodegradable polymer drug-eluting stent,BP-DES)的远期预后。方法 连续纳入阜外医院2013年1—12月1572例置入BP-DES的冠心病患者,PCI术后随访2年,比较随访期间合并DM与未合并DM患者的远期预后。结果1572例患者中DM患者421例(DM组),非DM患者1151例(非DM组)。DM组合并危险因素(高血压、高脂血症、既往心梗病史、既往PCI/CABG病史)、其他合并症(既往脑卒中病史、外周动脉疾病史)、使用相关药物(使用β受体阻滞剂和钙离子拮抗剂)以及相关冠状动脉病变情况(右冠脉和三支病变)的比例均高于非DM组(P<0.05)。2年随访结果显示,DM组再发心肌梗死(心梗)的发生率高于非DM组(3.6%比1.5%,P=0.01)。主要不良心脑血管事件、全因死亡、心源性死亡、靶血管血运重建、靶病变血运重建、支架内血栓、脑卒中以及出血和大出血的发生率2组比较差异无统计学意义(P>0.05)。COX回归分析显示,DM是置入BP-DES冠心病患者再发心梗的独立危险因素(HR=2.432,95%CI:1.215～4.870,P=0.012)。多因素COX分析显示:DM并不是置入BP-DES冠心病患者再发心梗的独立危险因素(HR=2.289,95%CI:0.984～4.833,P=0.056)。吸烟、多支病变、B2或C型病变是置入BP-DES冠心病患者不良临床预后的独立危险因素。结论 冠心病合并DM患者常伴随更多临床高危因素和复杂冠状动脉病变;置入BP-DES的DM患者再发心梗的发生率高于非DM患者。经校正多种危险因素后,DM并不是置入BP-DES冠心病患者再发心梗的独立危险因素;而传统的临床高危因素及复杂高危的冠脉病变则是不良临床预后的独立危险因素。     

相同患者杂交置入CYPHER和TAXUS 支架术后再狭窄研究

目的:比较在相同患者中杂交置入的CYPHER和TAXUS支架术后再狭窄的比率,以排除患者因素对再狭窄的影响,判定2种支架再狭窄率的真实差别。方法:回顾性分析2004年4月～2006年4月于北京阜外医院接受杂交置入并完成6个月造影随访的患者101例,其中CYPHER支架170枚,TAXUS支架138枚,据此分成2组。结果:2组基线病变的特点差异无统计学意义。CYPHER组支架内和病变血管段再狭窄率均低于TAXUS组(分别为:5.2%∶12.8%,P<0.05;6.5%∶15.4%,P<0.05),最小管腔直径和晚期管腔丢失CY-PHER组也明显低于TAXUS组[分别为:(2.01±0.02)∶(1.96±0.03)mm,P<0.01;(0.11±0.04)∶(0.31±0.02)mm,P<0.01]。结论:CYPHER支架再狭窄率低于TAXUS支架。     

冠状动脉病变中低危合并糖尿病患者临床特点及介入术后远期预后研究

目的探讨合并糖尿病、冠状动脉病变解剖中低危(SYNTAX评分≤32)的冠心病患者, 经皮冠状动脉介入治疗(PCI)术后远期预后的影响因素。方法本研究为前瞻性单中心观察性研究。连续纳入2013年1至12月在阜外医院行PCI且SYNTAX评分≤32、合并糖尿病的患者。根据患者SYNTAX评分水平分为SYNTAX评分≤22组和23≤SYNTAX评分≤32组。主要终点是5年心原性死亡、再发心肌梗死, 次要终点包括5年全因死亡和重复血运重建。采用Cox比例风险回归模型分析PCI术后远期预后的影响因素。结果共纳入3 899例糖尿病合并冠心病患者, 年龄(59.4±9.8)岁, 其中男性2 888例(74.1%)。SYNTAX评分≤22组3 450例, 23≤SYNTAX评分≤32组449例。术后5年, 与SYNTAX评分≤22组相比, 23≤SYNTAX评分≤32组患者重复血运重建发生率更高[18.9%(85/449)比15.2%(524/3 450), log-rankP=0.019], 两组全因死亡、心原性死亡和再发心肌梗死发生率差异无统计学意义(log-rankP均>0.05)。多因素...