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.     

动脉调转分期手术中左室训练的临床应用

目的 总结动脉调转分期手术中左室训练的临床经验。方法 2001年4月至2004年5月，为7例大动脉转位病儿做左室训练术。左室训练包括体肺动脉分流和肺动脉环缩两项操作。全组肺动脉收缩压，动脉收缩压值，从术前的0．34增加至0．76。2例需要同期做原发房间隔切除，1例需要二次校正肺动脉环缩。结果 全组无手术死亡，4例在术后2周左右顺利完成二期动脉调转术，治愈出院。1例术后3个月再入院，做二期动脉调转，术后死于肝功能衰竭。2例因术后并发症未作二期手术。结论 左室训练为年龄超过新生儿期的单纯大动脉转位病儿做动脉调转术提供了必要的准备；房间交通对左室训练有重要作用；快速二期手术可获得良好的临床结果。     

冠状动脉旁路移植术对冬眠心肌的作用

目的：探讨冠状动脉旁路移植术（CABG）对冬眠心肌的作用。方法：对123例曾患心肌梗死在CABG前后,分别作硝酸异山梨醇脂介入^99mTc－甲氧基异丁基异腈（ISDN^99mTc－MIBI） 灌注显像、小剂量多巴酚丁胺超声负荷试验）LDDSE）和 射断层氟脱氧葡萄糖（PET18F－FDG）心肌代谢显像以鉴别科眠心肌的存在,并观察CABG后相应节段灌注、代谢和收缩功能的变化。结果：（1）38例ISDN^99mTc－MIBI灌注显像术前后比较,正常灌注节段数从159例至195,异常灌注节段数从183减至147,ISDN阳性组灌注计分从术前的8．12减笃术后的3．76,ISDN阴性组无明显变化。（2）65例LDDSE术前后比较,在有收缩储备的133段中,CABG后运动改善的有112段,无收储备191段中,运动改善的有31段。（3）45例PET18F－FDG代谢显像术前后比较,在代谢－灌注不匹配、部分匹配和匹配三组,节段室壁运动改善率分别为87．5％、55．6％和28．6％。全组无手术和住院死亡病例发生。出院后随访5－40个月,无远期死亡。123例中、91例心功能Ⅰ级（74％）,32例心功能Ⅱ级（26％）。结论（1）对心肌梗死后合并心功能不全的患CABG能取得良好的临床效果;（2）ISDN^99mTc－MIBI心肌灌注显像、LDDSE和PET18F－FDG心肌代谢显像均能较准确地鉴别科眠心肌和梗死心肌、,为外科治疗抉择提供重要参考依据,并提供有价值的预测。     

婴幼儿心脏术后全身毛细血管渗漏综合征的临床诊断与治疗

1997年12月至1998年11月,我们抢救心脏术后并发全身毛细血管渗漏综合征病儿12例,均获成功.现报告如下.     

改良Damus-Kaye-Stansel手术治疗单心室合并主动脉瓣下狭窄(附1例报告)

功能性单心室是一种复杂先天性心脏畸形,一部分病例合并或在行减状手术后继发主动脉瓣下狭窄(SAS),是目前先天性心脏病外科治疗的一个难点.2006年3月,我们对1例合并主动脉瓣下狭窄的单心室病儿成功实施了Damus-Kaye-Stansel(D-K-S)手术,术后效果满意,现报道如下.     

PERITONEAL DIALYSIS AFTER REPAIR OF CONGENITAL HEART DISEASE IN CHILDREN

Objective. To investigate the effect of peritoneal dialysis on fluid balance and outcome in children who receive cardiac operation.Methods. From July to Dec. 2000, 12(2.08%) patients of 576 consecutive children who underwent heart operation required peritoneal dialysis because of acute renal failure. The mean age of these 12 patients was (2.9-2.0) years (range, 5 months-7 years) and the mean body weight was (12+3) kg (range, 7.4-18.5 kg ).Results. The interval between the operation and the initiation of peritoneal dialysis was (21.2+11.4) hours (4.4-42 hours). The duration of peritoneal dialysis was (6.3+4.8) days (0.47-15 days). Mortality in these 12 patients was 25%. Fluid removed by peritoneal dialysis was(34.7+17.8) ml . kg-1 . day-1. Asymop-tomatic hypokalemia, thrombocytopenia and hyperglycemia were frequent complications, which were easily managed. Hemodynamics and pulmonary function improved during the study period.Conclusion. The early initiation of peritoneal dialysis is an effective and safe     

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.     

急性心肌梗塞溶栓后再灌注心律失常临床分析

对24例急性心肌梗塞（AMI）进行静脉溶栓后，于CCU室进行24h心电监测，观察溶栓后发生再灌注心律失常（RA）随时程变化的特点。再灌注组与未灌注组比较：两组均发生了心律失常，室性早搏发生率为100％；再灌注组心律失常发生的频率以溶栓后8h内最高，8h后明显减少，而未灌注组无此特点。加速性定性自主心律（AIVR）只见于善灌注组，发生率为77％；两组室性心动过速发生率相当，各有1例转为室颤，导致死亡；再灌注心律失常多为自限性，无需特别药物治疗。     

改良Damus-Kaye-Stansel手术治疗单心室合并主动脉瓣下狭窄(附1例报告)

功能性单心室是一种复杂先天性心脏畸形,一部分病例合并或在行减状手术后继发主动脉瓣下狭窄(SAS),是目前先天性心脏病外科治疗的一个难点.2006年3月,我们对1例合并主动脉瓣下狭窄的单心室病儿成功实施了Damus-Kaye-Stansel(D-K-S)手术,术后效果满意,现报道如下.     

珠海市现代急救模式与急救体系建设的探讨

现代急救体系是国家或地区应对突发公共事件的重要组成部分，而急救体系的构成由急救模式决定。目前，国际上的现代急救模式主要有两大类：消防救护模式和医疗急救模式，前者以英美模式为代表，其急救体系由消防救护机构和非医疗专业救护队伍构成；后者以法德模式为代表，其急救体系由医疗机构和专业的医疗救援队伍构成。我国港、澳、台地区急救模式为消防救护模式，大陆的急救模式为医疗急救模式。我国的医疗急救模式又以急救机构职能、急救队伍组成和政府投入不同而分为：指挥调度型、单纯院前型、院前院内独讧型和依托型.珠海市急救指挥中心于2002—2005年结合科研项同《珠海市院前急救现状捌查和建立新型急救模式的研究》，对现代急救模式与急救体系建设进行探讨如下。