体外循环下小儿肌部室间隔缺损的镶嵌治疗

目的 探讨镶嵌模式(hybrid procedure)治疗小儿肌部室间隔缺损(Mvsd)的手术方法及临床应用.方法 2006年1月至2010年6月,在体外循环心内直视手术下采用手术及封堵相结合的镶嵌技术矫治小儿Mvsd 45例,其中男20例,女25例;年龄52天～12岁;体重3～32 kg.7例为单个Mvsd,38例为多发性VSD.同时合并大血管错位(D-TGA)1例、法洛四联症(TOF)2例、肺动脉狭窄(PS)3例、动脉导管未闭(PDA)6例、房间隔缺损(ASD)6例、主动脉缩窄1例.均在心脏停跳后直视下将导引钢丝经三尖瓣孔自心脏右室面穿过VSD至左室面,直视下置入导引器,然后送入封堵器,完成Mvsd封堵.多发性VSD 38例,予自体心包片修补膜周部等较大的VSD,心内其他畸形同期完成矫治.结果 42例置入单枚封堵器(直径4～10 mm)、3例置入双枚封堵器(直径4～7 mm).手术经过顺利,术前左室射血分数(EF)均在正常范围,术后1天小于8月龄组EF均值低于正常,大于8月龄组EF正常,两者差异有统计学意义.术后常规每天给予5 mg/kg肠溶阿司匹林3～6个月.术后随访超声检查示封堵器位置无偏移,无残余分流,无二尖瓣、主动脉瓣反流、Ⅲ度传导阻滞及新发心律失常等.术后因重症感染放弃治疗1例,无远期死亡病例.结论 体外循环下镶嵌技术治疗小儿 Mvsd明显降低了围手术期并发症及病死率,简化了手术过程,降低了手术风险,是一种安全、有效的方法.

Abstract：

Objective To summarize the technique and clinical experience of hybrid procedure under cardiopulmonary bypass (CPB) in children with muscular ventricular septal defect (mVSD). Methods From January 2006 to June 2010, 45 cases of mVSD underwent hybrid procedure with CPB. mVSDs were closed with devices under direct vision in 45 cases. Of them, there were 20 males and 25 females. They ranged from 52 days to 12 years [mean (2.05 ±2.48) year] in age and from 3 to 30 kg [(11.93 ±7.70)kg] in body weight. Preoperatively, most of children were highly susceptible to respiratory tract infections. The hybrid approach was used in all patients with CPB under the guidance of transesophageal echocardiography (TEE). The diameter of mVSDs ranged from 2 to 7 mm under TEE. Of 45 cases, 40 patients had increased rates of pulmonary blood flow. 29 patients had left axis deviation and 12 cases had sinus arrhythmia on electrocardiography (ECG). 19 had other congenital heart lesions, including transposition of great arteries in 1 case, tetralogy of Fallot in 2, pulmonary artery stenosis in 3, patent ductus arteriosus in 6, atrial septal defects in 6) and aorta coactation in 1. The quantity of VSDs were from 1 to 7 (single, in 7; two, in 24 case; three, in 8 case; four, in 5 case and seven, in lease. 37 patients were combined with pulmonary hypertension in our cohort. 38 patients with another large VSD and 19 with other congenital heart lesions were required surgical repair at sometime. Results The hybrid procedures were undertaken in all 45 cases of this cohort. All cases were successful and no deaths occurred during operation. A total of 48 devices were implanted in 45 patients, including single devices in 42 cases (device size ranged from 4 to 10 mm) and two devices in 3 cases (device size ranged from 4 -7 mm). The average time on CPB was (58.28 ±20.70) min , while aortic crossclamp time was(34. 94 ± 14.75) min. In addition, the time on mechanical ventilation postoperatively ranged from 2 hours to 6 days. Compared to the older children, 20 infante aged less than 8 monhad a significant difference in cardiac function in the early postoperative period. One infant was given up treatment because of serious infection. Anather cases recovered with the use of supportive treatment, such as using vasoactive agents, digoxin, inhaling nitric oxide, diuresis, and so on. The enteric-coated aspirin was given at dose of 5 mg ? kg -1. day -1 for a period of 3 to 6 months as usual postoperatively. All patients attended follow-up at 1 week, 1 month, 3 months, 6 months, 1 year and 2 years post-procedure. No major complications were encountered during this period. All cases were no instance of migration of any of the devices, residual shunt, aortic regurgitation, atrioventricular valve dysfunction, Ⅲo atrial-ventricular conduction block, new arrhythmia, and so on. There are no death in long-term follow-up. Conclusion Hybrid procedure is safe and effective for the closure of congenital heart defects in children.     

薰衣草对牙科焦症治疗效果分析

目的:评价薰衣草气味对牙科焦虑患者治疗效果.方法:选取2010年8月大庆油田总院门诊阻生牙拔除患者152例,对照组77例在无任何干扰下常规动力电钻拔牙,治疗组75例在薰衣草精油气味下动力电钻拔牙,2组治疗前均填写改良牙科焦虑量表(MDAS),术前、术中均监测血压,术后记录患者VAS评分.结果:数据分析显示,治疗组焦虑患...     

不同牙体预备形式瓷贴面修复的临床效果

<正>瓷贴面技术在临床上广泛应用于前牙美容修复,常规瓷贴面的预备形式包括开窗、对接、包绕三种类型。本文对不同预备形式的瓷贴面进行3⁵年的追踪观察,探讨牙体预备方式对瓷贴面修复效果的影响。1资料与方法1.1病例资料观察2005-01—2006-12在口腔科完成瓷贴面修复患者26例。男9例,女17例;年龄19～50岁。共174     

阿德福韦酯联合拉米夫定治疗乙型肝炎后失代偿性肝硬化90例疗效观察

<正>乙型肝炎后失代偿性肝硬化患者病情较重,国际公认的抗HBV药物目前只有IFN和核苷(酸)类似物,且它们都只是阻断病毒复制,而不能彻底清除病毒。IFN对失代偿性乙肝肝硬化患者来说当属禁忌。     

慢性乙型肝炎的疗效预测和优化治疗策略

乙型肝炎抗病毒治疗的药物包括两大类：α-干扰素类和核苷（酸）类似物。目前临床抗病毒方案存在疗效不佳和耐药率高的缺点,而探索预测疗效的指标,并在此基础上优化抗病毒治疗方案提高疗效,降低耐药率成为我国乙型肝炎临床研究的重点。抗病毒药物优化的关键就在于：在适当的时机选择合适的抗病毒药物,并在治疗过程中监测应答情况,对疗效欠佳的患者及时调整治疗方案,以提高远期疗效,降低耐药的发生。在中国制定一套适合我国国情的抗病毒优化治疗策略将是我国乙型肝炎治疗领域亟待解决的重要问题之一。     

颅咽管瘤手术入路的选择

目的 探讨颅咽管瘤的个体化手术入路的选择.方法 时我科从2009年4月～2011年7月收治的26例颅咽管瘤患者,结合患者术前症状和体征、影像学特点、手术入路、手术效果和随访情况等进行回顾性分析.结果 经翼点入路11例中,8例全切除,近全切除3例.额下入路3例,2例全切除,1例近全切除.前纵裂入路3例,经胼胝体入路6例,经终板入路4例,均全切肿瘤.术后主要并发症为:尿崩症(84.6％),血电解质紊乱(61.5％)和癫痫(15.4％).术后随访3～30个月,21例患者正常工作生活.结论 根据患者的具体病情选择合适的手术入路,有助于增加颅咽管瘤手术全切率,降低患者的病死率及致残率,极大地提高患者术后的生活质量.     

恩替卡韦和替诺福韦治疗对HBV相关肝癌的影响与争鸣

<正>由于口服核苷(酸)类似物能有效抑制HBV DNA并降低肝脏终点事件包括肝细胞癌(HCC)的风险,当前国内外指南均建议具有抗病毒指征的慢性乙型肝炎(CHB)患者接受核苷(酸)类药物治疗,其中具有较高耐药屏障和安全性的一线抗病毒药物包括恩替卡韦(ETV)、替诺福韦二吡呋酯(TDF)和替诺福韦艾拉酚胺(TAF)。尽管长期口服核苷(酸)类抗病毒药物已大大减少CHB患者肝脏终点事件的发生,但并未完全消除HCC的发生风险。近年来多篇相关研究就一线抗     

关节软骨损伤修复的MRI评价

不同软骨损伤修复方法可以阻止或延缓关节软骨损伤所致的骨关节炎进程.MRI可对不同软骨修复方法及修复术后不同阶段进行无创性评价.就MRI常规扫描序列及生理性成像序列对软骨修复组织的不同评价标准予以综述.     

来氟米特与霉酚酸酯治疗乙肝病毒相关性肾炎的疗效比较

目的比较来氟米特(LEF)与霉酚酸酯(MMF)治疗乙型肝炎病毒相关性肾炎(HBV-GN)的临床疗效。方法 20例血清HBV标记物阳性、病理诊断为乙型肝炎病毒相关性肾炎的患者,随机分为两组,每组10例,第一组采用LEF联合激素治疗,第二组采用MMF联合激素治疗,LEF或MMF正规使用6个月以上。两组中有HBV-DNA复制的均给予干扰素-α或恩替卡韦治疗。观察治疗前及治疗6个月以后的血尿常规、24h尿蛋白定量、肝肾功能、白蛋白及血脂等指标变化,以及用药期间所有不良反应。结果①两组接受治疗后,尿蛋白明显减少(P<0.01),血白蛋白明显上升(P<0.01)。②治疗6个月后LEF组总有效率为80.0%,MMF组总有效率为80.0%,两组之间无统计学差异;其中完全缓解率分别为40.0%和50.0%,部分缓解率分别为40.0%和30.0%,均无统计学差异(P>0.05)。③两组患者均耐受良好,无明显副作用。结论 LEF和MMF联合激素治疗均能有效缓解乙型肝炎病毒相关性肾炎,不良反应轻微。     

髋膝关节置换围术期骨质丢失的研究现状及防治

人工关节置换术对解除患者疼痛和提高其生活质量具有重要意义。随着预期寿命的延长和对生活质量要求的提高,越来越多的晚期骨性关节炎和髋部骨折患者接受髋膝关节置换术。骨性关