肺高压型复杂先天性心脏病患者雾化吸入糖皮质激素对术后急性肺损伤及肺功能不全的影响

目的 探讨吸入性糖皮质激素对肺高压型复杂先心病患者体外循环术后急性肺损伤和肺功能不全的疗效。方法 入组2015－2016年武汉亚洲心脏病医院就诊的肺高压型复杂先心病患者,所有患者在体外循环下行矫治术后随机分为两组：试验组给予布地奈德＋基础雾化剂,对照组给予生理盐水＋基础雾化剂,吸入方式、时间及剂量均相同,其他呼吸道管理措施及临床治疗原则无差异。对比分析主要观察指标及次要指标。结果 试验组在无创呼吸机时间、ICU时间及住院时间上短于对照组（43.67±25.52 vs 59.72±20.91,5.89±2.74 vs 7.83±2.31,10.50±6.37 vs 13.11±6.10,均P＜0.05）,其他主要指标无差异,各次要指标在观察阶段中后期试验组优于对照组（如术后第7天白细胞水平11.16±3.26 vs 13.62±3.19,P=0.028）,早期则无差异（如术后第3天白细胞水平15.07±3.22 vs 15.89±3.39,P=0.464）。结论 应用吸入性糖皮质激素可在一定程度上一定时间段内减轻术后急性肺损伤,促进肺功能恢复并缩短病程。     

微创冠状动脉搭桥术初步报告

目的：微创冠状动脉搭桥术可减少体外循环引起的并发症,患者术后疼痛轻,恢复快,出血输血少,住院时间短,医疗费用低。方法：自1998年8月至1999年4月采用前胸正中切口,应用左胸廓内动脉、双侧胸廓内动脉和大隐静脉为12例冠心病患者施行微创冠状动脉搭桥术,占同期冠状动脉搭桥术22％。年龄45～80岁（平均65岁）,左室射血分数23％～69％（平均47％）,平均搭桥2．1根。结果：平均ICU时间和住院时间分别为1～2d（平均1.2d）和12～20d（平均12d）术后平均6d出院,较同期常规冠状动脉搭桥术短（P＜0.05）。胸腔引流量和输血分别为280～750ml（平均415ml）,0～600ml（平均160ml）,较同期常规冠状动脉搭桥术少（P＜0.05）。11例手术存活,1例死于呼吸衰竭。短期随访（1～8个月）患者心绞痛症状消失,活动量增加。2例患者术后2个月随访冠脉造影,吻合口满意率100％。结论：微创冠状动脉搭桥术安全、经济、有效,并可应用于多支血管病变,值得推广应用。     

Prognostic value of frontal QRS-T angle in predicting survival after primary percutaneous coronary revascularization/coronary artery bypass grafting for ST-elevation myocardial infarction

BackgroundFrontal QRS-T angle (FQRST) has previously been correlated with mortality in patients with stable coronary artery disease, but its role as survival predictor after ST-elevation myocardial infarction (STEMI) remains unknown.MethodsWe evaluated 267 consecutive patients with STEMI undergoing reperfusion or coronary artery bypass grafting. Data assessed included demographics, clinical presentation, electrocardiograms, medical therapy, and one-year mortality.ResultsOf 267 patients, 187 (70%) were males and most (49.4%) patients were Caucasian. All-cause mortality was significantly higher among patients with the highest (101–180°) FQRST [28% vs. 15%, p = 0.02]. Patients with FQRST 1–50° had higher survival (85.6%) compared with FQRST = 51–100° (72.3%) and FQRST = 101–180° (67.9%), [log rank, p = 0.01]. Adjusting for significant variables identified during univariate analysis, FQRST (OR = 2.04 [95% CI: 1.31–13.50]) remained an independent predictor of one-year mortality. FQRST-based risk score (1–50° = 0 points, 51–100° = 2 points, 101–180° = 5 points) had excellent discriminatory ability for one-year mortality when combined with Mayo Clinic Risk Score (C statistic = 0.875 [95%CI: 0.813–0.937]. A high (>4 points) FQRST risk score was associated with greater mortality (32% vs. 19%, p = 0.02) and longer length of stay (6 vs. 2 days, p < 0.001).ConclusionFQRST represents a novel independent predictor of one-year mortality in patients with STEMI undergoing reperfusion. A high FQRST-based risk score was associated with greater mortality and longer length of stay and, after combining with Mayo Clinic Risk Score, improved discriminatory ability for one-year mortality.     

冠状动脉旁路移植术后心房颤动临床研究

目的　调查冠状动脉旁路移植术后心房颤动 (房颤 )发生率和临床表现 ,并探讨其易患危险因素。　方法　连续收集 116例接受冠状动脉旁路移植手术的冠心病患者 ,男性 93例 ,女性 2 3例 ,术后监测心律状况、观察临床特点。详尽考查患者术前、术中、术后诸因素 (变量 )。采用单因素分析和逻辑多元回归分析 ,筛选术后房颤相关因素。　结果　 33例于冠状动脉旁路移植术后出现房颤 ,发生率2 8.4%。发生房颤者大多有明显症状 ,经静脉药物转复率较低 ,多元回归分析表明高龄、左心房扩大为冠状动脉旁路移植术后发生房颤的独立危险因素。　结论　房颤为冠状动脉旁路移植术后常见心律失常 ;增龄和左心房扩大为重要的独立危险因素     

Viscoelastic properties of the autologous bypass grafts: A comparative study among the small saphenous vein and internal thoracic artery

Internal thoracic artery (ITA) and small saphenous vein (SSV) are two viable conduits for coronary artery bypass grafts. The aim of this study was to investigate the viscoelastic behavior of the small saphenous vein and internal thoracic artery under compressive and tensile loadings at body temperature. The dynamic mechanical analysis was used to measure the viscoelastic properties of the ITA and SSV at both the desired temperature and load frequency range. Storage modulus, loss modulus as well as phase angle of both the blood vessels were measured at the temperature of 37 ± 1 °C and under a sinusoidal load with the frequency range of 1–2 Hz. The mean storage and loss modulus of the SSV were both higher than that of the ITA. Furthermore, the SSV showed a higher stiffness and internal friction compared to those values under the tensile load. While ITA was stiffer under the tensile load, no considerable difference was observed among the compressive and tensile loss modulus. A more intense viscous behavior was observed under the radial direction. The results also revealed that the SSV has much higher stiffness whereas less viscous behavior compared to the ITA, especially in the radial direction. The results may have implications not only for understanding of the viscoelastic time-dependent mechanical behavior of the ITA and SSV but also for tissue engineering applications to make scaffolds according to the real time-dependent viscoelastic mechanical properties of these arteries and veins.     

Bariatric surgery and diabetes remission: Sleeve gastrectomy or mini-gastric bypass?

AIM:To investigate the weight loss and glycemic control status[blood glucose,hemoglobin A1c(HbA1c)and hypoglycaemic treatment].METHODS:The primary risk factor for type 2 diabetes is obesity,and 90%of all patients with type 2 diabetes are overweight or obese.Although a remarkable effect of bariatric surgery is the profound and durable resolution of type 2 diabetes clinical manifestations,little is known about the difference among various weight loss surgical procedures on diabetes remission.Data from patients referred during a 3-year period(from January2009 to December 2011)to the University of Naples"FedericoⅡ"diagnosed with obesity and diabetes were retrieved from a prospective database.The patients were split into two groups according to the surgical intervention performed[sleeve gastrectomy(SG)and mini-gastric bypass(MGB)].Weight loss and glycemic control status(blood glucose,HbA1c and hypoglycaemic treatment)were evaluated.RESULTS:A total of 53 subjects who underwent sleeve gastrectomy or mini-gastric bypass for obesity and diabetes were screened for the inclusion in this study.Of these,4 subjects were excluded because of surgical complications,7 subjects were omitted because young surgeons conducted the operations and 11 subjects were removed because of the lack of follow-up.Thirtyone obese patients were recruited for this study.A total of 15 subjects underwent SG(48.4%),and 16underwent MGB(51.6%).After adjusting for various clinical and demographic characteristics in a multivariate logistic regression analysis,high hemoglobin A1c was determined to be a negative predictor of diabetes remission at 12 mo(OR=0.366,95%CI:0.152-0.884).Using the same regression model,MGB showed a clear trend toward higher diabetes remission rates relative to SG(OR=3.780,95%CI:0.961-14.872).CONCLUSION:Although our results are encouraging regarding the effectiveness of mini-gastric bypass on diabetes remission,further studies are needed to provide definitive conclusions in selecting the ideal procedure for diabetes remission.     

Prolonged systemic delivery of tirofiban in a thrombus-laden saphenous vein graft

Results from previous trials have shown conflicting results from local delivery of thrombolytic agents to diminish thrombus burden before intervention in native coronary arteries and saphenous vein grafts. We described a patient with an acute coronary syndrome who was treated for 24 hours with systemic tirofiban (Aggrastat®), a glycoprotein IIb/IIIa inhibitor, for the treatment of a degenerated saphenous vein graft with a TIMI grade 4 thrombus (large-sized thrombus). Angiographic evaluation 48 hours later revealed complete resolution of the thrombus with normal coronary blood flow. (Int J Cardiovasc Intervent 2003; 5: 92-94)     

Elective EC-IC bypass for unclippable intracranial aneurysms

Ligation of the carotid artery in the neck has become part of the surgical armamentarium for treating inaccessible or technically difficult intracranial aneurysms. Obliteration of an aneurysm by sacrificing the parent vessel has also been employed for the treatment of unclippable posterior circulation and middle cerebral artery aneurysms. Because parent vessel occlusion is not well tolerated by all individuals, the use of an extracranial-intracranial bypass has been advocated in order to improve the safety of this procedure. The purpose of this report is to detail our methods and results with the use of extracranial-intracranial bypass for the treatment of giant internal carotid and middle cerebral artery aneurysms in 35 patients and review the litereture to determine the status of the use of the bypass for other intracranial aneurysms.     

心脏瓣膜置换术病人体外循环期间血浆内皮素、房钠利尿多肽和血流动力学变化

目的 了解体外循环（CPB）期间血浆内皮素（ET）、房钠利尿多肽（ANP）与血流动力学指标变化及其相互之间的关系。方法 用放射免疫法测定16例心脏瓣膜置换手术病人的术前及CPB期间血浆内皮素、房钠利尿多肽水平。结果 诱导前血浆ET为（2.68±1.8）pg/ml，与对照组[（2.22±0.7）pg/ml]相比无显著差异（P>0.05），而血浆ANP为（738±559）pg/ml，明显高于对照组[（72.7±14.5）pg/ml，P<0.001]。CPB期间血浆ET无明显变化，而血浆ANP在体外循环初期明显下降，停CPB时恢复至CPB前水平。CPB期间及停CPB时SVRI明显降低，血球压积（Hct）与血管阻力指数（SVRI）关系密切。结论 CPB期间血浆ET无明显变化，而血浆ANP下降为血液稀释所致，SVRI降低主要在于血液稀释。