重症心脏瓣膜置换术的体外循环管理

目的:回顾性总结重症心脏瓣膜病置换术体外循环经验.方法:105例重症心脏瓣膜病患者,使用stockerⅢ型心肺机及膜式氧合器,体外循环中采用中度低温,预充白蛋白并附加人工肾超滤,心肌保护用高钾含血停搏液灌注.结果:105例患者均顺利脱机,无1例死亡.体外循环时间60～180 min,主动脉阻断时间60～120 min,所有患者均顺利脱离体外循环,心脏自动复跳86例,电击19例.结论:手术中加强心肌保护,可减低手术后的功能衰竭和并发症,并可有效提高手术成功率.     

唇腭裂早期治疗中对患者及其父母的支持

唇腭裂早期治疗是对唇腭裂患儿出生后存在的生理功能障碍、外貌缺陷，以及随生长发育畸形的变化，术后继发的牙颌系统畸形，患儿及父母的精神心理健康问题进行一系列治疗护理，直到成为身心康复的个体，唇腭裂的治疗是长期，复杂的过程，护理是在此系列治疗中针对患者及父母各阶段存在的知识缺乏提供适当的信息，对患者及父母精神心理状况，围手术期的问题，语音异常等进行健康教育，为患儿及父母提供必要的帮助，可取得良好效果。     

颈外静脉瓣膜窦段及其临床应用

经研究表明颈外静脉的瓣膜、缩窄环、瓣膜窦及窦段静脉壁共同组成一个灵敏地、高强度地抗逆流装置。本文称之为瓣膜窦段并报道189段的尸体解剖和光镜观察结果;测定尸体、活体和手术中瓣膜窦段的抗逆流功能,表明颈外静脉适于用无瓣导管作脑积水等分流途径。初步探明颈外静脉怒张的原因和消除怒张的简便方法以及术前鉴定瓣膜窦段位置和功能的方法。对2例脑积水用无瓣导管作侧脑室颈外静脉分流取得初步疗效。     

Results of the Ross operation in a pediatric population

Objective: To analyse the results of the mid-term clinical and echocardiographic follow-up of the pediatric Ross operation. Methods: Echo-Doppler follow-up of 53 consecutive pediatric Ross procedures performed between 1994 and 2003. Median age was 9.7 years at time of operation (2 weeks–17.7 years). Six patients were younger than 3 months. Median age at follow-up was 15.6 years. Aortic valve/left ventricular outflow tract (LVOT) anomalies were congenital in 49 (92%). Seventy percent had previous surgery or balloon valvuloplasty. Root replacement was used in all. Thirteen patients (25%) had LVOT enlargement. Mean cross-clamp time was 113 (69–189) minutes. Results: Early mortality occurred in 3 patients after emergency surgery following balloon failure (n=1) and extended Ross following interrupted arch/VSD repair (n=2). Late mortality was due to LV fibroelastosis in 2 patients and complicated pulmonary artery stenting in another. RVOT reoperations were required because of late homograft obstruction in 2 patients and because of pulmonary artery stenosis in another. Five patients (9.4%) were reoperated for pulmonary autograft dilatation (n=3) and for leaflet fibrosis or perforation (n=2). Autografts were repaired in two patients, while a mechanical valve was inserted in 3 cases. At 9 years the actuarial survival and event free survival were 89 and 74%, respectively. At last follow-up 90% of autograft diameters indexed to body surface area was above the 90th percentile of normal aortic root diameters. LVOT and RVOT gradients were low and autograft insufficiency was trivial to mild in 84% and mild to moderate in 16%. Autograft stenosis was not noticed. Conclusions: The pediatric Ross procedure remains an important tool but autograft dilatation also occurs in the pediatric population. The significance of this finding has yet to be determined.     

唇腭裂患者上颌骨牵引成骨术后发音方式的变化

目的:通过对行颅外支架式上颌骨牵引成骨术(rigidexternaldistraction,RED)唇腭裂患者治疗前后的错误发音数量变化、不同发音部位、不同发音方法以及不同类型错误发音发生特点及其变化评价,分析上颌骨RED对患者发音方式的影响。方法:1999年至2001年行上颌骨RED的唇腭裂术后上颌发育不足患者21例,其中男性13例,女性8例,平均年龄15.05岁。所有患者RED前后进行语音测听并分类。治疗前后错误发音的差异性用非参数检验。结果:RED术后42.9%患者错误发音数较RED前增加,19.0%减少,38.1%无变化。从发音部位,舌尖前音错误发音发生率最高,其次为舌面音。从发音方法,错误发音多发于塞擦音。错误发音类型以咽喉摩擦/爆破音为主,其次为腭化构音和声门爆破音。上颌骨RED后腭化构音累及音节数减少,但咽喉摩擦/爆破音和声门爆破音反而增加,尤其是咽喉摩擦/爆破音。结论:唇腭裂患者经RED前移上颌骨后,会对患者发音方式产生影响,在行语音治疗前需考虑全面。     

The impact of mitral valve morphology on the long-term outcome of mitral balloon valvuloplasty.

BACKGROUND: The effect of mitral valve morphology (MVM) on the long-term results of mitral balloon valvuloplasty (MBV) is not well established. The aim of the study was to evaluate the impact of MVM on long-term outcome of MBV. METHODS: Five hundred and eighteen consecutive patients (mean age, 31+/-11 years) who underwent successful MBV were followed up for 0.5-16.5 (mean, 6+/-4.5) years. Patients were divided into two groups according to their mitral echo score (MES) before MBV: group A (n=340; MES8). RESULTS: We report the immediate and long-term clinical and echocardiographic results of the above-mentioned 518 consecutive patients. The mitral valve area was significantly larger in group A than in group B, both immediately after MBV (2.0+/-0.3 vs. 1.82+/-0.3 cm2, respectively; P<0.0001) and also at the last follow-up (1.8+/-0.33 vs. 1.5+/-0.33 cm2, respectively; P<0.0001). Restenosis occurred in 38/340 (11%) in group A vs. 73/178 (41%) in group B (P<0.0001). Actuarial freedom from restenosis at 5, 10, 15 years were 92+/-2%, 85+/-3%, 65+/-6% for group A vs. 72+/-4%, 44+/-5%, 9+/-6% for group B (P<0.001). Event-free survival rates at 5, 10, 15 years for group A were 93+/-1%, 88+/-2%, 66+/-6% vs. 82+/-3%, 59+/-6%, 8+/-7% for group B (P<0.0001). Stepwise Cox multivariate regression analysis identified MES, preprocedure functional class, and postprocedure mitral valve area相似文献   

ABL50血气分析仪电、液路故障维修

本文介绍ABL50型血气分析仪使用过程中遇到的电、液路故障处理方法。     

Concomitant mitral valve repair and left ventricular reconstruction in a patient with chronic ischemic mitral regurgitation and inferior left ventricular aneurysm

The surgical approach to ischemic mitral regurgitation with concomitant inferior left ventricular aneurysm remains uncertain in terms of the indication for operation and the short-and long-term outcomes. We performed concomitant mitral valve repair, left ventricular reconstruction, and aortic valve replacement on a 71-year-old male with severe ischemic mitral regurgitation, inferior left ventricular aneurysm, and degenerative aortic regurgitation. Postoperative status was in New York Heart Association functional class I without mitral regurgitation 8 months after operation. We discuss, and review the procedures reported in the literature.     

血栓前体蛋白与心脏瓣膜置换术后的抗凝监测

目的：探讨血栓前体蛋白(TPP)在心脏机械瓣膜置换术后抗凝治疗监测中的意义，及制定术后抗凝治疗的合理方案。方法：比较抗凝组(60例)和对照组(20例)的国际标准化比率(INR)、TPP，并比较抗凝组中有、无房颤的病人华法林用量、INR和TPP，对抗凝组病人TPP和INR的关系作一元线性回归分析，比较各组的INR和血浆TPP浓度。结果：抗凝组与对照组相比，TPP低、INR高。抗凝组有房颤者的血浆TPP浓度高于窦性心律者。线性回归分析结果表明，TPP和INR无明显相关性。出血病人的血浆TPP浓度明显低于正常高限(6μg／ml)。结论：TPP是心脏机械瓣置换术后抗凝治疗理想的辅助监测指标。术后有房颤心律者的血栓栓塞危险性增加。抗凝治疗应同时检测INR和TPP。     

Long-term follow-up of elderly patients with severe aortic stenosis treated by balloon aortic valvuloplasty. Importance of haemodynamic parameters before and after dilatation

Early and late prognosis after percutaneous balloon aortic valvuloplasty (PBAV) was assessed in 38 consecutive elderly patients (mean age, 78.5 +/- 6.1 years). Significant valve opening was achieved in 35 patients. The hospital mortality was 8% (three patients); two other patients died within the first month and three underwent aortic valve replacement. At 2 years follow-up, there were 10 additional deaths (seven cardiac deaths) and five patients had symptom recurrence managed by aortic valve replacement (3) or repeat PBAV (2). Overall, six patients underwent surgery without untoward events and six had repeat PBAV. Only two out of six patients with repeat PBAV had sustained improvement; one was referred to surgery and the remaining three died soon after the second PBAV. One- and 2-year survival were respectively 72 and 62% and percentage of survivors with persistent improvement 68 and 41%. Although aortic valve area after PBAV was associated with outcome, predictors of poor long-term prognosis were primarily related to the pre-operative haemodynamic status. Patients with pulmonary resistances greater than 400 dynes cm-1 s-5 had the poorest outcome (chi 2 = 18.4-P less than 0.0001). Overall, signs of heart failure were predictors of poor long term follow-up. These data indicate that long-term success of PBAV is mainly related to the left ventricular dysfunction noted prior to intervention.