肺心病心力衰竭患者心功能与血浆脑钠肽、c-反应蛋白关系分析

目的探讨肺心病心力衰竭患者脑纳肽(BNP)、超敏C反应蛋白(hs-CRP)与心功能关系,为临床诊断评估肺心病心力衰竭患者提供依据。方法选择我院肺心病心力衰竭患者200例(疾病组),并进行心功能分级;选取同期健康人群200例(对照组),测量血清hs-CRP、BNP水平。结果疾病组BNP和hsCRP分别为415.28±96.73f g/ml和86.83±17.50 ng/ml,均高于对照组(P0.05);随着心功能分级Ⅰ级Ⅱ级、Ⅲ级、Ⅳ级的增加,BNP和hs-CRP逐渐增高,差异均有统计学意义(P0.05)。结论肺心病心力衰竭患者hs-CRP、BNP水平明显升高,可作为临床评估指标。     

预防性应用IABP治疗高危冠心病的有效性和安全性

目的:观察高危冠心病患者预防性应用经主动脉内球囊反搏(IABP)治疗的有效性和安全性。方法:入选符合高危冠心病患者59例,分为IABP组(预防性使用IABP,n=23)和非IABP组(未使用或被动型使用IABP,n=36),IABP组PCI前常规预防性的植入IABP,非IABP组未植入IABP或因病情恶化被动性植入IABP。术中术后观察指标:1IABP相关的并发症(血小板下降、贫血、下肢栓塞、坠积性肺炎等);2恶性心律失常、心力衰竭、心源性休克的发生率;31年内主要不良心血管事件(MACE)发生率。结果:IABP组贫血和坠积性肺炎或栓塞的发生率显著高于非IABP组(P0.05),两组血小板下降的比例无明显差异;IABP组发生心力衰竭、心源性休克和恶性心律失常的比例显著低于非IABP组(P0.05);两组再发心绞痛或非致死性心肌梗死和再次血运重建发生率无显著差异,IABP组1年内病死率显著低于非IABP组(P0.05)。结论:高危冠心病患者预防性应用IABP能有效地改善血流动力学,增加冠脉灌注,减少心力衰竭、恶性心律失常和心源性休克的发生,提高了高危冠心病患者1年的存活率,且并未发生与IABP植入相关的严重并发症。     

川崎病致冠状动脉病变外科治疗的效果分析

目的:分析和讨论川崎病致冠状动脉病变外科治疗的临床效果和经验。方法:回顾分析2004年1月~2012年12月对13例川崎病致冠状动脉病变患者的临床资料。本组患者均行冠状动脉旁路移植术。所有患者均使用乳内动脉。8例体外循环手术,5例常温手术。2例行冠状动脉瘤成形术,1例行血栓清除术。1例行二尖瓣置换术。结果:手术死亡1例。体外循环时间41~455(137±136)min,心肌阻断时间18~117(50±37)min,桥血管数量1~3(2.1±0.8)条。随诊3个月~6年,患者症状减轻或消失。动脉瘤直径减小。结论:冠状动脉旁路移植是治疗川崎病致冠状动脉病变的有效方法,无需同期处理冠状动脉瘤。     

高血容量血液稀释对老年患者围术期血流动力学的影响

目的:观察高血容量血液稀释(hypervolemic hemodilution,HHD)对老年患者围术期血流动力学的影响。方法:选取20名无心脏病史的麻醉手术患者;10名患者65周岁,10名55周岁。所有入试患者在术前接受相同的HHD处理(60 g/L羟乙基淀粉静脉输注,15 ml/kg)。在血液稀释后不同时间使用经食管多普勒超声监测(transesophageal Doppler monitoring,TDM)患者的血流动力学变化,同时监测患者血细胞比容(Hct)、血红蛋白、血气及心电变化。结果:所有患者手术期间均未发生任何并发症。两组患者间的一般资料、生化检查数据、Hct、血气等均无统计学差异。HHD后对照组(55周岁)的心排出量(cardiac output,CO)升高,老年组(65周岁)降低。对照组的心率(heart rate,HR)下降和心搏指数(stroke index,SI)升高(P0.05),而老年组HR无明显改变,SI轻微下降。血液稀释后对照组患者的外周血管阻力值有明显下降(P0.05),而老年患者出现了升高的趋势。结论:无心脏病史的老年患者并不能很好耐受术前急性高容量血液稀释。HHD可以导致由SI下降所致的CO下降。     

Effect of the baseline HbA1c on the MACEs in patients with coronary artery disease after percutaneous coronary intervention

Background The present studies evaluated the association between admission glucose and adverse outcomes of people with coronary artery disease(CAD) after primary percutaneous coronary intervention(PCI), but the effects of glucose control levels on these patients' outcomes are not fully studied, and the prognostic value of hemoglobin A1c(Hb A1c) for a better survival is still uncertain. Methods Our study included 440 patients with CAD undergoing the PCI therapy after admission, and who were divided into 2groups, one had Hb A1 c ≤ 6.5%(n = 309), the other 6.5%(n = 131). Then, we gave these patients clinical follow-ups at the first, third, sixth, twelfth month respectively after PCI. Results There were no significant differences between the two groups at the baseline characteristics and the drugs taken by the patients after PCI. But we found that the outcomes of major adverse cardiac events(MACEs) were significantly better in Hb A1 c ≤6.5% group than in Hb A1 c 6.5% group(P = 0.016) according to the COX multivariate regression analysis. Conclusion The MACE-free survival after PCI is significantly better when Hb A1 c is≤ 6.5% than Hb A1 c is 6.5%.     

Surgical incision in complete video-assisted mitral valve replacement

Background Prosthetic mitral valve replacement is a common surgical treatment of mitral valve disease.Complete video-assisted mitral valve replacement represents the contemporary minimally invasive cardiac surgery in valve disease surgical therapy. In the field of minimally invasive cardiac surgery, the success of the operation is largely depending on surgical incision, it also reflects the surgeon's technique level. Method From February 2010 to February 2013, 80 cases of cardiac patients with mitral valve pathological changes in our department who had received surgical treatment of complete video-assisted mitral valve replacement were recruited, they were divided into two groups according to the surgical incision: midclavicular group(M group,n = 50) and parasternal group(P group, n = 30). The clinical data were recorded including: cardiopulmonary bypass time, aortic clamping time, volume of thoracic drainage after operation, ICU tracheal intubation time,postoperative days of hospital stay and time for observing the postoperative complications. The comparison between two groups was performed using t-test analysis. Result Both M Group and P Group had favorable surgical view, there were no emergency situation of redo median sternotomy during initial operative period or intraoperative death, no pericardial tamponade, no infection, and no other serious postoperative complications.Whereas, there were 2 cases of redo operation for stanch bleeding in M Group and 1 case of perivalvular leakage in P Group. Nevertheless, 3 months later, the result of reexamine showed that the perivalvular leakage had vanished. The clinical data was shown as follow(M Group vs. P Group): cardiopulmonary bypass time(90.2 ± 28.7 vs. 87.3 ± 24.5 min, P 0.05), aortic clamping time(65.2 ± 17.4 vs. 68.6 ± 21.9 min, P 0.05),1st day volume of thoracic drainage after operation 1(75.8 ± 35.6 vs. 53.2 ± 25.6 mL, P 0.05), ICU tracheal intubation time(9.6 ± 3.4 vs. 8.4 ± 4.5 hours, P 0.05), postoperative days of hospital stay(7.3 ± 2.2 vs. 6.9± 3.2 days, P 0.05). T-test analysis of the data of each groups showed that there were no significant statistically difference. Conclusions Appropriate surgical incisions guarantee a favorable surgical view and the success of the whole process during intraoperative period. In both midclavicular and parasternal approaches, the complete video-assisted mitral valve replacement is able to be accomplished safely and successfully. Due to the current development level of thoracoscopic instruments and equipment, the surgical incision and approach for video-assisted mitral valve replacement are diversified. As a result, diversified surgical incisions can be customized according to the variegated pathological changes of cardiac patients.