CO2部分重吸入法测心排血量在冠脉搭桥术中的应用

目的 观察CO2部分重吸入法测心排血量在冠脉搭桥术中的应用。方法 选择冠脉搭桥术26例,于诱导后、切皮、体外循环转流前、停转流后60min、停转流90min、术毕及术后监护室各时点采用CO2部分重吸入法测心排血量（RBco),并与温度稀释法（TDco)作比较。结果 于诱导后、切皮、停转流90min、术毕、术后监护室RBco和TDco测量数值均无显著性差异（P＞0．05）,于转流前、转流后60min测量值有显著性差异（P＜0．05）。各时点RBco和TDco相关系数均P＜0．01,其中术后监护室中的相关系数最高,r＝0．8511。结论 CO2部分重吸入法测心排血量在冠脉搭桥术术后监测中有良好的准确度,术中监测也有一定的临床价值。     

瘢痕内切除瘢痕瓣回植联合药物注射治疗瘢痕疙瘩

目的:分析手术切除联合药物注射治疗瘢痕疙瘩的疗效。方法:瘢痕部分切除瘢痕瓣回植联合药物扩大注射一个疗程。结果:57块瘢痕疙瘩治愈47块,显效8块。结论:瘢痕内切除瘢痕瓣回植结合药物扩大注射治疗瘢痕疙瘩效果满意。     

面部凹陷畸形的修复

目的 探讨面部凹陷畸形的修复方法及其效果.方法 对面部凹陷畸形患者11例,采用自体脂肪颗粒注射移植9例:其中1例注射4次,3例注射2次,其余5例均注射1次.同侧岛状颞筋膜瓣修复2例.结果 9例自体脂肪颗粒注射移植者,效果满意.2例同侧岛状颞筋膜瓣修复者,其中1例术后形成血肿,予以清除,效果亦均较满意.结论 自体脂肪颗粒注射移植及同侧岛状颞筋膜瓣移植对轻、中度面部凹陷畸形的修复不失为一良好方法,值得推广.     

Coronary artery bypass grafting with bilateral internal thoracic arteries for Bland-White-Garland syndrome in an adult

A 46-year-old man with anomalous origin of the left coronary artery from the pulmonary artery (Bland-White-Garland syndrome) is reported. We successfully performed coronary artery bypass grafting with the use of bilateral internal thoracic arteries and ligation of the anomalous left coronary artery. The patient was discharged from the hospital after an uneventful postoperative course and postoperative coronary angiography, which revealed patent internal thoracic arteries and no leakage of blood flow from the anomalous left coronary artery to the pulmonary artery. This surgical procedure is technically simple and useful for adult patients with Bland-White-Garland syndrome. To our knowledge, this is one of only a few reports on coronary artery bypass grafting with bilateral internal thoracic arteries as a treatment of Bland-White-Garland syndrome.     

Internal fixation and muscle pedicle bone grafting in femoral neck fractures

Background:

The treatment of displaced intracapsular femoral neck fracture is still an unsolved problem. Non-union and avascular necrosis are the two main complications of this fracture, especially if patient presents late. Muscle pedicle bone grafting has been advocated to provide additional blood supply. We present analysis of our 32 cases of displaced femoral neck fracture treated by internal fixation and quadratus femoris based muscle pedicle bone grafting.

Materials and Methods:

Open reduction and internal fixation with muscle pedicle grafting was done in 32 patients. The age of patients varied from 14-62 years (average age 45 years) with male to female ratio of 13:3. Twenty-nine fractures were more than three weeks old. All the cases were treated by Meyers'' procedure. The fracture was internally fixed after open reduction and then a muscle pedicle graft was applied. It was supplemented by cancellous bone graft in seven cases. Fixation was done by parallel cancellous lag screws (n = 19), crossed Garden''s screws (n = 7), parallel Asnis screws (n = 5) and Moore''s pin (n = 1).Quadratus femoris muscle pedicle graft was used in 32 cases. In the initial 12 cases the graft was fixed with circumferential proline sutures, but later, to provide a secure fixation, the graft was fixed with a cancellous screw (n = 20). Postoperative full weight bearing was deferred to an average of 10 weeks.

Results:

Union was achieved in 26/29 (89.65%) cases which could be followed for an average period of 3.4 years, (2-8.5 years) with good functional results and had the ability to squat and sit cross-legged. Results were based on hip rating system given by Salvatti and Wilson. The results were excellent in 15 cases, good in four cases, fair in four cases and poor in six cases. Complications were avascular necrosis (n = 2), transient foot drop (n = 2), coxa-vara (n = 1) and temporary loss of scrotal sensation (n = 1).

Conclusion:

Muscle pedicle bone grafting with internal fixation is a viable treatment option in displaced femoral neck fractures with late presentation.     

Near-infrared spectroscopy for noninvasive evaluation of chest wall ischemia immediately after left internal thoracic artery harvesting

OBJECTIVE: The conclusions remain controversial about whether the sternal blood flow is preserved or diminished after internal thoracic artery (ITA) harvesting for coronary artery bypass grafting (CABG), especially in diabetic patients. We investigated the blood supply of the chest wall noninvasively using near-infrared spectroscopy (NIRS) immediately after CABG. METHODS: The study group comprised 30 patients who underwent CABG using a skeletonized left ITA through median sternotomy. As a control group, three nondiabetic patients undergoing valve surgery through median sternotomy were also included. On arrival of the patient in the intensive care unit immediately after surgery, two reflectance sensors were placed on the bilateral parasternal regions at the fourth intercostal space to record regional oxygen saturation (rSO(2)) and hemoglobin index (HbI) continuously approximately for 17 h. RESULTS: The differences in right and left values (R-L rSO(2) and R-L HbI) were significantly greater in the diabetic patients than in the nondiabetic patients (3.74% +/- 2.47% vs. 1.98% +/- 1.67 %, p = 0.036; and 0.28 +/- 0.19 vs. 0.13 +/- 0.13, p = 0.020). The R-L HbI was significantly greater in the on-pump patients than in the off-pump patients, although there was no significant difference in R-L rSO(2). Both R-L rSO(2) and R-L HbI were similar among the control, nondiabetic, and off-pump patients. CONCLUSION: The technique of NIRS enables noninvasive, continuous monitoring of chest wall perfusion immediately after ITA harvesting. Our study using NIRS showed a decrease in blood flow and oxygen metabolism of the hemisternum after LITA harvest in diabetic CABG patients.     

三种移植骨材料修复骨缺损能力的比较研究

目的 研究单纯异种无机骨，复合骨髓异种无机骨以及自体皮质骨修复骨缺损的能力。方法 取健康6月龄纯系新西兰大白兔22只，制作兔桡骨节段性骨缺损（1.5cm)模型。根据植入物的不同，随机分为自体皮质骨组（10肢），单纯异种无机骨组（10肢），复合骨髓的异种无机骨组（20肢）和空白对照组（4肢），术后2、4、6、8、12周进行放射线片和组织学观察。结果 单纯异种无机骨植入组，直至12周，仍为缓慢的骨传导过程，周边骨小梁向无机骨内爬行替代，异种无机骨内大部分为纤维组织，只有少数中心区域有新骨形成，而复合骨髓的异种无机骨植入后2周即有新骨形成，8周无机骨基本吸收替代完毕，12周髓腔形成，塑形改造，基本相关于自体皮质骨移植的融合速度，结论 复合骨髓的异种无机骨的成骨能力明显优于单纯异种无机骨，与自体皮质骨相当。     

常温不停跳冠状动脉搭桥术对机体氧供需的影响

目的：研究常温心脏不停跳冠状动脉搭桥术对机体氧供需平衡的影响。方法：16例冠心病患者，在咪唑安定，芬太尼，丙泊酸，维库溴铵及异氟醚静吸复合麻醉下，心脏不停跳行冠状动脉搭桥手术，术中监测ECG，SpO2及血液动力学指标。于冠脉血管吻合前后，分别取挠动脉及肺动脉血，测定血红蛋白（Hb)和动脉血氧饱和度（SaO2)，并计算全身氧供需平衡，结果：冠状动脉搭桥前后CaO,CvO2,DO2,VO2,O2ER,A-aDO2等均无明显变化（P＞0．05），CO搭桥后比搭桥前增加，但无显著性差异，结论：常温心脏不停跳冠状动脉搭桥手术对全身氧供需平衡没有明显影响。