国产重组人脑钠素与硝普钠用于心脏手术围术期处理的对比研究

目的 对重组人脑钠素（rhBNP）用于心脏手术围术期处理的可行性、安全性和有效性进行初步观察，并与硝普钠的作用进行比较。方法 选择择期心脏手术病人22例，随机分为rhBNP组（B组）和硝普钠（SNP）组（s组），每组11例。比较rhBNP与SNP对病人血流动力学和肝肾功能的影响。结果 与给药前和S组比较，B组用药后15、30、60、120和180min各点心输出量增加显著（P〈0．05，P〈0．01）；B组与给药前比较，给药后即刻、15、30和60min时点外周血管阻力下降显著（P〈0．05）；给药后即刻、15和30点与S组比较，下降显著（P〈0．05）。B组肺毛细血管楔压（PCWP）与用药前比较，用药后即刻、15、30、60、120和180min下降显著（P〈0．05，P〈0．01）；与S组比较，给药后30、60、120和180min差异有统计学意义（P〈0．05，P〈0．01）。S组PCWP与用药前比较，用药后60min、120min和180min下降显著（P〈0．05）。B组与输注rhBNP前以及S组比较，平均动脉压、心率和中心静脉压差异均无统计学意义。输注rhBNP后病人24h尿量明显增加。用药过程中以及30d后进行电话随访，未见药物不良反应。结论 rhBNP用于心脏手术围术期处理是可行的，具有改善心功能和稳定循环的作用。     

National survey on the management of primary hyperparathyroidism by Swiss endocrinologists

Background From the endocrine surgeon’s perspective, it is important to know how endocrinologists manage patients with primary hyperparathyroidism (pHPT). The aim of this survey was to evaluate the preoperative diagnostic workup and referral pattern for parathyroidectomy by Swiss endocrinologists. Materials and methods The survey was conducted by mailing a questionnaire to all members of the Swiss Society for Endocrinology and Diabetes in spring 2005. Results The questionnaire was sent back by 68 of 124 endocrinologists (55%). The median annual case volume of patients with pHPT was 6 (range 1–50). The mean fraction of these patients referred for surgery was 59 ± 24%. This fraction was significantly higher in the German-speaking part of Switzerland than in the French-speaking part (67 ± 21% vs 51 ± 27%). When considering surgery for asymptomatic pHPT, 62% of the endocrinologists rely routinely on the recommendations of the NIH consensus conference and 86% on the subsequent guidelines of the workshop in 2002. Sixty-seven percent of the endocrinologists routinely perform localization studies before possible referral for surgical exploration. Typically, they consisted of an ultrasonography of the neck (93%) and a ^99mTc-MIBI scintigraphy (80%). The impact of the availability of a minimally invasive surgical procedure on the number of patients referred for surgery seems to be considerable. Sixty-one percent of the participants would expand the indication for surgery if the operation could be done by a limited surgical approach. Conclusions In a relevant fraction of patients with pHPT, endocrinologists still do not regard curative therapy as mandatory. Surprisingly, there are significant cultural differences concerning referral patterns to surgery between the German-speaking and the French-speaking parts of Switzerland. Minimally invasive procedures seem to lower the threshold for referral for surgical therapy. This work was presented at the 2nd Biennial Congress of the ESES, May 2006, Krakow, Poland.     

单臂外固定支架联合腓肠肌内侧头肌皮瓣治疗胫腓骨骨折合并大面积皮肤撕脱伤

目的探讨单臂外固定支架联合腓肠肌内侧头肌皮瓣治疗胫腓骨骨折合并胫前大面积皮肤撕脱伤的疗效。方法18例患者先进行急诊清创,采用单臂AO外固定支架固定骨折、腓肠肌内侧头肌皮瓣局部旋转覆盖外露胫骨。撕脱的皮肤修成全厚皮片回植供皮区,其中5例仍有缺损,另取同侧大腿全厚皮片移植。结果均无感染,15例旋转皮瓣完全成活,2例皮瓣远端表皮坏死,经换药治愈,1例皮瓣远端全层坏死,经植皮治愈。撕脱皮片回植13例成活,5例小部分坏死,其中3例经换药治愈,2例经中厚皮片植皮愈合。5例大腿皮片完全成活。平均随访19.5(10~36)个月,骨折平均愈合时间4(3.5~6)个月。所有患者行走正常,3例膝关节屈伸活动受限,4例踝关节屈伸受限。结论采用单臂外固定支架联合腓肠肌内侧头肌皮瓣治疗胫腓骨骨折合并胫前大面积皮肤撕脱伤,疗效肯定。     

胸腔镜下胸交感神经干切断术治疗手汗症(附300例报告)

目的总结胸腔镜胸交感神经干切断术300例的临床经验。方法分析2003年1月至2006年1月经胸腔镜胸交感神经干T_2～T_4切断术治疗手汗症的临床资料。以患侧手掌皮肤温度较术前升高1℃～3℃或更高,转干燥者为有效。手掌皮肤温度较术前增加小于1℃仍为潮湿者为无效。结果300例手术均获成功,术后患者手掌多汗症状消失,双手转为干燥温暖状,术后掌温升高(2.8±0.8)℃;282例术后随访1～36个月无一例复发,术后转移代偿性多汗60例占21.2%。结论胸交感神经干切断术是治疗手汗症安全、微创和有效的方法。     

Ross术后中远期主动脉瓣反流的危险因素分析

Objective To analyze the risk factors of the postoperative mid- and long-term aortic valvular regurgitation after ROSS procedure(pulmanary valve homograft transplantation). Methods Between March 1998 and July 2007,47 patients[25male, 22 female, mean age (13.31±5.79) years, ronge 1-34 years] with aortic valvular disease underwent the Ross procedure at our insti tution. There were 6 patients suffering fron rheumatic heart disease and 41 patients suffering from congenital heart disease. The aver age aortic blood flow velocity was (4.67±3.47) m/s, the average pressure gradient across aortic valve (88.26±58.06)mm Hg, LVEDD (45.53 ±10.78) mm, EF 0.69±0.08. All the patients were followed up in out-patient departement by ultrasonic cardio gram. Multiple logistic regression analysis was performed to find out the risk factors of the postive aortic valvular regurgitation. Results There was no poetoperative death in hospital. The mean follow-up periods was (36.15±22.1) months, rasnge from 12 to 110 months and none long-dated death. Compared with the data recorded in hospital, the diamenters of the aortic sinus and aortic annu lus enlarged significantly, respectively from (26.16±5.10) mm to (32.37±6.84) tam and from (19.41 ～3.98) mm to (23.45± 5.86) mm. The average flow velocity d the homograft (new aortic valve) was(1.39±0.48) m/s, graclient pressure (8.17+6.16) mm Hg. Mild aortic regurgitstion was present in 5 patients (10.6%), moderate aortic tegmgitafion in 2 pmieats (4.3%) and aevere aortic regurgitation in 1 petient (2.1%). The rate of free from regurgitation was 82.9%. Multiple logistic analyses identified the per esence of bicuspid aortic valve, enlargement of aortic annulus and age above 14 years as the risk factors for posterative aortic regurg itation. Conclusion The Ross procedure is a safe and effective procedure with good clinical results in mid-and long-term follow-up. However, the presence of bicuspid aortic valve, enlargement of aortic annulus and age above 14 years preoperatively were identified as the risk factors for postoperative aortic regurgitation.     

改良Norwood手术临床应用

目的总结改良Norwood手术的临床应用经验。方法2004年7月和2005年3月分别为1例7月龄单心室伴左心室流出道梗阻女婴,采用主肺动脉和主动脉弓下缘直接吻合、主动脉肺动脉人工血管分流完成改良Norwood手术;1例出生13 d左心发育不良综合征新生儿,采用主肺动脉和主动脉弓下缘直接吻合、右心室肺动脉人工血管分流完成改良Norwood手术。结果例1术后平稳,动脉压为85～100/25～40mmHg（1 mm Hg=0．133kPa）,动脉血氧饱和度为0．75～0．85,术后第3d撤离辅助呼吸,第11 d出院。例2术后平稳,动脉压为65～80／40～60mmHg,动脉血氧饱和度为0．67～0．89,术后第12 d撤离辅助呼吸,第28 d出院。结论改良Norwood手术的先进方法和技术,值得在我国推广应用。     

电视胸腔镜心血管外科手术150例

目的 总结、分析150例电视胸腔镜心血管外科手术的临床结果。方法 应用电视胸腔镜手术技术对动脉导管未闭、房间隔缺损、室间隔缺损、三尖辨关闭不全、冠状动脉-肺动脉瘘、心包积液、原发性长Q-T综合征、雷诺病，心包囊肿等进行治疗。结果 动脉导管未闭均成功在胸腔镜下钳闭；房缺、室缺在胸腔镜体外循环下进行补片修补，冠状动脉瘘胸腔镜下修补；心包积液进行心包活检与开窗引流；长Q-T综合征进行胸腔镜下左T2、T3胸交感神经节切除，均无严重并发症，术后患者恢复良好。结论 电视胸腔镜心血管外科手术可取得满意的临床治疗结果。     

创伤性膝关节脱位失稳性的检查与治疗

目的：探讨创伤性膝关节脱位失稳性的检查方法、手术时机与治疗方法。方法：本组63例创伤性膝关节脱位，男48例，女15例；年龄16-75岁，平均36．6岁。鲜新膝关节脱位40例，陈旧膝关节脱位23例。按Wascher膝关节脱位分型标准：KD—Ⅰ型1例，KD—Ⅱ型13例，KD-Ⅲ型17例，KD—Ⅳ型18例，KD—Ⅴ型14例。结合物理与影像学检查评判患膝稳定性。单纯开放手术治疗53例，单纯关节镜治疗4例，关节镜加开放手术治疗4例，截肢1例，全膝关节置换1例。结果：膝MRI阳性率100％（39／39），膝应力位X线检查阳性率100％（19／19），膝关节镜阳性率93．3％（14／15）。按Lysholm膝关节评分标准：治疗前陈旧伤组平均（37．17±5．33）分，新鲜伤组平均（37．41±5．38）分；治疗后陈旧伤组平均（67．33±14．72）分，新鲜伤组平均（82．45±12．13）分（Z=-3．061，P=0．002）。结论：膝关节应力位X线检查、MR及关节镜检查对评判创伤性膝关节脱位的稳定性有积极意义，失稳性创伤膝关节脱住手术治疗的关键是早期，鲜新伤以修复为主，陈旧伤以重建为主。     

手法复位石膏外固定治疗Barton骨折

Barton骨折是桡骨远端背侧、掌侧缘骨折,合并腕的半脱位,是一种较少见的关节内骨折。自1998年以来对21例Barton骨折患者采用闭合手法整复、石膏夹板外固定治疗,经随访观察,疗效满意。