目的 总结6例危重冠心病患者在左心转流辅助下行不停跳冠状动脉旁路移植术的应用经验和疗效观察.方法 回顾性分析本院在2021年2月至12月收治的6例危重冠心病患者,在全麻下经右上肺静脉-离心泵-保温装置-升主动脉插管建立左心转流行不停跳冠状动脉旁路移植手术的临床资料,通过观察辅助治疗前后的血流动力学及血气指标的变化,评价辅助效果.结果 左心转流辅助流量平均(3.2±0.5)L/min,辅助时间平均(83±12)min,辅助后患者的血流动力学指标较辅助前显著改善,肺动脉压由(45±15)mmHg下降至(27±13)mmHg(P=0.039);平均动脉压由(63±12)mmHg上升至(71±11)mmHg(P=0.045),但脉压较辅助前降低.患者动脉血气指标无明显改变,pH、氧分压、二氧化碳分压、血糖、乳酸在辅助前后差异无统计学意义;红细胞压积值由辅助前的(0.35±0.01)下降至(0.31±0.02),有统计学差异(P=0.001).患者在手术结束后均成功脱离左心辅助,术后ICU气管插管带管时间(8.5±1.9)h,ICU停留时间(1.8±0.9)d,均顺利出院.结论 在简易左心转流下行不停跳冠状动脉旁路移植术,通过减少经过左心的血液容量负荷,避免了术中搬动心脏时血流动力学的剧烈波动,安全可行.

Vascular smooth muscle cells (VSMCs) are the predominant cell type of the aortic middle layer, the abnormal number or function of which has been demonstrated to have a role in thoracic aortic aneurysm (TAA). Here, this study aimed to identify the function of circ_0008285 in VSMC apoptosis.

Objective:To analyze the mid-and long-term efficacy of simple mitral valve replacement and mitral valve combined with aortic valve replacement in the treatment of rheumatic heart disease.Methods:A total of 82 patients with rheumatic heart disease admitted to the Fuwai Central China Cardiovascular Hospital from March 2020 to October 2021 were selected, and they were divided into control group and observation group by dichromatic sphere method, with 41 patients in each group. The control group was treated by mitral valve replacement surgery alone, while the observation group was treated by mitral valve combined with aortic valve replacement surgery. The surgical and postoperative indicators were compared between the two groups. The cardiac function indicators, including cardiac function grading, left atrial diameter (LAD), left atrial volume index (LAVI), cardio-thoracic ratio (C/T) and left ventricular ejection fraction (LVEF), were compared between the two groups before surgery, 6 months after surgery, and 1 year after surgery.Results:The operation time, cardiopulmonary bypass time, cross-clamp time, and auxiliary time in the observation group were longer than those in the control group ( P<0.05), and the intraoperative bleeding volume was less than that in the control group ( P<0.05); however, there was no statistically significant difference in intensive care unit (ICU) time, postoperative drainage volume, and hospital stay between the two groups ( P>0.05). Before surgery, there was no statistically significant difference in any cardiac function indicator between the two groups ( P>0.05). Six months and 1 year after surgery, the heart function grading, LAD, LAVI, and C/T in the observation group were lower than those in the control group, while the LVEF was higher than that in the control group, with statistically significant differences ( P<0.05). Conclusions:Compared with mitral valve replacement surgery alone, mitral valve combined with aotic valve replacement in the treatment of rheumatic heart disease may prolong the operation time, cardiopulmonary bypass time, cross-clamp time, and auxiliary time; however, it has less bleeding, and can better improve mid- and long-term cardiac function.

Objective:To investigate the effect of coronary artery bypass grafting combined with heart valve replacement on coronary heart disease (CHD) complicated by heart valve disease.Methods:A total of 90 patients with CHD and heart valve disease who were admitted to Fuwai Central China Cardiovascular Hospital from June 2019 to July 2021 were selected, and the patients were divided into contemporaneous group and non-contemporaneous group according to the operation plans, with 45 cases in each group. The non-contemporaneous group was treated with coronary artery bypass grafting and heart valve replacement at the different times, while the contemporaneous group was treated with coronary artery bypass grafting and heart valve replacement at the same time. The excellent and good rate of surgery, postoperative conditions, left ventricular ejection fraction (LVEF) level, left ventricular end-diastolic diameter (LVED) level, cardiac function class, ischemia duration, the number of ischemia occurrences and the risk of adverse events were compared between the two groups.Results:The excellent and good rate of surgery in the contemporaneous group (95.56%, 43/45) was higher than that in the non-contemporaneous group (80.00%, 36/45), and the difference was significant ( P<0.05). The ventilator application time and hospital stay in the contemporaneous group were shorter than those in the non-contemporaneous group ( t=19.73, 14.75; all P<0.05). The LVEF in the contemporaneous group was higher than that in the non-contemporaneous group 3 months after operation, and the LVED was shorter than that in the non-contemporaneous group ( t=6.19, 4.02; all P<0.05). The cardiac function classification in the contemporaneous group was better than that in the non-contemporaneous group ( U=3.21, P=0.001). The duration of ischemia in the contemporaneous group was shorter than that in the non-contemporaneous group, and the number of ischemia occurrences was less than that in the non-contemporaneous group 3 months after operation ( t=15.30, 51.24; all P<0.05). The incidence of adverse events in the contemporaneous group (6.67%, 3/45) was lower than that in the non-contemporaneous group (24.44%, 11/45), and the difference was significant ( P<0.05). Conclusions:Concurrent coronary artery bypass grafting combined with heart valve replacement in the treatment of CHD complicated by heart valve disease is beneficial to improve the rate of excellent and good operation, improve the level of cardiac function and ischemia, and speed up the recovery of patients, with great safety.

Objective:To analyze the relationship between serum microRNA (miR)-146a, miR-499 and new onset atrial fibrillation after off-pump coronary artery bypass grafting (OPCABG) in patients with coronary heart disease (CHD).Methods:A Total of 118 patients with CHD treated in the First Affiliated Hospital of Zhengzhou University from August 2019 to August 2021 were selected as the research subjects. All patients were treated with OPCABG, and were observed for 7 days after operation. The patients with atrial fibrillation during the observation period were included in the occurrence group, and those without atrial fibrillation served as the non-occurrence group. The levels of serum miR-146a and miR-499 were measured the next day after admission, and general information of the two groups was asked and recorded. The relationship between serum miR-146a, miR-499 and new onset atrial fibrillation after OPCABG in patients with CHD was analyzed by independent sample t-test and the Logistic regression analysis. Results:Among the included 118 patients with CHD, 28 cases developed atrial fibrillation after OPCABG, accounting for 23.73%. After comparison of the general data and laboratory indicators between the two groups, the eligible variables were included. The Logistic regression analysis showed that serum miR-146a and miR-499 levels were significantly increased in the occurrence group as compared with those in the non-occurrence group (1.36±0.18 vs. 1.24±0.16, 2.13±0.22 vs. 1.95±0.18) ( t=3.439, 4.487, P<0.05). The receiver operating characteristic (ROC) curve was drawn and showed that the area under the curve (AUC) of serum miR-146a and miR-499 alone and combined to predict atrial fibrillation after OPCABG in patients with CHD were 0.788, 0.815 and 0.860 respectively, which had certain predictive value. Conclusion:The overexpression of serum miR-146a and miR-499 is related to atrial fibrillation after OPCABG in patients with CHD. The preoperative detection of both levels can predict the risk of postoperative atrial fibrillation.

55岁女性患者，因发作性胸痛入院。X线胸片检查示镜面右位心，胸腹腔脏器全反位；头颈部CTA检查示右侧颈内动脉起始处重度狭窄近闭塞；冠状动脉造影检查示三支血管严重病变。2022年2月在全麻下行非体外循环不停跳冠状动脉旁路移植术+右侧颈动脉内膜剥脱术。先患者先垫高右侧肩，行右侧颈动脉内膜剥脱术；然后取平卧位，更换经口气管插管，正中开胸，行非体外循环不停跳冠状动脉旁路移植术。联合手术共计用时5.5 h，术中血流动力学稳定，术毕返心外ICU，术后第2天转出ICU，术后9天痊愈出院。目前随访5个月，患者恢复正常工作和一般体力活动。

目的 分析二尖瓣关闭不全(MI)患者冠脉搭桥术(CABG)后低氧血症发生情况及其影响因素.方法 回顾性分析2018年10月至2020年10月在我院行CABG治疗的74例MI患者的临床资料,根据患者是否发生低氧血症将其分为发生组与未发生组,比较两组患者的基本情况,分析导致MI患者CABG术后发生低氧血症的相关影响因素.结果 74例MI患者中有20例(27.03％)CABG术后发生低氧血症.发生组吸烟史占比、合并慢性肺病占比、BMI均高于未发生组,LVEF低于未发生组(P<0.05);经Logistic回归分析结果显示,有吸烟史、BMI偏高、合并慢性肺病、LVEF偏低是MI患者CABG术后发生低氧血症的影响因素(OR>1,P<0.05).结论 MI患者CABG术后发生低氧血症与其吸烟史、BMI偏高、合并慢性肺病、LVEF偏低密切相关,术前应给予患者针对性干预,以有效减少术后低氧血症的发生.

目的 观察双极射频消融联合心理治疗对风湿性心脏病(Rheumatic heart disease,RHD)合并心房颤动(Atrial fibrillation,AF)患者的效果及对其抑郁、焦虑情绪的影响.方法 选择2019年1月～2020年12月接诊的150例RHD合并AF患者,随机分为:观察组(纳入75例,行双极射频消融+心理治疗)、对照组(纳入75例,行双极射频消融),比较两组间的超声功能参数、抑郁及焦虑评分、术中指标、房颤消除率、健康调查简表(SF-36).结果 (1)术后6个月,观察组超声功能参数、抑郁及焦虑评分、SF-36评分优于对照组(P＜0.05);(2)观察组转流时间(127.64±27.58)min、主动脉阻断时间(69.14±12.48)min 均少于对照组(158.57±34.85)min、(75.23±17.54)min(P＜0.05);(3)观察组术后1、3、6个月时的房颤消除率均高于对照组(P＜0.05).结论 对RHD合并AF患者行双极射频消融联合心理治疗,可以提高房颤消除率,改善心功能,恢复正常窦性心律,减轻抑郁、焦虑情绪,提高生活质量.

目的 探讨皮下脂肪部分剔除预防心脏术后胸骨正中切口愈合不良的疗效.方法 选取2019年3月至2020年5月在我科行胸骨正中切口的心脏手术患者539例,按切口缝合方式分为两组:皮下脂肪部分剔除组(对照组)和常规组,比较其发生切口愈合不良的比率和术后总住院时间.结果 皮下脂肪部分剔除组心脏术后胸骨正中切口愈合不良率显著少于常规组(0比6.97％,P<0.05),术后总住院时间显著短于常规组[(11.7±4.9)d比(13.54±7.3)d,P<0.05].结论 皮下脂肪部分剔除可显著降低心脏术后胸骨正中切口愈合不良的发生率并缩短术后总住院时间,可广泛应用于临床.

目的 探讨不停跳(非体外循环)冠状动脉搭桥术中内窥镜获取大隐静脉的手术方法及临床应用价值.方法 回顾性分析阜外华中心血管病医院2018-01—2019-06行不停跳冠状动脉搭桥术的200例冠状动脉三支严重病变患者的临床资料.分为内窥镜获取大隐静脉组(EVH组)和传统切开获取大隐静脉组(OVH组),各100例.比较2组围术期相关指标、术后下肢并发症发生率、住院期间和术后6个月时术侧下肢感觉异常情况.术后6个月时,根据冠脉CTA结果统计桥血管闭塞率.结果 2组总手术时间、获取大隐静脉时间、术后ICU滞留时间、下肢切口裂开率、再次清创发生率,以及术后6个月随访时的桥血管闭塞率差异均无统计学意义(P>0.05).EVH组下肢切口长度、术后开始下床活动时间均短于OVH组;切口脂肪液化、皮下淤血、水肿等并发症发生率,以及住院期间和术后6个月时的术侧下肢感觉异常率均低(短)于OVH组.差异均有统计学意义(P<0.05).结论 在不停跳冠状动脉搭桥术中,传统切开和内窥镜获取大隐静脉的手术时间、获取大隐静脉时间、术后ICU滞留时间,以及下肢切口裂开率、再次清创发生率和术后6个月随访时的桥血管闭塞率相仿;但内窥镜获取大隐静脉具有切口小、患者术后可早期下床活动,以及切口脂肪液化等并发症发生率低和住院时间短、术后6个月时的术侧下肢感觉异常率低等优势.

Objective:To explore the treatment strategies for different types of poor healing of median thoracic incision after cardiac surgery.Methods:A retrospective analysis was performed on 1 067 adult patients in Fuwai Huazhong Cardiovascular Hospital from February 2017 to January 2020. The operations included coronary artery bypass grafting, heart valve repair or replacement, coronary artery bypass grafting + valve repair or replacement, correction of congenital heart disease, modified extended Morrow procedure, etc. All of them adopted the median thoracic surgical incision. After operation, 44 patients had different types of poor incision healing, including 19 males and 25 females, aged (65.2±6.73) years. After active treatment, all of them healed well.Results:The fat liquefaction of median thoracic incision occurred in 14 cases, and all of them were cured by dressing change and pressure bandage. The poor healing of local median thoracic incision occurred in 11 cases, and all of them were cured by secondary suturing after debridement. The whole median thoracic incision was poorly healed in 10 cases, the secondary suturing was performed after debridement; the middle incision in 1 case was given debridement and suturing again, and the other cases all healed well. The sternal wire loosening occurred in 5 cases, the debridement and suturing were performed after tightening the wire, and the healing was good. The sternum dehiscence occurred in 4 cases, all of them were treated with transposition of pectoralis major myocutaneous flap and were cured at one time.Conclusion:For different types of poor incision healing of median thoracic operation after cardiac surgery, taking individualized treatment methods can achieve satisfactory clinical results.

Objective:To explore the relationship between serum microRNA (miR)-335 and miR-193b levels and prognosis in patients with coronary heart disease (CHD) after coronary artery bypass grafting (CABG).Methods:106 patients with CHD admitted to Central China Fuwai Hospital, Zhengzhou University from June 2018 to June 2020 were selected as the research subjects, all patients were treated with CABG, the patients were followed up for 12 months after operation, according to the prognosis of patients (whether adverse cardiovascular events occurred), they were divided into a poor prognosis group and a good prognosis group. The serum levels of miR-335 and miR-193b at admission were detected and compared between the two groups, the relationship between the serum levels of miR-335 and miR-193b at admission and the prognosis of patients with CHD after CABG was analyzed.Results:Among 106 patients with CHD after CABG treatment and follow-up, 34 cases had adverse cardiovascular events, accounting for 32.08%; the levels of cholesterol (TC) (6.02±0.87) mmol/L, triglyceride (TG) (1.87±0.40) mmol/L in poor prognosis group were higher than those in good prognosis group (4.45±0.62) mmol/L, (1.53±0.31) mmol/L, and the levels of miR-335 (0.55±0.29), miR-193b (0.46±0.25) were lower than those in good prognosis group (0.81±0.27), (0.76±0.24), the differences were statistically significant ( t=10.577, 4.940, 4.571, 5.869, P<0.05); there was no statistical significant difference in other data between the two groups ( P>0.05); after the single Logistic regression analysis, the P value was relaxed to <0.1, the eligible factors were included, and the multiple logistic regression model was established, the results showed that the overexpression of TC ( B=3.666, odds ratio ( OR)=39.106, 95% confidence interval ( CI): 8.551-178.831), TG ( B=2.888, OR=17.959, 95% CI: 4.516-71.423) might be a risk factor for the prognosis of patients with CHD after CABG ( OR>1, P<0.05), the high expression of miR-335 ( B=-3.324, OR=0.036, 95% CI: 0.007-0.190), miR-193b ( B=-5.068, OR=0.006, 95% CI: 0.001-0.054) levels might be a protective factor for the prognosis of patients with CHD after CABG ( OR<1, P<0.05); the ROC curve was drawn, and the results showed that the area under curve (AUC) of serum miR-335 and miR-193b levels at admission in predicting poor prognosis of patients with CHD after CABG treatment were all >0.70, which had certain predictive value, when the cut-off values of serum miR-335 and miR-193b at admission were 0.640 and 0.660, the best predictive value could be obtained. Conclusion:The serum levels of miR-335 and miR-193b are closely related to the prognosis of patients with CHD after CABG, the combined detection of the two is helpful to monitor the prognosis of patients with CHD.

目的:分析急性心肌梗死(AMI)并发室间隔穿孔(VSR)患者院内死亡的相关因素.方法:回顾性分析我院冠心病监护病房(CCU)2018年1月-2020年12月收治的92例AMI并VSR患者的临床资料,根据是否发生院内死亡,将患者分为院内死亡组(45例)和院内存活组(47例),分析患者院内死亡的相关因素.结果:AMI并发VSR患者院内病死率为48.9％.院内存活组与院内死亡组患者入住CCU时Killip心功能Ⅲ～Ⅳ级、B型利钠肽(BNP)水平、平均动脉压(MAP)、血乳酸、白细胞、C反应蛋白(CRP)、序贯器官衰竭评分(SOFA评分)、住院期间合并消化道出血患者比例、手术治疗患者比例及住院时长均差异有统计学意义(均P＜0.05).Logistic多因素回归分析显示,患者入住CCU时SOFA评分(OR=1.501,95％CI:1.211～1.862,P＜0.01)及住院期间手术治疗(OR=0.035,95％CI:0.007～0.168,P＜0.01)是患者院内死亡的独立相关因素.结论:手术(介入封堵术及外科修补术)是治疗AMI并发VSR患者的有效手段,而患者入住CCU第1天的SOFA评分可能与患者院内死亡相关.

Objective:To investigate the relationship between tumor necrosis factor-α (TNF-α) G308A single nucleotide polymorphism and complications after heart valve replacement.Methods:The clinical data of 173 patients with valve replacement in our hospital from January 2018 to January 2020 were collected, and they were divided into complication group and non-complication group according to whether there were complications. Genotyping technique was used to detect TNF-α (TNF-α) polymorphism 308 G/A was genotyped. The genotypes of TNF-α 308 were analyzed. The genotypes of TNF-α 308 in different complications were analyzed; Multivariate logistic regression analysis was used to screen the independent risk factors of postoperative complications.Results:The frequency of GG genotype in patients without complications (80.54%, 120/149) was significantly higher than that in patients with complications (54.17%, 13/24, χ2=7.109, P<0.05). The frequency of GA genotype in patients without complications (13.42%, 20/149) was significantly lower than that in patients with complications (29.17%, 7/24, χ2=6.001, P<0.05). The frequency of AA genotype in patients without complications (6.06%, 9/149) was significantly lower than that in patients with complications (16.67%, 4/24, χ2=4.917, P<0.05). The frequency of G allele in patients without complications (87.25%, 130/149) was significantly higher than that in patients with complications (68.75%, 17/24, χ2=6.987, P<0.05). The frequency of G allele in patients without complications (12.75%) was significantly lower than that of a genotype in patients with complications (31.25%, χ2=6.153, P<0.05). The level of TNF-α in peripheral blood of the patients without complications [(1.23±0.27) ng/ml] was significantly lower than that of patients with complications [(1.85±0.35) ng/ml, t=4.991, P<0.05]. The level of TNF-α in peripheral blood of patients with GG genotype [(1.03±0.23) ng/ml] was significantly lower than that of patients with GA genotype patients [(1.45±0.28) ng/ml, t=3.019, P<0.05]. The level of TNF-α in peripheral blood of patients with GA genotype [(1.98±0.31) ng/ml] was significantly higher than that of AA genotype patients [(1.45±0.28) ng/ml, t=4.018, P<0.05]. Multivariate logistic regression analysis showed that TNF-α and G308A were independent factors of postoperative complications. Conclusion:TNF-α and G308A are independent factors of complications after valve replacement.

目的:探讨氨溴索对微创心脏手术患者肺损伤的保护作用.方法:按照随机数字法将2012～2016年在我院行微创心脏手术的252例患者分为A、B、C、D四组,每组63例.A、B、C三组患者从术前1d～术后第3 d分别静脉滴注低剂量[3 mg/(kg·d)]、中剂量[9 mg/(kg·d)]、高剂量[15 mg/(kg·d)]氨溴索,D组患者给予生理盐水.以术前、术后即刻、术后第1 d、2 d及3 d四组的呼吸指数(RI)、氧合指数(OI)、血清肺表面活性物质相关蛋白-A(SP-A)、血清细胞间黏附因子-1(ICAM-1)及血浆肿瘤坏死因子-α(TNF-α)水平评价肺保护作用.结果:在术后即刻,四组的RI、SP-A、ICAM-1、TNF-α 均明显高于术前;A、B、C三组患者在术后第1 d、2 d和第3 d的RI、OI、SP-A、ICAM-1、TNF-α 均明显低于D组的患者;C组患者在术后第2 d的RI(0.38±0.13 vs 0.49±0.11、0.45±0.12)、OI(mmHg,1 mmHg=0.133 kPa;387.05±52.50 vs 431.96±58.46、433.94±57.52)、SP-A(pmol/L;71.45±10.63 vs 88.45±12.19、83.32±12.45)、ICAM-1(μg/ml;71.54±12.39 vs 102.41±18.45、97.20±16.63)、TNF-α(μg/ml;54.20±15.31 vs 83.45±17.52、76.19±16.24)均明显低于A、B两组患者,差异均有统计学意义(P均<0.05).结论:氨溴索对微创心脏手术中的肺损伤具有保护作用,大剂量氨溴索的保护作用更加快速明显.

目的 研究国人阿司匹林、氯吡格雷药物基因检测结果特点及该技术在指导冠状动脉旁路移植术后个体化用药中的临床应用价值.方法 选取行单纯冠状动脉旁路移植术患者846例,术前均行阿司匹林、氯吡格雷药物基因检测,分别统计两种药物基因检测结果的特点,术后依据基因检测结果及循证医学证据的建议进行个体化抗血小板治疗,分析术后在院期间新发动脉血栓形成事件及抗血小板药物应用相关出血的发生率,并随机抽取部分患者应用血栓弹力图来验证抗血小板疗效.结果 阿司匹林检测血小板内皮聚集受体1(PEAR1)基因野生型(GG) 321例(37.9％),突变杂合型(GA)407例(48.1％),突变纯合型(AA)118例(14.0％),其中基因型为野生型的患者如合并高龄(≥70岁)、消化道溃疡病史或胃大部切除术后,则使用铝镁匹林片(Ⅱ)(阿斯德)(114 mg/d)进行抗血小板治疗,其余患者使用阿司匹林肠溶片(拜阿司匹灵)常规剂量(100 mg/d).氯吡格雷检测的基因为细胞色素P450 2C19(CYP2C19)和对氧磷酶1(PON1),其中,基因型组合为GG+GG、GG+GA、GA+GG即表明患者对氯吡格雷应答良好或仅有较低的抵抗风险,此类患者给予氯吡格雷常规剂量(75 mg/d)应用,共429例(50.7％);相反,基因型组合为AA+AA、AA+GA、AA+GG、GA+AA、GA+GA及GG+AA的患者均存在较高的氯吡格雷抵抗风险,共417例(49.3％),使用氯吡格雷抗血小板治疗需至少增加50％～70％的剂量或已不适合应用该药进行抗血小板治疗,研究采用直接替换为替格瑞洛180 mg/d(分两次服用)的方法进行双联抗血小板治疗.术后在院期间新发心肌梗死4例、脑梗死3例、抗血小板药物应用相关出血3例(鼻出血2例,牙龈出血1例).术后口服抗血小板药物治疗3～5天随机选择完成血栓弹力图血小板功能检查的患者共109例,结果显示AA抑制率(63.48±8.85)％,ADP抑制率(53.43± 14.10)％,MAADP值36.67±6.25 mm.结论 对于冠状动脉旁路移植术后的双联抗血小板治疗,单中心结果显示国人具有较高的氯吡格雷基因抵抗概率,基因检测技术在氯吡格雷和替格瑞洛的药物选择上具有重要的参考价值.而有消化道出血高危因素的患者,阿司匹林基因检测结果可以作为药物减量的重要依据.

Objective: To investigate the mid-and long-term clinical effects of tricuspid valvuloplasty with the implantation of an artificial plastic ring.Methods: Data of 677 patients who had functional tricuspid regurgitation and left cardiac valve disease and underwent tricuspid valvuloplasty and left cardiac valve surgery were retrospectively.Among these patients, 353 underwent simple suture annuloplasty（group A） while the rest 324 patients underwent artificial plastic ring annuloplasty（group B）.The two-year and more-than-two-year clinical and ultrasonocardiograph（UCG） follow-up data of the two groups were obtained and compared.Results: A total of 600 patients（88.6%） completed the long-term follow-up（more than two years）.The two-year follow-up showed no significant difference in the incidence of mild tricuspid regurgitation between the two groups（82.2% vs.92.7%, P=0.37）.However, there were significantly more cases that developed into moderate to severe tricuspid regurgitation in group A than in group B（17.8% vs.7.3%, P=0.031）.The long-term follow-up revealed that the recurrence rate of tricuspid regurgitation in group B was significantly lower than that in group A（11.0% vs.25.0%, P=0.029）, and the ratio of cases developing into moderate to severe tricuspid regurgitation in group A was significantly higher than that in group B（28.9% vs.9.9%, P=0.007）.The comparison between the two intra-group time segments showed that the development of tricuspid regurgitation in group A was significantly increased（28.9% vs.17.8%, P=0.022）, but in group B it was relatively stable（9.9% vs.7.3%, P=0.52）.Conclusions: Artificial ring annuloplasty is associated with significantly less tricuspid regurgitation than simple suture annuloplasty.

目的 对比分析非体外循环冠状动脉搭桥术(OPCABG)与体外循环下心脏不停跳冠状动脉搭桥术(ONPBH)治疗冠心病合并左室功能减退的近期效果,探讨左室功能减退患者的手术策略选择.方法 回顾性分析2014年1月至2016年12月河南省人民医院收治的拟行手术治疗的73例冠心病合并左室功能减退患者,根据手术方法分为OPCABG组(40例)和ONPBH组(33例),对比分析两组手术相关指标、手术前后的左室射血分数(LVEF)及左室舒张末期内径(LVEDd)变化.结果 ONPBH组桥血管数量多于OPCABG组,手术时间、呼吸机辅助时间及ICU停留时间均长于OP-CABG组,总引流量、术后红细胞、术后血浆总量及主动脉内球囊反搏(IABP)使用率均大于OPCABG组,差异有统计学意义(P均<0.05).术前两组LVEF和LVEDd水平比较,差异无统计学意义(P>0.05);术后1个月,两组LVEF和LVEDd较术前均改善,差异有统计学意义(P<0.05),组间比较,差异无统计学意义(P>0.05).结论 OPCABG与ON-PBH术治疗冠心病合并左室功能减退均可改善患者心功能,相较ONPBH,OPCABG能缩短手术时间、呼吸机辅助时间及ICU停留时间,减小手术创伤.

目的 探讨胸骨下段小切口在非体外循环冠状动脉旁路移植术中应用的效果.方法 回顾性分析 2012年 6 月至2014年 12 月前降支单支病变的冠心病患者行胸骨下段小切口非体外循环冠状动脉旁路移植术 19 例的临床资料,其中男 11 例、女 8 例,年龄 59.6(44～68)岁.所有患者均游离左乳内动脉与前降支吻合,其中 1 例因术中探查见第一对角支近端明显粥样斑块且对角支粗大,遂向上延长切口,全胸骨打开,游离大隐静脉行对角支搭桥,近端吻合于升主动脉,术后 1、3、6、12 个月进行随访.结果 其中 1 例术中转为常规胸骨正中切口手术,其余 18 例手术胸骨下段小切口完成,术中血流动力学稳定,无围术期急性心肌梗死及死亡病例,无乳内动脉损伤、无吻合口漏血及恶性心律失常发生,无大出血、二次开胸止血及切口感染等并发症出现,术后住院 4～ 6 d,监护室入住时间、呼吸机辅助通气时间及住院费用均较常规开胸手术明显降低,术后随访期间无心绞痛复发病例.结论 胸骨下段小切口行非体外循环冠状动脉旁路移植术,创伤较小,安全可靠;而且是一种操作相对简单,容易掌握及可灵活应变的小切口微创手术,尤其适合于初学小切口冠状动脉旁路移植术术者.

Objective: To evaluate the anthracyclines-induced cardiotoxicity in patients with early-stage breast cancer. Methods: This retrospective study analyzed data of 64 patients (aged from 36 to 59 years old) with early-stage breast cancer after surgery. Patients were divided into ACT group (n=21), FAC group (n=19) and EC group (n=24). The NCI CTC 4.0 scores was used to evaluate the side effects at the time of 2 weeks, 4 weeks and 6 weeks after chemotherapy. Meanwhile, the level of cTnT, the incidence of abnormal electrocardiogram (ECG) and left ventricular ejection fraction (LVEF) were used to evaluate the anthracyclines-induced cardiotoxicity, the follow-up observation points were as follows: at the acute cardiotoxicity (time A), subacute cardiotoxicity (time B), 24 months after chemotherapy (time C), 36 months after chemotherapy (time D), 48 months after chemotherapy (time E), 60 months after chemotherapy (time F). The 3-years and 5-years overall survival and progress free disease survival among three groups were compared. Results: The ages, clinical stage, the size of tumor, axillary lymph node positivity and Eastern Cooperative Oncology Group Scores were similar among three groups (P>0.05); the incidence of side effects level 4 was 0. The levels of cTnT in the three groups were significantly lower than those at the baseline and time points C, D, E and F (all P<0.05), and the levels of cTnT were significantly higher in EC group than in FAC and ACT group at the time points B, C, D, E and F (P<0.05); however, the incidence of abnormal ECG and LVEF was similar among the 3 groups (P>0.05). The 5-year overall survival was 95.2% (20/21) ,100% (19/19) and 95.8% (23/24) in ACT group, FAC group and EC group, respectively; 5-year progress free disease survival was 95.2% (20/21) ,94.7% (18/19) and 91.7% (22/24) in ACT group, FAC group and EC group, respectively (P>0.05) . Conclusions: Patients with early-stage breast cancer after surgery could tolerate the anthracyclines-induced cardiotoxicity. Three chemotherapy schemes of ACT, FAC and EC, especially the EC protocol, could affect the myocardial damage. However, outcome is comparable among patients treated with above chemotherapy schemes in this patient cohort.