目的 比较体外与非体外循环冠状动脉旁路移植术(CABG)对患者术后谵妄发生率的影响.方法 回顾性分析阜外医院外科重症监护室(SICU)2020年1月至2021年4月收治的单纯行CABG患者信息,根据手术方式分为体外循环组和非体外循环组.比较两组患者的基本资料、基础疾病,术前超声射血分数(EF)值和术前血肌酐水平.终点指标为两组患者住院期间的谵妄发生率.结果 共607例患者纳入本研究,其中体外循环组495例,非体外循环组112例.两组患者年龄、性别比例、基础疾病(高血压、糖尿病、既往卒中史)、术前最后一次EF值、术前血肌酐值均无统计学差异.术中平均搭桥个数两组无统计学差异,体外循环组平均转机时间(123.7±46.8)min,主动脉阻断(89.9±33.6)min.术后呼吸机使用时间两组无统计学差异.ICU停留时间体外循环组高于非体外组[(3.0±1.8)d比(2.5±1.7)d,t=2.603,P=0.009].术后主要不良心脑血管事件(MACCE)发生率及连续性肾脏替代治疗(CRRT)两组均无统计学差异.体外循环组105例患者发生谵妄(21.2％),非体外循环组14例发生术后谵妄(12.5％).基于倾向性评分的逆概率加权回归分析提示OR值为2.402(95％CI:1.337～4.317),P=0.004.结论 非体外循环冠状动脉旁路移植术可降低术后患者谵妄的发生率.

目的 总结右心室肿瘤的手术治疗经验.方法 回顾性分析我院2009年7月至2016年12月共20例进行右心室肿瘤切除术患者的临床资料.结果 男性13例,女性7例,平均年龄(35.9±22.5)岁,良性肿瘤19例,恶性肿瘤1例,心内膜肿瘤14例,心肌间肿瘤3例,心外膜肿瘤3例.20例患者均采取正中开胸,在体外循环下完成手术,根治性切除15例,姑息性切除5例,同期行三尖瓣系统修复6例,平均转机时间(85.6±38.2) min,平均主动脉阻断时间(63.3±32.5)min,手术相关并发症1例,平均术后住院时间(8.3±2.0)d.平均随访时间(38.9±31.9)个月,随访过程中恶性肿瘤患者死亡,根治性切除组有1例复发,复发率6.7％(1/15).右心室心肌间肿瘤与心外膜肿瘤相较于心内膜肿瘤更不易于进行根治性切除(P=0.026).姑息性切除术会延长术后住院时间(P=0.001).结论 手术是治疗右心室肿瘤的主要方法,肿瘤根治性切除预后较好,姑息性切除和恶性肿瘤预后较差,且姑息性切除术会延长患者术后住院时间.右心室肿瘤切除的同时需要注意保护三尖瓣功能,必要时应积极进行三尖瓣的修复.

目的 研究利用超声心动图量化评估二尖瓣成形手术难度的可行性.方法 回顾性分析2012年1月至2013年12月我院术前经胸超声心动图可准确定位病变部位的退行性二尖瓣病变行二尖瓣成形术312例患者的临床资料.按照评分系统将手术难度评为1～9分,并分为简单(1分)、中等(2～4分)、复杂(≥5分)三组.其中简单组121例,男86例、女35例,平均年龄(51.6±12.6)岁.中等组158例,男105例、女53例,平均年龄(51.1±12.8)岁.复杂组33例,男25例、女8例,平均年龄(49.3±13.0)岁.结果 不同难度等级的手术复杂程度存在显著差异.简单组、中等组、复杂组体外循环时间分别为(111.7±45.5)min、(117.7±40.4)min、(153.4±74.2)min (P＜0.001).三组主动脉阻断时间依次为(77.5±33.8) min、(83.2±29.9)min、(108.8±56.2)min,差异有统计学意义(P＜0.001).三组使用手术技术分别为(2.1±0.4)种、(2.4±0.6)种、(2.8±0.8)种,差异有统计学意义(P＜0.001).但不同难度等级的近期、远期效果差异无统计学意义.结论 利用超声心动图量化评估二尖瓣成形手术难度是可行的.

AIM To analyze risk factors for repeat sternotomy (RS) in adult cardiac surgery (CS) and to identify the impact on outcomes.METHODS A retrospective study was conducted by analyzing the data of 242 patients with RS of CS from September 2009 to September 2015 at the 55th Ward of Adult Cardiac Center in Fuwai Hospital.Continuous variables were analyzed using 2-sample t tests and categorical variables were compared using 2-or Fisher's exact test.RESULTS Among the 242 patients,major injury (MI) occurred in 5 cases (2.1％) and no significant difference was found between the MI group and the nonMI group related to the interval since last sternotomy (8.3 ± 5.0 years vs.2.5 ± 8.8 years,P =0.286).Occurrence rate of MI was not statistically different between the primary coronary artery bypass graft and other operations (6.3％ vs.1.8％,P =0.292),or between the pericardium had closed or not (0％ vs.7.4％,P =0.275).The operative mortality rate was 1.7％ (4/242) and the operative mortality among the patients with MI during RS was not statistically different with those without MI (0％ vs.1.7％,P =0.919).CONCLUSION RS in adult CS is relatively safe and MI during RS is not a dangerous predictor of operative mortality.

左心室肿瘤发病率低,仅占全部心脏肿瘤的2.5%～5.0%[1],多为个案报道.现总结本中心17例左心室良性肿瘤手术治疗经验,报道如下.

AIM The investigation studied the investigate the outcomes of mitral annuloplasty with prosthetic rings in patients with ischemic mitral regurgitation (IMR) and ventricular aneurysm.METHODS Seventytwo patients with IMR and ventricular aneurysm who underwent mitral valve repair and ventricular aneurysm restoration were enrolled and 33 of them underwent mitral annuloplasty with prosthetic rings.The surgical and long-term outcomes of the patients were analyzed.RESULTS Surgical mortality was 6％ and mitral regurgitation was significantly corrected after surgery.During follow-up,moderate or above moderate mitral regurgitation was observed in 18％ of the patients.Although the use of mitral annuloplasty ring led to prolonged cardiopulmonary bypass time and cross-clamp time,it alleviated the long-term mitral valve regurgitation.CONCLUSION In patients with IMR and ventricular aneurysm,mitral valve repair is feasible and safe in reconstructing mitral valve function.The use of mitral annuloplasty ring could potentially alleviate long-term mitral valve regurgitation.

AIM To evaluate our experience of mitral valve repair in combination with left ventricular restoration and coronary artery bypass graft (CABG) for post-infarction ventricular aneurysm and mitral regurgitation so as to improve the clinical results for these patients.METHODS From January 2001 to December 2008,32 consecutive patients with left ventricular aneurysm and ischemic mitral valve regurgitation underwent nitral valve repair combined with ventriculoplasty and CABG.Clinical findings were reviewed retrospectively and the duration of follow-up was 46-175 months.RESULTS Operative mortality was 3％.One-year and 5-year survival rates were,respectively,97％ and 74％.During follow-up,three patients (9％) had NYHA class Ⅲ and Ⅳ and three patients (9％) had ≥2 + mitral regurgitation.The surgical technique for ventriculoplasty and the approach for mitral valve repair did not significantly affect the clinical outcomes.CONCLUSION Combined mitral and left ventricular reconstruction and coronary revascularization is effective for ischemic left ventricular aneurysm with mitral regurgitation.Short-and long-term clinical outcomes are satisfactory.

Objective To compare the perioperative and long-term curative effect between mitral valvuloplasy (MVP) and mitral valve replacement (MVR) in treatment of ischemic mitral regurgitation (IMR) complicated by ventricular aneurysm.Methods The patients (n=49) undergone mitral valve operation were chosen from the Fuwai Hospital of Chinese Academy of Medical Sciences and Peking Union Medical College from July 2009 to Dec. 2015. All patients were divided, according to operation methods, into MVR group (n=9) and MVP group (n=40). The data from all patients were retrospectively analyzed and the patients were followed up for (3.1±2.0) y.Results The perioperative mortality had no statistical difference between 2 groups (P=0.569). IMR, left ventricular ejection fraction (LVEF) and left ventricular end-diastolic inner diameter (LVEDd) were significantly ameliorated in 2 groups before discharging from the hospital. LVEF was higher in MVP group than that in MVR group (P=0.016). There were 3 died cases during follow-up period. The long-term incidence of IMR was higher in MVP group than that in MVR group (P=0.020). LVEF and LVEDd had no statistical difference between 2 groups during final follow-up (P=0.981,P=0.596).Conclusion MVR and MVP have similar risk in patients with IMR complicated by ventricular aneurysm. There is long-term recrudescence risk after MVP, while there is no significant difference in long-term survival and heart function between MVR and MVP.

目的 比较75岁及以上老年人体外循环和非体外循环下冠脉搭桥术后的相关数据,明确两种手术对患者手术后早、中期的影响(2年内),为临床选择提供经验.方法 比较青岛阜外心血管病医院2010年10月到2013年5月期间接受冠脉搭桥手术的75岁及以上患者围术期及术后随访数据,分为体外循环组42例,非体外循环组68例,比较两组数据有无显著性差别.结果 两组病例术前左心室射血分数[(51.0±6.3)％比(50.0±7.6)％,P=0.427]和左心室舒张末期直径[(52.0±6.1)mm比(51.0±5.7)mm,P=0.752]无明显差别;手术操作时间[(3.7±0.9)h比(3.3±0.3)h,P=0.242]、远端吻合口数[(3.3±0.9)比(3.1±0.6),P=0.304]、术后住院时间[(10.9±3.1)d比(11.1±3.7)d,P=0.548]无明显差别;术后两组呼吸机辅助呼吸时间[(20.3±5.0)h比(13.8±5.7)h,P=0.038]、ICU居住时间[(87.6±19.2)h比(73.9±17.8)h,P=0.021]、术后输注红细胞量[(1.9±0.4)U比(0.7±0.6)U,P=0.035]及输血浆量[(320±121)ml比(180±88)ml,P=0.012]比较差异有统计学意义.术后3至6个月复查心脏彩超显示,左心室射血分数[(53.0±8.1)％比(51.0±9.6)％,P=0.560]和左心室舒张末期直径[(47.0±11.3)mm比(49.0±10.2)mm,P=0.376]未见统计学差异.两组患者术后1年、2年内心功能分级、全因死亡率、心血管事件再次入院比率未见统计学差异.结论 通过术后早、中期(2年)的临床资料比较,两种冠脉搭桥方法对75岁以上老年人均安全、有效.

Objective To analyze the 3D structure of mitral annulus in patients with mitral valve (MV) prolapse before and after MV repair with real-time 3D transesophageal echocardiography (RT-3D TEE).Methods RT-3D TEE was performed in 38 patients and 20 controls.Qlab was used for 3D quantification analysis.Results MV prolased patients had larger APD,CW,2D A,3D Min A (P＜0.05),smaller ellipticity(P＜0.05),while H,3D Min/2D A,AHCWR were similar (P＞0.05).After MV repair,ellipticity became larger and similar to the controls.All the other parameters significantly decreased (P＜0.05).Conclusions MV prolapsed patients had enlarged and more circular annulus.After MV repair,the annulus decreased obviously in dimensions and become more flattened while regained annular ellipticity.

目的 观察冠状动脉旁路移植(CABG)联合左心室室壁瘤(LVA)切除或折叠术治疗冠心病合并LVA的效果.方法 采用CABG联合LVA切除或折叠术治疗冠心病合并LVA患者46例,术前及术后1周行彩超检测左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD).结果 本组患者手术顺利,呼吸机使用时间(24.87±12.22)h.4例使用主动脉球囊反搏.术后1周LVEF为44.15%±4.50%,明显高于术前的38.72%±7.08%,P<0.05;术后1周LVEDD为(54.28±6.81)mm,明显低于术前的(61.85±7.09)mm,P<0.05.结论 CABG同期联合室壁瘤切除或折叠术治疗冠心病合并LVA安全有效.

目的：比较75岁及以上老年人体外循环和非体外循环下冠脉搭桥术后的相关数据，明确两种手术对患者手术后早期的影响（1年内）。方法选取我院2010年10月～2013年5月接受冠脉搭桥手术的75岁及以上患者110例，随机分为体外循环组42例和非体外循环组68例，对两组患者的围术期及术后随访数据进行比较。结果两组患者术前左心室射血分数（LVEF）和左心室舒张末期直径（LVDD）对比，差异无统计学意义（P＞0.05）；手术操作时间、远端吻合口数、术后住院时间对比，差异无统计学意义（P＞0.05），术后两组呼吸机辅助呼吸时间、ICU居住时间、术后住院费用、以及输血量对比，差异有统计学意义（P＜0.05）；术后3个月复查心脏彩超，LVEF和LVDD对比，差异无统计学意义（P＞0.05）。两组患者术后1年内全因死亡率、心血管事件再次入院比率对比，差异无统计学意义（P＞0.05）。结论通过术后早期（1年）的临床资料比较，体外循环与非体外循环冠脉搭桥均是75岁以上老年人治疗冠心病的安全、有效的方法，其中接受体外循环组的患者住院费用相对较少。

Objective: To compare the early and long-term outcomes between on-pump and off-pump coronary artery bypass grafting (CABG) in elder female patients. <br> Methods: A total of 763 female patients elder than 65 years of age received isolated CABG in our hospital from 1999-01 to 2008-12 were retrospectively studied. The patients were divided into 2 groups according to operational method: On-pump group,n=331 and Off-pump group,n=432. The mortality at 30 days post-operation, in-hospital clinical indexes and long term mortality with MACCE as all cause death, myocardial infarction (MI), stroke and repeated revascularization were compared between 2 groups. <br> Results: Compared with On-pump group, the patients in Off-pump group had the elder age (P<0.01), with the higher rate of cerebral vascular accident (P=0.023); less family history of coronary artery disease (P=0.012), angina (P<0.001) and emergent operation (P=0.015), less venous distal anastomoses (P<0.001) ; while higher incomplete revascularization (P<0.001). Logistic regression model comparison indicated that Off-pump group had the lower mortality at 30 days post-operation&nbsp;(P=0.038), less application of blood products (P<0.001), lower rate of >24h mechanical ventilation (P<0.001), less renal failure (P=0.022), pulmonary complications (P<0.001) and re-exploration for bleeding (P=0.021). The morbidity of all post-operative complications were similar between 2 groups (P=0.110). Cox regression model comparison showed that long-term all cause mortality (P=0.477) and occurrence of MACCE (P=0.265) were similar between the two groups. <br> Conclusion: Off-pump CABG would reduce the mortality at 30 days post-operation, have less application of blood products, shorter post-operative mechanical ventilation, less early post-operative renal failure, pulmonary complications and re-exploration for bleeding. While it could not reduce the long-term mortality and MACCE occurrence.

老年人口比例的增高及其心血管疾病的高患病率，使接受冠状动脉旁路移植术（CABG）的患者越来越趋于老龄化。同时，老年患者较低的生理功能储备且多合并伴随疾病使这类患者在接受冠状动脉旁路移植术后，死亡率及并发症的发生率明显增加。因此，在此类患者中，不使用体外循环且避免过多主动脉操作的非体外循环下冠状动脉旁路移植术越来越引起人们的重视，老年患者能否从中获益更多？既往的报道显示，高风险人群接受非体外循环冠状动脉旁路移植术可能获益更多。本文旨在对老年患者的两种手术方式的近远期疗效进行对比阐述。

Objective The clinical data of emergent and selective coronary artery bypass grafting were compared to define the perioperative risks and mortality of emergent operation. Methods To retrospectively analyze 58 patients who underwent emergent coronary artery bypass grafting (ECABG) and 504 patients who underwent selective coronary artery bypass grafting (CABG) performed by same surgeon during Jan, 2011 to Jun, 2013, and to compare the clinical data of two groups. Results Of two groups, no significant difference was found in preoperative left ventricular ejection fraction (LVEF) (P=0.387), left ventricular end-diastolic diameter (LVDD) (P=0.623), bypass grafts (P=0.423) and one year all-cause mortality post operation (P=0.594); But, average ventilator time (P=0.011), intensive care unit stay time (P=0.035), reoperation for bleeding (P=0.039), volume of drainage (P=0.000) and blood transfusion (P=0.003), postoperative in-hospital stay (P=0.006) had significant differences between two groups. The in-hospital mortality was higher in ECABG group (P=0.022). Conclusion The ECABG group was more at perioperative risk, but the all-cause mortality of one year post operation was same in two groups (P=0.594).

目的 探讨CMTM3在肥厚性心肌病患者的心肌组织中的表达情况及肥厚性心肌病的发病机制.方法 研究对象包括两部分:1)按每天15 mg/kg剂量腹腔注射异丙肾上腺素(ISO)诱导的心肌肥厚小鼠模型;2)2014年1月至2014年6月在阜外医院接受手术的肥厚性心肌病患者32例及3例正常心肌组织.使用半定量RT-PCR,real-time PCR及Western blot检测CMTM3在心肌组织转录和蛋白水平的表达.结果 1)在ISO诱导的心肌肥厚小鼠组织中,CMTM3 mRNA表达下调.2)在肥厚性心肌病患者病变的心肌组织中,CMTM3在转录水平和蛋白水平表达均下调.结论 CMTM3低表达致心肌组织增殖肥厚,可能参与了肥厚性心肌病发病.

目的：观察Carpentier软环在二尖瓣成形术中应用的近期效果。方法：二尖瓣关闭不全53例患者，术前心脏彩超检查均为二尖瓣后叶脱垂或并部分腱索断裂。术中在对二尖瓣后叶脱垂部分行楔形或矩形切除并成形后，使用Carpentier软环行二尖瓣成形术。术中通过注水试验及食管超声检查成形效果，术后1周复查心脏彩超，观察二尖瓣成形效果。结果：术前二尖瓣重度关闭不全49例，中度关闭不全4例。术后1周心脏彩超提示：二尖瓣少中量返流1例，少量返流3例，微少量返流6例。48例随访时间9.42±4.52个月，经心脏彩超检查，二尖瓣少中量返流1例，少量返流4例，微少量返流7例。结论：对二尖瓣后叶脱垂行楔形或矩形切除并成形，使用Carpentier软环治疗二尖瓣关闭不全效果良好。

AIM:To discuss the methods and results of bipolar radiofrequency ablation( RFA) for atrial fibrillation( AF) under open heart surgery for organic heart disease( OHD) so as to improve the therapy for this disease.METHODS:Clinical data of 57 patients with OHD and AF who underwent open heart surgery with concomitant bipolar RFA from August 2009 to May 2012 were analyzed retrospectively.Postoperative data were collected at the time of discharge and at 3,6 and 12 months after operation.RESULTS:All operations were successful.Cardiopulmonary bypass,aortic clamp and RFA were( 150 ± 37),( 126 ± 36) and( 24 ± 4) min,respectively.Normal sinus rhythm was achieved in 46( 79%) at the end of operation and in 45( 78%) patients at discharge,and in 41( 71%),40( 69%) and 42( 72%) patients at 3,6 and 12 months postoperatively.There were no RFA-related hospital mortalities and no complications.No patients required permanent pacemakers.Risk factors for ablation failure included longer duration of AF and larger left atrial diameter.CONCLUSION:RFA is a safe,easy and effective treatment for OHD patients with AF,with lower complication rates and high rates of restoring sinus rhythm.

目的 观察对比经典De Vega环缩术与Carpentier成形环治疗三尖瓣关闭不全的临床疗效.方法 对46例左心系统瓣膜病合并三尖瓣中重度关闭不全的患者,在左心系统瓣膜置换手术的同时,采用两种不同的方式行三尖瓣成形术.其中24例应用Carpentier成形环行三尖瓣成形术,22例行经典De Vega环缩术.采用回顾性临床研究方法,对两组患者术后三尖瓣反流程度、左室射血分数、右心室舒张期末内径进行比较.结果 术后两组患者均无死亡,恢复良好.术后早期超声结果证实,两组患者三尖瓣成形效果均良好,心功能均较术前改善,差异无统计学意义(P＜0.05).但远期随访显示,Carpentier成形环组较经典De Vega组效果佳,经典De Vega组三尖瓣反流程度及例数多于成形环组,两组间差异有统计学意义(P＜0.05).结论 采用Carpentier成形环行三尖瓣成形术治疗三尖瓣关闭不全,效果优于经典De Vega环缩术.

Objective: To evaluate the accuracy of real-time three-dimensional echocardiography(RT-3DE)for assessing left ventricular volume and function in coronary artery disease(CAD)patients with left ventricular aneurysm. Methods: A total of 116 CAD patients combined with left ventricular aneurysm were examined for their left ventricular end diastolic volume(LVEDV),left ventricular end systolic volume(LVESV)and left ventricular ejection fraction(LVEF)before and after the operation with two-dimensional echocardiography(2DE),RT-3DE and MRI respectively.The accuracy of 2DE and RT-3DE results were compared with MRI among different sized aneurysms. Results: ①In patients with small and medium size LV aneurysm,no real difference found between 2DE and RT-3DE with MRI for the above mentioned index,P>0.05 respectively.②With large size LV aneurysm,LVDVE and LVDSE measured by 2DE before operation were different from MRI,P<0.05 respectively.While pre-operative LVEF and other index after operation measured by 2DE weree no statistic differences from MRI;no differences between 3DE and MRI before and after the operation,P>0.05 respectively.③With giant LV aneurysm,before the operation,the value of LVDVE and LVDSE measured by 2DE and RT-3DE were lower than MRI,and LVEF was higher than MRI,P<0.05 respectively.After the operation,LVDVE and LVDSE measured by 2DE still lower than MRI,P<0.05 respectively.There were no statistic difference for the above index between RT-3DE and MRI after the operation. Conclusion: Compared with 2DE,for large and giant LV aneurysm,RT-3DE examination is closer to MRI for assessing left ventricular volume and function,it is accurate and reliable.For giant LV aneurysm,left ventricular volume measured by 2DE and RT-3DE before the operation were both lower than MRI.