Background: Serum uric acid (UA) is involved in the development of hypertension. However, its impact on mortality in hypertension remains unclear. We aimed to assess the association of cardiovascular and all-cause mortality with UA in a hypertensive population. Material/Methods: This study included 15 583 hypertensive patients from the NHANES study during 1999-2014. Weighted Cox regression analyses and cubic spline fitting were used to assess the relationship between UA and mortality risk. Results: Over a median follow-up of 7.4 years (116 351 person-years), a total of 3291 deaths occurred. Mortality was examined according to 5 predefined UA levels: 5.3.5, <= 3.5-5, 5-6, 6-7.5, and >7.5 mg/dL. In multivariable analysis with 5-6 mid as a reference, the hazard ratios (95% confidence interval) of total mortality across the 5 groups were 1.40 (1.05-1.88), 1.08 (0.95-1.21), 1.00 (reference), 1.14 (1.02-1.29), and 1.74 (1.50-2.02), respectively. According to a restricted cubic spline, we noted a U-shaped relationship between UA and total mortality. The U-shaped relationship between UA and cardiovascular mortality remained in both females and males. The increased cardiovascular mortality in the lowest and highest UA groups was attributed to stroke and heart-specific mortality, respectively. However, serum UA was not significantly associated with cancer mortality. Conclusions: Our findings showed a U-shaped relationship between serum UA levels and total and cardiovascular mortality in patients with hypertension. Furthermore, low UA was associated with stroke mortality, while higher UA was associated with heart-related mortality. Further research is needed to identify the potential mechanisms of UA in hypertension.

Objective To investigate the hemodynamic changes before and after Revivent surgery in patients with left ventricular apical aneurysm by cardiac magnetic resonance imaging ( CM R ) and echocardiography . Methods Twenty‐two cases with left ventricular apical aneurysm were examined by two‐dimensional and three‐dimensional transthoracic echocardiography 1 week before operation ,1 month and 12 months after operation ,by CM R 1 week before operation and 12 months after operation .Left ventricular end‐diastolic volume( LVEDV ) ,left ventricular end‐systolic volume ( LVESV ) ,left ventricular end‐diastolic diameter ( LVEDd ) , left ventricular end‐systolic diameter ( LVESd ) , left ventricular ejection fraction ( LVEF) ,stroke volume ( SV ) ,stroke output index ( SVI) ,cardiac output ( CO ) and cardiac output index ( CI) were quantitatively measured and statistical analysis were performed . Results T here were significant differences between preoperation and 1 month after operation for the measurements of LVEDV ,LVESV , LVEDd and LVEF by both CM R and echocardiography ( all P ＜ 0 .05 ) . Compared with preoperation , LVESd decreased significantly 12 months after operation ( P ＜0 .01) . However ,there were no significant differences between preoperation and 1 or 12 months after operation for the measurements of SV ,SVI ,CO and CI ( all P ＞ 0 .05 ) . T he consistency between CM R and echocardiography measurements was good . Conclusions Revivent surgery provides an effective and feasible treatment for patients with left ventricular apical ventricular aneurysm . T he dual‐modality imaging with CM R and echocardiography are reliable technical means to evaluate the changes of left ventricular heamodynamiscs during the perioperative period of Revivent

Objective To evaluate the safety and efficacy of epicardial ventricular restoration (EVR) using REVIVENT system in patients with antero-septal scar and dilated ischemic cardiomyopathy. Methods Ten ischemic heart patients with antero-septal scar underwent the operation. The scarred lateral left ventricular wall was apposed to the septal scar with serial paired anchors placed through epicardial transmural excluding the non-viable portions of the chamber. Left ventricular hemodynamic assessments as well as left ventricular ejection fraction, left ventricular end-systolic/diastolic volume (LVEDV/LVESV) and their indexes (LVEDVI/LVESVI) were measured by cardiac magnetic resonance (CMR). Results Ten ischemic heart failure patients with antero-septal scar, aged(55.2±13.9)years, received a hybrid epicardial ventricular restoration. Cardiac MR done at one a month after the procedure showed an elevation of LVEF from(27.8±4.6%)to(37.5±11.4)% (+35%, P<0.01). LVESV was significantly reduced from(149.9±61.6) ml to(109.9±58.0)ml (–26.7%, P<0.01), LVESVI was reduced from(84.8±36.7)ml/m2to(63.0±34.2) ml/m2(reduced by 25.7%, P<0.01); LVEDV was reduced from(203.0±64.0)ml to(167.9±58.2)ml (reduced by 17.3%, P<0.01), and LVESV was reduced from(114.5±37.8)ml/m2to(96.2±35.2)ml/m2(reduced by 16.0%, P<0.01). Cardiac output (CO) increased from(4.0±1.5)L/min to(4.8±1.2)L/min(increased by 20.0%, P=0.034) and cardiac index (CI) increased from(2.2±0.7)L/(min ? m2) to(2.7±0.7)L/(min ? m2) (increased by 22.4%, P=0.023). Conclusions Our preliminary experience on EVR using the REVIVENT system demonstrated signifi cant increase in LVEF, CO and CI, with decreases in LVEDV/LVESV at 1 month following the procedure. Its feasibility and safety need further evaluation in the future.

目的:评价40例胸腔镜辅助下二尖瓣手术的技术特点、安全性及应用价值.方法:2015年6月-2017年12月在厦门大学附属心血管病医院心外科接受胸腔镜二尖瓣手术治疗的40例患者.根据二尖瓣病变类型分为风湿性二尖瓣病变12例,二尖瓣退行病变24例,感染性心内膜炎4例,合并中重度三尖瓣关闭不全8例.手术采用双腔气管插管,单肺通气.股动、静脉插管,建立体外循环.右侧胸壁打孔,在胸腔镜辅助下迸行二尖瓣手术.结果:40例患者住院期间无死亡,未发生术后低心排,术中转正中开胸等严重并发症,1例患者术后弓流多,行二次胸腔镜下探查止血.全组患者二尖瓣成形26例,二尖瓣置换14例,其中8例同期行三尖瓣成形术.二尖瓣成形组行二尖瓣后叶部分切除并缝合15例、人工腱索18例、缘对缘技术2例、裂缺缝合1例、交界缝合3例,所有成形患者均使用二尖瓣成形环固定瓣环.结论:胸腔镜辅助二尖瓣手术治疗临床安全可行,对机体创伤小,美容效果好,具有良好应用前景.

目的:总结近4年来笔者所在中心感染性心内膜炎(infective endocarditis,IE)患者的临床特征,评估心脏外科手术治疗对改善IE预后的价值,以提高IE的临床诊疗水平.方法:回顾性收集2012年7月-2016年6月在厦门大学附属心血管病医院住院治疗的IE患者的流行病学资料、临床表现、并发症、治疗及预后资料.结果:共纳入IE患者123例,平均年龄(45.2±17.1)岁,其中62.6%为男性,73.2%来自于农村,仅15%可追溯感染源.85.6%存在基础心脏病,其中风湿性心脏病25.2%,先天性心脏病15.4%和心脏术史13.0%.48.8%血培养结果阳性,致病菌主要为链球菌属和葡萄球菌属.最常见的临床表现为发热(91.9%)、心脏杂音(82.1%)、贫血(72.4%),感染主要累及左心系统(88.6%),心功能不全(42.3%)、败血症(31.7%)和栓塞事件(17.9%)是最常见的并发症.83例IE接受心脏外科手术治疗,住院期间7例死亡(5.7%),远期随访共16例死亡(13.0%);手术组住院死亡率低于非手术组(3.6%,4.0%),但差异无统计学意义(P>0.05);手术组远期死亡率显著低于非手术组(7.2%,25%),差异有统计学意义(P=0.003).结论:IE基础心脏病因构成比和致病菌发生明显变化,预防及抗感染策略也需相应调整;缺乏特异性临床表现为IE早期确诊带来困难,改良版Duke诊断标准特异性好;外科手术治疗可改善IE患者预后,但具体手术时机仍存在争议.

Objective:To evaluate the performance of European system for cardiac operative risk evaluation(EuroSCORE) Ⅱ and the Society of Thoracic Surgeons(STS) score in patients with infective endocarditis(IE) undergoing cardiac surgery.Methods:Data were retrospectively collected from adult patients undergoing cardiac surgery for IE between July 2012 and March 2016 in our hospital.EuroSCORE Ⅱ and STS score were calculated.The discrimination and calibration of these two scoring system were assessed by receiver-operating characteristic(ROC) curve analysis and Hosmer-Lemeshow goodness-of-fit test.According to the EuroSCORE Ⅱ,patients were divided into the low risk group(＜3％),the medium risk group(3％～6％) and the high risk group(≥6％).Differences in prognosis among these three groups were compared.Results:Among 80 IE patients undergoing cardiac surgery,3 patients (3.75％) died in-hospital and total 6 deaths (7.5％) were observed during follow-up.The area under the ROC curve (AUC) for the EuroSCORE Ⅱ,STS,and combination of them was 0.836,0.833,and 0.846 to predict late mortality respectively;0.946,0.980,and 0.980 to predict in-hospital mortality respectively,which indicated good discriminative power.Hosmer-Lemeshow goodness-of-fit test showed significant P-values(P＞0.05) indicating good calibration and accuracy.The predictive in-hospital mortality was similar to actual mortality in the high risk group(11.8％ vs.10.3％,P=0.358),and significantly higher than that in the low risk and medium groups (P＜0.01).The predictive late mortality was similar to actual mortality in the medium risk group(4.1％ vs.4.2％,P=0.718),whereas was underestimated in the high risk group(1 1.8％ vs.17.2％,P＜0.05) and overrated in the low risk group(1.9％ vs.0％,P＜0.01).Conclusion:Both EuroSCORE Ⅱ and STS scoring system can satisfactorily predict in-hospital mortality and late mortality in patients with IE undergoing cardiac surgery.

目的 总结采用冠状动脉旁路移植术(CABG)治疗冠状动脉粥样硬化性心脏病的临床经验.方法 回顾性分析2004年1月至2015年7月736例冠状动脉粥样硬化性心脏病患者接受CABG治疗的临床资料.结果 736例患者中,564例接受非体外循环下CABG,168例接受体外循环下CABG.患者术后呼吸机辅助时间(19.6±31.4)h,监护室停留时间(43.1±45.9)h;术后平均住院时间(12.6±6.4)d.术后出现肾功能不全40例(5.5％),需要透析治疗19例(2.6％);88例患者在围手术期出现并发症,发生率约12.0％;围手术期死亡28例,死亡率为3.8％.结论 采用心脏停跳或不停跳下CABG治疗冠心病均可取得满意的近期临床效果,手术风险较低.

目的：总结非体外循环冠状动脉搭桥术治疗多支冠状动脉血管病变的临床经验，探讨其对多支冠状动脉血管病变的临床应用价值。方法回顾性分析2012年1月至2015年1月254例在我科行非体外循环下冠状动脉搭桥术的多支血管病变冠状动脉粥样硬化心脏病患者的临床资料，其中三支血管病变115例，三支血管病变+左主干病变139例。结果入组患者均接受非体外循环下冠状动脉搭桥术，平均术中搭桥2.94根，术中转为体外循环辅助支持4例，围手术期需IABP辅助20例，术中无死亡病例，患者在围手术期出现并发症32例，死亡6例。全组患者均接受随访，随访时间6~30个月，平均14.76个月。随访期间未出现心绞痛症状。结论非体外循环下冠状动脉搭桥术是多支血管病变患者的一种有效治疗方式，有利于患者的早期恢复。

目的 总结心脏外科手术后胸骨哆开的外科治疗经验.方法 回顾性分析2011年1月-2014年1月收治的7例心脏外科手术后出现胸骨哆开患者的临床资料,其中男4例,女3例;年龄35～72岁,平均(52.5±13.4)岁.冠状动脉旁路移植术后2例,心脏瓣膜置换术后4例,孙氏手术后1例.彻底清创,剔除坏死胸骨,全部拔除原胸骨钢丝,清除胸骨后感染组织,聚维酮碘纱布浸泡并反复冲洗,充分游离切口两侧组织,乃至分离至胸大肌内侧头使间断缝合时组织无明显张力,放置皮片及负压引流管以充分引流.结果 7例患者均取得良好的治疗效果.术后随访6个月,所有患者均胸骨固定,无明显胸廓畸形,未发现胸骨慢性迁延性感染.结论 对心脏外科术后出现胸骨哆开的患者应积极行手术清创,牢固稳固胸骨.切口血液供应丰富及全身状态改善对患者康复尤为关键.

目的：研究在主动脉夹层腔内修复术（TEVAR）中采用腹股沟斜行切口或Perclose血管闭合器的术后效果。<br>　　方法：回顾性分析20例在我院行TEVAR患者分别采用腹股沟斜行切口分离股动脉穿刺（15例）和采用双Perclose闭合器（5例）两种方法，并进行成分效果分析，以直接医疗收费代替成本，术后入路血管并发症（包括出血、股动脉血肿、假性动脉瘤和淋巴漏）的发生和经济负担为直接效果进行分析，以VAS疼痛评分量表和缩短患者术后下床活动时间为间接效果进行评价，并计算效果比。

Objective:To study the application of bedside continuous renal replacement therapy(CRRT)in acute renal failure after cardiac surgery.Method:The clinical data of 30 patients who occurred acute renal failure after cardiac surgery in our hospital from November 2012 to November 2014 were retrospectively analyzed.All patients were given bedside CRRT on the basis of routine treatment.The treatment results,the cardiac function and the renal function before and after the treatment were observed.Result:Among the 30 patients,26 cases survived and 4 cases died.In the 26 survival patients,23 patients were recovery and 3 patients were effective.The total effective rate was 86.67%.CRRT was applied in 2 to 24 hours after the operation,it was continuously applied for more than 24 hours,the mean time was (68.7±6.2)hours.The cardiac index(CI),heart rate(HR),mean arterial pressure(MAP),pulmonary capillary wedge pressure(PCWP),central venous pressure(CVP),oxygen saturation(SpO2),left ventricular ejection fraction (LVEF),oxygenation index(PaO2/FiO2),blood urea nitrogen(BUN),creatinine(Cr),HCO3-in blood,serum potassium and urine volume after treatment were better than before treatment,the differences were statistically significant (P<0.05).Conclusion:Bedside CRRT in patients with acute renal failure after cardiac surgery can effectively reduce the mortality rate and improve heart function and renal function.The curative effect of the treatment is remarkable and it has positive clinical significance.

Objective To study the diagnosis and treatment measures, misdiagnosis cause and preventive measures of aortic dissection. Methods Clinical data of one patient misdiagnosed with aortic dissection was retrospectively analyzed, and related literature was reviewed. Results A patient suffering from severe abdominal pain 6 for hours was admitted to our hospi-tal from a local hospital, where he had been misdiagnosed as acute pancreatitis and failed to respond to treatment there. The patient was confirmed as having acute aortic dissection by aortic computer tomography angiography. Under general anesthesia, the patient underwent thoracic endovascular aortic repair ( TEVAR) , and the celiac trunk dissection was confirmed. This pa-tient fully recovered after TEVAR, and was discharged from hospital seven days later. He was followed up for one year with good prognosis. Conclusion Atypical clinical performance of aortic dissection may be the cause of misdiagnosis. To avoid or reduce misdiagnosis and mistreatment, clinicians should enhance awareness of aortic dissection, carry out intensive research of the main points of diagnosis with the help of imagining examination.

主动脉夹层是指由于各种原因造成血管内膜局部撕裂，在动脉内形成真、假两腔，从而导致一系列包括胸背部撕裂样疼痛及累及器官缺血在内的临床表现。如果不进行恰当和及时的治疗，患者可能出现猝死。传统治疗方式为开胸人造血管置换术，但围手术期死亡率及并发症发生率也非常高。车祸及减速伤引起患者胸主动脉内膜撕裂导致的主动脉夹层较为少见，而新近开展的主动脉夹层腔内修复术（thoracic endovascular aortic repair ， TEVAR）是治疗该种疾病的有效方法［1］。2014年1—6月我院共收治该类患者2例，均得到及时诊断并采用该技术进行手术治疗，取得良好远期疗效。现报告如下。

OBJECTIVE To analyze the effect of using bundle therapy in the treatment of the ventilator-associated pneumonia(VAP) after major heart surgery.METHODS The bundle therapy,which included strict hand hygiene,elevation the head of bed 30-45 degrees,strengthening the oral care,and changing ventilator tube,was introduced to the patients who underwent major heart surgery between Jan 2008 and Dec 2010 in cardiac surgical intensive care unit(CSICU);the patients who underwent the major heart surgery from Jan 2005 to Dec 2007 were selected as the control group;the incidence of VAP,the duration of mechanical ventilation,the duration of CSICU stay and the hospital mortality of two groups were analyzed.RESULTS There was a descending trend of the quarter morbidity of VAP after the bundle therapy.Compared to the control group,the rates of VAP in the bundle therapy group were reduced(17.0 vs.28.2 episodes per 1000 mechanical ventilation days),the difference was statistically significant(P<0.01).The VAP patients in bundle therapy group had less duration of mechanical ventilation(84.8±39.4 vs.107.9±52.1 hours,the shorter CSICU stay(7.5±3.1 vs.9.6±4.7 days,the differences were statistically significant(P<0.05);the mortality of the VAP patients in the bundle therapy group was 6.5%,16.4% in the control group,the difference was not statistically significant.CONCLUSION This study shows that the bundle therapy can effectively reduce the incidence of VAP after the major heart surgery and improve the prognosis.

AIM To evaluate the curative effects of diltiazem on postoperative hypertension after surgical closure of patent ductus arteriosus(PDA)when sodium nitroprusside failed to control.METHODS A retrospective study was performed in 51 patients with postoperative hypertension after surgical closure of PDA in our center.Thirty-one patients,who received sodium nitroprusside for postoperative hypertension,were enrolled in the sodium nitroprusside group.Twenty patients,who received diltiazem when sodium nitroprusside failed to achieve satisfactory blood pressure control,were included in the diltiazem group.Clinical data,the mean blood pressure,heart rates before and 0,1,2,4,6 hours after the surgery,the drug doses and adverse drug reactions were compared between the two groups.RESULTS There were no significant differences in gender,age,weight,height,operation time and perioperative infusion volume between the two groups(P 0.05).The diameter of PDA in the diltiazem group was larger than that in the sodium nitroprusside group((7.4 ± 2.5)mm vs.(4.4 ± 1.4)mm,P 0.01).The heart rates at different time points in the diltiazem group were lower than those in the sodium nitroprusside group(P 0.01).The overall incidence of adverse drug reactions in the diltiazem group was lower than that in the sodium nitroprusside group(52% vs.20%,P 0.05).There was significant difference(P 0.01)in drug doses at different time interval in the sodium nitroprusside group with time-dependent trend,while there was no significant difference in the diltiazem group(P 0.05).CONCLUSION Intravenous diltiazem is effective and safe in postoperative hypertension after surgical closure of PDA when solium nitroprusside failed to control.

晚期梅毒可使任何一个内脏受累,其中以心血管梅毒最为常见,病变常累及主动脉瓣及升主动脉,可导致主动脉瓣关闭不全、冠状动脉狭窄、升主动脉瘤等[1].梅毒性心脏病导致主动脉瓣穿孔在临床上极为罕见.2007年11月-2010年3月厦门大学附属中山医院心血管外科共收治3例梅毒性心脏病导致主动脉瓣穿孔的患者,分析其临床资料并对相关的文献进行复习.

Electrosurgery equipment include high frequency diathermy, Argon plasma coagulation, bipolar vessel-sealing device and radio-frequency surgery. This article aims to introduce the principles and advances of electrosurgery equipment for understanding and safety use.

A 50-year-old woman suffered dyspnea for 6 months. Chest radiography and computed tomography showed a large mass in the pericardial cavity and massive pleural effusion (Figure 1). There was no border between the tumor and the cardiac tissue, and the heart was compressed by the tumor (Figure 2a). After subtotal resection, cardiac liposarcoma was identified by histology (Figure 2b). Funding This research received no specific grant from any funding agency in the public, commerical, or not-for-profit sectors.

目的 评价简化临床肺部感染评分(sCPIS)在成人心脏直视术后呼吸机相关肺炎(VAP)中的临床应用价值.方法 选择本院心脏外科重症监护病房(CSICU)2007-01～2009-12连续收治的成人心脏直视术后符合VAP临床诊断及病原学诊断的29例患者为VAP组,术后无VAP等肺部感染的34例患者为对照组,比较两组sCPIS分值,并计算sCPIS不同分值对VAP诊断的敏感度和特异度.根据VAP患者sCPIS分值的变化情况,再将VAP患者分为改善组和非改善组,比较发病后第3天及第5天两组呼吸机使用时间、CSICU入住时间和死亡率.结果 VAP组发病日sCPIS分值与对照组比较差异无统计学意义(P＞0.05);sCPIS分值5、6、7分对心脏直视术后VAP诊断的敏感度分别为93.1%、58.6%、24.1%,特异度分别为14.7%、52.9%、24.1%.改善组发病后第3天CSICU入住时间短于非改善组(P＜0.05),发病后第5天呼吸机使用时间、CSICU入住时间及死亡率低于非改善组(P＜0.01或P＜0.05).结论 sCPIS对心脏直视术后VAP的诊断准确性差,但通过动态观察sCPIS的变化有助于VAP的病情判断和预后评估.