目的 探讨不同胸骨固定方法对心脏直视手术后胸骨相关并发症的影响.方法 选取2021年于北京市垂杨柳医院及首都医科大学附属北京安贞医院心外科行心脏直视手术的成年患者342例.根据不同胸骨固定方法将其分为单股钢丝固定组(n=25)、双股钢丝固定组(n=251)与"8"字钢丝固定组(n=66).比较三组基线资料及患者术后胸骨相关并发症〔包括胸骨哆开(或松动)、胸骨表面或深部感染〕发生情况.结果 三组术后胸骨相关并发症发生率比较,差异有统计学意义(χ2=9.742,P=0.008);单股钢丝固定组术后胸骨相关并发症发生率分别高于双股钢丝固定组、"8"字钢丝固定组(P<0.05).结论 单股钢丝"8"字缝合或双股钢丝间断缝合较单股钢丝间断缝合固定胸骨可减少心脏直视手术后胸骨哆开等相关并发症的发生.
Objective To monitor the hemodynamics in elderly heart disease patients during off-pump coronary artery bypass grafting (CABG) with pulse-indicated continuous cardiac output (PiCCO) system. Methods Thirty elderly patients with coronary ateroclerotic heart disease who underwent off-pump CABG were included in this study. Their ABP, HR, CVP, CO, CI, GEF, SVI, ITBI and GEDVI were measured with PiCCO system at T0, T1, T2, T3 and T4 , respectively. Results The operation was successful for all the patients. The ABP, CVP, CO, GEF and SVI were significantly lower at T0 than at T3 and T4 , and at T0 than at T1 (P<0.05). The ITBI and GEDVI were significantly lower while the CI was significantly higher at T3 and T4 than at T0 (P<0.05). The patients recovered with no surgical and PiCCO manipulation-related complications. Conclusion PiCCO system is a simple and reliable device for monitoring hemodynamics in elderly coronary disease patients during off-pump CABG.
目的 三磷酸腺苷敏感性钾离子通道开放剂(PCOs)的应用是介导心脏超极化停跳的关键,以PCOs-Nicorandil,应用于纯种成年SD大鼠离体心,观测Nicorandil对心肌缺氧/再灌注的影响.方法 选用成年纯种SD大鼠共12只,随机分两组,对照组停灌30分钟,以Krebs-Hensenleit液(K-H液)再灌注30分钟;开放剂组停灌前以Nicorandil 100μmol/L灌注5分钟,停灌30分钟,以K-H液再灌注30分钟.观察指标:持续监测左室内压、左室内压变化速率(dp/dt)及心率、冠状动脉流量;免疫组化法检测HSP70的表达.结果 开放剂组再灌注时的LVP、心率、dp/dt及冠状动脉流量均较对照组高,其中dp/dt和冠状动脉流量的增加最为明显;开放剂组再灌注30分钟时的血流动力学结果均超过停灌前水平;HSP70于开放剂组的表达为阴性,对照组为阳性,两组差异有显著性.结论 Nicorandil对缺氧、再灌注离体心具有确实的保护作用.
冠状动脉粥样硬化性心脏病(简称冠心病)治疗原则:预防心肌梗死和猝死,改善生存;减轻症状和缺血发作,改善生活质量.单一治疗带有较大的局限性,最理想的是全方位的综合性治疗.现代冠心病的治疗方法可分为药物治疗、经皮冠状动脉介入治疗(PCI)和冠状动脉旁路移植术(CABG).
目的 评价国产二尖瓣成形环在心瓣膜成形外科中的疗效.方法 回顾1986年12月～1995年9月在全身麻醉中度低温体外循环下用国产二尖瓣成形环行成形术36例,其中二尖瓣成形28例次,三尖瓣成形9例次.结果 住院死亡4例.术后发生低心排血量综合征5例,呼吸功能不全2例,行气管切开1例,突发心室颤动3例,多器官功能衰竭2例,脑栓塞1例.随访31例无死亡.经超声心动图检查32个成形瓣膜,未见反流5例,轻度反流23例,中度以上反流2例,轻度狭窄2例.跨瓣压差＜1.07kPa(8mmHg)24例,1.07～1.73kPa(8～13mmHg)8例.结论 国产二尖瓣成形环在心瓣膜成形外科中具有重要地位.
