Search

色素性静脉旁视网膜脉络膜萎缩

冠心病合并多发性骨髓瘤及肾功能衰竭患者行冠状动脉旁路移植术一例

Influence of Early Surgery on the Outcome of Infective Endocarditis

ObjectiveTo study the relationship between the timing of surgery and one-year outcome in patients with infective endocarditis. MethodsWe retrospectively analyzed the clinical data of 97 patients suffered from leftside native valve infective endocarditis with neoplasm, admitted in Shanghai First People's Hospital between January 2000 and December 2011. There were 65 males and 32 females with mean age of 55.2±16.3 years (ranged 29 to 75 years). They were divided into two groups according to whether the surgery was performed within a week after diagnosis. The in-hospital mortality and one-year mortality, embolism and re-infection were calculated and compared between the two groups. ResultsThere was no significant difference in the in-hospital mortality between the early surgery group and the conventional surgery group (1.9% versus 6.7%, P=0.241). While there was a significant difference in the rate of inhospital embolism related complications (1.9% versus 13.3%, P=0.030) between the two groups. There was no significant difference in one-year mortality between the two groups (1.9% versus 8.9%, P=0.122). The incidence rate of embolism related complication was 5.8% in the early surgery group and 20.0% in the conventional surgery group with a statistical difference (P=0.034). There was one patient with recurrent cerebral infarction among the 11 patients of cerebral infarction in the early surgery group,while 6 recurrent patients in the 9 patients with cerebral infarction in the conventional surgery group (9.1% versus 66.7%, P<0.005). ConclusionsEarly surgery in patients with left-side native valve infective endocarditis can't reduce the in-hospital mortality and one-year mortality but does decrease embolic events significantly. Early surgery is feasible in the patients with cerebral infarction.

体外循环冠状动脉旁路移植术围手术期血浆脑钠肽的变化及其临床意义

目的 观察体外循环冠状动脉旁路移植术(CABG)围手术期血浆脑钠肽（brain natriuretic peptide,BNP）的变化规律。 方法 2005年7～10月我院收治20例CABG患者，分别于麻醉诱导后，主动脉开放前，开放后20 min，进入ICU，术后12 h，24 h和48 h测量血浆BNP浓度，分析围手术期BNP的变化规律，以及BNP与心功能、血流动力学指标及术后血浆肌酸激酶同工酶(CKMB)、肌钙蛋白(TNT)等的相关关系。 结果 麻醉诱导后BNP与左心室射血分数（LVEF）呈明显负相关（r=-0.912，P=0.000），与左心室舒张期末内径（r=0.714，P=0.000），肺毛细血管楔压(PCWP，r=0.809，P=0.000），中心静脉压(r=0.787，P=0.000）呈明显正相关。手术前后BNP浓度的差异有统计学意义（F=42.259,Plt;0.01），从主动脉钳开放后逐步上升，并在术后24 h达峰值。进入ICU，术后12 h，24 h的BNP浓度与PCWP呈明显正相关（r=0.602，P=0.005；r=0.554，P=0.011；r=0.631，P=0.003），与CK-MB浓度呈明显正相关(r=0.528，P=0.017；r=0.638，P=0.002；r=0.882，P=0.000)；但与TNT浓度的相关性不明显。 结论 冠心病患者术前血浆BNP浓度能正确反映术前的心功能状态；心肌缺血再灌注损伤是术后BNP大量释放的原因；术后BNP监测能正确及时地反映患者的心功能状态，特别是前负荷状态。

Effect of different resuscitation fluids on interleukin-8 and tumor necrosis factor-α in rats with traumatic hemorrhagic shock

Objective To investigate effect of different resuscitation liquids and different resuscitation methods on contents of interleukin-8 (IL-8) and tumor necrosis factor-α (TNF-α) in early resuscitation process of rats with traumatic hemorrhagic shock. Methods Sixty-four healthy SD rats (450–550 g) were chosen and divided into 4 groups randomly and averagely: crystal liquid limited resuscitation group, colloidal liquid limited resuscitation group, 7.5% NaCl limited resuscitation group, and colloidal liquid non-limited resuscitation group. There were 16 rats in each group. All the experimental rats were weighed before intraperitoneal injection of pentobarbital sodium anesthesia. Animal model was established via Chaudry’s method. The rats were killed and the abdominal aorta bloods were drew on hour 2, 6, 12, and 24 after recovering from anesthesia. The contents of IL-8 and TNF-α in plasmas were detected by enzyme linked immunosorbent assay. Results The contents of IL-8 and TNF-α among three kinds of limited resuscitation groups on hour 6 after resuscitation were significantly higher than those on hour 2 after resuscitation (P<0.05) and reached the peaks, then began to decrease. On hour 12 after resuscitation, the contents of IL-8 and TNF-α were decreased continuously among three kinds of limited resuscitation groups (P<0.05). The contents of IL-8 and TNF-α in the colloidal liquid non-limited resuscitation group at each point time were significantly higher than those among three kinds of limited resuscitation groups (P<0.05), which in the crystal liquid resuscitation group were significantly lower than those in the other limited liquid resuscitation groups (P<0.05). Conclusions In process of liquid resuscitation of rats with traumatic hemorrhagic shock, limited resuscitation method is better than that of non-limited resuscitation method. Among three kinds of limited resuscitation methods, crystal resuscitation liquid is more effective than the other two resuscitation liquids in prohibiting releases of IL-8 and TNF-α in rats with traumatic hemorrhagic shock.

鼓泡式改良左心引流管在心内直视手术中的应用

目的介绍鼓泡式改良左心引流管在心内直视手术中的应用。方法138例先天性心脏病、风湿性心瓣膜病及其它心脏疾病患者在心内直视手术中采用鼓泡式改良左心引流管进行左心减压引流。结果全部患者置入鼓泡式改良左心引流管顺利,拔除不困难,引流效果良好。结论鼓泡式改良左心引流管在负压吸引过程中侧孔不容易因吸附被软组织堵塞,引流效果可靠。

不中断冠脉循环下直视双极射频消融治疗心房颤动

摘要： 目的 总结直视双极射频消融治疗心房颤动（AF）的临床经验。 方法 回顾性分析2008年4月至2010年1月我科治疗34例心脏病合并心房颤动患者的临床资料，其中男11例，女23例；年龄34～75岁，平均年龄44岁。心功能分级(NYHA)Ⅲ级以上的风湿性心脏瓣膜病30例，冠状动脉粥样硬化性心脏病2例，房间隔缺损和室间隔缺损伴重度肺动脉高压各1例，均在直视双极射频消融治疗心房颤动时采用不中断心脏冠脉循环的方法保持心肌有氧灌注，同期行二尖瓣置换术21例，主动脉瓣及二尖瓣双瓣膜置换术8例，二尖瓣及三尖瓣置换术1例，冠状动脉旁路移植术2例，房间隔缺损修补术1例和室间隔缺损修补术1例。 结果 术后发生一过性低心排血量综合征和室性心律失常各1例，全组无手术死亡。术后即时窦性心律为10000% （34/34），术后1周时为44.12%（15/34），出院时为64.70%(22/34)。随访时间1～17个月，随访6个月后因血栓栓塞死亡1例，失访1例。出院后1个月时窦性心律维持率为78.79%（26/33），3个月时为85.18%（23/27），6个月时为87.50%（21/24），1年时为88.23%（15/17）。  结论 在不中断冠脉循环下施行直视心房颤动改良迷宫双极射频消融术，简单可行，效果可靠，对重症患者更加安全。

心脏不停跳心内直视术在瓣膜外科的应用

Comparison of monopolar and bipolar radiofrequency ablation in patients with atrial fibrillation and concomitant rheumatic heart disease

Objective To compare the effect of monopolar and bipolar radiofrequency ablation in patients with atrial fibrillation and concomitant rheumatic heart disease. Methods The clinical data of 261 patients who underwent valve replacement and radiofrequency Maze Ⅲ procedure in Shanghai First People's Hospital from 2010 to 2015 were retrospectively analyzed. According to the radiofrequency ablation system, patients were assigned to a monopolar radiofrequency ablation group (n=209, 129 males, 80 females, aged 59.6±9.7 years) and a bipolar radiofrequency ablation group (n=52, 36 males, 16 females, aged 58.6±11.2 years). After procedures, clinical factors such as patients' basic information, perioperative complication and mortality, the elimination rate of atrial fibrillation were measured. Results There was no statistic difference in perioperative morbidity and mortality between two groups. The ablation time of the monopolar radiofrequency ablation group was longer than that of the bipolar group (29.7±3.3 minvs. 22.3±7.8 min,P=0.035). Postoperative diameter of left atrium was reduced in both groups. Compared with the monopolar radiofrequency ablation group, bipolar group had a better elimination rate of atrial fibrillation at three months and one year follow-up (82.0%vs. 66.3%,P=0.037; 80.0%vs. 59.6%,P=0.008). Conclusion Valve replacement combined with radiofrequency Maze Ⅲ procedure is safe and efficient. Compared with monopolar radiofrequency ablation, bipolar radiofrequency ablation has advantage on elimination rate of atrial fibrillation, ablation time and cardiopulmonary bypass time.

Value of ContrastEnhanced Ultrasound in Differential Diagnosis of Benign and Malignant Breast Mass

ObjectiveTo investigate the value of contrastenhanced ultrasonography in differential diagnosis between benign and malignant breast mass. MethodsTotally 65 patients with 70 breast masses were evaluated by general ultrasonography and contrastenhanced ultrasonography with contrast agent SonoVue. The related indexes, such as the degree and mode of contrast enhancement, the lesion boundaries and dissipation mode, were used to describe the difference between benign and malignant mass, which was also compared with pathological results. ResultsHistopathological examination revealed that benign mass was in 37 cases and malignant in 28 cases. The sensitivity, accuracy, positive predictive value, and negative predictive value of contrastenhanced ultrasonography with contrast agent SonoVue were significantly higher than that of general ultrasonography (Plt;0.05), while no significant difference in diagnostic specificity and misdiagnosis rate was observed between them (Pgt;0.05). All tumors showed contrast enhancement in various degrees. Of 28 patients with enhanced mass, hyperenhancement in 22 cases and nodular inhomogeneous enhancement in 21 cases were observed and the boundaries of malignant tumor were irregular with ill-defined and radial enhancement. Most of benign tumors were represented by weak, homogeneous enhancement, and the shape was regular with smooth and tidy boundary and intact capsule except seven cases with unclear boundary. These imaging characteristics of benign and malignant tumors were obviously different (P=0.000). In the resolution phase, both benign and malignant mass showed heterogeneous or homogeneous dissipation, which was not significantly different (P=0.791). ConclusionCompared with general ultrasonography, contrast enhanced ultrasonography may be more helpful for the differential diagnosis of benign and malignant breast tumors.