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find Author "徐志云" 44 results
  • 心血管手术风险预测研究与现状

    手术风险预测模型是术前风险评估的重要工具,在外科临床工作中起着十分重要的作用,它对手术适应证的确定、手术相关危险因素的识别、评分标准的确立以及不同中心手术疗效的比较都具有十分重要的意义。而心脏外科手术因受到多方面因素的影响,其围术期的病死率仍较高。因此,在心脏外科临床研究领域很早便开展了有关建立手术风险预测模型的工作。 从国外研究背景来看,至1986年美国胸外科医师协会(The Society of Thoracic Surgeons,STS)公布的第一个心脏术后风险预测模型Parsonnet评分系统起,近20余年间在北美、欧洲及澳洲等地区相继出现了一系列高质量的手术风险预测模型。目前,被广泛应用的预测评分系统包括Parsonnet评分系统、欧洲心脏手术风险评估系统(the European System for Cardiac Operative Risk Evaluation ,EuroSCORE)、STS评分系统及美国心脏病学院/美国心脏协会(American College of Cardiology/American Heart Association,ACC/AHA)评分系统等。  而从国内研究现状来看,由北京阜外心血管病医院牵头联合全国32家心脏中心率先建立了首个国内大型多中心冠状动脉旁路移植术数据库及中国冠状动脉旁路移植术评分系统(SinoSCORE),同时完成了EuroSCORE对我国冠心病患者手术死亡预测能力的评价研究。但目前国内有关其他重要预测评分系统的评价研究以及对我国心脏瓣膜病患者手术风险预测评价研究的报道仍相对缺乏。北京阜外心血管病医院撰写的“不同心脏手术风险预测评分系统对中国冠状动脉旁路移植术后患者早期死亡的预测”论文,收集了该院2006年11月至2007年12月年间1 559例18岁以上施行单纯冠状动脉旁路移植术(CABG)患者的临床资料,参照STS评分系统、EuroSCORE、Parsonnet评分系统和ACC/AHA评分系统的评分及分组方法,采用HosmerLemeshow(HL)卡方检验及受试者工作特征(ROC)曲线下面积的统计学方法,完成了4种预测评分系统对我国行CABG患者早期死亡的预测评价研究,提示除STS评分系统对单纯CABG患者具有潜在的临床应用可能外,其他3种评分系统对单纯CABG术后早期死亡风险预测的准确性均较差。而上海第二军医大学长海医院撰写的“EuroSCORE模型对心瓣膜手术患者死亡风险的预测”论文,收集了该院1998年1月至2008年12月年间4 155例各类心脏瓣膜手术患者的临床资料,参照additive和 logistic EuroSCORE评分及分组方法,采用HL卡方检验及ROC曲线下面积的统计学方法,完成了EuroSCORE模型对心脏瓣膜手术患者在院死亡率的预测评价研究,提示EuroSCORE模型对该中心心脏瓣膜手术患者死亡风险预测的准确性较差。 两篇论文的研究均表明,目前国际上公认的几种重要的手术风险预测评分系统对我国心脏手术患者术后早期死亡的预测效能均存在不同程度的限制,而建立适合我国患者心脏手术的风险预测模型及评分标准具有必要性及重要性。讨论中作者均提出由于地域及人种的差异,我国心脏手术患者的病因学与国外患者存在较大的差异,尤其是心脏瓣膜病的流行病学特点差异,是导致最终结论差异的重要原因。但两篇论文也同样存在一定的研究局限: (1)均为单中心研究,虽样本量较大,但我国地域广大,各心脏中心接诊患者的病种、病情轻重程度及诊疗技术仍存在一定差异,故应用单中心研究对研究结论的正确性可能会造成不同程度的影响,因此仍需扩大样本量以得到更为准确的研究结论。(2)临床资料的收集以回顾性研究为主,且各临床变量的采集标准国内尚未统一,评分系统中变量的定义也存在一定差异,故每例患者评分预测的真实结果存在一定偏倚,对研究结论的准确性也存在影响。随着对手术风险预测模型的临床研究重视程度不断地增加,目前我国各心脏诊疗中心均已开始建立各自的心脏外科临床数据库,故建议加强国内相关临床研究的学术交流,统一数据库建立方法及临床变量的采集标准,建立符合我国国情的大型多中心心脏外科临床数据库,用以进一步规范我国心脏手术术前风险评估工作,这对制定相关临床指南以及进一步降低心脏手术 在院病死率及并发症发生率,必将起到非常积极的作用。综合国内外心脏手术风险预测模型的建立方法和纳入因素,目前均没有考虑到“人”的因素,也就是说同样的手术,由技术水平不同的医师或医院实施,其结果实际上存在很大的差异,而术后处理不恰当也可造成较大的差异。因此,目前在制定手术风险预测模型时,实际上是建立在外科医师手术技术水平相当、正确实施手术和正确处理患者的基础上。就当前而言,要将医师的水平和能力考虑在内,确实非常困难,实际上也无法做到,这也是目前各种风险预测模型所存在的共同限制。  “不同心脏手术风险预测评分系统对中国冠状动脉旁路移植术后患者早期死亡的预测”和“EuroSCORE模型对心瓣膜手术患者死亡风险的预测”两篇论文均紧紧把握了目前我国心脏外科术前风险预测模型相关临床研究的重要方向,研究目标明确,样本量较大,科研设计合理,统计学方法正确,结论可信,具有较高的学术价值和社会价值,对临床工作具有一定的指导意义,希望在今后的研究工作中能不断完善。

    Release date:2016-08-30 05:57 Export PDF Favorites Scan
  • Current issues should be emphasized on preoperative evaluation of heart valvular disease

    Preoperative evaluation is crucial for heart valvular surgery. This article discusses some issues that need to be emphasized: the impact of hypertension on the severity of aortic valve lesions, and how to improve the accuracy of clinical assessment; the identification of functional tricuspid regurgitation, in order to choose the appropriate surgical technique; the need for right ventricular function testing, and the use of risk scoring models, to better grasp surgical timing and indications and improve efficacy; and the importance of evaluating atrial mitral and/or tricuspid regurgitation complications in chronic atrial fibrillation, and making rational choices for interventional and surgical treatment.

    Release date:2024-05-28 03:37 Export PDF Favorites Scan
  • The Advancement of Early Enteral Nutrition in Critical Patients after Cardiopulmonary Bypass

    Early enteral nutrition after cardiopulmonary bypass (CPB) has been shown to have beneficial effects on intestinal integrity, lower mortality and also on the patient’s immunocompetence. Even in critical patients after CPB, enteral nutrition should be reasonable to start early and also be supplemented by parenteral nutrition in order to meet energy requirement. We conclude that enteral nutrition is preferable in the majority of patients with severe hemodynamic failure, but gastrointestinal complication and hypocaloric feeding should be simultaneously noticed. This paper comprehensively described enteral nutrition’s protective mechanism and effects on digestive system, enteral nutrition’s implementing methods after CPB, and problems or prospects needing attention in execution.

    Release date:2016-08-30 06:09 Export PDF Favorites Scan
  • Progress in Evaluating Quality of Life in Postoperative Patients with Valvular Heart Disease Using SF-36 Health Survey

    Abstract: Quality of life (QOL) refers to an individual’s perception and subjective evaluation of their health and well-being, and has become an important index to evaluate the outcomes of clinical treatment in the last past decades. There are a large number of different instruments to evaluate QOL, and the 36-Item Short Form Health Survey (SF-36) is currently one of the most widely used instruments. In recent years, SF-36 has been used to evaluate QOL of valvular heart disease patients to investigate the risk factors those influence their postoperative QOL, provide more preoperative evaluation tools for clinical physicians, and improve postoperative outcomes of patients with valvular heart disease. However, it is now just the beginning to use SF-36 to examine QOL of valvular heart disease patients. Because of significant differences in sample size, follow-up period, country and culture, current research has some controversial results. This review focuses on the progress in evaluating QOL in postoperative patients with valvular heart disease using SF-36.

    Release date:2016-08-30 05:50 Export PDF Favorites Scan
  • 肺动脉瓣球囊扩张术后瓣叶损伤致再狭窄一例

    Release date:2016-08-30 06:23 Export PDF Favorites Scan
  • Results and Methods of Aortic Root Replacement for the Patients with Severe Aortic Valve Infective Endocarditis

    Objective To improve the surgical results of infective endocarditis, the results and methods of aortic root replacement in patients with severe aortic valve infective or prosthetic valve endocarditis were summarized. Methods From Sept.1995 to June 2008, there were 11 patients with severe aortic valve endocarditis treated surgically, included 6 active endocarditis and 5 healed endocarditis. Preoperative arterial blood bacterial culture were positive in 6 patients. Preoperative echocardiography showed all patients had various degree of aortic regurgitation or paraprosthetic leakage, left ventricular endsystolic diameter(LVESD) was 6.0±0.7cm, LVESD was equal or greater than 5.5cm in 7 patients, left ventricular ejection fraction (LVEF) was 47.8%±11.2%, and LVEF was equal or less than 50% in 8 patients. After careful debridement, composite conduit (9 patients) or cryopreserved allograft (2 patients) was used to replace the aortic root. Concomitant procedures were coronary artery bypass grafting in 4 patients, mitral annuloplasty in 3 patients, and ventricular septal defect repair in 1 patient. Results There was one patient died of postoperative cardiac arrest, one patient had Ⅲ° atrioventricular block and pacemaker implanted. Ten patients were followed up, followup time were from 3 months to 13.2 years. During the followup period, one patient had recurrence of endocarditis and died, others survived uneventually. Conclusion Aortic root replacement must be considered in following patients: endocarditis combined with root aneurysm or sinus aneurysm, infectious disease involved in sinus wall or nearby coronary ostia, annulus impairment and severe destructive annulus after debridement. The key points of the surgery are debriding the infectious tissue completely, preventing aortic root bleeding. Although the root replacement is relatively complex, the surgical results could be improved after complete debridement of infectious tissue.

    Release date:2016-08-30 06:05 Export PDF Favorites Scan
  • Methods and Results of Supra-annular Aortic Valve Replacement for Patients with Severely Damaged Aortic Annulus

    Abstract: Objective To summarize the methods and results of supra-annular aortic valve replacement(AVR) in patients with severely damaged aortic annulus. Methods Supra-annular AVR was performed in 5 patients between March 2008 and Dec. 2010 in Changhai Hospital, Second Military Medical University. There were 4 males and 1 female with their mean age of 46.3 years (ranging from 38 to 53 years). Non-specific infectious diseases were diagnosed in 4 patients who had severe paravalvular leakage after their first AVR operations (2 patients with Behcet’s disease and 2 patients with arteritis), and one patient had severe infectious endocarditis. All the patients had severely destroyed aortic annulus and could not undergo routine AVR. The prosthetic valves were fixed to the aortic sinus wall between the annulus and coronary arterial ostia, and the sutures passed through from the outside of aortic wall into the inside and prosthetic valve ring. Coronary artery bypass grafting was performed if the coronary ostium was involved. Results All patients recovered from the operations uneventfully, and were followed up from 6 months to 3 years. All patients were in New York Heart Association(NYHA) functional class Ⅰ or Ⅱ during the follow-up period, and paravalvalar leakage, pseudoaneurysm and aortic root aneurysm were not found by the examination of 3D computed tomographic angiography and echocardiography at 6 months(4 cases), 1 year(2 cases), and 3 years(1 case), respectively . Conclusions Supra-annular AVR is an alternative surgical method for patients with severely damaged aortic annulus. The procedure is simple and effective to prevent paravalvular leakage and pseudoaneurysm formation.

    Release date:2016-08-30 05:48 Export PDF Favorites Scan
  • Surgical Treatment of Ascending Aortic Root Aneurysms

    Abstract:Objective To summarize the experiences in surgical treatment of ascending aortic root aneurysms. Methods One hundred and one patients (age ranging from 14 to 72 years, mean 42.7 years) with ascending aortic root aneurysms were diagnosed as having Marfan syndrome (58 cases), annuloaortic ectasia (34 cases), bicuspid aortic valve (5 cases), aorto arteritis (4 cases) combined with aortic valve incompetence (96 cases) and aortic valve stenosis (4 cases) , preoperatively with type A dissection (26 cases) and acute left heart failure (5 cases). Our operations consisted of 4 Wheat procedures, 13 Cabrol or modified Cabrol procedures, 1 David and 83 Bentall procedures. Concomitant operations included hemi-arch replacement or descending aorta intraluminal stent grafting (16 cases), total arch replacement or descending aorta intraluminal stent grafting (4 cases), mitral valve replacement or anuloplasty (14 cases) and coronary artery bypass grafting (CABG, 8 cases). Results The overall mortality was 6.9%(7/101), and decreased to 3. 6%(3/83) after the year 2000. Main postoperative complications were low cardiac output (10 cases), respiratory insufficiency (9 cases), and renal inadequacy (9 cases). Follow-up was completed in 94 patients. During the period of follow-up, one patient died and 5 patients with Marfan syndrome suffered with type B dissection. Conclusion Bentall procedure is the method of choice for ascending aortic root aneurysms. Preoperative left heart function and surgical techniques give the crucial impact on the outcome of surgery.

    Release date:2016-08-30 06:23 Export PDF Favorites Scan
  • 应用自体心包瓣置换术治疗主动脉瓣病变

    目的 报告无支架自体心包瓣置换主动脉瓣手术的临床应用效果。 方法 11例单纯主动脉瓣病变患者行自体心包瓣置换主动脉瓣手术,术后定期随访。 结果 11例均存活,顺利出院,随访时间5~30个月,平均随访时间24.2±5.6个月。1例因中等量反流而行二次手术,其余10例心包瓣膜功能良好。 结论 该手术是一种治疗单纯主动脉瓣病变较为理想的方法,术后患者无需长期抗凝,手术近期效果满意,远期效果有待进一步随访。

    Release date:2016-08-30 06:33 Export PDF Favorites Scan
  • Longterm Results of Tetralogy of Fallot in Adults

    Abstract: Objective To evaluate the longterm results of surgical treatment of tetralogy of Fallot (TOF) in adults and discuss the perioperative treatment skills. Methods From January 2000 to March 2008, 149 patients older than 14 years with tetralogy of Fallot received surgical treatment in Changhai Hospital. Among the patients, there were 78 males and 71 females with ages ranged from 14 years to 53 years and the average age was 26.3 years. Twenty patients had previous pulmonary arterial shunts before radical treatment. A total of 129 patients underwent primary radical treatment. Thirtyeight patients received a right ventricular outflow tract patch, 107 patients had transannular patch, and 4 patients had homograft aorta with valves. Results Hospital mortality was 4.0%(6/149). Four patients died of low cardiac output syndrome (LCOS), and multiple organ failure, and 2 patients died of acute renal failure. The postoperative complications included pleural effusion in 11 patients, pulmonary edema in 10 patients, severe LCOS in 9 patients, severe cardiac arrhythmia in 7 patients, reoperation for excessive bleeding in 7 patients, reintubation in 6 patients, and residual ventricular septal defect (VSD) in 5 patients (two of them had reoperation for residual VSD repair and 2 received transcatheter closure of VSD). One hundred and thirtyfour patients were followed up for 3 to 102 months (47.2±28.6 months) with a followup rate of 93.7%(134/143). Late death occurred in 2 patients, one of whom died of secondary infective endocarditis and the other had a sudden death 29 months after operation. During the followup, one patient had residual VSD (2 mm), but had a normal life. The peak systolic right ventricletopulmonary artery pressure gradient exceeded 40 mmHg in 4 patients. Two patients had severe pulmonary regurgitation. A total of 132 patients survived and had an improved life. One hundred and twentyone patients had class Ⅰ heart function (NYHA), and 11 patients in class Ⅱ. Conclusion The pathophysiologic conditions of the patients with tetralogy of Fallot in adults are very complicated due to longterm right ventricle outlet stricture and chronic hypoxia. Preoperative evaluations and postoperative treatment of complications are necessary. The systemicpulmonary arterial shunts should be performed when hypotrophy of the pulmonary arteries or left ventricles exists. Repair of tetralogy of Fallot in adults has acceptable morbidity and mortality rates with goodlongterm outcomes.

    Release date:2016-08-30 06:02 Export PDF Favorites Scan
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