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find Author "王东进" 29 results
  • Prognostic significance of test of cardiac troponin T and renal function in acute type A aortic dissection

    Objective To measure the rate of changes of the cardiac troponin T (cTnT) and serum urea nitrogen (N), serum creatinine (Cr), estimated glomerular filtration rate (eGFR) of acute type A aortic dissection (AAAD) patients before and after surgery, and to explore the prognostic significance of the rate of changes. Methods We retrospectively analyzed 77 AAAD patients' clinical data between August 2015 and March 2016 from the department of the cardiothoracic surgery in Nanjing Drum Tower Hospital. There were 57 males and 20 females with an average age of 51.1±13.1 years. The test results of cTnT, N, Cr, eGFR were recorded. Patients were divided into three groups based on the duration of ventilation: less than 48 hours, 48 hours to 7 days, longer than 7 days, and divided into two groups based on whether postoperative dialysis was performed: dialysis group and non-dialysis group. Results In the groups with different duration of ventilation, the rate of cTnT change differed significantly. The rate of Cr and eGFR change in the group with the duration of ventilation longer than 7 days showed significantly different compared to other two groups. We found that the rate of Cr and eGFR change were statistically significant between the dialysis group and the non-dialysis group. In the receiver operating characteristic curve (ROC), the optimal cut-off value of the Cr growth rate for predicting postoperative dialysis therapy was 58.1%, and the optimal cut-off value of the eGFR decline rate was 45.5%. Conclusion The rate of changes in cTnT, N, Cr and eGFR can be used as a reliable mean to evaluate respiratory and renal function for AAAD patients in the early stage, which will facilitate an early assessment of the prognosis of AAAD patients.

    Release date:2017-03-24 03:45 Export PDF Favorites Scan
  • 同种肺动脉瓣治疗肺动脉瓣缺如综合征一例

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  • Advances of aortic valve repair for aortic regurgitation

    The first aortic valve repair was performed in 1958, but the clinical outcome was limited. Since the invention of prosthetic valves, aortic valve replacement has become and still maintained the dominated surgical treatment option. As the impact of the prosthetic valve-related event to quality of life of the patients and the studies of the mechanism of aortic regurgitation and the functional anatomy of aortic root grow, the application of aortic valve repair gets more popular, and the short- and mid-term outcomes are good.

    Release date:2018-01-31 02:46 Export PDF Favorites Scan
  • Risk factors for sternal wound infection after various cardiac operations

    Objective To evaluate the risk factors for sternal wound infections after various cardiac operations. Methods We retrospectively analyzed the clinical data of 2 924 consecutive patients (28% female) in our hospital from 2010 to 2014 year. Their median age was 69 years (interquartile range of 60 to 76 years). Procedures included isolated coronary artery bypass grafting (CABG), isolated valve repair or replacement, and valve procedures plus CABG. Results Sternal wound infection was detected in 110 (3.8%) patients among the 2 924 patients: 67 of 1 671 patients (4.0%) after CABG, 17 of 719 (2.4%) after valve operations, and 26 of 534 (4.9%) after valve+CABG operation. In the CABG patients, bilateral internal thoracic artery harvest procedure, operation time>300 minutes, diabetes, obesity, chronic obstructive pulmonary disease, and female were independent risk factors for sternal wound infection. In the valve operation patients, only revision for bleeding as an independent predictor for sternal infection. For combined valve plus CABG patients, revision for bleeding and operation time>300 minutes were independent risk factors for sternal infection. Conclusion Risk factors for sternal wound infections after cardiac operations vary with the type of surgical procedure. In patients undergoing valve operations or combined operations, procedure-related risk factors (revision for bleeding, operation time) independently predict infection. In patients undergoing CABG, not only procedure-related risk factors but also bilateral internal thoracic artery harvest and patient characteristics (diabetes, chronic obstructive pulmonary disease, obesity, female) are predictors of sternal wound infection. Preventive interventions may be justified according to the type of operation.

    Release date:2017-04-01 08:56 Export PDF Favorites Scan
  • 主动脉瓣成形术治疗先天性主动脉瓣关闭不全12例

    Release date:2016-08-30 06:18 Export PDF Favorites Scan
  • 华法林抗凝过量致自发性后腹膜出血一例

    Release date:2016-08-30 05:51 Export PDF Favorites Scan
  • 右侧乳缘下切口在再次瓣膜手术中的应用

    目的 探索经右侧乳缘下切口行再次瓣膜手术的临床应用效果。 方法 2012 年 12 月至 2017 年 3 月南京大学医学院附属鼓楼医院共 20 例患者经右侧乳缘下切口行再次瓣膜手术(右侧乳缘下切口组),其中男 11 例、女 9 例,平均年龄(51±8)岁。选取同时期 20 例经胸骨正中切口再次行二、三尖瓣手术患者(正中开胸组),其中男 13 例、女 7例,平均年龄(46±5)岁。右侧乳缘下切口组采用股动静脉插管,上腔静脉常规直角插管,第 4 肋间进胸,不断肋骨,常规升主动脉阻断或心室颤动下完成二、三尖瓣成形或置换、心房颤动消融和左房折叠等术式。 结果 正中开胸组有 3 例开胸时出现心脏破裂,而右侧乳缘下切口组只有 1 例游离下腔静脉时右房破裂。右侧乳缘下切口组开胸体外循环时间和术后住院时间均显著短于正中切口组[(55.0±22.0)min vs.(94.0±38.0)min,P<0.001;(12.3±3.7)dvs.(15.7±6.7)d,P=0.032]。右侧乳缘下切口组开胸时出血量和术后 24 h 引流量均显著少于正中开胸组[(92.0±37.0)ml vs.(342.0±157.0)ml,(202.0±117.0)ml vs.(567.0±254.0)ml,P均<0.001]。 结论 右侧乳缘下切口行再次心脏手术可完成除升主动脉和主动脉瓣操作之外的任何瓣膜和左房操作,具有手术创伤小、出血少、患者术后恢复快、美容效果好等优点。此外,对于外科医生而言,该技术手术难度较低,如果具备正中切口的解剖基础,完全可胜任此手术,但术中需注意肺和心肌保护。

    Release date:2018-03-05 03:32 Export PDF Favorites Scan
  • LEFT VENTRICULAR RECONSTRUCTION IN PATIENTS WITH LEFT VENTRICULAR ANEURYSM AFTER MYOCARDIAL INFARCTION

    Objective To discuss left ventricular reconstruction methods and effectivness in patients with left ventricular aneurysm after myocardial infarction. Methods Between June 2003 and August 2008, 23 patients with left ventricular aneurysm after myocardial infarction were treated. Of them, 13 were male and 10 were female with an average age of 61.2 years (range, 47-74 years). According to New York Heart Association (NYHA) criteria for cardiac function, there were 3 cases of grade I, 6 cases of grade II, 10 cases of grade III, and 4 cases of grade IV. The coronary arteriongraphy showed singlevesseldisease in 2 cases, double-vessel disease in 5 cases, triple-vessel disease in 16 cases. The locations of ventricular aneurysm were the apex cordis in 18 cases, antetheca and parieslateral is in 4 cases, and interior wall in 1 case. The left ventricular ejection fraction was 36.52%± 12.15%, and left ventricular diastol ic final diameter was (62.30 ± 6.52 ) mm. Nine patients received standard l inear repair, 6 patients received standard l inear repair after endocardial ring shrinkage, and 8 patients received patch suture after endocardial ring shinkage. Results Two cases died perioperatively, and re-thoracotomy was performed to stop bleeding in 1 case. Incisions healed by first intention in the other patients without early compl ication. Twentyone patients were followed up 7-48 months (median, 19 months). At 6 months after surgery, the left ventricular ejection fraction 46.52% ± 9.41% were significanly improved when compared with that at preoperation (t=2.240, P=0.023); the left ventricular diastol ic final diameter (52.23 ± 5.11) mm were significantly decreased when compared with that at preoperation (t=2.170, P=0.035). The cardiac function according to NYHA criteria was at grade I in 8 cases and at grade II in 13 cases. One patient died of cerebral hemorrhage at 18 months after operation and the activities of daily l iving recoverd in the others. Conclusion Individual theraputic methods are used according to patients’ different conditions for left ventricular aneurysm after myocardial infarction.

    Release date:2016-08-31 05:44 Export PDF Favorites Scan
  • Protecting Effect of Remote Ischemic Preconditioning on Myocardium in Cardiac Valve Surgery

    ObjectiveTo investigate whether there is a protecting effect of remote ischemic preconditioning (RIPC) on patients underwent cardiac valvular surgery. MethodWe retrospectively analyzed the clinical data of 72 adult patients underwent cardiac valvular surgery in our hospital from Febuary 2014 through April 2015 year. There were 26 males and 46 females with an age ranging from 23-68 years. We devided 72 patients into a RIPC group and a control group. There were 14 males and 28 females with a mean age of 48.87±12.28 years in the RIPC group. After the induction of anesthesia, the RIPC group was induced by three cycles of right upper limb ischemia and reperfusion using a blood pressure cuff. The blood pressure cuff was inflated to 200 mm Hg and we held it on for 5 minutes, deflated to 0 mm Hg and maintained for 5 minutes, which was defined as one cycle. There were 10 males and 20 females with a mean age of 47.70±8.07 years in the control group. We placed a standard blood pressure gasbag on the right upper limb for 30 minutes without inflation in the control group. We recorded the clinical data including cardiopulmonary bypass (CPB) time, the cross-clamping time of ascending aorta, preoperative ejection fraction (EF), EF after discharging, postoperative complica-tion and mortality. Blood were sampled preoperatively (T0), 30 minutes after RIPC (T1), 30 minutes aftr the cardiopul-monary bypass finished (T2), 24 hours (T3), 48 hours (T4) and 72 hours (T5) after surgery to detect the concentration of troponin T (cTnT) and creatine kinase-MB (CK-MB). We counted the person-time used dopamine and norepinephrine. ResultThere was no death in both groups. The mechanical ventilation time, the time of ICU stay, the time of hospital stay, the number of person used vasoactive agent, and the EF when discharging showed no statistical difference between the two groups. Levels of cTNT in the RIPC group were statistically lower than those in the control group at T2 and T3 (P=0.001, P=0.001). Levels of CK-MB in the RIPC group were statistically lower than those in the control group at T2, T3, and T4 (P=0.011, P=0.010, P=0.033). ConclusionRIPC may have protective effect on myocardium for patients underwent cardiac valvular surgery.

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  • 右腋下直切口在体外循环心脏直视手术中的应用

    目的 介绍使用右腋下直切口进行体外循环心脏手术的临床结果及治疗体会,总结临床经验。 方法 使用右腋下直切口对2 058例先心病和心脏瓣膜病施行手术,其中先心病1 466例,心脏瓣膜疾病592例,所有患者均行气管内插管,静脉复合或吸入麻醉;取左侧卧位60. ~90. ,切口上端起自腋中线第3肋,下端止于腋前线第5肋,在腋中线第7肋间切 一1.5cm小口备用,沿第4肋骨上缘或第3肋进胸;沿右膈神经前切开心包并悬吊利于升主动脉及心脏显露;以长扁桃钳夹住主动脉插管前端,帮助完成主动脉插管。经手术切口内置入上腔静脉直角插管,从第7肋间小切口导入直角下腔静脉插管。阻断升主动脉,经主动脉根部插管灌注心脏停搏液,切开右心房或肺动脉和右心室流出道切口进行先天性心脏病手术。 体外循环结束后,拔除主动脉插管,缝合心包上段大部分,经第7肋间小切口放置胸腔引流管。 结果 全部患者中二次开胸止血23例(1.12%) ,切口感染或愈合不良14例(0.68%) ,发生其他各种并发症65例(316%) ,均经对症治疗后痊愈,随访时无异常。2 058例中共死亡6例,总死亡率为0.29% (6/2 058) ,其中先心病患者3例,死亡率为0.20% (3/1 466) ;心脏瓣膜病患者3例,死亡率为0.5% (3/592) .结论 右腋下直切口本身固有的美观效果、较宽的手术适应证以及与常规切口相比具有的优点,值得并适于在临床应用。

    Release date:2016-08-30 06:16 Export PDF Favorites Scan
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