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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。

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。

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

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。

心脏不停跳心内直视术在瓣膜外科的应用

心脏不停跳心瓣膜置换术治疗重症心脏瓣膜疾病

周围神经损伤的修复

荧光素钠静脉注射后的二次过敏反应

报告3例十分少见的荧光素钠静脉注射后引起的二次过敏反应。分别表现为晕厥、腹痛、腹泻或似癫痫样发作。文中对引起过敏反应的可能机理进行了探讨，并提出对过敏患者进行观察随访的必要性。 （中华眼底病杂志，1994，10：186-187）

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.