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find Keyword "大血管" 14 results
  • Study on the Relationship between Serum Visfatin and Eldly Type 2 Diabetes Mellitus withMacrovascular Lesion

    目的:探讨visfatin与老年2型糖尿病及其大血管并发症和相关代谢指标的关系。方法:将66例老年糖尿病患者分为合并大血管病变组(MCV)35例和非大血管病变组(nMCV)31例,并选64例健康人做对照。采取酶联免疫测定法(ELISA)测定空腹血清visfatin浓度;并测定各组的空腹血糖、胰岛素、血压和血脂水平;用胰岛素抵抗指数(HOMAIR)HOMAIR评价胰岛素抵抗,分析各指标间的相关性及与大血管并发症的相关性。结果:①老年2型糖尿病组血清visfatin浓度高于正常对照组,差异有统计学意义(Plt;0.01)。但正常对照组与2型糖尿病组中nMCV组比较,visfatin浓度差异无统计学意义(Pgt;0.05)。②老年2型糖尿病组中大血管病变组(MCV)血清visfatin浓度明显高于非大血管病变组(nMCV),差异有统计学意义(Plt;0.01)。③相关分析显示,老年2型糖尿病组血清visfatin浓度与腰围(WC)、甘油三酯(TG)均呈显著正相关,与性别、年龄、HOMAIR呈正相关。进一步以visfatin为应变量,以年龄、性别、BMI、WC、收缩压(SBP)、舒张压(DBP)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、空腹血糖(FPG)、空腹胰岛素(FINS)、HOMAIR为自变量进行多元逐步回归分析,TG、WC和年龄是血清visfatin独立相关因素。④在老年T2DM组,以有无大血管并发症为应变量(Y=1,n=0),各指标为自变量,进行logistic回归分析,visfatin进入回归方程。结论:血清visfatin与2型糖尿病的发病不相关,但在老年2型糖尿病中与其大血管并发症有关。

    Release date:2016-08-26 03:57 Export PDF Favorites Scan
  • Mid-term Results of Cardiovascular Surgery Employing Extracorporeal Circulation in Patients Dependent on Dialysis

    Objective To summarize our experience of cardiovascular surgery for patients dependent on dialysis, and evaluate its safety and efficacy.?Methods?Clinical data of 10 consecutive patients dependent on maintenance dialysis underwent cardiovascular operations between Dec. 2004 and April 2011 in Peking Union Medical College Hospital were analyzed retrospectively. There were 6 male and 4 female patients, aged between 23 to 71 (57.6±13.2) years. They were put on dialysis 3-98 (25.2±30.6) months prior to operation due to diabetic nephropathy in 6 patients, chronic glomerulitis in 3 patients and systemic lupus erythemus in 1 patient, and 8 were dependent on hemodialysis and 2 on peritoneal dialysis. Five patients underwent coronary artery bypass grafting, one underwent Bentall procedure,two underwent aortic valve replacement, one underwent mitral valve replacement, and one underwent superior vena cava thrombectomy and patch repair. Patients underwent dialysis on the day before elective operation, followed by continuous ultra-filtration during cardiopulmonary bypass, and then bedside heparin-free continuous veno-venous hyperfiltration-dialysis started 5-32 hours after the operation. Conventional peritoneal dialysis or hemodialysis was resumed 4-7 days after operation.?Results?All operations were successfully completed. Cardiopulmonary bypass time was (125.8±33.5)minutes, aortic clamp time was(77.2±25.5) minutes. One in-hospital death occurred due to septic shock after deep chest wound infection. One patient underwent re-exploration due to pericardial temponade to achieve hemostasis. Three patients experienced atrial fibrillation and were all converted to sinus rhythm by amiodarone. Nine patients recovered to discharge and were followed-up for 8-76 months. Two late deaths occurred due to intracranial hemorrhage and liver carcinoma respectively. Seven survived patients were all in New York Heart Association grade II functional class, and none of them experience major advertent cardiac events related to grafts or prosthetic valve. One patient switched to hemodialysis 14 months after discharge due to peritonitis.Conclusion?Cardiovascular surgery can be practiced in patients dependent on maintenance hemodialysis or peritoneal dialysis with appropriate peri-operative management, so that symptoms can be relieved and quality of life improved.

    Release date:2016-08-30 05:50 Export PDF Favorites Scan
  • 侵犯心脏大血管局部晚期肺癌的外科治疗

    摘要: 目的 总结侵犯大血管和左心房的局部晚期非小细胞肺癌的外科治疗经验。 方法 回顾性分析我科2005年2月至2009年11月期间对32例局部晚期(T4N0M0、T4N1M0、T4N2M0)非小细胞肺癌患者(男27例,女5例;年龄48~73岁,中位年龄58岁)采用原发肿瘤加部分心房或大血管切除治疗的临床资料。侵犯上腔静脉和无名静脉5例,肺动脉干4例,左心房23例。行左全肺及左心房部分切除13例,左全肺及肺动脉干部分切除4例,右全肺及左心房部分切除9例(其中2例在体外循环辅助下进行),右肺中下叶及部分左心房切除1例,右肺上叶及上腔静脉部分切除人工血管置换3例,上腔静脉修补2例。 结果 本组32例患者无手术死亡,手术完全切除16例。术后仅有3例发生心律失常。 肿瘤病理类型:鳞癌25例,腺癌5例,大细胞癌2例。术后pTNM分期:T4N0M03例,T4N1M0 11例,T4N2M0 18例。所有患者术后随访6个月~5年,中位生存时间15个月;T4N0 M0、T4N1M0患者的中位生存时间为19个月,T4N2M0患者的中位生存时间为10个月。1例患者无瘤生存5年。 结论 侵及心房大血管的局部晚期肺癌(Ⅲb期)采用扩大切除术能提高根治性手术切除率,改善患者生活质量,提高局部晚期肺癌患者的生存率。

    Release date:2016-08-30 06:02 Export PDF Favorites Scan
  • Progress in Early Diagnosis and Treatment of Severe Heart and Great Vessel Injury

    Severe heart and great vessel injuries were a fatal traumatic entity. How to improve the survival rate of these victims still was a challenge to date. This paper included: the pathogenesis and resuscitation of commotio eordis ; traumatic pericardial rupture associated with heart luxation and/or diaphragmatocele in pericardial cavity; indication selection of emergency room thoracotomy for severe heart injury and traumatic aortic disruption treated with endovascular stent graft. For the purpose of increasing our recognition of the severe trauma and making the early diagnosis and management as early as possible. The main relative references published in recently 5 years were reviewed.

    Release date:2016-08-30 06:22 Export PDF Favorites Scan
  • 腋动脉插管在体外循环手术中的应用

    目的总结腋动脉插管在心脏大血管体外循环手术中应用的经验。方法对22例心脏大血管疾病患者手术中采用腋动脉插管完成体外循环动脉灌注,介绍腋动脉插管的技术要点;分析腋动脉插管的并发症发生情况及其与预后的关系。结果手术施行腋动脉插管顺利,体外循环满意。术后发生肢体麻木2例,出院时症状均消失或明显减轻;手术死亡4例,死亡原因与腋动脉插管无关。结论采用腋动脉插管作为心脏大血管手术中建立体外循环的动脉灌注,其方法简单、疗效可靠、并发症少,可减少手术中神经系统并发症的发生,值得进一步推广应用。

    Release date:2016-08-30 06:25 Export PDF Favorites Scan
  • Effects of Glycometabolic Control on Macrovasculopathy in Diabetes: Evaluation and Suggestion

    Release date:2016-09-07 02:28 Export PDF Favorites Scan
  • Surgical Management of Mediastial Tumor Invading the Heart or Great Vessels

    ObjectiveTo summarize the surgical management of complicated mediastinal tumor involving the heart or great vessels. MethodsWe retrospectively analyzed the clinical data of 38 patients with complicated mediastinal tumor invading the heart and large blood vessels underwent extended thymectomy in our hospital between February 1997 and May 2014. There were 26 males and 12 females at age of 41.3± 13.6 years ranking from 4 to 68 years. Multiple personalized procedures were applied within the 38 patients and some patients underwent more than one procedure. Besides the resection of mediastinal tumor, 3 patients underwent partial right atrial resection. Sixteen patients underwent resection, plasty or grafting vessels. Ten patients took partial excision and repair of pericardium. Eight patients underwent pulmonary wedge resection. Two patients underwent lobectomy. Two patients required cardiopulmonary bypass. ResultAll operations were completed successfully. There was no perioperative mortality. The operating time was 105-282 min and blood loss was 200-1 500 ml. The postoperative complications rate was 23.7%. The incidence of ICU admission was 47.4% with an average ICU stay of 1.8 days. The average length of post-operative hospital stay was 11.2 days. The five-year survival rate was 57.0%. ConclusionSurgical resection of mediastinal tumor invading the heart or great vessels is complicated and highly risky. However, desirable clinical outcome can be achieved with comprehensive perioperative assessment and appropriate surgical procedures.

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  • Surgical Emergency Treatment of Penetrating Heart and Great Vessels Trauma: Experience of 26 Patients

    目的总结心脏大血管穿透伤的临床特点、早期诊断和救治经验,提高抢救成功率。 方法回顾性分析2007年7月至2014年6月我院26例心脏大血管穿透伤患者的临床资料,男23例、女3例,年龄16~71(22.0±8.4)岁。其中刀刺伤25例,钢锥刺伤1例;心脏穿透伤23例,升主动脉刀刺伤2例,主肺动脉刀刺伤1例;心脏压塞型7例,失血休克型8例,心脏压塞+失血休克型2例,亚临床型9例。26例就诊后30 min至3 h急诊在全身麻醉下行开胸手术治疗,侧开胸手术20例,前正中开胸手术6例,其中2例在体外循环下手术。 结果全组死亡2例,均为失血休克型,1例69岁右心室贯通伤和右冠状动脉主干损伤男性患者术中死于低心排血量综合征,1例38岁右心室前壁穿透伤男性患者术后死于纵隔感染导致的多器官功能衰竭,其余患者痊愈出院,救治成功率达92.3%。18例随访1个月至7年,无后遗症发生。 结论迅速明确伤情,及时诊断,急诊开胸探查是提高心脏大血管穿透伤抢救成功率的关键。

    Release date:2016-11-04 06:36 Export PDF Favorites Scan
  • Protective effect of autologous platelet separation on blood in surgery for Standford type A aortic dissection: A randomized controlled trial

    Objective To investigate the protective effect of autologous platelet separation on blood in surgery for Standford type A aortic dissection. Methods A total of 180 patients with Standford type A aortic dissection undergoing elective major vascular surgery in our hospital from July 2014 to March 2016 were enrolled. There were 123 males and 57 females with age ranging from 19 to 68 years and weight of 50-85 kg. The patients were randomly divided into two groups. Patients in group A (n=92, 65 males, 27 females, mean age of 45±21 years) received intraoperative autologous blood recovery; while those in group B (n=88, 58 males, 30 females, mean age of 43±24 years) received autologous platelet rich plasma (APRP) and intraoperative autologous blood recovery. The whole process of platelet separation was completed before heparinization. The relevant indicators of blood coagulation function before the induction of anesthesia (T1), before heparinization (T2), immediately postoperatively (T3) and 1 h (T4), 24 h (T5) postoperatively were measured. Cardiopulmonary bypass, aortic cross-clamping time, drainage volume at postoperative 1 h, 24 h and allogeneic blood transfusion volume were recorded. Results The whole blood volume of group B in the platelet separation in emergency was 1 305±110 ml, and collected platelet rich plasma was 275±30 ml, platelet counts (630±220)×109/L, accounting for 25%±5% of platelets of whole blood, and platelet separation time was 32±9 min. Compared with group A, platelet count at postoperative 1 h in group B was significantly higher; drainage volume at postoperative 1 h, 24 h, allogeneic red blood cells, plasma transfusion volume and allogeneic platelet infusion rate decreased significantly (P<0.05). Group B had less postoperative complications (P<0.05). Conclusion Preoperative autologous plateletpheresis combined with intraoperative autologous blood recovery can significantly improve the coagulation function of patients with vascular surgery, and reduce the amount of allogeneic blood transfusion and postoperative bleeding.

    Release date:2017-01-22 10:15 Export PDF Favorites Scan
  • Analysis on the management of laboratory critical values in the Department of Cardiovascular Surgery

    Objective To review and analyze the statistics of laboratory critical values in the Department of Cardiovascular Surgery in order to improve the procedures of dealing with these values and provide references for the enhancement of the nursing level. Methods We retrospectively analyzed laboratory critical values of 236 inpatients in the Department of Cardiovascular Surgery from April 2013 to April 2014. General data of the patients including the type of critical values, the critical value, distribution, clinical processing time and complications related to the critical values. Results A total of 208 laboratory critical values of 185 inpatients were analyzed including abnormal blood potassium was involved in 99 (47.60%); abnormal blood glucose was involved in 13 (6.25%); abnormal blood sodium was involved in 11 (5.29%); abnormal blood troponin was involved in 13 (6.25%); and 72 cases had other kinds of critical values (34.62%). A total of 136 critical values were closely related to the Department of Cardiovascular Surgery. Among them, 60 cases had a processing time of 15 minutes or shorter. After re-examination, 16 were confirmed to be fake critical values; and 11 critical values did not need to be treated according to the condition of the patients. There were altogether 27 cases of complications related to critical values, including 23 cases of arrhythmia related to abnormal blood potassium, 2 cases of abnormal muscle strength caused by abnormal blood sodium, and 2 cases of hypoglycemia. After the critical values were handled, related complications disappeared without any recurrence. Conclusions Perfect regulatory regime and process of recording and handling laboratory critical values are important for nurses in our department to carry out more accurate measures in treating these critical values including abnormal blood potassium, blood glucose, blood sodium, and blood troponin, etc. In order to continuously improve medical and nursing quality, nurses should pay more attention to the identification and treatment of laboratory critical values.

    Release date:2017-02-22 03:47 Export PDF Favorites Scan
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