Objective To investigate whether the individualized anticoagulation therapy based on CYP2C9 and VKORC1 gene is superior to empirical anticoagulation therapy after artificial heart valve replacement surgery in Uygur patients. Methods From December 2012 to December 2015, 210 Uygur patients who underwent artificial heart valve replacement surgery at the First Affiliated Hospital of Xinjiang Medical University were randomly assigned to a genetic anticoagulation therapy group (group A, n=106, 41 females and 65 males, aged 44.7±10.02 years) or an empirical anticoagulation therapy group (group B, n=104, 47 females and 57 males, aged 45.62±10.01 years) according to the random number table. CYP2C9 and VKORC1 genotypes were tested in the group A and then wafarin of administration in anticoagulation therapy was recommended. Patients in the group B were treated with conventional anticoagulation. Patients in both groups were followed up for 1 month and coagulation function was regularly tested. Results The percentage of patients with INR values of 1.8-2.5 after 4 weeks warfarin anticoagulation treatment in the group A was higher than that in the group B (47.1% vs. 32.7%, P=0.038). The rate of INR≥3.0 in the warfarin anticoagulation therapy period in the group A was lower than that in the group B (21.6% vs. 26.5%, P=0.411). The time to reach the standard INR value and the time to get maintenance dose were shorter in the group A compared with the group B (8.80±3.07 d vs. 9.26±2.09 d, P=0.031; 14.25±4.55 d vs. 15.33±1.85 d, P=0.032). Bleeding occured in one patient in the group A and three patients in the group B (P=0.293). Embolic events occured in three patients in the group A and five patients in the group B (P=0.436). Conclusion Compared with the empirical anticoagulation, the genetic anticoagulation based on wafarin dosing model can spend less time and make more patients to reach the standard INR value. However there is no significant difference between the two groups in the ratio of INR≥3.0, bleeding and embolic events in the warfarin anticoagulation therapy.
目的总结常温体外循环下经肺动脉内补片修补术治疗成人粗大型动脉导管未闭（patent ductusarteriosus，PDA）的临床经验。 方法回顾性分析新疆医科大学第一附属医院收治的62例直径大于15 mm PDA患者的临床资料，其中男45例、女17例，年龄18～35岁；常温体外循环辅助下经肺动脉前壁切开，用Foley气囊导管堵住PDA开口直视下行补片修补术，合并其它心内畸形的同期进行矫正。 结果全组病例无早期死亡，术中体外循环时间（40.78±11.03）min，住院时间（12.55±8.41）d。通过电话及门诊随访56例，失访6例，失访率9.68%，随访时间2～18（11±5）个月，无1例死亡，复查心脏超声未见残余分流。术后出现低心排血量综合征2例、不同程度的高血压8例，经积极治疗后均痊愈出院。 结论经肺动脉内补片修补术治疗成人粗大型动脉导管未闭，手术操作简单、风险小、效果良好。
ObjectiveTo systematically review the effectiveness and safety of aspirin-clopidogrel combined anti-platelet therapy after coronary artery bypass grafting (CABG). MethodsDatabases including The Cochrane Library (Issue 2, 2013), PubMed, EMbase, CBM, CNKI, WanFang Data and VIP were searched electronically from their inception to September 2013 for randomized controlled trials (RCTs) about aspirin-clopidogrel combined anti-platelet therapy after CABG. Two reviewers selected literature independently according to the inclusion and exclusion criteria. After data extraction and methological quality assessment of the included studies, meta-analysis was performed using RevMan 5.2 software. ResultsA total of six RCTs involving 901 patients were included, of which 449 cases were in the aspirin-clopidogrel group (A+C) and 452 cases were in the aspirin with or without placebo group (A+P). The results of meta-analysis showed that: compared with A+P, A+C significantly reduced occlusion rates of the saphenous vein graft (RR=0.59, 95% CI 0.43 to 0.80, P=0.000 6). But no significant difference was found between the two groups in occlusion rates of the left internal mammary artery graft (RR=0.88, 95% CI 0.35 to 2.18, P=0.78), radial artery graft (RR=0.43, 95% CI 0.13 to 1.46, P=0.18), pleural fluid drainage volume (MD=-1.68, 95%CI-48.69 to 45.32, P=0.94), incidence of major bleeding events (RR=1.20, 95% CI 0.39 to 1.65, P=0.75), major cardiovascular events (OR=0.81, 95% CI 0.38 to 1.72, P=0.58), and mortality within 30 days (RR=0.64, 95% CI 0.17 to 2.44, P=0.52). ConclusionIn reducing occlusion rates of the saphenous vein graft, the A+C group is more effective than the A+P group. Due to the limited quantity and quality of the included studies, the above conclusion still needs to be verified by carrying out more high-quality RCTs.
Objective To analyze the clinical efficacy of totally thoracoscopic surgery and conventional thoracotomy in repair of ventricular septal defect (VSD). Methods We retrospectively reviewed the clinical data of 50 VSD patients admitted to the First Affiliated Hospital of Xinjiang Medical University from January 2015 to January 2017. According to the surgical pattern, they were divided into two groups: a totally thoracoscopic surgery group (21 patients, 13 males, 8 females, aged 38.36±10.02 years), and a thoracotomy group (29 patients, 18 males, 11 females, aged 42.36±13.02 years). The operation time, hospital stay, ventilator-assisted time and thoracic drainage were compared between the two groups. Results There was no death in two groups. In the thoracoscopic group the duration of cardiopulmonary bypass (CPB) time and the aortic clamping time were longer than those of the thoracotomy group (P<0.05), but postoperative drainage, patients with postoperative use of blood products and postoperative hospital stay were less (P<0.05). There was no statistically significant difference between the two groups in operation time, postoperative ventilator-assisted time or duration of ICU stay. Conclusion Compared with the conventional thoracotomy, totally thoracoscopic VSD repair with less trauma, quicker recovery and less blood use, is safe and reliable and can be used as a preferred surgical intervention.