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find Author "张玉海等" 2 results
  • 慢性缩窄性心包炎手术径路的选择

    目的 探讨慢性缩窄性心包炎的外科最佳手术径路选择,总结临床经验。方法 回顾性分析 1970年9月至 2009年 9月中国医科大学附属第一医院收治 538例慢性缩窄性心包炎患者的临床资料,按手术径路不同将其分为两组,胸骨正中切口组: 324例,男 204例,女 120例,年龄( 44.5±10.0)岁;左胸前外侧切口组: 214例,男 130例,女 84例,年龄( 46.5±6.8)岁。比较两组患者术后心功能和并发症发生情况。结果 胸骨正中切口组死亡 1例,术后 2 d死于顽固性室性心律失常。左胸前外侧切口组死亡 9例,其中死于多器官功能衰竭 1例,呼吸衰竭 2例,低心排血量综合征 2例,严重肺部感染 3例;1例于第 3次复发手术中发生左心室破裂死亡。胸骨正中切口组心功能较左胸前外侧切口组明显改善,中心静脉压较左胸前外侧切口组降低,胸腔积液、肺炎和脓胸发生率均低于左胸前外侧切口组( P< 0.05)。随访 385例(胸骨正中切口组 231例、左胸前外侧切口组 154例),随访时间 3个月~ 15年,心功能明显改善,均恢复正常工作和学习。胸骨正中切口组缩窄性心包炎复发 4例,左胸前外侧切口组复发 17例,均经相应的治疗治愈或好转。结论 心包剥脱术是治疗慢性缩窄性心包炎的有效手段,胸骨正中切口径路是外科治疗慢性缩窄性心包炎最佳的手术径路。

    Release date:2016-08-30 05:49 Export PDF Favorites Scan
  • Longterm Effects of Preoperative Glucocorticoid Treatment on Outcomes of Cardiac Surgery

    Abstract: Objective [WTBZ]To evaluate the longterm effects of preoperative glucocorticoid treatment on postoperative complications and survival rates for patients receiving cardiac surgery. Methods [WTBZ] We selected 57 patients including 22 males and 35 females at an average age of 52.3±11.2 years in the First Hospital of China Medical University who took steroids for a long time because of various combined diseases from September 2002 to August 2009 in the trial group, and we chose another 171 patients including 62 males and 109 females at an average age of 53.6±9.2 years who were hospitalized at the same time and had comparative basic features in the control group. There was no statistical difference between the two groups in age, gender, and organ function. Different kinds of surgeries including coronary artery bypass grafting, heart valvuloplasty or valve replacement, coronary artery bypass grafting combined with heart valve replacement, and congenital heart disease surgery were performed on the patients. The proportion of surgeries carried out was similar in the two groups. Postoperative complications were compared between the two groups, and survival rates at the end of 6 months and one year followup were observed. Results [WTBZ]There was no statistical difference between the two groups in complications with respect to cardiopulmonary bypass (CPB) time (t=1.27, Pgt;0.05), reoperation for excessive postoperative bleeding (χ2=0.03, P=0.87), sternal and mediastinal infection (χ2=0.04, P=0.84), stroke (χ2=0.07, P=0.79), and gastrointestinal tract complications (χ2=2.89, P=0.09). The incidence of ventricular arrhythmia and requirement for intraaortic balloon pump in the trial group was higher, but no statistical difference was detected (χ2=2.24, P=0.13; χ2=2.20, P=0.14, respectively). Patients in the trial group were more likely to require prolonged ventilation (t=2.32, Plt;0.05), had higher rate of atrial fibrillation (χ2=4.09, P=0.04), and higher inhospital mortality (χ2=5.35, P=0.02). The sixmonth and oneyear survival rates were 0.79±0.10 and 0.73±0.12, respectively for the trial group, 0.94±0.09 and 0.86±0.10, respectively for the control group. Conclusion Longterm steroid treatment leads to higher atrial fibrillation incidence, longer ventilation time and increases the mortality rate following cardiac surgery.

    Release date:2016-08-30 05:57 Export PDF Favorites Scan
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