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find Keyword "心功能" 67 results
  • 严重心功能不全致呼吸机依赖患者成功脱机一例

    Release date:2016-08-26 02:09 Export PDF Favorites Scan
  • Clinical Observation of Insulin Resistance and Diabetic Cardiac Insufficiency in Type 2 Diabetes Mellitus

    【摘要】 目的 探讨2型糖尿病(T2DM)胰岛素抵抗导致糖尿病性心功能不全的临床表现特点及相关激素的改变。 方法 2008年1-4月对T2DM患者35例(胰岛素抵抗指数HOMA-IRlt;2.69者19例为A1组,HOMA-IR≥2.69者16例为A2组)及健康体检者20人B组测体重指数(BMI)、空腹血糖(FPG)、胰岛素、心钠素(ANP)、脑钠素(BNP)水平;心脏彩色多普勒超声分别测E/A、e/a、S/D、LVEF、DT期。 结果 A2组BMI较A1、B组均明显增加(Plt;0.05),A1、B组间差异无统计学意义(Pgt;0.05)。ANP、BNP及DT值在A1、A2组均较B组增高(Plt;0.05),BNP在A2组高于A1组(Plt;0.05),ANP、DT值在A1、A2组间差异均无统计学意义(Pgt;0.05)。E/A、e/a和S/D在A1、A2组均较B组降低(Plt;0.05),A1、A2组间差异均无统计学意义(Pgt;0.05)。A2组患者LVEF较A1、B组均明显降低(Plt;0.05),A1、B组间差异无统计学意义(Pgt;0.05)。 结论 随着胰岛素抵抗加重,心肌舒张顺应性较差和收缩力下降,伴随相关激素(心脏利钠肽)分泌增加,最终产生心功能不全的临床表现、体征及多普勒超声心动图表现。【Abstract】 Objective To investigate the clinical features and related hormone changes of diabetic cardiac insufficiency leaded by insulin resistance in type 2 diabetes mellitus (T2DM). Methods From January to April 2008, 35 patients with T2DM (group A1: HOMA-IRlt;2.69, n=19; group A2: HOMA-IR≥ 2.69, n=16) and 20 subjects without T2DM (group B) were enrolled. The body mass index (BMI), fasting plasma glucose (FPG), insulin (FINS), atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), and E/A, e/a, S/D, LVEF and DT stage of all subjects were detected. Results The BMI in group A2 was higher than those in group A1 and group B (Plt;0.05), while the difference between the later two groups was not statistically significant (Pgt;0.05). The ANP, BNP and DT stage were all higher than those in group B (Plt;0.05), the BNP was higher in group A2 than in group A1 (Plt;0.05), while the difference of neither ANP nor DT stage between the later two groups was statistically significant (Pgt;0.05). The values of E/A, e/a and S/D in group A1 and A2 were all lower than those in group B (Plt;0.05), while there were no statistically significant diferences between group A1 and A2 (Pgt;0.05). The values of LVEF of group A1 and A2 were both significantly reduced than that in group B (Plt;0.05), and the values in group A2 were the lowest (Plt;0.05). Conclusion With the aggravating of insulin resistance, myocardial contractility and diastolic function will decline, meanwhile the ANP and BNP secretion will increase, and then the clinical and echocardiographic manifestation will appear.

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  • Clinical Analysis of Laparoscopic Cholecystectomy Under Lower Pneumoperitoneal Pressure for Patient with Cardiofunction Ⅱ (Report of 18 Cases

    【摘要】目的 探讨心功能Ⅱ级患者在低气腹压下行腹腔镜胆囊切除术的可能性。 方法 总结我院2003年7月至2004年7月间收治的18例心功能Ⅱ级患者行低气腹压腹腔镜胆囊切除术的临床资料。 结果 18例心功能Ⅱ级患者中17例完成腹腔镜胆囊切除,1例中转开腹。 结论 心功能Ⅱ级患者行低气腹压腹腔镜胆囊切除术是可行的。

    Release date:2016-08-28 04:28 Export PDF Favorites Scan
  • Comparative Study on the Efficacy and Safety of Thrombolysis and Anticoagulation Therapy for Patients with Acute Sub-Massive Pulmonary Thromboembolism

    Objective To compare the clinical efficacy and safety of thrombolysis with anticoagulation therapy for patients with acute sub-massive pulmonary thromboembolism. Methods The clinical data of 84 patients with acute sub-massive pulmonary thromboembolism were analyzed retrospectively, mainly focusing on the in-hospital efficacy and safety of thrombolysis and/ or anticoagulation. The efficacy was evaluated based on 6 grades: cured, markedly improved, improved, not changed, deteriorated and died. Results Among the 84 patients,49 patients received thrombolysis and sequential anticoagulation therapy( thrombolysis group) , 35 patients received anticoagulation therapy alone( anticoagulation group) . As compared with the anticoagulation group, the thrombolysis group had higher effective rate( defined as patients who were cured, markedly improved or improved, 81. 6% versus 54. 3%, P = 0. 007) , lower critical event occurrence ( defined as clinical condition deteriorated or died, 2. 0% versus 14. 3% , P = 0. 032) . There was no significant difference in bleeding rates between the two groups ( thrombolysis group 20. 4% versus anticoagulation group 14. 3% , P gt; 0. 05) . No major bleeding or intracranial hemorrhage occurred in any of the patients. Conclusions Thrombolysis therapy may be more effective than anticoagulation therapy alone in patients with acute sub-massive pulmonary thromboembolism, and thus warrants further prospective randomized control study in large population.

    Release date:2016-09-14 11:22 Export PDF Favorites Scan
  • Clinical Analysis of Patients with Acute Pulmonary Embolism, Normal Blood Pressure, and Right Ventricular Dysfunction

    Objective To analyze the clinical features of patients with acute pulmonary embolism ( APE) with normal blood pressure and right ventricular dysfunction. Methods 130 hospitalized patients with normotensive APE between January 2009 and January 2012 were retrospectively analyzed. The patients underwent transthoracic echocardiography to determine if they were complicated with RVD. The clinical features, risk factors, diagnosis, and treatment were analyzed and compared between the normotensive APE patients with or without RVD. Results 41 normotensive APE patients with RVD were as RVD group, and other 89 patients without RVD were as non-RVD group. The incidences of syncope ( 34.1% vs. 7.8% ) , tachycardia( 41.4% vs. 21.3% ) , P2 hyperthyroidism( 46.3% vs. 25.8% ) , jugular vein filling ( 12.1% vs. 1.1% ) , and cyanosis ( 26.8% vs. 8.9% ) were all significantly higher in the RVD group than those in the non-RVD group ( P lt; 0.05) . Computed tomography pulmonary angiography ( CTPA) revealed that the incidences of thromboembolism involving proximal pulmonary artery ( 58. 3% vs. 8. 3% ) and thromboembolism involving lobar pulmonary ( 77.8% vs.51.2% ) were also higher in the RVD group ( P lt; 0.001, P = 0.025 ) . In the RVD group, the patients were assigned to received thrombolysis plus anticoagulation therapy, or anticoagulation therapy alone. The clinical indicators ( heart rate, PaCO2 , AaDO2 , SPAP, TRPG) were all statistically improved after thrombolysis or anticoagulation treatment ( P lt;0.001) . But compared with the patients who underwent anticoagulation therapy alone, the cost of treatment and the incidence of minor bleeding were significantly higher, and the levels of AaDO2 , SPAP and TRPG were statistically lower in the patients with thrombolysis plus anticoagulation therapy. Conclusions For APE patients with central pulmonary embolism demonstrated by CTPA, syncope, and tachycardia, transthoracic echocardiograph should be performed as early as possible to confirm RVD diagnosis. For normotensive APE patients with RVD, anticoagulant treatment can achieve higher efficacy of costeffectiveness ratio.

    Release date:2016-09-13 03:46 Export PDF Favorites Scan
  • Application of One and A Half Ventricle Repair for Acute Right Ventricular Dysfunction after Biventricular Repair

    Objective To investigate clinical outcomes of one and a half ventricle repair for acute right ventricular dysfunction after biventricular repair. Methods Clinical data of 5 pediatric patients with congenital heart diseases who underwent emergency bidirectional Glenn shunt without cardiopulmonary bypass for acute right ventricular dysfunction after biventricular repair,converting the operation into one and a half ventricle repair,from February 2007 to June 2012 in Qingdao Women and Children Hospital were retrospectively analyzed. There were 4 male patients and 1 female patient with their age of 7-18 months and body weight of 6-13 kg. Preoperative diagnosis included pulmonary atresia with intact ventricular septum (PA/IVS) in 1 patient,tricuspid stenosis (TS) with ventricular septal defect (VSD) and atrial septal defect (ASD) in 2 patients,and tricuspid stenosis with tetralogy of Fallot (TOF) in 2 patients. Postoperative care focused on cardiopulmonary support and control of pulmonary artery pressure. Results Mean pulmonary artery pressure (mPAP) was 12-18 mm Hg at 72 hours after emergency bidirectional Glenn shunt. Mechanical ventilation time was 3-182 hours and ICU stay was 2-13 days. Postoperatively 1 patient died of pulmonary hypertension crisis. The other 4 patients were discharged with their transcutaneous oxygen saturation in the resting state of 93%-99%,which was improved in different degrees compared with preoperative value. These 4 patients were followed up from 6 months to 4 years. Three patients were in NYHA classⅠand 1 patient was in NYHA class Ⅱ during follow-up. Echocardiography showed smooth vena cava to pulmonary artery anastomosis without thrombosis formation. Conclusion One and a half ventricle repair can be used as an adjunct surgical strategy for acute right ventricular dysfunction after biventricular repair.

    Release date:2016-08-30 05:47 Export PDF Favorites Scan
  • 92例非体外循环冠状动脉旁路移植术的临床分析

    目的 总结非体外循环冠状动脉旁路移植术治疗冠心病或合并左心功能不全或心肌梗死患者的临床经验。 方法 回顾性分析2008年1月至2013年1月宜昌市第一人民医院92例冠心病或合并左心功能不全或心肌梗死患者行非体外循环冠状动脉旁路移植术治疗的临床资料,其中男71例,女21例;年龄(64.25±7.93) 岁。术前心功能(NYHA分级) Ⅲ~Ⅳ级44例,不稳定型心绞痛21例,左主干病变>50% 8例,3支血管病变46例。92例冠心病患者中发生心肌梗死19例,心肌梗死发生率为20.65%。 结果 手术时间(5.43±1.46) h,术后中位机械通气时间1.0 d,中位住ICU时间3.0 d,远端吻合口数(2.70±0.82) 个。围术期死亡1例,术后左心室射血分数(LVEF)<50% 19例,发生心律失常16例,呼吸衰竭24例,肾功能衰竭31例,低心排血量13例,住ICU时间延迟53例,主动脉内球囊反搏4例,院内感染11例。发生上述并发症的患者均经相应的治疗治愈或好转。术后血肌酐与术前相比有所增高,差异有统计学意义[(110.22±53.03) μmol/L vs. (84.70±26.87) μmol/L,t =5.163,P=0.000)。术后随访91例,随访时间为术后0.5个月至2年。术后0.5个月常规心脏超声心动图检查未发现异常;术后1个月移植血管发生狭窄或血管闭塞3例,出现胸闷5例,2年后下肢取血管部位疼痛20例, CTA检查移植血管狭窄或血管闭塞10例。上述病变均经对症处理好转。 结论 非体外循环冠状动脉旁路移植术治疗冠心病或合并左心功能不全的冠心病患者,疗效满意。

    Release date:2016-08-30 05:47 Export PDF Favorites Scan
  • 206例心脏生物瓣膜临床应用分析

    目的总结分析异种生物瓣膜置换术的临床应用结果,评价生物瓣膜在心脏外科中的应用效果和趋势。方法回顾性分析 2004年 7月至 2008年 7月在中国医科大学附属第一医院接受异种生物瓣膜置换术患者 206例的临床资料,男 157例,女 49例;年龄 44~ 79(64.7±13.2)岁。置换生物瓣膜 227枚,联合置换机械瓣膜 11枚;同期行冠状动脉旁路移植术( CABG)51例,房 /室间隔缺损修补术 7例。结果术后早期( 30 d内)死亡 7例。院外随访 6个月~ 5年,平均随访 23个月,随访 134例,随访率 67.3% ( 134/199)。随访患者心功能均得到不同程度的改善,未发现瓣周漏、感染性心内膜炎、血栓和出血等并发症。彩色多普勒超声心动图提示生物瓣膜功能良好,无明显衰败迹象。结论异种生物瓣膜置换疗效确切,并发症少,近期效果较好。

    Release date:2016-08-30 05:50 Export PDF Favorites Scan
  • Echocardiography in Evaluation of Right Ventricular Function

    Abstract: Right ventricular dysfunction or right heart failure is a complex clinical syndrome and often leads to a poor prognosis and high mortality. In order to detect right ventricular dysfunction at an early stage, provide a therapy guidance and evaluate treatment outcomes, right ventricular function evaluation has aroused more and more concern in clinical physicians. With the advantages of being non-invasive, accuracy and repetitiveness, echocardiography is used extensively in the assessment of heart function. In this review, we focus on how to use echocardiography to evaluate right ventricular function easily, efficiently, accurately and sensitively, and provide a good foundation for its further clinical application.

    Release date:2016-08-30 05:51 Export PDF Favorites Scan
  • 心功能不全冠心病患者非体外循环冠状动脉旁路移植术的疗效分析

    分析心功能不全冠心病患者施行非体外循环冠状动脉旁路移植术(OPCAB)的临床资料,探讨其手术风险,提出治疗方案。 方法 将2004年1月至2008年6月首都医科大学附属北京安贞医院66例冠心病患者,按心功能不同分为3组,每组22例,组1:男18例,女4例;年龄55.3±9.1岁;术前左心室射血分数(LVEF)lt;30%;组2:男19例,女3例;年龄55.5±10.2岁;30%≤LVEFlt;40%;组3:男17例,女5例;年龄55.8±8.7岁;LVEF≥40%;组2和组3作为对照。观察围术期临床资料包括术前调整时间、移植血管支数、同期室壁瘤手术、呼吸机辅助呼吸时间、主动脉内球囊反搏(IABP)使用时间、住ICU时间、强心药种类、术后住院时间和住院费用等的改变。 结果 术后无死亡和严重并发症发生,均痊愈出院。组1术前调整时间(18.9±14.6 d vs. 10.8±7.4 d,P=0.023)、使用IABP例数(7 vs.1, P=0.012)、住ICU时间(3.0±0.7 d vs. 1.2±0.6 d,P=0.008)、强心药种类(1.6±0.7种 vs. 1.0±0.2种,P=0.000)、术后住院时间(17.4±12.1 d vs. 11.8±34 d,P=0.038)和住院费用(11.4±5.2万元 vs. 7.6±1.7万元,P=0.007)均多于组3,两组比较差异均有统计学意义。3组患者均获得随访,随访时间3~6个月,均生存,随访期间无明显心绞痛发作。 结论 心功能不全患者行OPCAB手术安全,但所需医疗资源多,须慎重选择。

    Release date:2016-08-30 05:56 Export PDF Favorites Scan
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