Objective To explore the diagnosis and treatment of critically ill patients suffering from obstructive sleep apnea-hypopnea syndrome ( OSAHS) . Methods Critically ill patients with OSAHS admitted in intensive care unit from January 2003 to December 2007 were retrospectively analyzed. Results Seventy-nine critically ill patients were diagnosed as OSAHS. The initial diagnosis of OSAHS was made by history requiring, physical examination, and Epworth sleepiness score evaluation. The final diagnosis was comfirmed by polysomnography thereafter. Base on the treatment of primary critical diseases, the patients were given respiratory support either with continuous positive airway pressure ( CPAP) or with bi-level positive airway pressure ventilation ( BiPAP) . Two cases died and the remaining 77 patients were cured anddischarged. Conclusions Timely diagnosis of OSAHS is important to rescue the critically ill patients. Respiratory support combined with treatment of primary critical diseases can improve the outcomes of these patients.
Objective To evaluate preventive effectiveness of pocket esophagogastric anastomosis for postoperativeanastomotic leak，stricture and gastroesophageal reflux disease （GERD），and investigate clinical significance of Montreal definition and classification of GERD after esophageal reconstruction. Methods Clinical data of 1 078 patients whoreceived 2 different surgical procedures for resection of esophageal or cardiac carcinoma from June 2007 to June 2011 in our hospital were retrospectively analyzed. In the experimental group，there were 582 patients who received pocketesophagogastric anastomosis，including 403 male and 179 female patients with their age of 60.4±12.6 years. There were 399 patients with esophageal carcinoma and 183 patients with cardiac carcinoma，392 patients receiving esophagogastrostomyabove the aortic arch and 190 patients receiving esophagogastrostomy below the aortic arch respectively. In the control group，there were 496 patients who received conventional end-to-side esophagogastric anastomosis，including 343 male and 153 female patients with their age of 59.2±12.8 years. There were 322 patients with esophageal carcinoma and 174 patients with cardiac carcinoma，317 patients receiving esophagogastrostomy above the aortic arch and 179 patients receivingesophagogastrostomy below the aortic arch respectively. A survey questionnaire was made on the basis of relevant diagnosticstandards to investigate the incidence of postoperative anastomotic stricture and GERD of the 2 groups during follow-up.Results The incidence of postoperative anastomotic leak of the experimental group was significantly lower than that of the control group ［0% （0/582）versus 1.0% （5/496），χ2=5.835，P=0.016］. Patients in the experimental group had less severeGERD symptoms，and the percentage of patients who needed antacid therapy for extraesophageal symptoms of GERD ofthe experimental group was significantly lower than that of the control group ［1.6% （33/541） versus 12.6% （57/453），χ2=23.564，P=0.000］. The incidence of anastomotic stricture of the experimental group was significantly lower than that of thecontrol group ［0.9% （5/539） versus 7.3% （34/465），χ2=25.124，P=0.000］，and especially，the incidence of severe anastomoticstricture of the experimental group was significantly lower than that of the control group ［0% （0/539） versus 4.7% （22/465），χ2=24.883，P=0.000］. There was no statistical difference in five-year survival rate. Conclusion Pocket esophagogastric anastomosis is better than conventional end-to-side esophagogastric anastomosis for the prevention of postoperative anastomoticleak，stricture and GERD. Montreal definition and classification of GERD is suitable for the diagnosis of postoperativeGERD after esophageal reconstruction.
ObjectiveTo summarize our experience of right axillary straight mini-thoracotomy for surgical treatment of common congenital heart diseases in infants. MethodsWe conducted a retrospective analysis of 369 infants undergoing open heart surgery through right axillary straight mini-thoracotomy in the 153th Central Hospital of People's Liberation Army from April 2009 to April 2013. There were 191 males and 178 females with their mean age of 8.2±3.1 months (range, 3-12 months)and body weight of 7.8±4.5 kg (rang, 4.5-11.2 kg). Surgical procedures included ventricular septal defect (VSD)repair in 290 patients, atrial septal defect (ASD)repair in 16 patients, VSD and ASD repair in 34 patients, VSD repair and mitral valvuloplasty in 4 patients, valvotomy for pulmonary valve stenosis (PVS)in 9 patients, ASD repair and valvotomy for PVS in 6 patients, correction of partial anomalous pulmonary venous connection in 4 patients, and correction of partial atrioventricular canal defect in 6 patients. ResultsSix patients (1.6%)died postoperatively. Postoperative complications included right atelectasis in 3 patients, right pneumothorax in 2 patients, pneumonia in 16 patients, incision fat liquefaction in 12 patients, third-degree atrioventricular block in 1 patient, cerebral air embolism in 1 patient, and reexploration for bleeding in 3 patients. A total of 295 patients were followed up for 6 to 12 months after discharge. Residual VSD shunt was found in 4 patients, and mild mitral regurgitation was found in 2 patients. ConclusionClinical outcomes of right axillary straight mini-thoracotomy during open heart surgery are satisfactory for infants with common congenital heart diseases, but strict indications and skillful surgical techniques are needed.