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find Author "杨敏" 28 results
  • 胆石性肠梗阻2例报告

    Release date:2016-08-29 03:19 Export PDF Favorites Scan
  • Analysis of preoperative left ventricular dysfunction and perioperative complications in coronary artery bypass grafting: A case control study

    Objective To identify the relationship between preoperative left ventricular dysfunction and perioperative risk factors in coronary artery bypass grafting (CABG). Methods The clinical data of 192 patients who underwent CABG from November 2015 to October 2016 were analyzed retrospectively. The patients were divided into three groups by preoperative left ventricular ejection fraction (LVEF) in echocardiography: a serious left ventricular dysfunction group (LVEF≤35%, 23 patients, 15 males and 8 females at age of 63.91±5.36 years), a moderate left ventricular dysfunction group (35%<LVEF<50%, 24 patients, 20 males and 4 females at age of 66.29±6.03 years) and a normal left ventricular function group (LVEF≥50%, 145 patients, 86 males and 59 females at age of 66.60±6.41 years). Results The overall mortality was 4.16% (8/192), 17.39% (4/23) in patients with LVEF≤35% and 2.76% (4/145) in those with LVEF≥50%. Preoperative LVEF≤35%, hypoxia, assisted circulation, acute kidney injury (AKI) and postoperative continuous renal replacement therapy (CRRT) were risk factors of perioperative mortality in coronary artery surgery. LVEF≤35% and CRRT were independent preditors of mortality. There were significant differences in mortality and postoperative complications between the serious left ventricular dysfunction group and other two groups. Conclusion Postoperative mortality and complications are obviously serious in the patients with LVEF≤35%. We should pay more attention to preoperative risk factors. Postoperative individual manipulation, intra-aortic balloon pump and CRRT can enhance survival of those patients.

    Release date:2018-05-02 02:38 Export PDF Favorites Scan
  • 心脏手术围术期辅助循环的应用与管理

    目的总结心脏手术围术期应用辅助循环的经验. 方法 13例患者(左心室射血分数平均0.37±0.06)中行冠状动脉旁路移植术10例,机械瓣膜置换术2例,马方综合征(Marfan syndrome)患者行Bentall手术1例.术后不能脱离心肺转流(CPB)9例,术后并发心肌梗死、严重室性心律失常和心脏骤停4例,分别采用主动脉内球囊反搏( IABC)、转子泵或离心泵左心转流和体外膜肺氧合等辅助循环治疗. 结果 6例存活出院,平均辅助循环时间44.0±32.5小时.不能脱离 CPB的 9例患者,经辅助循环支持后7例脱离CPB,4例存活;在ICU行辅助循环的 4例患者中,2例存活. 结论辅助循环是治疗心脏手术后严重心力衰竭和室性心律失常的有效方法.

    Release date:2016-08-30 06:32 Export PDF Favorites Scan
  • 左心室及双心室辅助装置对缺血心肌的影响

    目的 比较左心室辅助装置(LVAD)和双心室辅助装置(BVAD)对缺血心肌再灌注后心脏血流动力学、心肌能量代谢物质和心肌超微结构中线粒体形态的影响。 方法 将16只绵羊随机分为LVAD组和BVAD组,每组8只,常温阻断升主动脉25分钟,造成双心室缺血损伤的动物模型。结扎右颈内动脉远端,在心脏复跳后应用转子泵分别行LVAD(左心室-右颈内动脉径路)和BVAD(左心室-右颈内动脉和右心室-肺动脉径路)辅助循环120分钟。测定血流动力学、心肌三磷酸腺苷、磷酸肌酸,观察心肌超微结构变化。 结果 施行BVAD或LVAD辅助循环的同时增加容量负荷能够显著改善心脏血流动力学,但LVAD组右心房压显著高于BVAD组(P<0.05);BVAD组右心室心肌三磷酸腺苷、磷酸肌酸含量和心肌线粒体比表面值均高于LVAD组(P<0.05)。 结论 BVAD比LVAD更有助于促进双心室缺血损伤心肌的功能恢复。

    Release date:2016-08-30 06:33 Export PDF Favorites Scan
  • 双相正压通气治疗急性呼吸窘迫综合征

    目的 探讨双相气道正压 (BIPAP)通气模式治疗急性呼吸窘迫综合征 (ARDS)患者的疗效及其对血流动力学和气道力学的影响. 方法 随机将 20例ARDS患者分为BIPAP通气模式组(BIPAP组)和间歇正压通气模式组 (IPPV组),行机械通气治疗,每组各10例.观察两组血流动力学、血气分析、呼吸力学指标. 结果 BIPAP组机械通气时间平均为 13天,显著低于 IPPV组的21天 (P<0.05).BIPAP组患者安定、吗啡和万可松用量显著低于IPPV组( P< 0.05);IPPV组吸气峰压、平台压和呼气末正压均显著高于BIPAP组 (P<0.05).心率、平均动脉压、平均肺动脉压、体循环阻力和心脏指数两组差别无显著性意义(P>0.05),但IPPV组肺血管阻力显著高于BIPAP组(P<0.05).两组间动脉血氧分压、二氧化碳分压和pH值差别无显著性意义 (P>0.05),BIPAP组混合静脉血氧分压显著高于 IPPV组(P<0.05). 结论 BIPAP通气模式人机关系协同性好,能够降低肺血管阻力,增加混合静脉血氧分压,缩短了ARDS治疗的机械通气时间.

    Release date:2016-08-30 06:34 Export PDF Favorites Scan
  • Clinical Observation of Externalroute microsurgery in the Treatment of Rhegmatogenous Retinal Detachment

    目的:观察显微镜直视下经外路手术治疗孔源性视网膜脱离的临床疗效。方法:孔源性视网膜脱离38例(38眼),术前在三面镜下检查裂孔位置、大小及脱离范围;在手术显微镜直视下行裂孔及变性区定位,放出视网膜下液,在裂孔及周围行视网膜冷凝,作硅胶垫压及环扎带。最后顶起硅胶垫压块,证实裂孔位于巩膜脊前坡上,视裂孔位置及眼压情况,玻璃体腔内注入C3F8。术后观察视力、眼压、葡萄膜反应及视网膜复位情况。结果:视网膜裂孔封闭36眼(94.74%),视网膜完全复位34眼(89.47%),视网膜下积液2眼(5.26%),于7~10d吸收。有2眼术后发现垫压嵴偏离视网膜裂孔,经再次手术调整后视网膜复位。术后视力提高28眼(73.68%)。结论:显微镜直视下经外路视网膜脱离手术视野清晰,操作简便,手术效果良好。

    Release date:2016-09-08 09:56 Export PDF Favorites Scan
  • Fresh Amniotic Membrane Transplantation Combined with Mitomycin C for Recurrent Pterygium Clinical Observation

    目的:观察新鲜羊膜移植联合丝裂霉素C治疗复发性翼状胬肉的临床疗效。方法:对32例(38眼)复发性翼状胬肉行翼状胬肉切除联合新鲜羊膜移植加丝裂霉素C治疗,观察术后角膜上皮愈合、胬肉复发情况。结果:术后随访3~24个月,有2眼复发,复发率为5.26%。结论:新鲜羊膜移植联合丝裂霉素C治疗复发性翼状胬肉降低了复发率,无严重手术并发症,是一种安全有效的手术方法。

    Release date:2016-09-08 10:00 Export PDF Favorites Scan
  • DIAGNOSIS AND TREATMENT OF SPLENIC VENOUS HYPERTENSION (REPORT OF 6 CASES)

    目的探讨脾静脉高压的临床特征及诊断依据。方法 回顾性分析6例脾静脉高压病例的临床症状、体征、影像学检查及术中发现等资料。结果 临床症状主要表现为呕血和便血; CT扫描3例脾静脉狭窄,3例脾静脉显示不清; 术中测定门静脉压力,切脾前左侧为2.94±0.2 kPa(35.0±2.1 cmH2O),高于右侧的1.96±0.2 kPa(20.0±2.3 cmH2O),切脾后左侧为2.06±0.1 kPa(21.0±1.3 cmH2O),右侧为1.76±0.1 kPa(18.0±1.4 cmH2O),二者无明显差异。术中探查脾静脉,5例脾静脉栓塞,1例狭窄。结论 术前CT增强扫描,术中测定左右半门静脉压力以及术中发现脾静脉栓塞或狭窄,可以诊断脾静脉高压。

    Release date:2016-09-08 02:01 Export PDF Favorites Scan
  • Risk Factors of Death in Patients Undergoing Continuous Renal Replacement Therapy after Cardiac Surgery

    ObjectiveTo investigate the risk factors of death in patients undergoing continuous renal replacement therapy (CRRT) after cardiac surgery. MethodsWe retrospectively analyzed records of 66 adult patients without history of chronic renal failure suffering acute kidney injury (AKI) following cardiac surgery and undergoing CRRT in our hospital between July 2007 and June 2014. There were 38 males and 28 females with mean age of 59.11±12.62 years. They were divided into a survival group and a non-survival group according to prognosis at discharge. All perioperative data were collected and analyzed by univariate analysis and multivariate logistic regression analysis. ResultsIn sixty-six adult patients, eighteen patients survived with a mortality rate of 72.7%. Through univariate analysis and multivariate logistic regression, risk factors of death in the post-operative AKI patients requiring CRRT included hypotension on postoperative day 1 (B=2.897, OR=18.127, P=0.001), duration of oliguria until hemofiltration (B=0.168, OR=1.183, P=0.024), and blood platelet on postoperative day 1 (B=-0.026, OR=0.974, P=0.001). ConclusionHypotension on postoperative day 1 (POD1) is the predominant risk factor of death in patients requiring CRRT after cardiac surgery, while blood platelet on POD1 is a protective factor. If CRRT is required, the sooner the better.

    Release date:2016-10-02 04:56 Export PDF Favorites Scan
  • Efficacy and Safety of Radiofrequency Ablation versus Amiodarone for Atrial Fibrillation: A Meta-analysis

    ObjectiveTo systematically evaluate the efficacy and safety of radiofrequency ablation versus amiodarone in the treatment of atrial fibrillation, so as to provide reference for the chosen of clinical treatment options. MethodsWe searched PubMed, The Cochrane Library (Issue 10, 2014), CNKI, VIP and WanFang data from inception to October 2014 to collect randomized controlled trials (RCTs) comparing radiofrequency ablation versus amiodarone for atrial fibrillation. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.3 software. ResultsA total of 4 RCTs involving 511 atrial fibrillation patients were included. The results of meta-analysis showed that:compared with amiodarone, radiofrequency ablation could reduce the risk of atrial fibrillation recurrence (RR=0.35, 95%CI 0.22 to 0.55, P<0.000 01). There was no significant difference in all-cause mortality (RR=0.97, 95%CI 0.17 to 5.61, P=0.97) between both groups. The incidence of adverse events in the radiofrequency ablation group was 7.7%, and was lower than 12.7% of the amiodarone group, but there was no significant difference between the two groups. ConclusionCurrent evidence shows that, compared with amiodarona, radiofrequency ablation is related to lower recurrence rate and higher efficacy, but there is no difference in the safety between the two interventions. However, due to the limited quality and quantity of included studies, higher quality studies are needed to verify the above conclusion.

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