west china medical publishers
Author
  • Title
  • Author
  • Keyword
  • Abstract
Advance search
Advance search

Search

find Author "王明岩" 10 results
  • Recent Research and Development of Aspirin Resistance after Coronary Artery Bypass Grafting

    Abstract: Coronary artery bypass grafting (CABG) has become more and more popular, but how to decrease the thrombotic stenosis of saphenous vein grafts remains a tough problem clinically. Some researchers raised that aspirin resistance (AR) may be one of the most principal causes of graft thrombus and many correlative studies have been reported in recent years.In this article, we reviewed and analyzed the concept and evaluation criterion, incidence rate, mechanisms, clinic significance, and preventing strategy of AR, expecting to deepen the understanding of AR and help to optimize the antiplatelet therapy for postCABG patients with AR.

    Release date: Export PDF Favorites Scan
  • 原发性心包肿瘤的诊断与治疗

    目的 总结原发性心包肿瘤的诊断和外科治疗方法,以进一步提高其疗效。 方法 2005 年4 月至2009 年9 月中国人民解放军总医院共收治非囊肿性原发性心包肿瘤患者7 例,男3 例,女4 例;平均年龄47(33 ~ 64)岁。 4 例完整切除肿瘤,其中1 例因侵犯相邻肺组织而将相应肺叶切除;2 例行姑息性切除;1 例探查后取一小块组织行活组织检查。 结果 无院内死亡。术后病理证实4 例为恶性,3 例为良性。恶性肿瘤患者术后2 例行化疗,1例行放疗;随访3 例,分别于术后3 个月、7 个月和11 个月后死亡。良性肿瘤患者术后随访6 ~ 8 个月,未见复发。结论 良性肿瘤一经确诊应尽早手术切除;恶性心包肿瘤较易误诊,如无远处转移,应积极争取手术治疗,化疗和放疗效果均不理想。

    Release date:2016-08-30 05:48 Export PDF Favorites Scan
  • 尿毒症患者血液透析期间行体外循环心脏手术二例

    Release date:2016-08-30 05:49 Export PDF Favorites Scan
  • 三尖瓣置换术治疗Ebstein畸形合并巨大心脏一例

    Release date:2016-08-30 05:50 Export PDF Favorites Scan
  • 心脏病合并甲状腺功能减退症患者的外科治疗

    目的 总结心脏病合并甲状腺功能减退症患者行外科手术治疗的临床经验。 方法 回顾性分析2001年9月至2009年5月解放军总医院19例心脏病合并甲状腺功能减退症患者行外科手术治疗的临床资料,男7例,女12例;年龄50~76岁,平均年龄63.20岁。冠心病15例,主动脉瓣狭窄1例,房间隔缺损1例,慢性心包炎2例;均合并甲状腺功能减退症。所有患者术前给予左旋甲状腺素钠(40~120 mg/d)口服治疗,根据其耐受程度、促甲状腺激素和甲状腺激素水平调整用量,将甲状腺激素水平调整至基本正常。行体外循环冠状动脉旁路移植术6例,非体外循环冠状动脉旁路移植术9例,房间隔缺损修补术1例,主动脉瓣置换术1例,心包剥脱术2例。术后按原剂量或加量口服左旋甲状腺素钠片,检测手术前、后甲状腺激素指标的改变。 结果 无手术死亡,术后所有患者均未发生低三碘甲状腺原氨酸(T3)综合征,甲状腺功能指标与术前比较均有不同程度的降低,以血清总三碘甲状腺原氨酸和血清游离三碘甲状腺原氨酸降低最为明显,体外循环手术患者下降幅度更大。术后继续给予甲状腺素钠口服,并持续服用维持量的甲状腺素钠。随访19例,随访时间4~7个月,随访期间均持续服用维持量的甲状腺素钠,心功能分级(NYHA)Ⅰ级14例,Ⅱ级5例;患者恢复正常生活。 结论 合并甲状腺功能减退症的心脏病患者行心脏手术是安全、可行的,体外循环和非体外循环心脏手术后甲状腺激素均有所降低,体外循环手术患者下降更明显,术后应警惕发生低T3综合征和低T3、T4综合征。

    Release date:2016-08-30 05:57 Export PDF Favorites Scan
  • Comparison Between Midterm Patency of Sequential and Individual Saphenous Vein Grafts after Off-pump Coronary Artery Bypass Grafting

    Abstract: Objective To compare the midterm patency rates of individual and sequential saphenous vein grafts (SVG) as coronary bypass conduits of offpump coronary artery bypass grafting (OPCAB) and evaluate the impact of the grafting techniques (individual or sequential grafts) on the graft patencyafter OPCAB. Methods The clinical data of 398 patients in General Hospital of the People’s Liberation Army receiving OPCAB with individual and sequential grafts from June 2005 to March 2009 were retrospectively analyzed. There were 301 males and 97 females with their age ranged from 53 to 82 years (63.6±10.3 years). A total of 714 distal coronary anastomoses on 448 SVG were assessed by using 64multislice computed tomography (64MSCTA) at an average of 19.8±23.6 months (3 months to 5 years) after OPCAB procedure. The blood flow of grafts in the proximal segment of individual and sequential SVG and the patency rates of grafts and anastomoses were compared, and the effect of different locations on the patency rate of the anastomoses was analyzed. Results The mean blood flow in double SVG (37.11±16.70 ml/min vs. 25.15±14.24 ml/min, P0.042) and in triple SVG (37.56±19.58 ml/min vs. 25.15±14.24 ml/min, P=0.048) were both significantly higher than the flow in single SVG. The anastomoses on the sequential conduits had better patency (95.1% vs. 90.1%, P=0.013). The patency of sideto side anastomoses was better than that of endtoside anastomoses (97.0% vs. 93.1%, P=0.002) and that of the individual endtoside anastomoses (97.0% vs. 90.1%, P=0.041). There was no significant difference between distal anastomoses in sequential and those in single grafts (P=0.253). No significant difference was observed between the two methods in regard to the three major coronary systems (including the anterior descending branch, the right coronary artery, and the circumflex branch). However, anastomoses on sequential grafts had superior patency to those on individual grafts in the right coronary system (P=0.008). Conclusion The midterm patency of a sequential SVG conduit after OPCAB is excellent and generally superior to that of an individual one. The best runoff coronary artery should be placed at the distal end and the poor coronary vessels should be arranged in the middle of the grafts.

    Release date:2016-08-30 05:57 Export PDF Favorites Scan
  • 主动脉瓣及瓣上狭窄合并升主动脉扩张一例

    Release date:2016-08-30 05:57 Export PDF Favorites Scan
  • 人工心脏瓣膜置换术后血栓性瓣膜功能障碍的治疗

    Release date:2016-08-30 06:03 Export PDF Favorites Scan
  • Surgical Treatment of Cardiac Complications Caused by Permanent Pacemaker Implantation

    Objective To investigate clinical features and treatment strategy of cardiac complications caused by permanent pacemaker (PPM) implantation.?Methods?We retrospectively reviewed clinical records of 10 patients with cardiac complications caused by PPM who received surgical treatment in General Hospital of People’s Liberation Army from January 2003 to May 2010. There were seven males and three females with an average age of 62.9 years. One patient had an Atrial demand inhibited pacemaker (AAI) PPM and the other nine patients had a DDD PPM. Cardiac complications included infective endocarditis (IE) in 5 patients, tricuspid insufficiency (TI) in 4 patients and pulmonary artery thrombosis in one patient. According to their respective situation, these patients underwent different surgical treatment such as tricuspid valve plasty (TVP), tricuspid valve replacement and/or removal of PPM lead and vegetations as part of intensive debridement of the infected area.?Results?Postoperatively, all the patients were successfully discharged. Five patients whose PPM lines and leads were preserved in the surgery had normal PPM function. Three PPM-dependent patients whose PPM leads were removed in the surgery received a PPM reimplantation later. Nine patients were followed up for an average of 5.5 months and all these patients had a significantly improved quality of life. One patient after TVP had mild TI during follow-up. Conclusion Surgical treatment should be performed as early as possible when infection is too severeto control in patients with IE caused by PPM. PPM-induced TI may be hard to be diagnosed preoperatively, and transesophageal echocardiography or surgical exploration should be considered to establish the diagnosis. Measures should be taken to protect PPM if PPM lines and leads are preserved during operation. Patients whose PPM lines and leads are removed during the surgery need to choose a suitable time for PPM reimplantation.

    Release date:2016-08-30 05:50 Export PDF Favorites Scan
  • Early Results and Risk Factors of Surgical Revascularization for Patients with Ischemic Heart Disease and Left Ventricular Dysfunction

    ObjectiveTo analyze the early results and risk factors of surgical revascularization for patients with ischemic heart disease and left ventricular dysfunction. Methodsclinical data of 318 patients with ischemic heart disease and left ventricular dysfunction with left ventricular ejection fraction (LVEF)≤50% who underwent coronary artery bypass grafting (cABG) from January 2003 to July 2013 was retrospectively reviewed. There were 266 males and 52 females with a mean age of 62.6±9.2 years (range 36 to 83). seventy-six patients underwent off-pump cABG (oPcAB) and 242 patients underwent conventional cABG. Fifteen patients underwent concomitant mitral valve repair or replacement. The patients who underwent left ventricular aneurysmectomy (LVA) were excluded from this study. Perioperative data were collected including the risk factors, echocardiographic results, morbidities and mortalities. The risk factors were analyzed with the endpoints of adverse events and mortalities to find the elements that influence the early results of the procedure. ResultsThe EuroscorE Ⅱ predicted operative mortality rate was 2.78±4.02% (range 1.00% to 45.00%) and actual mortality rate was 1.9% (6/318). Three of 6 patients died from low cardiac output syndrome. Totaladverse events rate was 47.2% (150/318) including prolonged ventilation (25.2%), low cardiac output syndrome (6.3%),ventricular arrhythmia (4.4%), acute renal dysfunction (4.1%), myocardial infarction (3.8%), cerebralvascular accident(2.8%), and re-exploration for bleeding (0.6%). Compared with those preoperatively, the LVEF was significantly improvedfrom 42.14%±5.94% to 45.64%±8.33% (t=6.084, P=0.000), and the left ventricular end diastolic dimension (LVEDD) wassignificantly reduced from 53.96±6.28 mm to 48.64±7.50 mm (t=-9.681, P=0.000) postoperatively. The logistic multiplevariables regression analysis showed perioperative intra-aortic balloon pump (IABP) implantation was mutual risk factorof prolonged ventilation and low cardiac output syndrome. ConclusionSurgical revascularization is an effective optionfor patients with ischemic heart disease and left ventricular dysfunction, demonstrated by improved LVEF and reducedLVEDD. Low cardiac output syndrome is the main cause of operative death. Perioperative IABP implantation is mutualrisk factor of prolonged ventilation and low cardiac output syndrome. Meticulous perioperative management plays a keyrole in satisfactory early results.

    Release date: Export PDF Favorites Scan
1 pages Previous 1 Next

Format

Content