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find Author "龚志云" 2 results
  • 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.

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  • 25 例急诊心脏瓣膜置换术的临床分析

    目的总结急诊心脏瓣膜置换治疗危重心脏瓣膜病患者的临床经验。方法回顾性分析 2008 年 4 月至 2018 年 4 月内科药物治疗无效的接受急诊手术治疗 25 例重症瓣膜病患者的临床资料(除外主动脉夹层、急诊搭桥同期行瓣膜手术及心脏肿物累及瓣膜手术的病例)。其中男 14 例、女 11 例,平均年龄(45.0±14.6)岁。均合并严重的心功能不全(Ⅳ级),8 例术前需要机械通气。感染性心内膜炎 11 例,均可见明显赘生物,其中 4 例合并瓣周脓肿;瓣膜重度狭窄 8 例,急性瓣膜重度关闭不全 6 例,包括急性腱索断裂 4 例、二尖瓣成形术后失败再次急诊行置换术 2 例。所有患者均在急诊、全身麻醉、体外循环下行瓣膜置换术。结果所有 25 例患者手术后住院期间死亡 6 例(24.0%),其中 5 例死于多脏器功能衰竭,1 例死于感染复发导致的败血症。另有 1 例术中出现Ⅲ度房室传导阻滞安装永久性起搏器;2 例术后早期出现脑出血,经积极治疗后康复,其余均顺利出院。随访 1~120 个月,随访率 100%(19/19),1 例术后 3 个月出现肺部感染死亡,其余患者的心功能均改善明显(Ⅰ级 3 例,Ⅱ级 15 例)。结论手术指征明确的重症瓣膜患者在内科药物治疗无效时应积极选择急诊手术治疗,不仅能够挽救患者的生命,还能提高患者远期生存质量。

    Release date:2019-07-17 04:28 Export PDF Favorites Scan
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