Abstract: Objective To evaluate myocardial protection effect of different myocardial protective strategies for patients undergoing double valve replacement （DVR） . Methods From Jun. 2005 to Dec. 2005, 32 patients with predominant aortic valve stenosis undergoing DVR in Xinqiao Hospital were included in this study. These patients were randomly divided into four groups with 8 patients in each group： （1） antegrade perfusion group：Cold-blood cardioplegia was delivered antegradely through aortic root, and mitral valve replacement （MVR）was performed. Then cold-blood cardioplegia was delivered antegradely through left and right coronary ostia, and aortic valve replacement （AVR） was performed； （2）retrograde perfusion group：Cold-blood cardioplegia was delivered retrogradely and intermittently through coronary sinus, and DVR was performed； （3）antegrade＋retrograde perfusion group：The route of cold-blood cardioplegic infusion was antegrade during MVR procedure first and then retrograde during AVR procedure；and （4）beating heart group：Oxygenated blood from cardiopulmonary bypass machine was delivered retrogradely and continuously through coronary sinus, and DVR was performed with beating heart. Early clinical outcomes were observed. Serum cardiac troponin I （cTnI） was measured by enzyme-linked immunosorbent assay（ELISA）. Serum creatine kinase-MB （CK-MB） and myocardial lactic acid release rate were measured by Hitachi7150 Automatic Chemistry Analyzer. Myocardial mitochondria malondialdehyde （MDA） level was measured through thiobarbituric acid reagent species analysis. Results All the 32 patients survived their surgery and were discharged successfully. Myocardial lactic acid release rate at 80 min after aortic cross-clamping, serum cTnI and CK-MB on the first postoperative day, myocardial mitochondria MDA levels of beating heart group were 13.59%±6.27%,（1.17±0.25） ng/ml, （56.43±16.50） U/L and（2.18±1.23） nmol/（ng.prot）respectively, all significantly lower than those of retrograde perfusion group ［（33.49%±8.29%, （1.82±0.58 ）ng/ml, （78.31±21.27） U/L （5.07±2.35） nmol/（ng.prot），P＜0.05］ and antegrade＋retrograde perfusion group［20.87%±7.22%, （1.49±0.23） ng/ml,（66.67±19.13） U/L,（4.34±1.73） nmol/（ng.prot），P＜0.05］, but not statistically different from those of antegrade perfusion group ［18.83%±5.97%, （1.41±0.32） ng/ml, （63.21±37.52） U/L, （3.46±1.62） nmol/ （ng.prot），P＞0.05］. Conclusion All the four myocardial protective strategies are effective myocardial protection methods for DVR patients. Continuous retrograde perfusion with beating heart and intermittent antegrade perfusion can provide better myocardial protection, and therefore are preferred for DVR patients. The combination of antegrade and retrograde perfusion is easy to administer and does not negatively influence surgical procedures. Retrograde perfusion is also effective as it takes only a short time.
目的 了解成都市围孕期妇女的孕前保健认知度及需求状况。 方法 2011年7月－2012年1月对成都市225名初产孕妇为调查对象，采用访谈及问卷进行调查，回收有效问卷217 份。 结果 217名中仅13名进行了孕前保健，孕前保健的参与率较低（5.99%）；孕妇的年龄和受教育程度对孕前保健的认知度、参与率比较差异有统计学意义（P＜0.05）；孕前小剂量叶酸服用率11.20%，但正确服用率仅为1.50%。48.84%（106/217）听说过孕前保健，其中36.79%（39/106）知道孕前保健的最佳时间，但不完全了解孕前保健内容；55.67%（59/106）的夫妇知道需在孕前改变不良生活方式；21.69%（23/106）知道部分孕前检查内容，44.34%（47/106）知晓孕前补充小剂量叶酸预防神经管缺陷，仅3.77%（4/106）知道孕前遗传咨询。获取知识途径依次为网络22.64%（24/106），社区宣传或讲座24.53%（26/106），朋友同事33.96%（36/106），医院15.09%（16/106），书刊和广告3.77%（4/106），但仅10.10%的妇女是通过培训渠道获取的知识。高达89.40%的妇女迫切希望参加孕前保健及相关预防出生缺陷的知识培训，并希望去社区或妇幼专科医院接受相关孕前咨询及检查。 结论 成都市围孕期妇女孕前保健认知度较低，导致孕前保健的参与率较低、依从性较差，叶酸服用率低而不规范；孕前保健知识培训及服务形式、内容急待增强。围孕妇女孕前保健需求较高，倾向价廉、便捷的社区医院和妇幼专科医院。
Objective To explore the impact of COVID-19 infection on the early clinical efficacy of valve replacement patients. MethodsThe perioperative data of patients who underwent single valve replacement in our center from January to February 2023 were collected continuously. According to the COVID-19 infection situation, the patients were divided into a COVID-19 infected group and a non-infected group. The relevant data of the two groups were compared, including general situation, comorbidities, operation time, aortic occlusion time, postoperative ventilator use time, intensive care unit (ICU) stay time, myocardial enzyme profile and respiratory related complications were statistically analyzed. The primary end point of the study was the incidence of postoperative respiratory and circulatory system complications, and the secondary end point was postoperative myocardial enzyme profiles in both groups. ResultsA total of 136 patients were included, including 53 males and 83 females, with an average age of 53.4±10.2 years. Thirty-two patients underwent aortic valve replacement, 102 mitral valve replacement, and 2 tricuspid valve replacement.There was no significant difference in the incidence of postoperative disease between the two groups (9.09% vs. 11.43%, P=0.654), and the duration of postoperative mechanical ventilation in the novel coronavirus infection group [913.50 (465.50, 1 251.00) min vs. 1 201.00 (1 003.75,1 347.75) min, P=0.001], ICU stay time [2 (2, 3) d vs. 3 (2, 3) d, P＜0.001) was a new champions league group, the myocardial enzyme spectrum [TnI-I: 2.66(1.19, 5.65) ng/mL vs. 4.76 (2.55, 7.93) ng/mL, P=0.001; BNP: 192.00 (100.93, 314.75) pg/mL vs. 608.5 (249.75, 1150) pg/mL, P＜0.001], and the difference was statistically significant. Conclusion For single valvular disease patients undergoing elective surgery, the short-term efficacy of surgical treatment after recovery from COVID-19 infection was relatively good, and the incidence of in-hospital mortality and postoperative complications was not significantly increased.