短期进入高原从事高强度工作所致高原反应是值得探讨的问题,查阅文献,探讨其病因及发病机理、临床表现,总结国内外在诊断、预防及治疗方面的经验,探索一套可行、有效的预防及治疗措施,具有重要的临床意义。
Objective To study the clinical results and operative methods of mitral valvoplasty in patients of congenital heart disease with mitral insufficiency. Methods One hundred and twelve patients of congenital heart disease with mitral insufficiency had been treated with valve repair procedure. The surgery was performed under extracorporeal circulation and moderate hypothermia. Most of the patients were diagnosed atrioventricular septal defects (29 cases), ventricular septal defect (25 cases), patent ductus arteriosus (14 cases), and atrial septal defect (14 cases) before operation. The main pathologic characters of mitral valve were mitral valve annular dilatation (58 cases), leaflet lesions (37cases), anterior and posterior leaflet prolapse (36 cases). The surgery consisted of complex methods to repair mitral valves, including rings annuloplasty (22 cases), closure of the commissure (18 cases), double-orifice method (14 cases), chords reimplantation and so on. Results Seventy two patientshad 0 to I class mitral valve regurgitation and 26 patients had Ⅱ class mitral valve regurgitation during the retrial period by echocardiography, only one case needed re-operation. The patients with left ventricular end diastolic diameter (LVEDD) more than 45mm had a reduction of left atrial diameter (from 45.8±10.7mm to 34.4±8.9mm, t=6.53, 7.89,(Plt;)0.001) and left ventricular diameter (from 58.6±10.9 mm to 44.3±8.5 mm, t=7.89, Plt;0.001) after operation. Conclusions Surgical operation on mitral valve regurgitation of congenital heart defect is a benefit and a compound method and transesophageal echocardiography may help the surgeon in estimating the surgical efficacy during operation.
目的 探讨血尿酸与胰岛素分泌和敏感性的关系。 方法 对成都市龙泉驿区2007年6月－7月间20～75岁常住自然人群565人进行人口学、腰围、臀围、血压、75 g葡萄糖耐量及胰岛素测定（0、30、120 min），血脂、血肌酐及血尿酸检测。以早期胰岛素分泌功能指数（△I30/△G30）和葡萄糖处置指数（DIo）代表胰岛素分泌功能，以Matsuda 指数代表胰岛素敏感性，分别与血尿酸进行相关性研究。 结果 男性的血尿酸与年龄呈负相关，与舒张压、葡萄糖负荷后120 min胰岛素和甘油三酯呈正相关。女性的血尿酸与甘油三酯、低密度脂蛋白、血肌酐呈正相关，与高密度脂蛋白、Matsuda指数呈负相关。无论男性和女性，均未发现血尿酸与△I30/△G30、DIo相关。 结论 女性的胰岛素敏感性下降与血尿酸升高有关。未发现血尿酸与胰岛素分泌有相关关系。
ObjectiveTo investigate the prognostic value and consistency of prognostic nutritional index (PNI) and patient-generated subjective global assessment (PG-SGA) in perioperative nutritional status of patients with esophageal cancer.MethodsClinical data of 224 patients, including 186 males and 38 females with an average age of 63.08±8.42 years, who underwent esophageal cancer surgery in our hospital from November 2017 to August 2018 were retrospectively reviewed. The PNI was calculated according to the results of the first time blood and biochemical tests, and the PG-SGA assessment was also performed. According to the PNI value, the patients were divided into a good nutrition group (PNI≥45, 60 patients) and a malnutrition group (PNI<45, 164 patients). According to the PG-SGA score, the patients were divided into a good nutrition group (PG-SGA<4, 75 patients) and a malnutrition group (PG-SGA≥4, 149 patients). Nutrition-related haematological indexes and body mass index (BMI) were compared between the two groups, and the consistency of PNI and PG-SGA for nutritional assessment was analyzed.ResultsThe nutrition-related haematological indexes in different PNI groups were statistically different in the perioperative period (P<0.01). The longitudinal changes of prealbumin in patients of different PG-SGA groups were statistically different (P<0.05); the BMI of patients in different PG-SGA groups was statistically different in the perioperative period (P<0.01). The Kappa coefficient of the two indicators was 0.589 (P<0.001).ConclusionBoth PNI and PG-SGA can predict the nutritional risk of patients with esophageal cancer to some extent. PNI is an objective monitoring indicator, and PG-SGA is a subjective evaluation indicator, the combined use of which can more comprehensively reflect and predict the nutritional status of patients, and provide an important reference to the development of individualized nutrition support programs.
ObjectiveTo investigate the application of computational fluid dynamics (CFD) in hemodynamic evaluation of aortic root reconstruction.MethodsThe clinical data of 1 patient with severe aortic valve stenosis was analyzed. Enhanced CT images were used as the original data, and professional software was used to reconstruct the three-dimensional (3D) model and fluid mechanics simulation of the aorta (including preoperative, postoperative and ideal conditions).ResultsThe 3D reconstruction model could directly present the distribution of valve calcification and the dilatation of the ascending aorta. The remodeled sinotubular junction and sinus structure were observed in the model under postoperative and ideal conditions. The improvement of ascending aorta dilatation was evaluated statistically by the diameter distribution before and after surgery. CFD simulation showed that the area of high flow velocity, pressure intensity and wall shear stress before surgery were consistent with the expansion area of the ascending aorta, and the restricted blood flow acceleration was observed at the angle between the arch and the descending aorta. In the ideal condition, the streamline of blood at the descending aorta was more stable and flat compared with preoperative or postoperative conditions, and there was no obvious abnormal high pressure and high wall shear stress area in the ascending aorta. The cardiopulmonary bypass time was 106 min, of which the aortic cross-clamp time was 60 min. The cardiac echocardiography indicated that the aortic valve worked well, and the peak systolic blood velocity was 1.7 m/s. The length of hospital stay after surgery was 12 d, including 2 d in ICU. The ventilator use time was 11.6 h. The patient did not have any remarkable discomfort during the 1-year follow-up.ConclusionCFD can be used to evaluate anatomic and hemodynamic abnormalities before aortic root reconstruction surgery. Postoperative reconstruction simulation can be performed again to evaluate the surgical effect, and meanwhile, virtual improvement can be tried for the unresolved problems to accumulate diagnosis and treatment experience, so as to provide patients with more accurate and personalized diagnosis and treatment procedure.
Abstract： Objective To summarize our surgical experience of tetralogy of Fallot（TOF） with anomalous coronary artery（ACA）， explore diagnostic method of ACA， and evaluate surgical strategy choices and clinical outcomes of right ventricular outflow tract（RVOT） reconstruction. Methods From January 2004 to January 2010， 29 patients with TOF and ACA underwent total correction in Wuhan Asia Heart Hospital. There were 18 male patients and 11 female patients with their median age of 7 years （5 months to 33 years）and median body weight of 18 （5 to 51） kg at operation. Their preoperative arterial oxygen saturation was 65%-91%. One patient underwent RVOT enlargement and repair of ventricular septal defect via right atrial approach. Three patients underwent RVOT enlargement， repair of ventricular septal defect and main pulmonary artery enlargement using autologous pericardium patch via right atrial approach. Three patients received pulmonary artery translocation （REV） technique. Five patients received double outlet technique. Eleven patients underwent RVOT enlargement via incisions above， below or beside coronary arteries （single patch or two patch technique）. Six patients underwent RVOT reconstruction using trans-annular patch after coronary artery bypass grafting. Results The median cardiopulmonary bypass time was 78 （65-102） min， median aortic crossclamp time was 50（40-82） min， and median operation time was 150 （126-178） min. There was no early death or severe coronary artery injury. Two patients underwent reexploration because of postoperative bleeding. Two patients had low cardiac output and were both cured with inotropic support. The median follow-up period was 51 （21-83）months and there was no late death during follow-up. All the patients were in New York Heart Association （NYHA） classⅠduring follow-up， their left ventricular ejection fraction was normal， there was no sign of myocardial ischemia in electrocardiogram， and their arterial oxygen saturation was 96%-99%.Mean early RVOT gradient （△P） was 19 （8-38） mm Hg， and the RVOT gradient （△P） did not increase during follow-up. Conclusion Preoperative diagnosis of ACA in TOF patients can be made by 64-slice multislice compute tomography （64-MSCT）. Proper surgical strategy for RVOT reconstruction should be chosen according to the distribution of coronary arteries to achieve satisfactory surgical outcomes.
Objective To investigate clinical outcomes of one-stage repair for patients with persistent truncus arter-iosus who missed optimal timing of surgery. Methods We retrospectively analyzed clinical data of 12 patients with persistent truncus arteriosus who had missed optimal timing of surgery and were admitted to Wuhan Asia Heart Hospital between June 2003 and August 2011. There were 7 male patients and 5 female patients with their median age of 4.5 （0.6-14.0）years and median body weight of 23 （6-36）kg. All the patients underwent one-stage surgical repair. There were 9 patients with Van Praagh type A1，2 patients with type A2，and 1 patient with type A4 persistent truncus arteriosus. There were 2 patients with anomalous origin of coronary artery，2 patients with moderate truncal valve insufficiency，and 3 patients with moderate tricuspid valve insufficiency which required concomitant surgical repair. All the patients received preoperative right heart catheterization which showed severe pulmonary hypertension. The median pulmonary-systemic blood flow ratio （Qp/Qs ratio） was 2.42 （1.50-5.26），and median pulmonary vascular resistance was 8.1 （4-12） Wood units. All the patients showed a positive pulmonary vasodilator response to oxygen. Right ventricular outflow tract （RVOT） reconstruction was achieved using a valved conduit in 7 patients and a valved patch in 5 patients. Results There was no in-hospital death in this group. Three patients had transient pulmonary hypertensive crisis during postoperative intensive care and were healed after proper treatment. Early postoperative pulmonary artery pressure monitoring in all the patients showed that main pulm-onary artery systolic pressure/radial artery systolic pressure was 0.48±0.12. All the 12 patients were followed up for 48（12-91）months. There were 10 patients with New York Heart Association （NYHA） classⅠand 2 patients with NYHA classⅡ during follow-up. One patient received reoperation for residual ventricular septal defect and right ventricular failure.Two patients required long-term medication treatment for high pulmonary vascular resistance and right ventricular failure. The latest echocardiography during follow-up showed that average pressure gradient across RVOT was 21 （16-42） mm Hg in patients with valved conduit for RVOT reconstruction and 18 （10-28） mm Hg in patients with valved patch for RVOT reconstruction. None of the patients required reoperation for RVOT obstruction. Pulmonary regurgitation was less than moderate degree in all the patients. Two patients with anomalous origin of coronary artery didn’t have symptoms or electrocardiogram changes of myocardial ischemia during follow-up. Conclusion For patients with persistent truncus arteriosus who missed optimal timing of surgery， one-stage repair can achieve good early and intermediate clinical outcomes，but long-term follow-up is needed to observe truncal valve regurgitation and right ventricular function.
ObjectiesTo investigate the impact of family nursing intervention on the quality of life in postoperative patients with benign prostatic hyperplasia (BPH). MethodsIn total, 60 consecutive patients who underwent BPH surgeries between December 2012 and January 2014 were enrolled and randomly assigned to receive either timely outpatient follow-ups and routine rechecks (control group) or nursing intervention of telephone call follow-ups and family visits by professional nurses (intervention group). Quality of life was assessed by international prostate symptom score (IPSS) and generic quality of life inventory-74 (GQOLI-74), and was compared before and after intervention between the two groups. ResultsThere were no statistically significant differences in GQOLI-74 scores of all dimensions at discharge between the intervention group and the control group (P>0.05). However, six months after discharge, GQOLI-74 scores of all dimensions were significantly different between the two groups (P<0.05), and were also significantly different from the scores at discharge in both groups (P<0.05). At discharge, IPSS scores were not significantly different between the two groups (P>0.05). Six months after discharge, IPSS scores of the intervention group (6.33±1.03) and the control group (7.83±0.94) were significantly different (P<0.05), and were also significantly different from the scores at discharge in the intervention group (7.93±1.31) and the control group (8.10±1.06) (P<0.05). Three patients in the control group (10.0%) were admitted into the hospital again due to bleeding, while there was no bleeding case in the intervention group. No such complications as urethrostenosis or urinary incontinence occurred in both groups. Conclusion Family nursing intervention improves effectively the quality of life in postoperative patients after surgeries for benign prostatic hyperplasia.
ObjectiveTo explore the value of modified method for intratumoral injection of thrombin in the treatment of iatrogenic pseudoaneurysms.MethodsClinical data of 28 patients with iatrogenic pseudoaneurysms after interventional treatment in our hospital from October 2012 to June 2018 were retrospectively analyzed. Twenty-one cases were treated with ultrasound-guided thrombin injection for pseudoaneurysms (Ultrasound group), and seven cases were treated with DSA-mediated balloon occlusion and thrombin injection for pseudoaneurysms (DSA group). The patients were followed-up at 1 day, 1 month and 3 monthS after operation.ResultsThe total success rates of the two groups were 100%. There was no treatment-related complications in the two groups. There was no recurrence after 1–3 months of treatment.ConclusionsIntratumoral injection of thrombin can be used for the treatment of iatrogenic pseudoaneurysm. The effect of the improved treatment is more significant. These two methods can be used as the best way to treat iatrogenic pseudoaneurysm with different neck diameters.
【摘要】 目的 探讨2型糖尿病合并下肢血管病变血管内介入治疗的临床意义。 方法 2009年1-5月对4例2型糖尿病合并下肢血管病变患者，根据血管狭窄情况选择不同介入治疗方式，行下肢动脉造影及动脉球囊扩张或支架成形术。 结果 4例患者均有表现静息痛及间歇性跛行，下肢血管超声显示糖尿病下肢动脉有不同程度的斑块、狭窄与血栓形成，病变累及下肢股动脉、髂动脉及胫前、足背动脉。介入治疗后患者下肢血管灌注得到明显改善，静息痛及间歇性跛行明显改善，皮温改善，需要截肢患者截肢平面显著降低。 结论 通过下肢血管DSA造影检查，准确了解糖尿病患者下肢血管的阻塞部位及程度，在保守治疗基础上选择不同方式的介入治疗，有助于下肢血管病变的明显改善。【Abstract】 Objective To investigate the clinical significance of intervention therapy for patients with type 2 diabetes combined with vascular lesions of lower extremities. Methods From January to May, 2009, four diabetic patients with vascular lesions of lower extremities were examined by Doppler ultrasonography and digital subtration angiography (DSA). All patients were treated by percutaneous transluminal angioplasty (PTA) or stenting therapy. Results Stenoses and obstruction of lower extremity blood vessels were observed in all patients. After intervention therapy, vascular perfusion of lower extremities was improved and signs of rest pain and intermittent claudication were relieved; the skin temperature was improved, and the amputation level was apparently decreased. Conclusion It suggests that DSA is effective in judging extend and location of blood vessel stenosis,and the interventional treatment could lead to a satisfying prognosis.