生物瓣和机械瓣置换术115例分析报告

目的　总结 115例生物瓣和机械瓣置换术的临床经验。方法　 1980年 5月— 1999年 12月全麻体外循环下行心脏瓣膜置换术 115例。替换侧倾碟瓣 91例 ,生物瓣 2 0例 ,双叶机械瓣 4例。本组中双瓣置换 2 2例 ,生物瓣衰坏需再次换瓣手术 8例。结果　早期死亡 11例 ,死亡率 10 1%。晚期死亡 4例。生物瓣术后衰坏时间 8～ 12年。结论　目前瓣膜置换术的成熟与进步其疗效已取得良好效果     

人工心脏机械瓣膜二尖瓣、主动脉瓣同期置换术后血栓形成导致急性心肌梗死诱发心源性休克1例

1病例资料 患者男性,56岁,因"风湿性心脏病行双瓣膜置换术(DVR)术后5年,突发胸闷、心悸、恶心伴出冷汗2h"于2009年3月30日入院.既往有高血压病史.5年前因风湿性心脏病于我院行"二尖瓣、主动脉瓣机械瓣置换术"(二尖瓣为27号St. Jude双叶机械瓣膜,主动脉瓣为23号CarboMedics双叶机械瓣膜),术后恢复良好,口服华法林抗凝治疗,国际标准化比率(1NR)控制在1.8～2.0.患者术前及术后一直存在快速房颤心律.     

儿童脑炎型军团病16例

军团病是由革兰阴性杆菌引起的、以肺炎为主要表现的全身感染性疾病。国内于1982年首次报道〔1〕。本病除散发病例外,北京郊县和唐山地区发现暴发流行〔2～4〕。本病以神经系统为首发表现的报道不多〔5～7〕,作者报告16例均为儿童军团病。1　临床资料1.1　一般情况　应用间接免疫荧光法(IFA)测定患儿病后3～4周单份血清中嗜肺军团菌抗体的滴度。根据美国疾病控制中心嗜肺军团菌感染的诊断标准,单份血清抗体滴度≥1∶256,则可确诊为嗜肺军团菌感染。27例患儿经IFA法确诊为军团病。详细询问其首发症状,其中16例(59.3%)以神经系统异常为首发…     

腹膜后Castleman病CT及MRI表现

Castleman病（CD）由Castleman等〔1〕于1954年首次报告和命名,至今病因不明。国内腹膜后影像学报道较少,影像描述不完整。外文文献也未有大宗病例报道,因未将腹膜后当一个整体发生部位来说明,而报道的腹膜后具有特征性的影像学表现均是个案报道。     

人脑及红细胞膜乙酰胆碱酯酶的芳基酰胺酶活性

Fujimoto〔1〕1974年首次报道了大鼠脑中存在5-羟色胺敏感的芳基酰胺酶，认为此酶可能催化水解芳基酰胺类解热镇痛药及麻醉剂。以后又证实5-羟色胺敏感的芳基酰胺酶活性是乙酰胆碱酯酶（AchE，EC3．1．1．7）的一个属性〔2〕。通过对胆碱酯酶活性与芳基酰胺酶活性在亲和层析、凝胶过滤、电泳、抗体沉淀等方面性质的比较及底物抑制实验已确证电鳗、羊基底神经节、猴脑、人红细胞膜等来源的AChE〔3、4〕及人血清丁酰胆碱酯酶（BuchE，EC3．1．1．8）〔5〕具有芳基酰胺酶活性，此酶的特点是受5-羟色胺特异性抑制并被酪胺激活。对人血清Bu…     

雷达部队新兵军事训练伤与心理因素的关系

军事训练伤是影响部队战斗力的常见因素,而作为刚入伍即参加高强度军事训练的新兵,无疑是军事训练伤高发生群体之一,有文献报道其发生率为24%～25%〔1-2〕,甚至高达30%～40%〔3〕。为深入探讨雷达部队新兵训练伤与心理因素的关系,笔者针对我部2009～2010年新兵训练伤81     

生物心脏瓣膜钙化及预防

心脏瓣膜置换术用于临床40余年。与机械瓣相比,生物瓣有其公认的优越性：(1)比较符合生理的中央流道,有效瓣膜口径较大,跨瓣压差小。良好的血流动力学性能;(2)血栓栓塞及溶血并发症低,一般不需长期抗凝治疗;(3)在两类瓣膜置换术后生存率相似的前提下,生物瓣置换者的生活质量更好。临床广泛应用经戊二醛(GA)处理的生物瓣一牛心包瓣和猪主动脉瓣易发生原发性衰败,使其临床应用受到限制,瓣膜钙化是衰败的主要原因之一。     

nm23H_1、H-ras基因在大肠癌中的表达与预后的关系

近年来的研究表明〔1、2〕,ｎｍ2 3 Ｈ1作为一种新的肿瘤转移抑制基因 ,是一种有价值的预后指标 ,其阳性表达者的转移率较低 ,生存期较长。而Ｈ ｒａｓ基因的过度表达则视为恶性程度高的表现 ,预后不良〔3〕。笔者曾就大肠癌ｎｍ2 3 Ｈ1、Ｈ ｒａｓ基因的表达与淋巴结转移等病理学因素的关系进行了研究〔4、5〕,探讨了两者对于大肠癌淋巴结转移等肿瘤演进方向的预测价值。经过数年的随访和样本扩大 ,现将结果报道如下。1　材料及方法1 .1　标本来源及处理　 1 993年 1 2月 1 996年 1 2月收集本院肿瘤外科手术切除的原发性大肠癌标本1 30例 ,…     

心脏瓣膜置换术后抗凝栓塞并发症研究

目的对心脏瓣膜置换手术后应用华法林抗凝出现栓塞并发症的情况进行随访,分析不同瓣膜置换及心房颤动对栓塞并发症发生情况的影响。方法对2012年1月1日至2014年12月31日期间于青岛大学附属医院心血管外科出院的行心脏瓣膜置换术的888例患者进行随访,记录其服用抗凝药物、出现栓塞并发症及病死的情况。根据置换瓣膜及心房颤动发生情况分为机械瓣组(机械瓣伴心房颤动组、机械瓣无心房颤动组)、生物瓣组(生物瓣伴心房颤动组、生物瓣无心房颤动组)、心房颤动组及无心房颤动组,统计各组患者栓塞并发症人次,计算并比较栓塞发生率(%/年)。结果完成随访患者共803例,随访率90.43%,排除31例术后院内病死患者,共纳入772例患者,随访2 590.59人年(0.18~5.00人年)。纳入患者总栓塞并发症26人次(1.00%/年)。机械瓣组栓塞13人次(1.08%/年),生物瓣组栓塞13人次(0.94%/年),组间比较,差异无统计学意义(P>0.05)。机械瓣伴心房颤动组栓塞8人次(1.57%/年),生物瓣伴心房颤动组栓塞10人次(2.12%/年),组间比较,差异无统计学意义(P>0.05)。心房颤动组栓塞18人次(1.83%/年),无心房颤动组栓塞8人次(0.50%/年),组间比较,差异有统计学意义(P<0.01)。机械瓣伴心房颤动组栓塞8人次(1.57%/年),机械瓣无心房颤动组栓塞5人次(0.72%/年),组间比较,差异无统计学意义(P>0.05)。生物瓣伴心房颤动组栓塞10人次(2.12%/年),生物瓣无心房颤动组栓塞3人次(0.33%/年),组间比较,差异有统计学意义(P<0.01)。结论机械瓣与生物瓣在瓣膜置换术后对患者栓塞的发生率无明显影响,但对于合并心房颤动患者,栓塞发生率高。     

流行性出血热并发急性呼吸窘迫综合征6例

急性呼吸窘迫综合征(ARDS)是流行性出血热的重要并发症及死亡原因之一,但少见报道。我院自1990年7月～1997年6月收治6例,现报道如下。1　临床资料1.1　一般情况　本组诊断均符合国家卫生部1987年颁布的流行性出血热防治方案标准〔1〕,并经特异性流行性出血热-IgM抗体阳性证实;ARDS诊断均符合1988年广州ARDS专题研讨会修定的标准〔2〕。其中男4例,女2例;年龄21～43岁,平均33.6岁。ARDS发生于流行性出血热重型1例,危重型5例;低血压休克期2例,少尿期4例。1.2　诱发因素　2例为休克,2例为肺部感染(其中1例为肺部感染合并感染性休克),1例…     

Aortic valve stenosis

There is a long latent period in the clinical course of aortic valve stenosis in adults. Symptoms usually occur in the case of critical stenosis, when aortic orifice area is under 0.7 cm2 (0.4 cm2/m2). In this study 78 patients with critical aortic valve stenosis were investigated. The first manifestation of the disease was dyspnea (78.2%), angina (52.5%), less often a syncope (34.6%), while 17.9% of patients were asymptomatic. Left ventricular systolic function was preserved in 77% of patients, while left ventricular dyastolic dysfunction occurred in almost all the patients. In 42 patients (53.4%) aortic valve replacement was performed. Left ventricular systolic function improved in 88.1% of patients postoperativelly, as well as in patients with preoperatively preserved or poor systolic function. Recovery was fast particularly during the first 6 postoperative months. After the surgery the improvement of the left ventricular dyastolic function was slower then systolic, particularly in patients with extreme hypertrophy of myocardium in whom the process of recovery might last several years.     

“Balloon valvulotomy” of congenital pulmonary valve stenosis with tricuspid valve insufficiency

The rare congenital anomaly of pulmonary valve stenosis and massive tricuspid valve insufficiency with intact ventricular septum is a lethal condition without reported survival after attempted treatment. In a neonate suffering from this syndrome, the pulmonary valve stenosis was relieved by rupturing the fused valve with a balloon catheter introduced transvenously. The desperate conditon of the patient quickly improved after this procedure, with subsequent disappearance of the tricuspid valve incompetence. Balloon rupturing of fused valves at angiography may represent a therapeutic alternative in cases in which surgical valvulotomy is associated with a high mortality.     

Accuracy of predicted orthogonal projection angles for valve deployment during transcatheter aortic valve replacement

BackgroundMulti-detector computed tomography (MDCT) predicted orthogonal projection angles have been introduced to guide valve deployment during transcatheter aortic valve replacement (TAVR). Our aim was to investigate the accuracy of MDCT prediction methods versus actual angiographic deployment angles.MethodsRetrospective analysis of 2 currently used MDCT methods: manual multiplanar reformations (MR) and the semiautomatic optimal angle graph (OAG). Paired analysis was used to compare the 2-dimensional distributions and means.ResultsWe included 101 patients with a mean (±SD) age of 81 ± 9 years. The MR and OAG methods were used in 46 and 55 patients, respectively. A ≥5% change from the predicted MDCT range in left anterior oblique/right anterior oblique (LAO/RAO) and the cranial/caudal (CRA/CAU) angle occurred in 42% and 58% of patients, respectively. The mean predicted versus actual deployment angles were significantly different (CRA/CAU: -2.6 ± 11.5 vs. -7.6 ± 10.7, p < 0.001; RAO/LAO 8.1 ± 10.9 vs. 9.5 ± 10.6, p = 0.048; respectively). The MR method resulted in a more accurate CRA/CAU angle (CRA/CAU: -4.6 ± 11.1 vs. -6.5 ± 11.8, p = 0.139; RAO/LAO 7.4 ± 11.2 vs. 10.4 ± 11.2, p = 0.008; respectively), whereas the use of the OAG resulted in a more accurate RAO/LAO angle (CRA/CAU: -0.9 ± 10.8 vs. -9±11.2, p < 0.001; RAO/LAO 9.05 ± 10.6 vs. 8.5 ± 9.9, p = 0.458; respectively). For the entire cohort, the 2-dimensional distributions and means of the predicted versus the actual angles were significantly different from each other (p < 0.001). We repeated our analysis using both MDCT methods and demonstrated similar results with each method.ConclusionsCurrently used MDCT methods for TAVR implantation angles are significantly modified before actual valve deployment. Thus, further refinement of these prediction methods is required.