ObjectiveTo summarize clinical outcomes of atrial septal defect (ASD)occlusion for patients with ASD and tricuspid regurgitation (TR). MethodsBetween July 2006 and January 2012, 98 patients with ASD and TR under-went ASD occlusion in Xinhua Hospital, Shanghai Jiaotong University School of Medicine. There were 36 male and 62 female patients with their age aging from 2 months to 80 years. All ASD were secundum ASD with their diameter of 3-23 mm. There were 60 patients with mild TR, 28 patients with moderate TR, and 10 patients with severe TR. All the patients received ASD closure without specific management for TR, including 51 patients under digital subtraction angiography (DSA), 46 patients via a minithoracotomy approach, and 1 patient guided by transthoracic echocardiography. All the patients were followed up with echocardiography to evaluate changes of TR after ASD closure. ResultsThere was no in-hospital death. ASD occlusion was not successful in 1 patient who was found to have residual ASD shunt on the third postoperative day. Another patient underwent reexploration for abnormal bleeding on the third postoperative day. All the other patients had uneventful postoperative recovery. Eighty-four patients were followed up for 1-64 (26.56±21.35)months. During follow-up, the patient who have residual ASD shunt on the third postoperative day received open chest repair 6 months after discharge. TR of 73 patients (86.90%)improved in different degrees. Preoperative severe TR in 10 patients changed into mild TR in 8 patients, moderate TR in 1 patients and still severe TR in 1 patient. Preoperative moderate TR in 26 patients changed into none TR in 6 patients, mild TR in 18 patients and still moderate TR in 2 patients. Preoperative mild TR in 48 patients changed into none TR in 40 patients and still mild TR in 8 patients. ConclusionFor patients with ASD and TR, conservative treatment strategy is recommended. Simple ASD closure can provide satisfactory clinical outcomes, and also avoid adverse complications of cardiopulmonary bypass including myocardial injury and lung injury.
【摘要】 目的 探讨腰部放置衬垫物对经皮冠状动脉介入手术后卧床患者的作用。 方法 选取2008年7〖CD3/5〗12月于我科行经皮冠状动脉介入手术后50例患者,随机分为试验组25例和对照组 25 例。试验组在常规护理基础上予腰部放置衬垫物,对照组25例予常规护理,手术次日对患者进行视觉模拟量表测试方法(VAS)评分。 结果 试验组VAS评分秩和检验低于对照组,差异有统计学意义(Plt;0001);两组除烦躁外其他并发症无显著差异。 结论 冠状动脉介入手术后患者在平卧位制动时予腰椎弯曲处放置衬垫物可降低患者腰部疼痛程度。【Abstract】 Objective To investigate the effects of lumbar pad on bed patients who uhderwent percutaneous coronary intervention operation. Methods The 50 patients who uhderwent percutaneous coronary intervention operation in our deparment from July to December 2008，then randomly divided into experimental group(25 patients)and control group(25 patients). Control group were received conventional care，the experimental group were received lumbar pad based on the conventional care. The second day after operation，the patients were scored by visual analog scale test method (VAS). Results The VAS scores of experimental group was lower than control group，the difference was statistically significant (Plt;0001). The differences of other complications between two groups except fidgety were not statistically significant. Conclusions Coronary intervention after surgery，the patients in peripharyngeal braking to bend lumbar pad material can reduce the waist ache degree.
Tricuspid regurgitation (TR) affects a wide population in China, and frequently coexists with other conditions as comorbidities. Moderate to severe TR is associated with a poor prognosis and medical treatment alone does not prevent progression of disease. Although minimal invasive catheter-based techniques might be an option for TR treatment in selected high risk patients, there is no relevant recommendations for the transcatheter treatment of TR in practice guidelines. Several transcatheter edge-to-edge repair devices are currently in preclinical and early clinical evaluation as potential novel treatment options for symptomatic TR in patients at increased risk for surgery, becoming as the most common technique applied for interventional TR treatment. Hence, the present study will introduce the clinical features of TR, the progress of edge-to-edge repair, and the application and challenges in the future.
目的探讨广泛门静脉血栓形成（portal vein thrombosis，PVT）的诊治经验。 方法回顾性分析笔者所在医院2004年1月至2012年12月期间收治的7例广泛PVT患者的临床资料。 结果按Yerdel’s分级7例患者属Ⅲ～Ⅳ级；男4例，女3例；年龄28～54岁，中位年龄45岁；起病至就诊时间4～10 d，平均6.9 d。表现为上腹痛3例，全腹痛、腹胀4例，血便2例，休克1例，腰背痛1例，恶心、呕吐3例。查体：有腹膜炎体征3例，左下腹压痛1例，腹水征阳性3例，肠鸣音消失2例，减弱1例。2例行D-二聚体检查均升高。所有患者超声检查均提示门静脉血栓形成、累及肠系膜上静脉。给予抗凝、祛聚、溶栓等基础治疗；1例经肠系膜上动脉导管溶栓，2例手术切除坏死肠管，其中1例同时行脾切除术。1例术后发生肠瘘，经保守治疗治愈；3例患者发生门静脉高压性胃肠病，口服普萘洛尔治疗。 结论早期行血浆D-二聚体及影像学检查，尽早行抗凝治疗，无禁忌时行溶栓或介入治疗以及实时手术治疗，PVT患者可有较好的预后。
Objective To evaluate the efficacy of statins pretreatment in patients before percutaneous coronary intervention (PCI). Methods Published literature on relevant randomized controlled trials (RCTs) were retrieved via electronic and handsearch in databases CNKI, CBM, MEDLINE and The Cochrane Library from January 1990 to May 2011. The references of these articles were also retrieved. Two reviewers independently identified articles according to the inclusion and exclusion criteria, extracted the data, assess the quality of the included studies, and then conducted meta-analysis using RevMan 5.0 software. Results A total of 10 trials involving 3 012 patients were included. The results of meta-analyses showed that: during the periprocedural period, the trial group had a lower incidence than the control group (98 of 1 514 cases, incidence 6.5%) in periprocedural myocardial infarction with a significant difference (OR=0.43, 95% CI 0.34 to 0.56, Plt;0.000 01). The composite of death, myocardial infarction, or target vessel revascularization in one month, essentially driven by periprocedural myocardial infarction, was reported 6.8% in the trial group and 15.1% in the control group (OR=0.41, 95% CI 0.32 to 0.53, Plt;0.000 01). Conclusion Current evidence supports the effectiveness of statin pretreatment used to reducing the rate of periprocedural myocardial infarction in patients before receiving PCI.