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负压装置胸腔穿刺术

外伤性主动脉弓和支气管同时破裂治疗成功一例

感染性心内膜炎继发肠系膜上动脉假性动脉瘤破裂一例

Thoracic Endovascular Aortic Repair for Stanford Type B Aortic Dissection

ObjectiveTo evaluate clinical outcomes of thoracic endovascular aortic repair (TEVAR)for the treatment of Stanford type B aortic dissection (AD)and descending aortic aneurysm. MethodsClinical data of 20 patients with Stanford type B AD or descending aortic aneurysm who underwent TEVAR in West China Hospital from March to June 2013 were retrospectively analyzed. There were 19 male and 1 female patients with their age of 41-76 (58.3±10.2)years. Clinical outcomes were analyzed. ResultsAmong the 20 patients, 18 patients were successfully discharged, 1 patient refused further postoperative treatment and was discharged, and 1 patient died postoperatively. Sixteen patients (88.9%)were followed up for over 3 months. In all the patients during follow-up, true lumen diameter recovered within the scope of intravascular stents, and there was thrombosis in false lumen or aneurysm lumen. ConclusionTEVAR provides a new choice with significant advantages for the treatment of Stanford type B AD, especially for the elderly and patients with concomitant serious diseases, so it is worthy of clinical application.

左心室异物四例

功能性三尖瓣关闭不全的外科治疗

主动脉瓣环扩大成形在双瓣膜置换术中的应用

目的介绍主动脉瓣环扩大成形在双瓣膜置换术（DVR）中应用的技术要点。方法对7例二尖瓣、主动脉瓣双瓣膜病变伴主动脉瓣环狭窄患者行DVR加主动脉瓣环扩大成形术。结果术后7d因呼吸衰竭死亡1例，其余患者顺利恢复，治愈出院。结论二尖瓣、主动脉瓣双瓣膜病变伴主动脉瓣环狭窄患者在DVR中采用主动脉瓣环扩大成形可有效扩大狭窄的主动脉瓣环，植入足够大的人工瓣膜，以提高手术的成功率和远期疗效。

主动脉瓣置换术后右乳内动脉假性动脉瘤一例

The Efficacy of Modified De Vega Technique Compares with the Traditional De Vega Technique for the Correction of Severe Tricuspid Regurgitation

摘要:目的:探讨改良De Vega环缩术与经典De Vega环缩术相比对于治疗重度三尖瓣返流是否具有更好的成形效果。方法: 2007年12月至2009年3月对29例重度三尖瓣返流的患者行De Vega环缩术。其中16例行改良De Vega环缩术,13例行经典De Vega环缩术,随访比较两组患者三尖瓣返流程度,右心室舒张期末内径,EF值及心功能分级。以秩和检验分析研究两组患者三尖瓣返流程度和心功能分级的差异,以t检验研究两组患者右心室舒张末期内径及EF值变化。结果:术前两组患者一般指标无显著差异。两组患者随访时间无显著差异。随访经典De Vega组重度返流1例,中度返流5例,轻度返流5例,微量及无返流2例;改良De Vega组无中、重度返流,轻度返流8例,微量及无返流8例。经分析显示两组患者三尖瓣返流程度结果差异有统计学意义(Plt;0.05)。经典De Vega组心功能分级I级5例,II级7例,III级1例;改良De Vega组I级7例,II级8例,III级1例,两组患者心功能差异无统计学意义(Pgt;0.05)。两组患者右室舒张期末内径及EF值组内比较随访与术前差异均有统计学意义(Plt;0.05),随访时组间比较差异有统计学意义(Plt;0.05), 改良De Vega环缩术随访时右室舒张期末内径缩小更显著,射血分数改善更明显。结论:改良De Vega环缩术治疗重度三尖瓣返流效果优于经典De Vega环缩术。Abstract: Objective: To compare the efficacy of one kind of modified De Vega technique and traditional De Vega technique for the correction of severe tricuspid regurgitation. Methods: From December 2007 to March 2009, 29 patients were treated with tricuspid valve annuloplasty. These were 16 patients in modified De Vega annuloplasty group and the others (13 patients) in traditional De Vega annuloplasty group. The grade of tricuspid regurgitation、New York Heart Association (NYHA) functional class、ejection fraction (EF) and the right ventricular enddiastolic dimension of two groups were followed and reviewed. Results: There was no statistically difference between two groups about preoperative characteristics and followup time. There was 1 patient with severe TR, 5 patients with moderate TR, 5 patients with mild TR and 2 patients without TR in traditional De Vega annuloplasty group after the operations. In modified De Vega annuloplasty group, no patient was observed with severe or moderate TR, 8 patients with mild TR, and 8 patients without TR. At interval time, there was significant difference in the grade of tricuspid regurgitation between two groups (Plt;0. 05). Both tricuspid valve plasty techniques could reduce the right ventricular enddiastolic dimension and improve ejection fraction significantly (Plt; 0. 05), and there was significant difference in the right ventricular enddiastolic dimension and ejection fraction at interval time between two groups (Plt;0.05). Conclusions: The outcome of modified tricuspid De Vega technique is superior to that of traditional De Vega technique in correcting severe tricuspid regurgitation.

修正胸部穿透伤生理评分的初步探讨

目的 探讨胸部穿透伤(PTT)创伤评分预测生死结局的效果，修正生理评分方法。方法 将295例PTT中127例急诊手术患者分为生存组和死亡组进行多种创伤评分，比较两组在各种创伤评分间的差别，分析各种评分指标预测生死和实际生死结果。比较两组入院时、麻醉时伤后时间和各种生理参数的差别，结合实际生死用Logistic回归分析计算各相关因素的权重,命名新指标为穿透伤进程评分（PICS）,比较并评价PICS和修正创伤评分(RTS)。结果 解剖评分的胸AIS和损伤严重度评估(ISS)在生存组和死亡组间差别具有显著性意义（Plt;0.05），而生理评分RTS在预测生死结局的敏感性时并不令人满意。按入院和手术麻醉时生理参数的变化，选择格拉斯哥指数（GCS）、伤后时间（T）、脉压（PP）、动脉收缩压（SBP）作为PICS的参数，经Logistic回归分析得到PICS权重和计算公式;PICS和RTS比较，其预测生死结局的准确性、敏感性提高，特异性不变，死亡误判率降低。结论 建议在急诊评价穿透伤时可试用PICS取代RTS作为生理评分，并进一步观察其临床应用的合理性。