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find Author "汪曾炜" 21 results
  • 老年瓣膜病患者心瓣膜置换术的临床分析

    目的 总结老年瓣膜病患者行心瓣膜置换术的经验,以提高手术效果。 方法 回顾性分析2000年1月至2009年4月沈阳军区总医院收治74例老年瓣膜病患者行心瓣膜置换术的临床资料,其中男51例,女23例;年龄60~74岁。术前经心电图、胸部X线片、彩色超声心动图、主动脉根部造影和左心室选择性造影检查诊断,均经手术证实,单纯二尖瓣病变45例;单纯主动脉瓣病变13例,其中7例为先天性二叶主动脉瓣畸形导致退行性改变;主动脉瓣和二尖瓣联合病变16例。均在全身麻醉体外循环下行心瓣膜置换术。 结果 全组无手术死亡,围术期死亡2例。74例患者体外循环时间58.0~136.5 min,主动脉阻断时间36.0~102.0 min。生存患者均无明显并发症,术后9~32 d顺利出院。 结论 心瓣膜置换术是治疗老年瓣膜病的安全方法,对左心房增大者进行减容并对三尖瓣关闭不全者进行良好处理,可获得满意的临床效果。

    Release date:2016-08-30 05:57 Export PDF Favorites Scan
  • 离体兔肺缺血再灌注损伤肺表面活性蛋白变化及保护

    目的 探讨最佳肺泡内氧浓度及温度对肺缺血再灌注损伤的保护作用.方法 离体兔肺在不同肺泡内氧浓度及不同温度下用非氧合血行肺动脉灌注30分钟,测定支气管肺泡灌洗液中血浆白蛋白(ALB),肺表面活性蛋白(SP,SP-A,SP-B,SP-C)占总蛋白含量的百分比,PS的活性并进行组织学观察.结果 肺泡内氧浓度与SP含量及活性成正比,与ALB含量成反比(Plt;0.01);肺泡内温度与ALB含量成正比,与SP含量及活性成反比(Plt;0.01).结论 (1)离体兔肺损伤明显,并减低了SP的含量和活性;(2)支气管肺泡灌洗液中SP,ALB含量和PS活性的测定是评价离体肺缺血再灌注损伤程度的可靠指标;(3)肺泡内充氧和低温对离体兔肺SP合成、活性、肺泡Ⅱ型细胞结构和功能有较好的保护作用.

    Release date:2016-08-30 06:35 Export PDF Favorites Scan
  • 埃布斯坦综合征合并预激综合征的外科治疗

    目的 为了提高手术疗效,总结埃布斯坦综合征(Ebstein syndrome)合并预激综合征的手术治疗经验. 方法 11例患者均有埃布斯坦综合征及严重三尖瓣关闭不全,合并A型预激综合征4例,B型 7例.术中电生理标测显示11例中有12条附加旁道,右心室游离壁6例,左心室游离壁3例,后间隔1例,后间隔和右心室游离壁双旁道1例.所有患者的房室附加旁道均在体外循环下被成功地手术切割;埃布斯坦综合征按Danielson方法行成形术9例,三尖瓣置换术2例. 结果 全组11例无手术后早、晚期死亡;术后随访4个月~6年,平均随访3.4±1.3年,无预激综合征复发,2例有轻度三尖瓣关闭不全.心功能Ⅰ级9例,Ⅱ级2例. 结论 手术治疗埃布斯坦综合征合并预激综合征,可同时纠正埃布斯坦综合征伴三尖瓣关闭不全和预激综合征,治疗效果良好.

    Release date:2016-08-30 06:32 Export PDF Favorites Scan
  • 心脏肿瘤的外科治疗

    目的总结心脏肿瘤的发生部位、肿瘤性质、诊断和外科治疗方法。方法1979年1月至2003年6月对195例心脏肿瘤患者行手术治疗,其中良性肿瘤186例(95.38%)、恶性肿瘤9例(4.62%);完整切除肿瘤188例,大部分或部分切除肿瘤7例。结果手术死亡5例,死亡率2.56%(5/195);手术成功190例(97.44%),术后随访3个月至15年,随访率96.84%(184/190),6例粘液瘤患者于术后4个月~2年内复发,4例恶性肿瘤分别于术后5个月~2年内死亡。结论心脏肿瘤以粘液瘤多见,彻底切除肿瘤是防止心脏肿瘤复发的关键,心脏恶性肿瘤手术近远期效果差;近10年心脏肿瘤呈逐年增加的趋势。

    Release date:2016-08-30 06:25 Export PDF Favorites Scan
  • 慢性缩窄性心包炎的外科治疗

    目的 总结慢性缩窄性心包炎的外科治疗经验。方法 78例患者术前均被明确诊断为慢性缩窄性心包炎,均在全身麻醉下经胸部正中切口行心包剥脱术。结果 术后中心静脉压6.5~14.0mmHg(1kPa=7.5mmHg),平均8mmHg。死亡1例,再次开胸止血2例,发生低心排血量综合征3例。术后病理检查:心包纤维结缔组织增生、玻璃样变性60例,呈于酪样结核病变18例(伴结核肉芽肿形成7例)。随访65例,随访时间3个月~10年,心功能(NYHA)均为I级,无心包缩窄复发和死亡。结论 手术是治疗慢性缩窄性心包炎惟一有效的方法,胸部正中切口是较佳的手术径路,心包切除范围应根据具体病情而定,力争将心包彻底松解切除。

    Release date:2016-08-30 06:23 Export PDF Favorites Scan
  • Changes of the Level of G Protein in Newborn Guinea-pig Myocardium Undergoing Global Ischemic Reperfusion

    ObjectiveTo study the changes of levels of α subunits of stimulatory (Gsα) and inhibitory guanine nucleotide binding protein (Giα) in newborn guinea pig (0 2 days old) myocardium undergoing global ischemic reperfusion, and influences on the changes by St.Thomas Ⅱ and cold blood cardioplegic solution.MethodsThirty newborn guinea pigs were randomly assigned to three groups. GroupⅠ ( n = 10): the newborn hearts suffered by hypothermic global ischemia; group Ⅱ( n =10): the newborn hearts arrested by St. Thomas Ⅱ , and group Ⅲ ( n = 10): the newborn hearts arrested by cold blood cardioplegic solution. Levels of Gsα and Giα were investigated with Western blot analysis.ResultsNo differences of levels of Gsα and Giα were found in three groups before ischemia ( P gt;0.05). The level of Gsα after ischemia was significantly decreased than before ischemia in groupⅠand group Ⅱ ( P lt; 0 01), whereas no pronounced changes in group Ⅲ ( P gt;0.05) were noted after ischemia. The level of Gsα in group Ⅲ was not significantly changed after reperfusion compared with before ischemia( P gt;0 05), and it was much higher than those in groupⅠand group Ⅱ ( P lt; 0 01). Level of Giα was found not markedly changed in group Ⅲ after reperfusion compared with that before ischemia, but was notable higher in groupⅠand group Ⅱ( P lt;0.01). ConclusionsSignificant decrease of level of Gsα, whereas marked increase of level of Giα are found in myocardium of newborn guinea pig undergoing hypothermic (20℃) ischemic reperfusion. No impact of St. Thomas Ⅱ on these changes is verified, but recovery to the level of Gsα and Giα before ischemia is achieved by cold blood cardioplegic solution after ischemia and reperfusion. Unbalance between Gsα and Giα is the one of the mechanisms of ischemic reperfusion injury for immature myocardium.

    Release date:2016-08-30 06:24 Export PDF Favorites Scan
  • 严重左心室功能不全冠心病患者的外科治疗

    目的总结有严重左心室功能不全[左心射血分数(LVEF)≤0.35]冠状动脉粥样硬化性心脏病(冠心病)患者行冠状动脉旁路移植术(CABG)的临床经验。方法18例有严重左心室功能不全的冠心病患者冠状动脉造影均显示为3支血管病变,在体外循环下行CABG,采用左乳内动脉18支与前降支吻合,采用桡动脉11支及大隐静脉26支与其它血管吻合。所有患者术前、术后均行正电子发射断层18F-脱氧葡萄糖显像(18F-FDGPET)检查,以判定心肌的存活状况。结果手术死亡1例,死于心室颤动。12例使用主动脉内球囊反搏(IABP),术后二次气管内插管3例。随访17例,随访时间14~26个月,所有患者心功能较术前均有不同程度的改善,LVEF(0.51±0.13)较术前(≤0.35)增大。2例出院后出现心绞痛复发。结论CABG是治疗严重左心室功能不全冠心病患者的有效治疗方法,其效果取决于存活心肌的多少及可再血管化的目标血管的数量。术中良好的心肌保护,积极应用IABP及护心通是手术成功的关键。

    Release date:2016-08-30 06:25 Export PDF Favorites Scan
  • Experimental Study on the Isolation, Culture and Identification of Mesenchymal Stem Cells from Human Bone Marrow in Vitro

    Objective To observe the morphology and growing status of mesenchymal stem cells(MSCs) of human bone marrow in vitro, in order to confirm that MSCs of human bone marrow are ideal seed cells and provide basic theory for further MSCs research. Methods The methods of density gradient centrifugation with lymphocyte separation medium for human and adherent filtration were used to isolate and purify MSCs of human bone marrow. We observed the cellular growth status and morphology of the primary MSCs and the surface antigens of second passage MSCs were tested. Results The primary culture cells fused into monolayer after 14-16 d. The passage cells kept the same morphological characteristics of primary culture cells. Ultrastructure of the second passage MSCs showed that the shape of nuclei was irregular, there were multiple nucleoli in some of the nuclei, and morphological differentiation of intracytoplasm organelles was immature. The growth curve of the first, fifth and tenth passage cells showed a logarithmic growth at day 3, a peak growth at day 5, and no clones occurred after tenth passage. Cloning efficiency of first passage, fifth passage and tenth passage was respectively 25.83%±2.93%, 14.67%±1.63% and 4.67%±0.52%. Test of MSCs phenotypic characteristics showed a high homogeneity among the cells and surface antigen profiles were positive for CD29, CD44 and negative for CD34, CD45. Conclusion The methods of density gradient centrifugation with lymphocyte separation medium for human and adherent filtration are simple, economic and efficient to isolate and purify MSCs from human bone marrow. With a high proliferating ability in vitro, MSCs from human bone marrow are ideal seed cells for tissue engineers.

    Release date:2016-08-30 05:59 Export PDF Favorites Scan
  • The Effect of Ischemic Preconditioning on Myocardial Ischemic Reperfusion of Elderly Rats

    Objective To investigate the effect of ischemic preconditioning(IPC) on myocardial ischemic reperfusion injury(I/R) of elderly rats. Methods Fiftysix Wistar rats, of which there were 28 aged from 21-23months(elderly rat) and 28 aged from 4-5months(young rat), were used to build isolated heart perfusion Langendorff model. The rats were divided into 7 groups with random number table(8 in each group): adult control group, adult I/R group, adult IPC group, elderly control group, elderly I/R group, elderly IPC group and elderly enhanced IPC group. The control group underwent a 90-min perfusion without any intervention; the I/R group underwent a 30-min equilibration period, then a 30-min ischemia and a 30-min reperfusion; the IPC group underwent a 10-min equilibration period, then a 5-min ischemia for twice and a 5-min reperfusion, after that a 30-min ischemia and [CM(158-3mm]a 30-min reperfusion; the enhanced IPC group underwent a 10-min equilibration period, then a 5-min ischemia for 4-times and a 5-min reperfusion, after that a 30-min ischemia and a 30-min reperfusion. The recovery rates of cardiac output(CO), left ventricular developed pressure (LVDP), the maximum rising and descending rate of left ventricular pressure (±dp/dtmax) after a 30-min reperfusion were compared among groups. The activity of creatine kinase (CK) in coronary outflow, the level of malonyldialdehyde (MDA) and superoxide dismutase (SOD) before ischemia and after a 30min reperfusion were detected. The myocardial infarction areas were compared among groups. Results After a 30min reperfusion, compared with adult I/R group, in adult IPC group CK reduced significantly(89.48±18.72 U/L vs. 115.76±16.72 U/L,q=6.061,Plt;0.01),the level of MDA decreased significantly(9.53±3.44 nmol/ml vs. 16.84±2.29 nmol/ml,q=7.732,Plt;0.01),the level of SOD increased significantly(584.7±122.62 U/ml vs. 429.46±85.24 U/ml,q=4.754,Plt;0.01),the recovery rates of CO,LVDP,+dp/dtmax and -dp/dtmax increased ignificantly(78.69%±9.68% vs. 65.10%±8.63%,83.61%±8.46% vs. 67.23±8.68%,81.68±8.68% vs. 67.89%±6.89%,89.79%±7.78% vs. 66.79%±8.46%,Plt;0.01), the myocardial infarction areas reduced significantly (5.25%±4.33% vs. 14.75%±8.02%,q=7.458,Plt;0.01)。There was no statistical significance between elderly IPC group and elderly I/R group in the above indexes(Pgt;0.05).However, There was statistical significances between elderly enhanced IPC group and I/R group. CK reduced significantly (88.60±28.32 U/L vs. 105.76±9.64 U/L,q=5.620,Plt;0.01),the level of MDA decreased significantly(8.38±3.36 nmol/ml vs. 16.80±3.06 nmol/ml,q=7.500,Plt;0.01),the level of SOD increased significantly(558.87±78.66 U/ml vs. 433.75±86.65 U/ml,q=7.335,Plt;0.01),the recovery rates of CO,LVDP,+dp/dtmax and -dp/dtmax increased significantly (77.99%±10.02% vs. 66.26%±9.78%,85.59%±6.67% vs. 73.90%±6.66%,83.87%±9.98% vs. 68.90%±8.68%,86.01%±766% vs. 70.39%±7.98%,Plt;0.01), the myocardial infarction areas reduced significantly (795%±6.32% vs. 1568%±10.36%,q=8.680, Plt;0.01). 〖WTHZ〗Conclusion The protective effect of IPC on I/R elderly rat hearts has weakened. The enhanced IPC is able to regain the protective effect of IPC on elderly rat hearts.

    Release date:2016-08-30 06:06 Export PDF Favorites Scan
  • Surgical correction of complete atrioventricular septal defect associated with tetralogy of Fallot

    Objective To summarize the experience of surgical correction of complete atrioventricular septal defect associated with tetralogy of Fallot(CAVSD-TOF). Methods Twelve patients aged 6-16(11.1±2.8) years underwent correction of CAVSD-TOF. The atrioventricular septal defect was closed through a right atriotomy and longitudinal right ventriculotomy in each case. The three-patch technique was used for the first 7 cases and two-patch technique for the later 5 cases. The commissure between the superior and inferior bridging leaflets of the left portion of the common atrioventricular valve was closed in each patient. Right ventricular outflow tract obstruction was relieved by a transannular patch. Results There were 4 deaths in the early postoperative period, 3 deaths in the first 7 cases compared to 1 death in the later 5 cases. The causes of death included severe low cardiac output syndrome(3 cases) and perfusion pulmonary edema(1 case). Six survivors were followed up from 3 months to 13.5 years. Heart function (NYHA) was class I or Ⅱ in all cases. Conclusion CAVSD-TOF can be corrected by using the two-patch technique and closure of atrioventricular septal defect through a combined approach through right atriotomy and right ventriculotomy. Routine closure of the commissure of the left portion of the atrioventricular valve achieves a low incidence of regurgitation.

    Release date:2016-08-30 06:28 Export PDF Favorites Scan
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