Objective To summarize experience in surgery about off-pump coronary artery bypass grafting(OPCAB)for the treatment of left main with three-vessel coronary disease. Methods OPCAB were perfomed in 33 patients of left main with three-vessel coronary disease. The left internal mammary artery(LIMA) was used to be the graft vessel to anastomose with left anterior descending. The saphenous vein was used to be the graft vessel to anastomose with left circumflex coronary artery, right coronary artery/posterior descend artery, diagonal branch, obtuse marginal branch. Results There was no operative death.The average number of grafting was 3.4 per case.There was no perioperative myocardial infarction, respiratory or hepatic or renal failure and other serious complications.Blood transfusion was not needed in 33% of cases.The angina pectoris was free after operation in all cases. Conclusions OPCAB is safe and effective for the treatment of left main with three-vessel coronary disease. The injuries were minimal. Preoperative preparation, using of intra-aortic balloon counterpulsation, operative matching, techniques and to create a skill and swift team for meet an emergency are the key factors to assure surgical outcome.
ObjectiveTo explore the effect of continuous nursing on lung transplant patients at home based on humanistic care. MethodsAccording to hospitalization order, patients who received lung transplantation in our hospital from January 2016 to October 2020 were divided into a control group and a nursing group. The control group was treated with routine lung transplantation education and regular follow-up after discharge, and the nursing group received humanistic care during follow-up, health education at discharge, cultural exchange activities, and home care plans. After discharge, the self-management ability at home, medication adherence and satisfaction of home care between the two groups were campared. ResultsA total of 60 patients were included in the study. There were 23 patients in the control group, including 16 males and 7 females, with an average age of 58.70±11.00 years. There were 37 pateints in the nursing group, including 25 males and 12 females, with an average age of 57.90±13.20 years. The scores of self-management ability at home of the nursing group (self-concept 27.41±2.37 points vs. 21.78±3.54 points; self-care responsibility 20.73±1.63 points vs. 16.83±2.79 points; self-care skills 41.46±3.77 points vs. 28.26±4.11 points; health knowledge level 57.95±4.10 points vs. 44.87±5.79 points) were higher than those in the control group (all P＜0.05). The medication adherence (7.47±0.46 points vs. 6.87±0.28 points) and satisfaction of home care (23.80±1.20 points vs. 20.50±1.90 points) in the nursing group were higher than those in the control group (both P<0.05). ConclusionContinuous nursing based on humanistic care for lung transplant patients can effectively improve the self-management ability, medication adherence and nursing satisfaction of patients after discharge.
Objective To evaluate the preliminary the therapeutic effect of the aortic proximal anastomosis device applied in coronary artery bypass grafting (CABG), and further to assess its safety and feasibility. Methods From January 2006 to May 2007， 50 patients underwent CABG were received the aortic proximal anastomosis device ［Novare Enclose Ⅱ device (Novare Surgical System, Cupertino, CA)］, in which 16 were underwent in onpump CABG and 34 in offpump CABG(OPCAB). The age was 56.2±18.7years(from 55 to 80 years), and there were 38 males and 12 females. Preoperative complications included hypertension in 28 cases, diabetes in 17 cases, old myocardial infarction 18 cases and old cerebral infarction in 15 cases. A total of 175 proximal anastomoses were performed (3.2±1.3), among which there were 152 vein, 12 free left internal mammary artery (LIMA) and 11 radial artery anastomoses. Results Intraoperative transient graft flow meter revealed a satisfactory blood flow. There were no device related complications, and there was no hospital death. 2 cases needed chest re-exploration for hemostasis, 2 cases needed tracheostomy for respiratory insufficiency, and 1 case needed hematodialysis for renal inadequacy caused by diabetic nephropathy. All this 5 patients got recovered and discharged after active treatment. There were no cerebra related complications and no severe cardiac accidents. Follow-up 1 to 3 months after surgery via telephone or letter revealed a 100% survival rate and a 100% exemption rate of cardiac accident. Conclusion Preliminary clinical application of the Novare Enclose Ⅱ device is safe and efficient, but its middle and longterm effect remains to be further observed.
【摘要】 目的 探讨重组人凝血因子Ⅷ制剂小剂量短程预防性输注能否有效减少中重度血友病A患儿关节出血问题。 方法 对2008年11月-2009年4月期间就诊的13例年龄3~11岁的中重度血友病A患儿，均在为期2个月内接受重组人凝血因子Ⅷ 2次/周、间隔3 d、每次7.5~10.0 U/kg的静脉预防性输注，记录治疗前2个月与治疗2个月时关节出血次数，以及同一关节反复发生出血的情况。 结果 治疗前关节出血的发生次数为（3.77±2.13）次，治疗后关节出血的发生次数为（0.46±0.87）次，治疗前后比较，差异有统计学意义（Plt;0.01）；治疗前靶关节出血的发生率为35.7％，治疗后靶关节出血的发生率为0.0%，治疗前后比较，差异有统计学意义（Plt;0.01）。患儿治疗成本约510~680元/（kg?2个月）。 结论 重组人凝血因子Ⅷ制剂小剂量短疗程预防性输注能有效减少中重度血友病A患儿关节出血次数，同时可有效减少靶关节出血的发生率，从而在一定程度上保护关节的功能。治疗费用相对可接受。【Abstract】 Objective To evaluate the efficacy of low-dose short-course infusion of recombinant human factor Ⅷ concentration in treating joint bleeding in children with severe and moderate hemophilia A. Methods Thirteen children aged 3 to 11 years old with severe or moderate hemophilia A were included in the present study from November 2008 to April 2009. For children in the treatment group, they were treated with low-dose short-course infusion of recombinant human factor Ⅷ concentration with a dose of 7.5-10.0 U/kg twice weekly as secondary prophylaxis for two months. The incidence of joint bleeding 2 months before treatment (control group) and during the 2 months of treatment (treatment group) was observed. Moreover, the incidence of their target joint bleeding was measured in both groups. Results Children in the control group had (3.77±2.13) joint bleedings while children in the treatment group had (0.46±0.87) joint bleedings, which was obviously lower than those in the control group (Plt;0.01). Meanwhile, the incidence of target joint bleeding in the treatment group was 0%, which was obviously lower than that in the control group (35.7%) (Plt;0.01). In the treatment group, the costs of treatment were about RMB 510-680 yuan/kg every 2 months. Conclusions Treatment with low-dose short-course infusion of recombinant human factor Ⅷ concentration can effectively decrease joint bleeding in children with severe and moderate hemophilia A, and can effectively decrease the incidence of target joint bleeding. Therefore, this method may play an important role in protection of the joint function in those patients at an acceptable cost.
Objective To investigate the effect of combined carotid endarterectomy (CEA) and offpump coronary artery bypass grafting (OPCAB) on patients with carotid arteriostenosis and coronary heart diseases. Methods A total of 121 consecutive patients with carotid arteriostenosis and coronary artery diseases underwent CEA and OPCAB between January 2003 and December 2009 in Nanjing First Hospital of Nanjing Medical University. There were 81 males and 40 females, with their ages ranged from 62 to 72 years (67.2±4.5 years). All patients had 3vessel coronary artery lesions, and there were 3 cases of left main coronary artery lesion. Unilateral carotid arteriostenosis (≥50%) occurred in 95 patients, and bilateral (≥50%) in 26 patients. The occurrence of stroke, myocardial infarction, angina pectoris and other complications after operation was observed, and followup was carried out. Results All patients underwent unilateral CEA including 50 on the right side and 71 left. The mean block time of carotid artery in CEA was 20.5±7.0 minutes. The average number of distal grafts per patient in OPCAB was 2.9±0.3. None of the patients had stroke or myocardial infarction and no perioperative death occurred. Eightyseven patients felt well in terms of their neuropsycho symptoms; 32 felt no change; and 2 worsened. Follow-up was done for all the patients with a follow-up rate of 100%. The mean time of the follow-up was 67.5±12.5 months. During this period, none of the patients manifested stroke, myocardial infarction or neuropsycho symptoms. Conclusion Concomitant OPCAB and CEA is a safe and effective procedure in patients with carotid arteriostenosis and coronary artery diseases. It can reduce the rate of postoperative stroke significantly. However, longterm outcome of the procedure needs operative experience accumulation, longterm follow-up and observation, and serious research and illumination.
Objective To evaluate the left ventricular remodeling after valve replacement for valvular heart disease with giant left ventricle. Methods The clinical material of 92 patients with valvular heart disease and giant left ventricle after valve replacement was retrospectively reviewed. The results of ultrosonic cardial gram（UCG） and the changes of cardiac function before and after operation were compared. Results There was no operative death. The value of left ventricular end-diastolic dimension （LVEDD）, left ventricular end-systolic dimension （LVESD）, left atrial dimension （LAD）, left ventricular ejection fraction （LVEF）, left ventricular fractional shortening （LVFS）, stroke volume （SV） and cardiothoracic ratio in 2 weeks and 2 months after operation were more decreased than those before operation（P〈0. 05）. The value of LVEDD and LAD in 2 months after operation were much more decreased than those in 2 weeks after operation （P〈0. 05）. The cardiac function in early stage after operation was more decreased than that before operation,but the cases of cardiac functional class Ⅱ （38 cases, 41.3% ） in 2 months after operation was significantly more than those before operation （5 cases, 5.4 % ）. Conclusions The early effect of left ventricular remodeling is significant for valvular heart disease with giant left ventricle after valve replacement. The diameter of left ventricle and left atrial are significantly decreased after operation. The protection for cardiac function should be carefully taken in order to prevent the occurrence of complication after operation.
Objective To investigate the effect of coronary artery bypass grafting (CABG) on patients with coronary heart disease and giant left ventricular dimension but without aneurysm. Methods The clinic data of 51 consecutive patients with coronary heart disease accompanied by enlarged left ventricle dimension without aneurysm, including 50 males and 1 female, undergoing CABG between January 2004 and December 2006 in Nanjing First Hospital of Nanjing Medical University was retrospectively reviewed. The patients were at the age of 54-61 years with an age of 57.5±3.2 years. All patients received CABG, combined with aortic valve replacement in 7, mitral valve replacement in 16, mitral valvoplasty in 17 and tricuspid valvoplasty in 7. After surgery, perioperative complications and mortality were closely observed and followup for a period of 37 months was carried out. Results The number of distal anastomoses per patient was 2.0-4.0(3.8±1.1). Four patients died perioperatively (7.8%), among whom 2 died from malignant ventricular fibrillation, 1 from acute kidney failure and 1 from stroke caused by severe low cardiac output syndrome. All other patients were discharged from hospital with good recovery. After operation, 5 patients had atrial fibrillation and 11 had ventricular fibrillation, but all of those patients survived after proper treatment. The followup period for 47 patients was 37-49 months (43±11months), with a followup rate of 100%. No death occurred during the follow-up. Ultrasound cardiography in the followup period showed that there was a decreased left ventricular enddiastolic dimension (59±2 mm vs. 68±5 mm; t=7.320, Plt;0.05) and an improved left ventricular ejection fraction (45%±17% vs. 34%±15%; t=4.770, Plt;0.05) compared with those before operation with statistical significance. Conclusion CABG is an effective surgical procedure in the treatment of coronary heart disease with giant left ventricular dimension but without aneurysm.
Abstract:Objective To investigate the reoperation indication,surgical timing and the key point of surgical treatment of prosthetic valve endocarditis （PVE） after valve replacement. Methods From February 2000 to July 2005,18 patients with PVE underwent surgery ,their clinical manifestation ,process of treatment and their prognosis outcome were analyzed. Results There were 3 patients （16.7 %） of early-death, 1 patient died of septic shock, and 2 patients died of multiple organ failure. Since 2003,there was no operative death for all 11 patients. There were 6 patients with respiratory insufficiency, 2 patients with renal insufficiency,which were recovered after treatment. The 15 survivors were followed up from 1 month to 5years. There was recurrence of infection in 1 patient who died after ineffective medical treatment. The other 14 patients recovered well. Conclusion It has high risk and high mortality for reoperation for PVE. Accurate reoperative indication,optimal surgical timing,radical debridment of infected tissue and correct perioperative use of antibiotics are the key factors to improve the reoperative result for PVE.