目的分析3D胸腔镜在再次心脏手术中的应用情况,总结手术技巧与经验。方法2015年4月至2018年5月,郑州市第七人民医院胸腔镜下再次二尖瓣/三尖瓣手术29例,为腔镜组;回顾2010年1月至2015年1月郑州市第七人民医院常规再次心脏手术患者资料,...目的分析3D胸腔镜在再次心脏手术中的应用情况,总结手术技巧与经验。方法2015年4月至2018年5月,郑州市第七人民医院胸腔镜下再次二尖瓣/三尖瓣手术29例,为腔镜组;回顾2010年1月至2015年1月郑州市第七人民医院常规再次心脏手术患者资料,适合胸腔镜下手术但行常规手术51例,为常规组。结果①两组手术时间(198.42±46.51 VS 316.51±126.81,t=8.92,P<0.01)、体外循环时间(125.86±62.92 VS 193.13±84.47,t=5.93,P<0.01)、呼吸机辅助呼吸时间(15.25±6.12 VS 30.46±11.93,t=10.07,P<0.01)、重症监护时间(31.61±21.25 VS 51.43±35.21,t=3.48,P<0.01),3D腔镜组明显短于常规组;引流量(354±112.69 VS 692.28±371.57,t=19.34,P<0.001)和红细胞使用率(4 VS 23,t=8.10,P<0.05)和血小板使用率(1 VS 24,t=16.37,P<0.001),3D腔镜组显著少于常规组;围术期疼痛评分,3D腔镜组显著低于常规组(3.05±0.69 VS 6.28±1.57,t=7.16,P<0.001);围术期死亡率和并发症发生率无显著区别。②3D胸腔镜再次二尖瓣/三尖瓣手术,1年后生活质量和心脏功能较常规手术无显著区别。结论再次心脏手术中,3D胸腔镜是具有微创、安全、可行的特点,值得开展胸腔镜心脏手术单位临床推广。展开更多
Plasma concentrations of endothelin in bloor from the femoral vein and the antecubital vein were measured in 35 patients with mitral stenosis and heart failure before and after percutaneous balloon mitralvalvuloplasty...Plasma concentrations of endothelin in bloor from the femoral vein and the antecubital vein were measured in 35 patients with mitral stenosis and heart failure before and after percutaneous balloon mitralvalvuloplasty(PBMV). The basal plasma concentrations of endothelin in blood from the antecubirtal vein in the patients were significantly higher than those in 32 control subjects (15. 40± 3. 32 vs. 9. 59± 2. 66 pg/ml, P<0. 001). Plasma endothelin concentrations in patients in New York Heart Association functional classes Ⅱ and Ⅲ were significantly higher than those in control subjects, respectively. The concentrations of endothelin in patients with atrial fibrillation were also significantly higher than those in patients with normal sinus rhythm. Ten to fifteen minutes after PBMV, plasma endothelin concentrations in blood from the femoral vein significantly decreased from 16. 14 ± 3. 34 to 13. 74 ± 3. 78 pg/ml (P<0. 01 ). Seventy-two hours after the procedure, the concentrations of endothelin in blood from the antecubital vein had fallen to 12. 31 ± 2. 55 pg/ml (P<0. 001 vs. before PBMV and control subjects). Plasma endothelin concentrations still tended to be higher in patients with atrial fibrillation than those in normal sinus rhythm, but the difference did not reach statistical significance. There were weak but significantly correlations of plasma endothe lin concentrations with the mean left atrial pressure (r= 0. 424 , P < 0.001 ), mean right atrial pressure (r=0. 323, P<0. 01), mean transmitral pressure gradient (r= 0. 397, P<0. 001), heart rate (r= 0. 350,P<0. 005)and mitral valve area (r=-0. 454, P<0. 001) in the patients before and after PBMV.展开更多
Plasma dynorphin A1-13 levels were measured in 33 patients with mitral stenosis before and after percutaneous balloon mitral commissurotomy (PBMC). The results show that the basal levels of plasma dynorphin in blood f...Plasma dynorphin A1-13 levels were measured in 33 patients with mitral stenosis before and after percutaneous balloon mitral commissurotomy (PBMC). The results show that the basal levels of plasma dynorphin in blood from the antecubital vein in the patients were significantly higher than those in 31 healthy control subjects. The increase in circulating dynorphin closely correlated with the functional cardiac status and the presence of atrial fibrillation. Ten to fifteen minutes after PBMC, plasma dynorphin levels in blood from the femoral vein increased significantly. Seventy-two hours after the procedure, the levels of plasma dynorphin in blood from the antecubital vein had decreased significantly , but they did not decrease to the normal range. Plasma dynorphin levels in blood from the femoral vein were positively correlated with the mean left atrial pressure and the mean right atrial pressure before the first balloon inflation. Plasma dynorphin levels in blood from the antecubital vein were positively correlated with the heart rate and the mean transmitral pressure gradient, and negatively with the mitral valve area before and 72 hours after PBMC.展开更多
文摘目的分析3D胸腔镜在再次心脏手术中的应用情况,总结手术技巧与经验。方法2015年4月至2018年5月,郑州市第七人民医院胸腔镜下再次二尖瓣/三尖瓣手术29例,为腔镜组;回顾2010年1月至2015年1月郑州市第七人民医院常规再次心脏手术患者资料,适合胸腔镜下手术但行常规手术51例,为常规组。结果①两组手术时间(198.42±46.51 VS 316.51±126.81,t=8.92,P<0.01)、体外循环时间(125.86±62.92 VS 193.13±84.47,t=5.93,P<0.01)、呼吸机辅助呼吸时间(15.25±6.12 VS 30.46±11.93,t=10.07,P<0.01)、重症监护时间(31.61±21.25 VS 51.43±35.21,t=3.48,P<0.01),3D腔镜组明显短于常规组;引流量(354±112.69 VS 692.28±371.57,t=19.34,P<0.001)和红细胞使用率(4 VS 23,t=8.10,P<0.05)和血小板使用率(1 VS 24,t=16.37,P<0.001),3D腔镜组显著少于常规组;围术期疼痛评分,3D腔镜组显著低于常规组(3.05±0.69 VS 6.28±1.57,t=7.16,P<0.001);围术期死亡率和并发症发生率无显著区别。②3D胸腔镜再次二尖瓣/三尖瓣手术,1年后生活质量和心脏功能较常规手术无显著区别。结论再次心脏手术中,3D胸腔镜是具有微创、安全、可行的特点,值得开展胸腔镜心脏手术单位临床推广。
文摘Plasma concentrations of endothelin in bloor from the femoral vein and the antecubital vein were measured in 35 patients with mitral stenosis and heart failure before and after percutaneous balloon mitralvalvuloplasty(PBMV). The basal plasma concentrations of endothelin in blood from the antecubirtal vein in the patients were significantly higher than those in 32 control subjects (15. 40± 3. 32 vs. 9. 59± 2. 66 pg/ml, P<0. 001). Plasma endothelin concentrations in patients in New York Heart Association functional classes Ⅱ and Ⅲ were significantly higher than those in control subjects, respectively. The concentrations of endothelin in patients with atrial fibrillation were also significantly higher than those in patients with normal sinus rhythm. Ten to fifteen minutes after PBMV, plasma endothelin concentrations in blood from the femoral vein significantly decreased from 16. 14 ± 3. 34 to 13. 74 ± 3. 78 pg/ml (P<0. 01 ). Seventy-two hours after the procedure, the concentrations of endothelin in blood from the antecubital vein had fallen to 12. 31 ± 2. 55 pg/ml (P<0. 001 vs. before PBMV and control subjects). Plasma endothelin concentrations still tended to be higher in patients with atrial fibrillation than those in normal sinus rhythm, but the difference did not reach statistical significance. There were weak but significantly correlations of plasma endothe lin concentrations with the mean left atrial pressure (r= 0. 424 , P < 0.001 ), mean right atrial pressure (r=0. 323, P<0. 01), mean transmitral pressure gradient (r= 0. 397, P<0. 001), heart rate (r= 0. 350,P<0. 005)and mitral valve area (r=-0. 454, P<0. 001) in the patients before and after PBMV.
文摘Plasma dynorphin A1-13 levels were measured in 33 patients with mitral stenosis before and after percutaneous balloon mitral commissurotomy (PBMC). The results show that the basal levels of plasma dynorphin in blood from the antecubital vein in the patients were significantly higher than those in 31 healthy control subjects. The increase in circulating dynorphin closely correlated with the functional cardiac status and the presence of atrial fibrillation. Ten to fifteen minutes after PBMC, plasma dynorphin levels in blood from the femoral vein increased significantly. Seventy-two hours after the procedure, the levels of plasma dynorphin in blood from the antecubital vein had decreased significantly , but they did not decrease to the normal range. Plasma dynorphin levels in blood from the femoral vein were positively correlated with the mean left atrial pressure and the mean right atrial pressure before the first balloon inflation. Plasma dynorphin levels in blood from the antecubital vein were positively correlated with the heart rate and the mean transmitral pressure gradient, and negatively with the mitral valve area before and 72 hours after PBMC.
