ObjectiveTo analyze the efficacy of one-stop carotid endarterectomy (CEA) and off-pump coronary artery bypass grafting (OPCABG) for patients with coronary artery disease (CAD) combined with carotid artery stenosis. MethodsThe clinical data of patients with CAD and severe carotid artery stenosis who underwent one-stop CEA and OPCABG in our department from March 2018 to June 2021 were retrospectively analyzed. Before the surgery, all patients routinely underwent coronary and carotid angiography to diagnose CAD and carotid artery stenosis. All patients underwent CEA first and then OPCABG in the simultaneous procedure. ResultsA total of 12 patients were enrolled, including 9 males and 3 females, aged 58-69 (63.7±3.4) years. All patients had unilateral severe carotid artery stenosis, and the degree of stenosis was 70%-90%. The lesions of carotid artery stenosis were located in the bifurcation of carotid artery or the beginning of internal carotid artery. All patients successfully underwent one-stop CEA combined with OPCABG. The number of bridging vessels was 2-4 (2.8±0.6). The operation time of CEA was 16-35 (25.7±5.6) min. There was no death during the perioperative or follow-up periods. No serious complications such as stroke and myocardial infarction occurred during the perioperative period. During the follow-up of 6-40 months, the patency rate of arterial bridge was 100.0% (12/12), and that of venous bridge was 95.5% (21/22). Cervical vascular ultrasound showed that the blood flow of carotid artery was satisfactory. ConclusionOne-stop CEA and OPCABG can be safely and effectively used to treat CAD and carotid artery stenosis. The early and middle-term curative effect is satisfactory.
Objective To compare the early compl ications of carotid stenting (CAS) and carotid endarterectomy (CEA) in treatment of carotid artery stenosis. Methods Between January 2005 and December 2007, 63 patients with carotid artery stenosis were treated with CEA in 36 cases (CEA group) and with CAS in 27 cases (CAS group). There were 42 males and 21 females with an average age of 67.5 years (range, 52-79 years). The locations were the left side in 28 cases and the rightside in 35 cases. The carotid stenosis was 60%-95% (mean, 79%). The major cl inical symptoms were stroke and transient ischemic attack. The cranial CT showed old cerebral infarction in 24 cases, lacunar infarction in 22 cases, and no obvious abnormal change in 17 cases. The encephalon, heart, and local compl ications were compared between 2 groups within 7 days after operation. Results In CEA group, encephalon compl ications occurred in 3 cases (8.3%), heart compl ications in 2 cases (5.6%), and local compl ications in 5 cases (13.9%); while in CAS group, encephalon compl ications occurred in 8 cases (29.6%), heart compl ications in 1 case (3.7%), and local compl ications in 3 cases (11.1%). The encephalon compl ication ratio of CAS group was significantly higher than that of CEA group (χ2=4.855, P=0.028); and there was no significant difference in other compl ications ratios between 2 groups (P gt; 0.05). Conclusion CEA is the first choice to treat carotid artery stenosis.
目的 研究需要行颈动脉外膜剥脱术脑瘫患儿全身麻醉（全麻）诱导时给予盐酸戊乙奎醚预防术后口腔分泌物过多的效果。 方法 2009年12月－2011年12月选择60例美国麻醉医师协会分级Ⅰ～Ⅱ级的需要在全麻下行颈动脉外膜剥脱术的脑瘫患儿，随机分为两组，每组30例。A组于麻醉诱导时静脉注射阿托品10 μg/kg，B组于麻醉诱导时静脉注射戊乙奎醚10 μg/kg。分别记录两组的麻醉持续时间、入室心率、气管插管后10 min的心率差、停药后的拔管时间及拔管时口腔分泌物评分[采用视觉模拟评分法（VAS）]。 结果 两组相比，患儿麻醉持续时间、入室心率和停药后拔管时间差异均无统计学意义（P＞0.05），而拔管时口腔分泌物的VAS评分差异有统计学意义（P＜0.05），其中口腔分泌物过多（VAS＞2分），A组为46.67%，B组为16.67%，B组比A组口腔分泌物更少，气管插管后10 min心率A组为（28.30 ± 9.73）次/min，B组为（9.93 ± 10.25）次/min，两组差异有统计学意义（P＜0.05）。 结论 盐酸戊乙奎醚能够有效减少需要行颈动脉外膜剥脱术的脑瘫患儿术后口腔分泌物过多的情况，且比常规应用阿托品的效果更好。
ObjectiveTo compare the effectiveness of radiofrequency ablation (RFA) combined with transilluminated powered phlebectomy (TIPP) vs. high ligation and stripping (HLS) combined with TIPP in patients with varicose veins of lower limbs.MethodsA retrospective analysis was made on the clinical data of 190 patients (206 limbs) of varicose veins of lower limbs who underwent surgical treatment in our hospital from December 2017 to July 2018, of them 88 patients (96 limbs) in RFA combined with TIPP group and other 102 patients (110 limbs) in HLS combined with TIPP group. The treatment effectiveness and quality of life was assessed with venous clinical severity score (VCSS) and chronic venous insufficiency questionnaire (CIVIQ-14) in three months and one year after surgery. Doppler ultrasound was used to evaluate the closure of great saphenous vein.ResultsBaseline characteristics were similar between the two groups (P>0.05). The RFA combined with TIPP group was better than the HLS combined with TIPP group in operation time, intraoperative bleeding, hospital stay time, postoperative bed time, resumption time of activities, as well as incidences of skin induration and limb numb (P<0.05). Occlusion rates of great saphenous vein in 3 months was 93.8% (90/96) in the RFA combined with TIPP group and 97.3% (107/110) in the HLS combined with TIPP group, and in one year was 91.7% (88/96) and 97.3% (107/110) respectively, there was no significant difference between the two groups at the same time point (P>0.05). The VCSS scores and CIVIQ-14 scores also improved significantly in two groups in 3 months and 1 year follow up (P<0.05), but there was no significant differences between the two groups at the same time point (P>0.05).ConclusionsRFA combined with TIPP is an effective method for the treatment of varicose veins of lower limbs. Compared with HLS, RFA has the same good effectiveness and quality of life, but it has the advantages of short operation time, rapid postoperative recovery, and less postoperative complications.
Abstract: Objective To retrospectively compare the difference of the effects of pulmonary thromboendarterectomy (PTE) between distal and proximal types of chronic thromboembolic pulmonary hypertension (CTEPH). Methods The data of 70 patients (including 44 male patients and 26 female patients, the average age was 46.2 years old, ranging from 17 to 72) with CTEPH having undergone PTE from March 2002 to March 2009 in Anzhen Hospital were retrospectively reviewed. We classified them into two different groups which were the proximal CTEPH group (n=51) and the distal CTEPH group (n=19) according to the pathological classification of the CTEPH. Clinical data, hemodynamics blood gas analysis and so on of both groups were compared. Results There was no perioperative deaths in both groups. Compared with the proximal group, cardiopulmonary bypass time [CM(159mm](189.5±41.5 min vs.155.5±39.5 min,P=0.003), aorta cross clamp time (91.3±27.8 min vs.67.2±27.8 min,P=0.002) and DHCA time (41.7±14.6 min vs.25.7±11.6 min,P=0.000) were significantly longer in the distal group. The incidence of residual pulmonary hypertension in the distal group was significantly higher than that in the proximal group (42.1% vs.13.7%,P=0.013), while the incidence of pulmonary reperfusion injury postoperatively in the proximal group was significantly higher than that in the distal group (41.2% vs.10.5%, P=0.021). SwanGanz catheterization and blood gas index were obviously improved in both groups. However, the pulmonary artery systolic pressure (PASP, 67.8±21.3 mm Hg vs.45.5±17.4 mm Hg,P=0.000) and the pulmonary vascular resistance ［PVR, 52.8±32.1 kPa/(L·s) vs.37.9±20.7 kPa/(L·s),P=0.024］ in the distal group were significantly higher than those in the proximal group and the partial pressure of oxygen in arterial blood of the distal group was significantly lower than that of the proximal group (76.7±8.7 mm Hg vs.88.8±9.3 mm Hg,P=0.000). After operation, 70 patients were followed up with no deaths during the followup period. The time of the followup ranged from 2 to 81 months (32.7±19.6 months) with a cumulative followup of 191.8 patientyears. Three months after operation, 47 patients were examined by pulmonary artery computer tomography angiogram (PACTA) and isotope perfusion/ventilation scan, which showed that the residual occlusive pulmonary artery segment in the proximal group was significantly fewer than that in the distal group (isotope perfusion/ventilation scan: 2.2±11 segments vs. 4.7±2.1 segments, P=0.000; PACTA: 3.5±1.4 segments vs. 4.9±2.0 segments,P=0.009). The New York Heart Association (NYHA) functional class and 6 minute walk distance (6MWD) in the proximal group were significantly better than those in the distal group (1.7±0.5 class vs 2.3±0.4 class; 479.2±51.2 m vs. 438.6±39.5 m, P=0.003). Venous thrombosis in double lower limbs reoccurred in two patients. According to KaplanMeier actuarial curve, the freedom from reembolism at 3 years was 96.7%±2.8%. Bleeding complications occurred in three patients. The linear Bleeding rate related to anticoagulation was 2.47% patientyears. Conclusion Although the early and midlong term survival rate of PTE procedure to treat both proximal and distal types of CTEPH is agreeable, the recovery of the PASP, PVR and 6MWD, and blood gases in patients with proximal type of CTEPH are significantly better than those in patients with distal type of CTEPH. On one hand, anticoagulation can singularly provide enough protection to patients with proximal type of CTEPH, but on the other hand, diuretics and pulmonary hypertension alleviation drug should be added to the treatment regimen for patients with distal type of CTEPH after the procedure of PTE.
Objective To estimate the relationship of methods and drugs for management of constrictive pericarditis during pericardiectomy. Methods We reviewed the records of 45 patients (mean age, 40.24±15.34 years) with a diagnosis of constrictive pericarditis who underwent pericardiectomy in our hospital from 2012 through 2014 year. During operation, inotropic agents, vasodilators and diuretics were used. According to the diuretics, patients were divided into two groups including a furosemide group(group F) with 38 patients and a lyophilized recombinant human brain natriuretic peptide (lrhBNP) group with 7 patients(group B). Results Preoperatively, 30 patients were pulmonary congestion, which was diagnosed by chest radiographs. Pericardiectomy was finished by off pump in 43 patients. Another 2 patients required cardiopulmonary bypass (CPB) for pericardiectomy. In the group F 52.6% of the patients needed vasodilators to reduce cardiac preloading following pericardiectomy. None of other vasodilators were used in the group B. After pericardiectomy, the fluctuation of systolic and diastolic pressure decreased significantly in the group B (P=0.01, respectively). In the group F, the fluctuation of diastolic pressure decreased significantly (P＜0.05). Low cardiac output was the most common postoperative problem. One patient accepted postoperative extracorporeal membrane oxygenation (ECMO) support. Postoperative poor renal function was found in 42.2% of the patients. Three of them needed hemofiltration. Postoperative poor renal function accompanied by poor hepatic function was found in 15.6% of the patients. One of them used dialysis and artificial liver. Three patients were respiratory failure with longer mechanical ventilation and tracheotomy. The overall perioperative mortality rate was 6.7% (3 patients). All patients, who died or used with hemofiltration, artificial liver and ECMO were found in the group F. Conclusion More stable haemodynamics after pericardiectomy may occur with using lrhBNP. lrhBNP may reduce postoperative major morbidity and mortality. Because of the small group using lrhBNP in our study, more patients using lrhBNP for pericardiectomy need to be studied.
周围静脉疾病是临床上的常见病和多发病，其发病率为20%～40%，皮肤营养障碍占2%～5%［1，２］ ,发病率比动脉疾病约高10倍，发病机理比动脉疾病复杂，分类方法亦不一致，至今存在着争论。下肢慢性静脉功能不全（chronic venous insufficiency,CVI）按其病因可分为原发性、继发性及先天性; 按解剖范围可分为浅、深和交通静脉3个系统，亦即包括浅静脉曲张、深静脉瓣膜功能不全、深静脉血栓形成后遗症、交通静脉瓣膜功能不全等［３，４］。多年来下肢浅静脉曲张主张施行大隐静脉高位结扎加剥脱术，但术后复发者较多。近年来，随着国内、外学者对CVI的深入研究，尤其是对深静脉瓣膜功能不全的认识，使传统下肢浅静脉曲张的概念发生了根本转变。下肢浅静脉曲张已不再被认为是一个独立的疾病，而是一种可由多种不同病因引起的共同临床表现……
Objective To identify the preoperative risk factors for prolonged mechanical ventilation (PMV) after pulmonary thromboendarterectomy (PTE). MethodsThe clinical data of patients who underwent PTE from December 2016 to August 2021 in our hospital were retrospectively analyzed. The patients were divided into two groups according to the postoperative mechanical ventilation time, including a postoperative mechanical ventilation time≤48 h group (≤48 h group) and a postoperative mechanical ventilation time>48 h (PMV) group (>48 h group). Univariable and logistic regression analysis were used to identify the preoperative risk factors for postoperative PMV. ResultsTotally, 90 patients were enrolled in this study. There were 40 patients in the ≤48 h group, including 30 males and 10 females, with a mean age of 45.48±12.72 years, and there were 50 patients in the >48 h group, including 29 males and 21 females, with a mean age of 55.50±10.42 years. The results showed that in the ≤48 h group, the median postoperative ICU stay was 3.0 days, and the median postoperative hospital stay was 15.0 days; in the >48 h group, the median postoperative ICU stay was 7.0 days, and the median postoperative hospital stay was 20.0 days. The postoperative PMV was significantly correlated with tricuspid annular plane systolic excursion (TAPSE) [OR=0.839, 95%CI (0.716, 0.983), P=0.030], age [OR=1.082, 95%CI (1.034, 1.132), P=0.001] and pulmonary vascular resistance (PVR) [OR=1.001, 95%CI (1.000, 1.003), P=0.028]. ConclusionAge and PVR are the preoperative risk factors for PMV after PTE, and TAPSE is the preoperative protective factor for PMV after PTE.