基于CCTA研究房颤患者行胸腔镜下LAAL术后左心耳形态与残余分流的相关性

目的:基于术后心脏CT血管成像(CCTA)技术,分析房颤(AF)患者行胸腔镜下左心耳缝扎术(LAAL)后残余分流(PDL)与左心耳(LAA)形态的关系。方法:选择暨南大学附属第一医院2017年11月至2023年4月间成功实施LAAL的AF患者62例,收集其临床资料,评估其术后CCTA图像并分析LAA形态学指标。根据LAAL术后复查结果将患者分为有PDL组(n=34)及无PDL组(n=28)。对两组患者之间具有统计学差异的各项指标进行Logistic回归分析,寻找危险因素。结果:将LAA各项参数指标纳入单因素Logistic回归进行分析,结果显示LAA短径(OR=0.393,95%CI:0.167~0.926,P=0.033)、LAA口长径(OR=0.330,95%CI:0.138~0.785,P=0.012)、LAA口短径(OR=0.083,95%CI:0.019~0.367,P=0.001)、LAA口周长(OR=0.078,95%CI:0.510~0.983,P=0.039)、LAA口面积(OR=0.499,95%CI:0.319~0.783,P=0.002)及LAA体积(OR=0.855,95%CI:0.768~0.953,P=0.005)均与术后PDL的发生相关。经多因素Logistic回归校正后,LAA口短径更长为PDL发生的独立危险因素。结论:经CCTA行LAA形态学评估对AF患者LAAL术后PDL的发生具有一定的预测价值,当LAA口短径较长时,需警惕PDL的发生。

Effect of MgCl2 Solution Impregnation Process on Properties of Alumina-spinel Castables

In order to improve the properties of purging plugs and to prolong their service life,this work attempted to impregnate alumina-spinel castables for purging plugs in refining ladle with saturated magnesium chloride solution under vacuum.After being impregnated for the first time,the specimens were treated in two different ways:(1)dried at 110℃for 24 h;(2)heated at 600℃for 3 h.Then they were impregnated for the second time.All specimens were heated at 1550℃for 3 h,then the cold properties and the high temperature properties were tested according to corresponding standards.Test results were compared and analyzed.The results show that:after being impregnated,the specimen have both better cold properties and high temperature properties,the microstructure analysis result proves that it is attributed to in situ formed spinel.However,because MgO produced by MgCl2-6H20 decomposing above 527℃can hydrate and destroy specimen microstructure,which can make the properties of specimens impregnated in the second way get worse.By comprehensive consideration,the first scheme way is more suitable.

深部胸壁感染655例外科治疗的单中心回顾性分析

目的探讨深部胸壁感染的外科治疗方法,以提高治愈率、降低复发率。方法回顾性分析河北医科大学附属燕达医院和北京中医药大学王府中西医结合医院2015年6月—2020年6月655例深部胸壁感染患者的临床资料,其中男450例、女205例,年龄(55.6±12.8)岁。肿瘤坏死胸壁感染8例,放疗后胸壁感染坏死15例,开胸术后胸壁感染632例(心脏大血管术后612例、普胸术后20例)。649例患者行清创及胸壁缺损肌瓣修复重建手术。结果平均手术时间(95±65)min,平均术中出血量(180±100)mL,平均术后住院时间(13±6)d。649例感染清创后肌瓣重建术中597例在术后2周内康复出院,伤口一期愈合率94.4%。全组患者死亡23例(3.5%)。中位随访时间25(2~40)个月,余632例患者中复发20例,复发率3.1%(20/632)。结论深部胸壁感染彻底清创后用帯蒂肌瓣修复胸壁缺损是最佳的治疗方法之一。