Transcatheter aortic valve implantation： a revolution in the therapy of elderly and high-risk patients with severe aortic stenosis

Transcatheter aortic valve implantation （TAV1） represents a real revolution in the field of interventional cardiology for the treatment of elderly or high-risk surgical patients with severe symptomatic aortic valve stenosis. Today, TAVI seems to play a key and a reliable role in the treatment of intermediate and maybe low-risk patients with severe aortic stenosis. TAVI has also evolved from a complex and hazardous procedure into an effective and safe therapy by the development of new generation devices. This article aims to review the background and future of TAVI, elinieal trials and registries with old and new generation TAVI devices and to focus on some open issues related to post-procedural outcomes.

Second-look surgery plus hyperthermic intraperitoneal chemotherapy for patients with colorectal cancer at high risk of peritoneal carcinomatosis:Does it really save lives?

The treatment of peritoneal carcinomatosis (PC) of colorectal origin with cytoreductive surgery(CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) has a 5-year recurrence-free or cure rate of at least 16%, so it is no longer labeled as a fatal disease, and offers prolonged survival for patients with a low peritoneal carcinomatosis index. Metachronous PC of colorectal origin is so predictable that there is a model which has been used to successfully determine the individual risk of each patient. Patients at risk are clearly identified; those with the highest risk have small peritoneal nodules present in the first surgery (70% probability of developing PC), ovarian metastases(60%), perforated tumor onset or intraoperative tumor rupture(50%). Current clinical, biological and imaging techniques still lack sufficient sensitivity to diagnose PC in its initial stages, when CRS plus HIPEC has a greater impact and a higher cure rate. Second-look surgery with HIPEC or prophylactic HIPEC at the time of the first intervention have been proposed as means of preventing and/or anticipating clinical or radiological relapse in at-risk patients. Both techniques have shown a significant decrease in peritoneal relapses and should be considered essential weapons in the management of colorectal cancer.

Hemodynamic monitoring and management of patients undergoing high-risk surgery:a survey among Chinese anesthesiologists

Hemodynamic monitoring and optimization improve postoperative outcome during high-risk surgery.However,hemodynamic management practices among Chinese anesthesiologists are largely unknown.This study sought to evaluate the current intraoperative hemodynamic management practices for high-risk surgery patients in China.From September 2010 to November 2011,we surveyed anesthesiologists working in the operating rooms of 265 hospitals representing 28 Chinese provinces.All questionnaires were distributed to department chairs of anesthesiology or practicing anesthesiologists.Once completed,the 29-item questionnaires were collected and analyzed.Two hundred and 10 questionnaires from 265 hospitals in China were collected.We found that 91.4%of anesthesiologists monitored invasive arterial pressure,82.9%monitored central venous pressure（CVP）,13.3%monitored cardiac output（CO）,10.5%monitored mixed venous saturation,and less than 2%monitored pulse pressure variation（PPV） or systolic pressure variation（SPV） during high-risk surgery.The majority（88%） of anesthesiologists relied on clinical experience as an indicator for volume expansion and more than 80%relied on blood pressure,CVP and urine output.Anesthesiologists in China do not own enough attention on hemodynamic parameters such as PPV,SPV and CO during fluid management in high-risk surgical patients.The lack of CO monitoring may be attributed largely to the limited access to technologies,the cost of the devices and the lack of education on how to use them.There is a need for improving access to these technologies as well as an opportunity to create guidelines and education for hemodynamic optimization in China.

Adjustable muscle plication:a new surgical technique for strabismic patients with high risk for anterior segment ischemia

【正】INTRODUCTION Anterior ciliary arteries provide 70%of the vascular supply of the anterior segment.A significant interruption of the vascular flow of these arteries increases the risk for anterior ischemia.Although the frequency of this special condition is low after strabismus surgery(1:13 000)[1],its effects may involve substantial visual problems[2].We report the successful outcome of a new surgical approach for strabismus management in a case of high risk for anterior ischemia.Specifically,we show the correction of the horizontal ocular deviation by means of an adjustable muscle

Prevalence of High Non-high-density Lipoprotein Cholesterol and Associated Risk Factors in Patients with Diabetes Mellitus in Jilin Province,China:A Cross-sectional Study

Dyslipidemia is a risk factor for cardiovascular diseases（CVDs）in patients with diabetes,and non-high-density lipoprotein cholesterol（non-HDL-C）is a better predictor of CVDs than low-density lipoprotein cholesterol（LDL-C）in patients with diabetes.Therefore,we aimed to investigate the distribution of non-HDL-C and the prevalence of high non-HDL-C level in Chinese patients with diabetes mellitus and identify the

Hybrid Common Femoral Artery Surgical Revascularization Associated to Endovascular Femoropopliteal Recanalization in High-Risk (ASA 3 - 4) Patients: A Seven-Year Period Institutional Experience

Objective: The present study was conceived to analyze the clinical benefit of hybrid interventions with surgical common femoral artery (CFA) reconstruction coupled to superficial femoral/popliteal endovascular recanalization for severe infrainguinal multilevel occlusive disease in high-risk ASA Class 3 - 4 patients. Material and Methods: From August 2008 until May 2015, a series of 143 hybrid infrainguinal interventions in 124 ASA Class 3 - 4 patients were performed in our department for Rutherford category 2 - 6 ischemic presentations. Patient demographics, specific risk factors, technical characteristics and patency results were retrospectively examined during a mean 36.8 months of follow-up. In a majority of 94 limbs (65%), the endovascular stage of interventions focused on long (>15 cm) femoropopliteal occlusions in parallel to regular CFA surgical revascularization. Two or three runoff tibial trunks were evinced in 84% cases, while one or none permeable vessel was found in 23 (16%) limbs. Results: Inasmuch surgical approach was successful in all cases, the endovascular stage was technically profitable in 134 (93%) cases. The ABI posto-peratively improved (>1.5) in 73% of cases, while clinical presentation gained at least one Rutherford category in 89% limbs. The mean hospital stay was 6.1 days (3 - 12 days) whereas the 30-day mortality rate in this homogeneous “high-risk” group of patients was 3.2%. Global risk factors alike age (>70 years/p = 0.0005), smoking ((p = 0.0170) and female gender (p = 0.0111), together with CTOs length (>15 cm/(p = 0.0470), severe calcifications (p = 0.0001), poor tibial runoff (p = 0.0001), TASC “C” and “D” lesions (p = 0.360 and (p = 0.0394), the stent number ((n = 3) and length (>6 cm) ((p = 0.0039 and (p = 0.0003) and the initial ABI scoring ((p = 0.0051) showed statistical negative influence on primary patency. Conclusion: Hybrid infrainguinal revascularization may afford useful results in selected ASA “high risk” patients, owning low invasiveness, reproducibility and acceptable patency in return to punctual postoperative surveillance.

Effects of Health Education with Problem-Based Learning Approaches on the Knowledge, Attitude, Practice and Coping Skills of Women with High-Risk Pregnancies in Plateau Areas

Objective: Given the unique cultural background, way of life, and physical environment of the Tibetan Plateau, this study aims to investigate the effects of health education using problem-based learning (PBL) approaches on the knowledge, attitude, practice, and coping skills of women with high-risk pregnancies in this region. Methods: 76 high-risk pregnancy cases were enrolled at Tibet’s Linzhi People’s Hospital between September 2023 and April 2024. 30 patients admitted between September 2023 and December 2023 were selected as the control group and were performed with regular patient education. 46 patients admitted between January 2024 and April 2024 were selected as the observation group and were performed regular patient education with problem-based learning approaches. Two groups’ performance on their health knowledge, attitude, practice and coping skills before and after interventions were evaluated, and patient satisfaction were measured at the end of the study. Results: There was no statistical significance (P P P Conclusions: Health education with problem-based learning approaches is worth promoting as it can help high-risk pregnant women in plateau areas develop better health knowledge, attitude and practice and healthier coping skills. Also, it can improve patient sanctification.

Nursing Effects of Medical Treatment Combination on Patients at High Risk of Developing Pressure Ulcers at Rural Homes

Objective:To explore the nursing effects of medical treatment combination on patients at high risk of developing pressure ulcers at rural homes.Methods:From January 2018 to December 2018,86 patients at high risk of developing pressure ulcers at rural homes who were in Wenjiang Hospital were randomly divided into a control group and an observed group.The control group received the routine publicity and education and visiting,while the observed group adopted the cooperative nursing model of medical treatment combination.Then compare the healing status and nursing satisfaction of the two groups.Results:Of the 43 patients with pressure ulcers in the observed group,18 had been in the second stage of pressure ulcers and 16 had been healed;14 had been in the third stage of pressure ulcers and 8 had been healed;11 had been in the fourth stage of pressure ulcers and 5 had been healed.The nursing satisfaction of the patients in the observed group was 95.35%.Conclusion:Conducting medical treatment combination on patients at high risk of developing pressure ulcers at rural homes can effectively improve the patients’and their families’awareness of pressure ulcer nursing,standardize their nursing behaviour,help recover the patients themselves and promote the patients’satisfaction.

经尿道前列腺等离子双极电切术治疗高危良性前列腺增生患者的多中心、前瞻性研究

目的探讨经尿道前列腺等离子双极电切术(transurethral plasmakinetic resection of prostate,TUPKP)治疗高危良性前列腺增生(BPH)患者的临床疗效。方法采用前瞻性多中心研究设计。在全国20家医院泌尿外科按照纳入排除标准,入组行TUPKP治疗的高危BPH患者,分析患者基线、围手术期及术后3个月随访的相关数据,评价疗效和安全性。结果2016年9月至2018年12月共入组229名高危BPH患者。与基线相比,术后3个月随访的国际前列腺症状评分改变量为-17.28[95%CI(-18.02,-16.54)]分、最大尿流率改变量为5.61[95%CI(0.68,10.54)]mL·s^(-1)、残余尿量改变量为-84.50[95%CI(-96.49,-72.51)]mL、生活质量评分改变量为-3.24[95%CI(-3.42,-3.06)]分,差异均具有统计学意义(P<0.05)。术中及术后并发症的发生率低,未发生与手术相关的不良事件。结论TUPKP可以用于治疗高危BPH患者,建议由技术熟练的术者实施手术。

广州市某三甲医院开展“疑难高风险患者谈话”的现状与效果分析

为进一步做细做实医疗投诉纠纷前端预防和源头化解工作,医院及时总结既往投诉纠纷事项中患者反映的突出问题和关心的焦点问题,结合医疗工作中存在的收治患者疾病类型较重、治疗方案复杂、风险高等特点,自2020年以来,积极在高风险科室开展疑难高风险患者谈话工作,形成了由医务管理部门、纠纷管理部门联合临床科室共同进行术前/治疗前谈话的工作机制。在医患沟通过程中充分贯彻以患者为中心的人文理念,促进沟通质量提升,使医疗安全更有保障,患者满意度高,取得了较好效果。

组合式外固定架治疗高危老年肱骨近端骨折患者术后凝血功能改变与年龄相关性分析

目的探究组合式外固定架治疗高危老年肱骨近端骨折术后患者凝血功能与年龄的相关性。方法回顾性分析2020年1月至2021年12月于河北省中医院骨伤科行组合式外固定架固定手术治疗的70例高危老年肱骨近端骨折患者的临床资料,其中男25例,女45例;60~69岁组22例,70~79岁组28例,80~89岁组18例,90~99岁组2例。比较4组患者术前1 d,术后1、3、7、14 d凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)、D-二聚体各指标变化情况。结果4组患者术前1 d,术后1、3、7、14 d PT、APTT、TT、FIB、D-D差异无统计学意义(P>0.05)。术后70例患者均未出现上肢深静脉血栓。组合式外固定架固定术治疗高危老年肱骨近端骨折手术前后患者凝血四项、D-二聚体指标变化与年龄的相关性较小。结论组合式外固定架固定术治疗高危老年肱骨近端骨折术后患者凝血功能不受年龄影响而改变,深静脉血栓的发生率低。

体外膜肺氧合辅助治疗高危复杂冠心病患者行PCI的临床效果

目的评估体外膜肺氧合(ECMO)辅助治疗接受经皮冠状动脉介入(PCI)的高危复杂冠心病患者(complex high-risk and indicated patients,CHIPs)的临床效果。方法回顾性分析52例CHIPs并接受PCI治疗的患者,按ECMO辅助时机分为术前辅助组(n=24)和术中辅助组(n=28)。对比两组患者基线资料、术前状态、院内病死率、冠状动脉造影结果、冠状动脉评分及并发症发生率。结果术前辅助组院内病死率显著低于术中辅助组(12.5%vs.64.3%,P<0.001)。术前辅助组中有5例(20.8%)联合使用主动脉内球囊反搏(intra-aortic balloon pump,IABP),而术中辅助组则为14例(50%)。两组白细胞计数、高密度脂蛋白水平、术中最差乳酸值及总病死率差异有统计学意义(均P<0.05),术前辅助组表现更佳。术前辅助组神经系统、心脏及四肢并发症的发生率也显著低于术中辅助组(均P<0.05),但冠脉评分、冠状动脉造影结果、冠脉血管病变程度、体外膜肺氧合上机操作时间、辅助时间及PCI手术时间等差异无统计学意义(均P>0.05)。结论ECMO辅助CHIPs患者PCI治疗时,术前应用更能有效降低病死率及ECMO相关并发症的发生率,可为CHIPs患者的治疗提供一种更为优化的策略。

预立医疗照护计划在高风险手术病人中的应用进展

介绍高风险手术病人和预立医疗照护计划的概念内涵,综述预立医疗照护计划在高风险手术病人中应用的必要性、启动时机、参与人员、讨论内容、干预措施、辅助工具、影响因素,以期为我国在外科环境中开展预立医疗照护计划提供参考。

EVALUATION OF A TUBULAR MESH AND A SPIRAL STENT WOVEN FROM TITANIUM NICKEL ALLOY FOR PROSTATIC OBSTRUCTION IN PATIENTS AT HIGH RISK FOR SURGERY REPORT OF 62 CASES

The use of two urethral stents woven from titanium nickel alloy (TiNi) in the form of a tubular mesh or a spiral stent (both made in China) is described. They were implanted in 62 patients,vith prostatic outflow obstruction. till patients were considered contraindicated for surgery. They were divided into a spiral stent group (group I) treated between March 1992 and May 1993, comprising 35 cases, and a tubular mesh group (group 2) treated between October 1993 and December 1994, comprising 31 cases, including four failures in group 1. Thirty-three out of the 35 patients in group 1 were treated successfully. Good results were achieved in eight cases (22.8%) and significant improvements occurred in 24 (68.5%), giving a total effective rate of 91.3%, with a follow-up of 11 to 27 months. Fourteen stents were removed within 6 months after the insertion and six more were removed within 12 months. The mean effective time of the stent in situ was 10.8 months. All 31 cases in the mesh group were treated successfully. Dramatically good effects were obtained in 28 cases (over 90%) and distinct improvements were achieved in two, giving a total effective rate of over 96.5%, with a follow-up of 6 to 14 months (mean 10.5 months). Cystoscopy was carried out in 12 patients after 6 months following the insertion. The major part of the meshes became covered by urothelium. Compared with the spiral, the mesh makes it possible to insert a prosthesis with a larger diameter and anti-pressure. The spiral, however, can be used as a temporary alternative for the relief of prostatic obstruction. A tubular mesh can work well for the relief of prostatic obstruction and remain in situ without causing major problems for at least I year.

中医调护法联合延续护理干预对糖尿病足高危患者足部护理知识及自我管理能力的影响

目的 探讨应用中医调护法联合延续护理干预对糖尿病足高危患者足部护理知识、自我管理能力的影响。方法 选取2021年1月-2023年2月本院收治的糖尿病足高危患者80例为研究对象,遵循随机数表法分成实验组(n=40)、对照组(n=40)。对照组患者应用常规护理,实验组患者在常规护理的基础上,给予患者加用中医调护法联合延续护理干预。比较两组患者的足部护理知识得分、干预前后患者自我管理能力得分变化。结果 实验组患者在干预后的足部护理知识得分各项均高于对照组,差异有统计学意义(P<0.05);在干预后患者自我管理能力的各方面得分相比干预前提高,而实验组分值高于对照组,差异有统计学意义(P<0.05)。结论 针对糖尿病足高危者,应用中医调护法联合延续护理干预,能显著提高患者足部护理知识掌握情况,此外也可提高患者自我管理能力。

高危老年胆总管大结石患者塑料胆管支架置入后支架堵塞的影响因素分析

目的探讨合并慢性病的高危老年胆总管大结石患者,经塑料胆管支架置入治疗后影响支架堵塞的危险因素。方法回顾性分析2016年1月至2024年3月因胆总管大结石在解放军总医院第一医学中心行ERCP下塑料胆管支架置入治疗的高危老年患者资料,所有患者均随访3个月并在3个月内行第二次ERCP治疗。根据患者是否出现支架堵塞将患者分为堵塞组和通畅组。比较两组间的一般资料、化验结果、结石大小、是否存在壶腹周围憩室、支架种类和直径等指标,采用多因素logistics回归分析评估影响塑料胆管支架堵塞的危险因素。结果共入组111例患者,其中堵塞组28例,通畅组83例,支架堵塞率为25.23%。单因素分析示术前白细胞计数、丙氨酸氨基转移酶、壶腹周围憩室、支架直径在两组之间比较,差异有统计学意义(P值均<0.05)。多因素logistics回归分析显示,WBC[OR(95%CI):1.209(1.074~1.361)]、支架直径[OR(95%CI):0.279(0.088~0.887)]、壶腹周围憩室[OR(95%CI):3.396(1.077~10.710)]是术后支架堵塞的独立危险因素(P值均<0.05)。结论术前白细胞计数升高及存在壶腹周围憩室的患者术后发生支架堵塞的风险高,直径更大的胆管支架可有效降低术后支架堵塞的风险。

粤北地区脑卒中高危人群筛查和干预项目患者满意度的影响因素分析

目的:分析粤北地区脑卒中高危人群筛查和干预项目患者满意度的影响因素,为粤北地区脑卒中高危人群筛查和干预工作提供理论指导。方法:通过问卷方式对粤北地区接受脑卒中高危人群筛查和干预的305例患者进行满意度调查,时间范围为2022年1月至2023年12月,主要内容包括患者基本情况、满意度评价内容。分析患者满意度分布情况,后采用多因素logistic回归模型分析患者满意度的影响因素。结果:305例患者中,满意组47例(18.22%),不满意组258例(81.78%)。两组患者在危害认知、医护人员态度、就医流程、住院健康教育方式、住院健康教育内容、就医环境、出院教育方式、出院教育内容、就医费用、随访方式、随访次数、复查的满意度方面比较,差异均具有统计学意义(P<0.05)。多因素logistic回归分析结果显示,对危害认知低(OR=4.677,P=0.004)、对就医费用不满意(OR=3.673,P=0.009)是患者满意度的独立危险因素。结论:应充分关注患者对当前脑卒中高危人群筛查和干预项目满意度的影响因素,以危害认知、就医费用为发展导向,健全脑卒中高危人群筛查和干预项目服务体系,满足患者的诊疗服务。

踝臂指数评价高危患者下肢外周动脉病多中心临床研究

目的 通过测量踝臂指数 (ankle -brachialindex ,ABI)评价我国高危患者下肢外周动脉病 (peripheralarterialdisease ,PAD)的患病情况。方法 对入院的 691例多家研究中心的高危患者进行踝臂指数测定 ,并进行资料收集和统计学处理。结果 691例高危患者中PAD患病率为 3 4.3 % ,在≤ 5 9岁高危患者中PAD患病率为 12 .5 % ,而在≥ 60岁老年高危患者中为 40 .0 %。冠心病(coronaryheartdisease ,CHD)患者PAD患病率为 3 5 .8% ,缺血性卒中 (ischemicstroke ,IS)患者PAD患病率为 3 5 .9%。 10 .7%的高危患者同时合并CHD、IS和PAD。同一年龄组内 ,不同性别的PAD患病率之间差别无统计学意义。PAD患者只有 6.3 %既往有PAD史记录 ,而绝大多数患者 (93 .7% )的PAD没有得到明确诊断。结论 动脉粥样硬化是多血管疾病 ;PAD在高危患者中常见 ,在≥ 60岁老年高危患者中更常见 ;PAD患病率与性别无关联。

芪苓通络方联合甲泼尼龙与环磷酰胺治疗特发性膜性肾病中高危患者临床观察

目的：观察芪苓通络方联合甲泼尼龙与环磷酰胺治疗特发性膜性肾病中高危患者临床疗效。方法：采用随机、对照的临床研究方法,将80例患者随机分为治疗组和对照组。对照组给予甲泼尼龙＋环磷酰胺,治疗组在对照组基础上予中药汤剂芪苓通络方加味治疗,比较两组患者疗效、24 h尿蛋白定量、血浆白蛋白、肾功能、血脂、纤维蛋白原、D-二聚体等指标的变化。结果：治疗组经6个月治疗后疗效优于对照组（P〈0.05）,24 h尿蛋白定量、纤维蛋白原、D-二聚体均下降,血浆白蛋白升高,与对照组比较差别有统计学意义（P〈0.05）;肾功能、血脂指标均改善,治疗过程中不良反应少。结论：中西医结合方案治疗特发性膜性肾病中高危患者疗效较好,安全性更高。

铥激光与绿激光治疗80g以上高龄高危BPH的疗效比较

目的:比较经尿道选择性绿激光前列腺汽化术(PVP)与经尿道铥(2微米)激光前列腺汽化切除术(TmLRP)治疗80 g以上高龄高危良性前列腺增生(BPH)的疗效。方法:分别用PVP及TmLRP治疗80 g以上高龄BPH患者各82例、36例。比较两种术式的手术时间、费用、术中失血量,并发症及近期疗效等指标。结果:118例均安全度过围手术期,未出现严重并发症,未输血。TmLRP组的平均手术时间、术后膀胱冲洗时间及手术费用均明显少于PVP组(P<0.05)。两组术后国际前列腺症状评分(IPSS)、生活质量评分(QOL)、残余尿量(PVR)及最大尿流率(Qm ax)均明显改善(P(0.05),但两组间改善程度无明显差别(P(0.05)。结论:PVP与TmLRP治疗80 g以上高龄高危BPH安全有效,TmLRP在手术时间及费用方面优于PVP。