Objective In patients with pulmonary atresia and intact ventricular septum (PAIVS) without right ventricular-dependent coronaries,catheter techniques including the use of a sniff wire,lasers,and radiofrequency have be...Objective In patients with pulmonary atresia and intact ventricular septum (PAIVS) without right ventricular-dependent coronaries,catheter techniques including the use of a sniff wire,lasers,and radiofrequency have been the most widely used as initial therapy. However,percutaneous perforation and balloon valvuloplasty were associated with higher rate of procedural failure and展开更多
Fontan surgery is a widely used palliative procedure that significantly improves the survival period of patients with complex congenital heart disease（CHD）. However, it does not decrease postoperative complication r...Fontan surgery is a widely used palliative procedure that significantly improves the survival period of patients with complex congenital heart disease（CHD）. However, it does not decrease postoperative complication rate. Previous studies suggested that elevated mean pulmonary artery pressure（m PAP） and vascular resistance lead to decreased exercise tolerance and myocardial dysfunction. Therapy with endothelial receptor antagonists（Bosentan） has been demonstrated to improve the patients＇ prognosis. A double-blind, randomized controlled trial was performed to explore the efficacy of Bosentan in treating patients who underwent the Fontan procedure. Eligible participants were randomly divided into Bosentan group and control group. Liver function was tested at a local hospital and the results were reported to the phone inspector every month. If the results suggested abnormal liver function, treatment would be adjusted or terminated. All the participants finished the follow-up study, with no patients lost to follow-up. Unblinding after 2-year follow-up, no mortality was observed in either group. However, secondary end-points were found to be significantly different in the comparable groups. The cardiac function and 6-min walking distance in the Bosentan group were significantly superior to those in the control group（P=0.018 and P=0.027）. Bosentan could improve New York Heart Association（NYHA） functional status and improve the results of the 6-min walking test（6MWT） in Fontan patients post-surgery, and no other benefits were observed. Furthermore, a primary meta-analysis study systematically reviewed all the similar clinical trails worldwide and concluded an overall NYHA class improvement in Fontan patients who received Bosentan treatments.展开更多
Introduction: Intensive care unit (ICU) provides advanced specialized medical and nursing care for critically ill patients. Advanced monitoring techniques are needed to prevent physiologic deterioration, while the und...Introduction: Intensive care unit (ICU) provides advanced specialized medical and nursing care for critically ill patients. Advanced monitoring techniques are needed to prevent physiologic deterioration, while the underlying disease treated and resolved. Frequents invasive procedure and treatment are used and affect the death rate and length of hospitalization. This study aimed to describe the variables associated with critically ill patients and describe the standard invasive procedures or treatments used among patients in ICU. Method: A retrospective comparative study which utilized the ICU electronic database. The data of 446 dead patients who have admitted to ICU between January 2014 and December 2016 as a case of sepsis, heart failure or COPD exacerbation were enrolled. Result: Almost of all patients had received intravenous fluid and vasoactive drugs. The mechanical ventilation support and insertion of the indwelling urethral catheter commonly used among patients with critical illnesses;78.3%, 41.3% respectively. One-third of all sepsis and heart failure patients were received CVC during ICU stay;patients with sepsis illness had less hospital length of stay than patients with heart failure and COPD (p Conclusion: We found a reduction in the death number among sepsis, heart failure and COPD patients with move forwards in years, the variety of death rate depends on the type of invasive procedure and treatment performed for each illness, mechanical ventilation support and insertion of indwelling urethral catheter commonly used among patients with critical illnesses.展开更多
Critical aortic valve stenosis in newborns is the cause of a severe clinical condition with the onset of symptoms during first hours after birth.We present a clinical case of a successful surgical correction of a crit...Critical aortic valve stenosis in newborns is the cause of a severe clinical condition with the onset of symptoms during first hours after birth.We present a clinical case of a successful surgical correction of a critical aortic stenosis using a hybrid method applied in a newborn during the first day of life.The infant was diagnosed with a hypoplastic left heart complex with an intact atrial septum(aortic and mitral valves stenosis variant),that led to the cardiogenic shock and acute pulmonary edema.The procedure included bilateral banding of the pulmonary artery branches and atrioseptostomy with stenting of the interatrial septum.The surgery was performed through a median sternotomy.展开更多
目的 观察针药并用治疗肺部手术后慢性咳嗽的临床疗效。方法 将60例肺部手术后慢性咳嗽患者随机分为治疗组和对照组,每组30例。对照组口服复方甲氧那明胶囊治疗,治疗组在对照组基础上采用针刺肺经腧穴治疗。比较两组治疗前后中文版莱斯...目的 观察针药并用治疗肺部手术后慢性咳嗽的临床疗效。方法 将60例肺部手术后慢性咳嗽患者随机分为治疗组和对照组,每组30例。对照组口服复方甲氧那明胶囊治疗,治疗组在对照组基础上采用针刺肺经腧穴治疗。比较两组治疗前后中文版莱斯特咳嗽问卷(Mandarin Chinese version of the Leicester cough questionnaire, LCQ-MC)评分、中医证候积分及各项炎性指标[血清白细胞介素-8(interleukin-8, IL-8)、肿瘤坏死因子-α(tumor necrosis factor, TNF-α)]的变化情况,并比较两组的临床疗效。结果 两组治疗后LCQ-MC评分较治疗前显著增加(P<0.01),中医证候积分较治疗前显著降低(P<0.01),且治疗组优于对照组(P<0.01)。两组治疗后血清IL-8和TNF-α水平均较治疗前显著降低(P<0.01),且治疗组低于对照组(P<0.01,P<0.05)。治疗组和对照组总有效率分别为86.7%和63.3%,两组比较差异有统计学意义(P<0.05)。结论 针药并用可有效改善肺部手术后慢性咳嗽的临床症状,提高临床疗效。展开更多
目的探讨超声引导下椎旁阻滞对机器人辅助腹腔镜肾切除术患者术后肺功能的影响。方法选择择期行机器人辅助腹腔镜肾切除术患者80例,男40例,女40例,年龄30~70岁,BMI 18.5~35.0 kg/m^(2),ASAⅠ或Ⅱ级。根据随机数字表法将患者分为两组:椎...目的探讨超声引导下椎旁阻滞对机器人辅助腹腔镜肾切除术患者术后肺功能的影响。方法选择择期行机器人辅助腹腔镜肾切除术患者80例,男40例,女40例,年龄30~70岁,BMI 18.5~35.0 kg/m^(2),ASAⅠ或Ⅱ级。根据随机数字表法将患者分为两组:椎旁阻滞联合全麻组(PG组)和单纯全麻组(SG组),每组40例。两组术后均使用羟考酮静脉镇痛。记录术前1 d、术后1~5 d的用力肺活量(FVC)、第1秒用力呼气容量(FEV_(1))、最大呼气中期流量(MMEF)和SpO_(2)。记录术后1~5 d静息和活动(咳嗽)时VAS疼痛评分。记录丙泊酚用量、瑞芬太尼用量,镇痛泵有效按压次数、总按压次数和补救镇痛例数。记录术后首次下床活动时间、术后首次肛门排气时间、术后住院时间和不良反应的发生情况。记录术后5 d肺部并发症和术后30 d再次住院的发生情况。结果与术前1 d比较,术后1~5 d两组FVC、FEV_(1)及MMEF均明显降低(P<0.05),PG组术后1~4 d、SG组术后1~5 d SpO_(2)明显降低(P<0.05)。与SG组比较,PG组术后1~3 d FVC、术后1~5 d FEV_(1)和术后1~4 d MMEF、术后1~3 d SpO_(2)明显升高(P<0.05),术后1~2 d静息和活动时VAS疼痛评分明显降低(P<0.05),丙泊酚和瑞芬太尼用量、镇痛泵有效按压次数、总按压次数及补救镇痛率明显减少(P<0.05),术后首次下床活动时间、术后首次肛门排气时间和术后住院时间明显缩短(P<0.05),术后不良反应发生率和术后5 d的肺部并发症发生率明显降低(P<0.05)。结论超声引导下椎旁阻滞可为机器人辅助腹腔镜肾切除术患者提供更好的术后早期镇痛,改善术后肺功能,降低肺部并发症发生率。展开更多
Background and Objective Ablation within the pulmonary sinus of Valsalva (PSV) becomes increasingly common in certain ventricular outflow arrhythmia. Understanding the regional anatomy is intensively concerned to avoi...Background and Objective Ablation within the pulmonary sinus of Valsalva (PSV) becomes increasingly common in certain ventricular outflow arrhythmia. Understanding the regional anatomy is intensively concerned to avoid procedure complications. The purpose of this study is to describe the anatomic relationships of PSV to its adjacent structures using computed tomographic coronary angiograms (CTCA).展开更多
Background:Bilateral banding of the branches of the pulmonary artery in patients with hypoplastic left heart syndrome(HLHS)and other duct dependent critical neonatal heart malformations can significantly reduce the in...Background:Bilateral banding of the branches of the pulmonary artery in patients with hypoplastic left heart syndrome(HLHS)and other duct dependent critical neonatal heart malformations can significantly reduce the incidence of severe complications in the postoperative period,especially in severely unstable patients.In our study we compared different surgical techniques of bilateral pulmonary artery banding(PAB)in respect to their success in balancing systemic and pulmonary blood flow.Methods:We included 44 neonates with a HLHS and congenital heart diseases(CHD)with a functional single ventricle underwent a hybrid operation:bilateral PAB and patent ductus arteriosus stenting.The hybrid surgery for method No.1 is performed as a one-stage procedure,together with patent ductus arteriosus(PDA)stenting.After median sternotomy,two Gore-Tex 1–2 mm wide bands with a diameter of 3–3.5 mm are put.When we apply method No.2 then the thread is used to create bands.Method No.3 is distinguished by intraoperative assessment of blood flow at the site of narrowing of the branches of the pulmonary artery and optional stenting of the PDA.The cuff for banding is made of Gore-Tex tubing.Effectiveness when applying method Nos.1 and 2 is assessed by the change in invasive blood pressure and oxygen saturation after narrowing of the branches of the pulmonary artery.Also,with these techniques PDA stenting by inserting the introducer via pulmonary artery trunk is performed.Results:HLHS with mitral or aortic valve atresia or both was present in 19 patients(43.1%),with severe left heart obstruction resulting in PDA dependent systemic circulation in 16 babies(36.4%).CHD with single ventricle physiology occurred in 9 patients(20.5%).14 babies(31.8%)undergo the procedure following the method No.1,8 patients(18.2%)method No.2 and 22 patients(50%)method No.3.Qp/Qs=1/1 was achieved in 30 patients(30/44,68.1%):as a result of the method No.1 was achieved in 5 patients(5/14,35.7%),method No.2 in 4 patients(4/8,50%),method No.3 in 21 patients(21/22,95.5%).Multivariate regression analysis revealed that method No.3 significantly increases the chances of hemodynamic efficacy operations(OR=35.0;p=0.005;CI(95%)3–411.5).Conclusion:Application of the operation technique No.3 in combination with the intraoperative assessment of blood flow parameters at the site of banding of the branches of the pulmonary artery are the most optimal criteria for achieving Qp/Qs=1/1.If there are signs of restriction at the level of the foramen ovale,atrioseptostomy should be done in the second stage after bilateral pulmonary banding.展开更多
BACKGROUND Tracheal neoplasms represent less than 0.1%of all malignancies and have no established treatment guidelines.Surgical resection with reconstruction is the primary treatment.This study demonstrates successful...BACKGROUND Tracheal neoplasms represent less than 0.1%of all malignancies and have no established treatment guidelines.Surgical resection with reconstruction is the primary treatment.This study demonstrates successful treatment of concurrent lung and tracheal tumors using surgical excision and intraoperative photodynamic therapy(PDT),highlighting the effectiveness and safety of this approach.CASE SUMMARY A 74-year-old male with a history of smoking and chronic obstructive pulmonary disease was diagnosed with tracheal squamous cell carcinoma and right lower lobe adenocarcinoma.A multidisciplinary team created a treatment plan involving tumor resection and PDT.The tracheal tumor was removed through a tracheal incision and this was followed by intraluminal PDT.The trachea was repaired and a right lower lobectomy was performed.The patient received a second PDT treatment postoperatively and was discharged 10 d after the tracheal surgery,without complications.He then underwent platinum-based chemotherapy for lymphovascular invasion of lung cancer.Three-month postoperative bronchoscopy revealed normal tracheal mucosa with a scar at the resection site and no evidence of tumor recurrence in the trachea or lung.CONCLUSION Our case of concurrent tracheal and lung cancers was successfully treated with surgical excision and intraoperative PDT which proved safe and effective in this patient.展开更多
文摘Objective In patients with pulmonary atresia and intact ventricular septum (PAIVS) without right ventricular-dependent coronaries,catheter techniques including the use of a sniff wire,lasers,and radiofrequency have been the most widely used as initial therapy. However,percutaneous perforation and balloon valvuloplasty were associated with higher rate of procedural failure and
基金supported by the National Natural Science Foundation of China(No.31330029)
文摘Fontan surgery is a widely used palliative procedure that significantly improves the survival period of patients with complex congenital heart disease（CHD）. However, it does not decrease postoperative complication rate. Previous studies suggested that elevated mean pulmonary artery pressure（m PAP） and vascular resistance lead to decreased exercise tolerance and myocardial dysfunction. Therapy with endothelial receptor antagonists（Bosentan） has been demonstrated to improve the patients＇ prognosis. A double-blind, randomized controlled trial was performed to explore the efficacy of Bosentan in treating patients who underwent the Fontan procedure. Eligible participants were randomly divided into Bosentan group and control group. Liver function was tested at a local hospital and the results were reported to the phone inspector every month. If the results suggested abnormal liver function, treatment would be adjusted or terminated. All the participants finished the follow-up study, with no patients lost to follow-up. Unblinding after 2-year follow-up, no mortality was observed in either group. However, secondary end-points were found to be significantly different in the comparable groups. The cardiac function and 6-min walking distance in the Bosentan group were significantly superior to those in the control group（P=0.018 and P=0.027）. Bosentan could improve New York Heart Association（NYHA） functional status and improve the results of the 6-min walking test（6MWT） in Fontan patients post-surgery, and no other benefits were observed. Furthermore, a primary meta-analysis study systematically reviewed all the similar clinical trails worldwide and concluded an overall NYHA class improvement in Fontan patients who received Bosentan treatments.
文摘Introduction: Intensive care unit (ICU) provides advanced specialized medical and nursing care for critically ill patients. Advanced monitoring techniques are needed to prevent physiologic deterioration, while the underlying disease treated and resolved. Frequents invasive procedure and treatment are used and affect the death rate and length of hospitalization. This study aimed to describe the variables associated with critically ill patients and describe the standard invasive procedures or treatments used among patients in ICU. Method: A retrospective comparative study which utilized the ICU electronic database. The data of 446 dead patients who have admitted to ICU between January 2014 and December 2016 as a case of sepsis, heart failure or COPD exacerbation were enrolled. Result: Almost of all patients had received intravenous fluid and vasoactive drugs. The mechanical ventilation support and insertion of the indwelling urethral catheter commonly used among patients with critical illnesses;78.3%, 41.3% respectively. One-third of all sepsis and heart failure patients were received CVC during ICU stay;patients with sepsis illness had less hospital length of stay than patients with heart failure and COPD (p Conclusion: We found a reduction in the death number among sepsis, heart failure and COPD patients with move forwards in years, the variety of death rate depends on the type of invasive procedure and treatment performed for each illness, mechanical ventilation support and insertion of indwelling urethral catheter commonly used among patients with critical illnesses.
文摘Critical aortic valve stenosis in newborns is the cause of a severe clinical condition with the onset of symptoms during first hours after birth.We present a clinical case of a successful surgical correction of a critical aortic stenosis using a hybrid method applied in a newborn during the first day of life.The infant was diagnosed with a hypoplastic left heart complex with an intact atrial septum(aortic and mitral valves stenosis variant),that led to the cardiogenic shock and acute pulmonary edema.The procedure included bilateral banding of the pulmonary artery branches and atrioseptostomy with stenting of the interatrial septum.The surgery was performed through a median sternotomy.
文摘目的 观察针药并用治疗肺部手术后慢性咳嗽的临床疗效。方法 将60例肺部手术后慢性咳嗽患者随机分为治疗组和对照组,每组30例。对照组口服复方甲氧那明胶囊治疗,治疗组在对照组基础上采用针刺肺经腧穴治疗。比较两组治疗前后中文版莱斯特咳嗽问卷(Mandarin Chinese version of the Leicester cough questionnaire, LCQ-MC)评分、中医证候积分及各项炎性指标[血清白细胞介素-8(interleukin-8, IL-8)、肿瘤坏死因子-α(tumor necrosis factor, TNF-α)]的变化情况,并比较两组的临床疗效。结果 两组治疗后LCQ-MC评分较治疗前显著增加(P<0.01),中医证候积分较治疗前显著降低(P<0.01),且治疗组优于对照组(P<0.01)。两组治疗后血清IL-8和TNF-α水平均较治疗前显著降低(P<0.01),且治疗组低于对照组(P<0.01,P<0.05)。治疗组和对照组总有效率分别为86.7%和63.3%,两组比较差异有统计学意义(P<0.05)。结论 针药并用可有效改善肺部手术后慢性咳嗽的临床症状,提高临床疗效。
文摘目的探讨超声引导下椎旁阻滞对机器人辅助腹腔镜肾切除术患者术后肺功能的影响。方法选择择期行机器人辅助腹腔镜肾切除术患者80例,男40例,女40例,年龄30~70岁,BMI 18.5~35.0 kg/m^(2),ASAⅠ或Ⅱ级。根据随机数字表法将患者分为两组:椎旁阻滞联合全麻组(PG组)和单纯全麻组(SG组),每组40例。两组术后均使用羟考酮静脉镇痛。记录术前1 d、术后1~5 d的用力肺活量(FVC)、第1秒用力呼气容量(FEV_(1))、最大呼气中期流量(MMEF)和SpO_(2)。记录术后1~5 d静息和活动(咳嗽)时VAS疼痛评分。记录丙泊酚用量、瑞芬太尼用量,镇痛泵有效按压次数、总按压次数和补救镇痛例数。记录术后首次下床活动时间、术后首次肛门排气时间、术后住院时间和不良反应的发生情况。记录术后5 d肺部并发症和术后30 d再次住院的发生情况。结果与术前1 d比较,术后1~5 d两组FVC、FEV_(1)及MMEF均明显降低(P<0.05),PG组术后1~4 d、SG组术后1~5 d SpO_(2)明显降低(P<0.05)。与SG组比较,PG组术后1~3 d FVC、术后1~5 d FEV_(1)和术后1~4 d MMEF、术后1~3 d SpO_(2)明显升高(P<0.05),术后1~2 d静息和活动时VAS疼痛评分明显降低(P<0.05),丙泊酚和瑞芬太尼用量、镇痛泵有效按压次数、总按压次数及补救镇痛率明显减少(P<0.05),术后首次下床活动时间、术后首次肛门排气时间和术后住院时间明显缩短(P<0.05),术后不良反应发生率和术后5 d的肺部并发症发生率明显降低(P<0.05)。结论超声引导下椎旁阻滞可为机器人辅助腹腔镜肾切除术患者提供更好的术后早期镇痛,改善术后肺功能,降低肺部并发症发生率。
文摘Background and Objective Ablation within the pulmonary sinus of Valsalva (PSV) becomes increasingly common in certain ventricular outflow arrhythmia. Understanding the regional anatomy is intensively concerned to avoid procedure complications. The purpose of this study is to describe the anatomic relationships of PSV to its adjacent structures using computed tomographic coronary angiograms (CTCA).
文摘Background:Bilateral banding of the branches of the pulmonary artery in patients with hypoplastic left heart syndrome(HLHS)and other duct dependent critical neonatal heart malformations can significantly reduce the incidence of severe complications in the postoperative period,especially in severely unstable patients.In our study we compared different surgical techniques of bilateral pulmonary artery banding(PAB)in respect to their success in balancing systemic and pulmonary blood flow.Methods:We included 44 neonates with a HLHS and congenital heart diseases(CHD)with a functional single ventricle underwent a hybrid operation:bilateral PAB and patent ductus arteriosus stenting.The hybrid surgery for method No.1 is performed as a one-stage procedure,together with patent ductus arteriosus(PDA)stenting.After median sternotomy,two Gore-Tex 1–2 mm wide bands with a diameter of 3–3.5 mm are put.When we apply method No.2 then the thread is used to create bands.Method No.3 is distinguished by intraoperative assessment of blood flow at the site of narrowing of the branches of the pulmonary artery and optional stenting of the PDA.The cuff for banding is made of Gore-Tex tubing.Effectiveness when applying method Nos.1 and 2 is assessed by the change in invasive blood pressure and oxygen saturation after narrowing of the branches of the pulmonary artery.Also,with these techniques PDA stenting by inserting the introducer via pulmonary artery trunk is performed.Results:HLHS with mitral or aortic valve atresia or both was present in 19 patients(43.1%),with severe left heart obstruction resulting in PDA dependent systemic circulation in 16 babies(36.4%).CHD with single ventricle physiology occurred in 9 patients(20.5%).14 babies(31.8%)undergo the procedure following the method No.1,8 patients(18.2%)method No.2 and 22 patients(50%)method No.3.Qp/Qs=1/1 was achieved in 30 patients(30/44,68.1%):as a result of the method No.1 was achieved in 5 patients(5/14,35.7%),method No.2 in 4 patients(4/8,50%),method No.3 in 21 patients(21/22,95.5%).Multivariate regression analysis revealed that method No.3 significantly increases the chances of hemodynamic efficacy operations(OR=35.0;p=0.005;CI(95%)3–411.5).Conclusion:Application of the operation technique No.3 in combination with the intraoperative assessment of blood flow parameters at the site of banding of the branches of the pulmonary artery are the most optimal criteria for achieving Qp/Qs=1/1.If there are signs of restriction at the level of the foramen ovale,atrioseptostomy should be done in the second stage after bilateral pulmonary banding.
文摘BACKGROUND Tracheal neoplasms represent less than 0.1%of all malignancies and have no established treatment guidelines.Surgical resection with reconstruction is the primary treatment.This study demonstrates successful treatment of concurrent lung and tracheal tumors using surgical excision and intraoperative photodynamic therapy(PDT),highlighting the effectiveness and safety of this approach.CASE SUMMARY A 74-year-old male with a history of smoking and chronic obstructive pulmonary disease was diagnosed with tracheal squamous cell carcinoma and right lower lobe adenocarcinoma.A multidisciplinary team created a treatment plan involving tumor resection and PDT.The tracheal tumor was removed through a tracheal incision and this was followed by intraluminal PDT.The trachea was repaired and a right lower lobectomy was performed.The patient received a second PDT treatment postoperatively and was discharged 10 d after the tracheal surgery,without complications.He then underwent platinum-based chemotherapy for lymphovascular invasion of lung cancer.Three-month postoperative bronchoscopy revealed normal tracheal mucosa with a scar at the resection site and no evidence of tumor recurrence in the trachea or lung.CONCLUSION Our case of concurrent tracheal and lung cancers was successfully treated with surgical excision and intraoperative PDT which proved safe and effective in this patient.
