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室間隔缺損的另一類型——左室右房通道一例

胸骨、肋骨嗜酸性肉芽腫16例的外科治療

Expression Change and Its Implication of Cell Adhesion Molecules CD11b/CD18, sPselectin in Perioperative Period of Cardiopulmonary Bypass

Abstract： Objective To observe the significance of the changes of cell adhesion molecules (CAM) CD11b/CD18 and sPselectin during the perioperative period of open heart surgery under cardiopulmonary bypass (CPB), and investigate the roles of CD11b/CD18 and sPselectin in systemic inflammatory response triggered by CPB. Methods Thirty patients including 18 males and 12 females, age ranged from 29 to 55 years (45.3±8.1 years) having undergone valvular replacement for rheumatic heart disease in our hospital were selected as the subjects of this research. After anesthesia induction, radial arterial blood sample was collected at six different time points including the time prior to skin incision, and 30 min, 1 h, 6 h, 12 h and 24 h following the start of CPB. The expression levels of CD11b/CD18 were tested by flow cytometry, and concentration of sP-selectin in the plasma was measured with enzymelinked immunosorbent assay(ELISA). Results The expression of CD11b/CD18 was elevated at 30min after CPB, and it reached the peak (581.44±215.26) at 6 h after CPB with significant differences (Plt;0.05). Its expression started to drop at 12 h after CPB, but it was still higher than the expression level before CPB. The expression returned under the level before CPB at 24 h after CPB with insignificance differences (Pgt;0.05). The expression of sPselectin in the peripheral blood started to rise evidently at 30 min after CPB, reaching the peak (51.44±10.06 ng/ml) with significant differences (Plt;0.05). Its expression level decreased at 12 h after CPB and fell back below the level before CPB with insignificant differences (Pgt;0.05). Conclusion CPB can cause the expression of CD11b/CD18 and sPselectin to rise in the peripheral blood, which may play an important role in the systemic inflammatory response triggered by CPB.

經冠狀靜脈竇持續低流量逆行灌注在雙瓣膜置換術中的應用

目的 總結冷晶體氧合血心臟停搏液經冠狀靜脈竇持續低流量逆行灌注在二尖瓣和主動脈瓣雙瓣膜置換術中的應用經驗。方法 將64例患者常規插管建立體外循環，降溫至32 ℃時阻斷升主動脈，先經主動脈根部或冠狀動脈開口順行灌注4 ℃冷晶體心臟停搏液(15～20 ml/kg)，心臟停搏后經冠狀靜脈竇持續低流量(70～150 ml/min)逆行灌注1∶4冷晶體氧合血心臟停搏液，于心內直視下行雙瓣膜置換術。 結果 開放主動脈后，53例(828%)患者心臟自動復跳，11例(17.2％)電擊復跳，均順利停機拔管。術后發生低心排血量綜合征3例，嚴重室性心律失常3例，死亡2例，其余患者9～13 d出院，無并發癥發生。隨訪56例（87.5%），隨訪時間5個月～2.5年，患者臨床癥狀消失，活動能力明顯改善，無晚期死亡；復查超聲心動圖提示人工機械瓣活動良好，無瓣周漏。 結論 冷晶體氧合血心臟停搏液經冠狀靜脈竇持續低流量逆行灌注具有良好的心肌保護效果。

女性重癥肌無力患者的外科治療與圍術期處理

摘要: 目的 總結女性重癥肌無力（MG）患者的外科治療及圍術期處理經驗。 方法 回顧性分析1979年1月至2007年12月收治的186例（包括川北醫學院附屬醫院胸心血管外科41例，南方醫科大學附屬南方醫院胸心血管外科145例）MG女性患者的臨床資料，年齡5～64歲，平均年齡43.9歲。按Osserman臨床分型，小兒MG45例，成人MG141例，其中眼肌型25例，輕度全身型63例，中度全身型29例，急性暴發型19例，晚期嚴重型5例。合并胸腺瘤166例，按Masaoka分期 I期40例，Ⅱ期69例，Ⅲ期44例，Ⅳ期13例。152例患者經胸骨正中切口徑路手術，行胸腺切除，縱隔淋巴結清掃術；34例胸腺無明顯增生經頸部橫切口行單純胸腺切除術。 結果 全組無手術死亡。圍術期發生MG危象22例，經相應的處理治愈。術后隨訪12個月以上165例,失訪21例。痊愈30例（18.18%）、基本痊愈28例（16.97%）、顯效60例（36.36%）、好轉25例（15.15%）、無效22例（13.33%）。Ⅰ型、Ⅱa 型、Ⅱb 型、Ⅲ型和Ⅳ型有效率分別為100.00%、93.10%、90.00%、77.27%和53.85%。 結論 女性MG患者經胸腺切除術治療效果良好；加強圍術期處理，合理使用抗膽堿酯酶藥物和激素，可減少各種MG危象的發生。