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巨大心臟患者術后氣管軟化塌陷二例

急診支氣管動脈栓塞術治療氣管鏡活檢后大咯血一例

Embosphere 微粒球栓塞大咯血出血靶血管的療效和安全性研究

目的 觀察 Embosphere 微粒球作為栓塞材料治療大咯血的近遠期療效和安全性。 方法 納入 2013 年 7 月至 2016 年 3 月收治的 82 例大咯血患者，采用 Embosphere 微粒球為主要的栓塞材料，栓塞支氣管動脈以及其他出血靶血管，觀察 24 h 內咯血有無停止，7 d 內有無咯血反復，以及圍手術期的不良反應。術后隨訪 1 年觀察咯血有無反復。 結果 患者術后 24 h 內咯血停止 78 例，明顯減少 3 例，無效 1 例；7 d 內有 1 例出現反復。近期有效率 97.6%（80/82）。隨訪 1 年，咯血復發 4 例，遠期有效率 92.7%（76/82）。圍手術期的不良反應主要為胸痛、胸悶和發熱，未發生嚴重并發癥。 結論 Embosphere 微粒球經出血靶血管栓塞治療大咯血的近期和中遠期療效確切，無嚴重的不良反應，值得臨床推廣應用。

Surgical Treatment Experience of Emergency Surgery in Treating Rheumatic Valves Patients with Preoperative Ventricular Electrical Storm

目的探討成人風濕性心臟瓣膜病術前并發心室電風暴（惡性室性心動過速、心室顫動）行急診手術的療效及體會。 方法回顧性分析2004年10月至2014年10月我院成人心臟瓣膜入院后突發惡性室性心動過速、心室顫動的患者6例，其中男2例，女4例，年齡35.0～64.0歲，平均49.8歲。6例患者均為風濕性心臟瓣膜病，二尖瓣中重度狹窄并主動脈瓣及三尖瓣中重度關閉不全2例，二尖瓣中重度關閉不全并三尖瓣中重度關閉不全4例，惡性心律失常發作后立即予艾司洛爾等藥物控制，病情基本穩定后急診手術。其中，行雙瓣膜置換+三尖瓣成形術2例，行二尖瓣置換+三尖瓣成形術4例。 結果無圍術期患者死亡，術后無心功能顯著惡化、無多臟器功能衰竭、無惡性室性心律失常。術后1～2周24 h動態心電圖提示室性早搏大于1 000次的2例，室性早搏500～1 000次1例，小于500次的患者3例，短陣室性心動過速2次的患者2例，短陣室性心動過速3次的患者1例。所有6例患者均安全出院，隨訪6個月至10年，無患者死亡。 結論急診外科手術聯合β受體阻滯劑在治療成人心臟瓣膜疾病術前突發的反復惡性室性心動過速、心室顫動安全有效。

The therapeutic effect and mid-term follow-up of 154 patients of multiple valvular surgery through right anterolateral intercostal thoracotomy: A retrospective cohort study

ObjectiveTo investigate the therapeutic effect, safety and effectiveness of multiple valvular surgery through right anterolateral intercostal thoracotomy, as well as the mid-term follow-up results and surgeon's learning curve.MethodsThe clinical data of 154 patients with multiple valvular disease were performed minimally invasive cardiac surgery in the Department of Cardiovascular Surgery, The First Affiliated Hospital of Air Force Medical University, from 2015 to 2019 were retrospectively analyzed. There were 103 males and 51 females, aged 23-68 years. Closed cardiopulmonary bypass was established through femoral artery and femoral vein, and the thoracic cavity was entered through a 6 cm transverse incision in the fourth intercostal space on the right side of sternum. Baseline and perioperative characteristics and postoperative outcomes were reviewed.ResultsThere was no perioperative death. The average cardiopulmonary bypass time was 159.3±39.4 min, and the aortic clamping time was 102.3±20.3 min. One patient underwent thoracotomy during the operation, and two patients underwent second thoracotomy for hemostasis. During the follow-up period of 10-55 months, 1 patient died, 2 patients developed mild perivalvular regurgitation, 6 patients developed moderate tricuspid regurgitation, and no serious cardiovascular events occurred in the rest of the patients.ConclusionOur findings demonstrate that multiple valvular surgery through right anterolateral intercostal thoracotomy is safe, and in an acceptable risk of complication. The early and middle follow-up results are satisfactory. The minimally invasive cardiac surgery can also meet the requirements of cosmetology, and is conducive to the recovery of patients' mental and physical health. This method is worthy of application in medical centers with rich experience in routine cardiac surgery.