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Objective To investigate the relationship between the systolic/diastolic orthostatic hypotension(OH S/OH-D) and myocardial infarction (MI) in the elderly.Methods 200 subjects without myocardial infarction (MI) aged 60 years and over in our urban district were selected.The orthostatic and supine blood pressure and heart rate were measured in supine position after resting for more than 5 minutes and at 0 and 2 minutes after standing.All eases were divided into systolic orthostatic hypotension(OH-S)or diastolic orthostatic hypotension(OH-D)groups based on the results of orthostatic hypotension,and followed up by telephone with mean period of 325 days.The primary endpoint was MI occurrence for analyzing the correlation between OH-S/OH-D and MI incidence.Results The prevalence rate of OH in this cohort was 38％,with OH-S 20％ and OH-D 18％.In the very elderly group(≥80 years)versus the elderly group,the occurrences of 0H and OH-S were(27％ vs.21 ％,P =0.036;22 ％ vs.15 ％,P =0.020),respectively,while no significant difference was found in OH-D between the two groups.After 325 day follow up,the prevalence of MI was significantly(P＜ 0.05)higher in the OH positive subjects than in the 0H negative subjects,which result was the same as the prevalence of MI in OH-S or and OH-D group.After adjusting for age,supine blood pressure,creatinine and cerebrovascular history,logistic regression analysis showed that MI was correlated with OH(HR 15.72,95％CI 3.29～74.23,P=0.002),OH-S(HR 8.552,95％CI 2.51～30.21,P=0.004)and OH-D(HR 3.80,95 ％CI 1.14～13.80,P=0.042).Compared with OH-D,OH-S had more significant correlation with MI.Conclusions Orthostatic hypotension,particularly systolic orthostatic hypotension,is common in elderly patients.The OH-S and OH-D have a significant correlation with MI.
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Objective To review our surgical treatment experience and analyze the surgical methods and efficacy of Stanford type A acute aortic dissection in elderly patients.Methods We recruited 24 patients aged over 60 years with Stanford type A acute aortic dissection treated surgically with deep hypothermic circulatory arrest and selective cerebral perfusion from June 2013 to September 2016.Depending on the patients` conditions, we selected different surgical methods, including Bentall operation in 3 cases, David operation in 1 case, partial aortic arc replacement+Bentall operation in 3 cases, total aortic arch replacement+stented elephant trunk implantation technique+Bentall operation in 12 cases, total aortic arch replacement+stented elephant trunk implantation technique+ascending aorta replacement in 5 cases, and concomitant coronary artery bypass grafting (CABG) in 3 cases.Results Surgical operation was successful in all the 24 patients.The average CPB time of the all patients was (192.9±37.1)min, the aortic cross-clamp time was (120±28.72)min, deep lower temperature of cerebral perfusion time was (36.2±11.3)min, and operation time was (544.8±91.2)min.Soon after the operation, two patients died of multiple organ dysfunction syndrome and renal failure complicated with infection, respectively.Postoperative complications included brain nerve dysfunction in 2 cases;renal insufficiency in 4 cases, which werelater treated with CRRT;pulmonary infection and tracheotomy in 3 cases;dysfunction in lower extremities in 1 case;hyoxemia in 3 cases;and incision infection in 2 cases.All the patients were followed up for 2-38 months, one patient was hospitalized because of hydropericardium and another one died of sudden death with unclear cause.Conclusion Surgical treatment of Stanford type A acute aortic dissection can obviously decrease the mortality and improve the quality of life.Total aortic arch replacement combined with transaortic stented graft implantation into the descending aorta is a classic clinical surgical treatment.Precise diagnosis, suitable surgical treatment and post-operative care are all important factors contributing to patients` recovery.
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Objective To explore the technology and curative effect of thoracic endovascular aortic repair (TEVAR) for Stanford type B aortic dissection.Methods The clinical data of 85 patients with Stanford type B aortic dissection,who were admitted to authors' hospital during the period from January 2010 to April 2016 to receive TEVAR,were retrospectively analyzed.Conventional left brachial artery puncture and straight incision of right femoral artery were employed in all 85 patients,and DSA of ascending aorta was performed to find out the position of rupture,the position of the true and false lumens,and their relationship with the vascular openings of important organs.Endovascular covered stent was implanted to seal off the primary rupture;reexamination of ascending aorta angiography was adopted to check the sealing-off condition of the proximal rupture and the changes of blood flow in the aortic branches as well as in the true and false lumens.Results Successful TEVAR was accomplished in 84 patients.One patient died of sudden rupture of aortic dissection during preoperative anaesthesia.The technical success rate was 100％.In 9 patients the covered stent partially overlapped the left subclavian artery,in one patient the left subclavian artery “chimney” stem completely obstructed both the left common carotid artery and the left subclavian artery,and bypass surgery between left common carotid artery and left subclavian artery was carried out in 2 patients.After the treatment,internal leakage of type Ⅰ was detected in 2 patients.No death occurred during hospitalization period.After the surgery the patients were followed up for 3 months to 3 years,and all patients survived.New rupture at the distal site occurred in 2 patients.Conclusion For the treatment of Stanford type B aortic dissection,TEVAR is safe and effective.Strict observance of surgical indications,careful operative manipulation,and strengthening postoperative management after discharge from hospital are the key points to ensure a successful surgery as well as to improve the long-term survival rate.
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Objective To investigate the effects of enhanced external counterpulsation on coronary heart diseas epatients who suffer from insomnia .Methods Ninety-two cases of coronary heart disease patients with insomnia were divided into observation group and control group randomly ,46 cases in each group .The cases in control group were given routine drug treatment and nursing for coronary heart disease and insomnia .On this base ,the cases in observation group were given EECP .Use the pittsburgh sleep quality index (PSQI) to evaluate the sleep quality of two groups on day of admission and 30d after treatment .The dimensions score and total score of two groups in each time were compared and analyzed .Results After the intervention of 30 d ,PSQI scores in the observation group were lower than those before intervention ,and lower than that of control group ,and there was statistical signifi-cance(P<0 .05) .Conclusion The EECP can relieve the insomnia of coronary heart disease patients ,and improve there sleep quali-ty .
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Objective To summarize clinical outcomes of interventional therapy on children with common congenital heart diseases(CHD).Methods A retrospective study was conducted.One hundred and fourteen patients with CHD were selected as our subjects,who underwent catheter interventional therapy in the Second Affiliated Hospital of Zhengzhou University from Jan.2004 and Dec.2012.The size of occluder was chose according to intraoperative echocardiography or cardiac imaging measurements,and occluder was released under assisted monitoring by subtraction angiography or cardiac ultrasound.Results There are all together 112 patients got the therapy successfully,2 cases failed(occluder detachment),and the success rate of operation was 98.2％.After the success of interventional,echocardiography examination showed that 11 cases were with star point across shunt,but the function of the around valve was not affected.One months after operation,echocardiography examination showed star point across shunt of 11 cases were disappeared,and no occluder was shifted as well as no thrombosis formed.Three months after operation,chest radiograph showed pulmonary congestion decreases and heart shadow was shrink.Thirty-eight cases were with three tricuspid regurgitation before operation and 32 cases were without reflux at 3 months after operation,and 6 cases relieved significantly.The patients were followed up for 6 months or 3 years,activity endurance was significantly improved than that before operation.No occluder was shiftand hemolysis and arrhythmia occurred.Meanwhile,No thrombosis or embolism occurred.Conclusion Interventional treatment for children with congenital heart disease is proved as a safe,effective methods and it have broad prospects in clinical application.
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Objective To investigate the protective effects of warm oxygenated leukocyte-depleted blood cardioplegia on myocardium during cardiac valve replacement. Methods Forty patients of both sexes undergoing elective valve replacement under CPB were randomly allocated into two groups (n = 20 each) : control group and study group. Warm blood cardioplegia was used in both groups, while in study group the leukocytes in the blood used for cardioplegia were depleted with FT-RL type leukocyte filter. The T0 of the cardioplegic solution was maintained at 32-35℃. Blood samples were taken for determination of plasma concentrations of human heart fatty acid-binding protein (HH-FABP) and malonaldehyde (MDA) and myocardial tissue was obtained from right atrium for determination of myeloperoxidase (MPO) activity before aortic cross-clamping (T0), immediately after (T1) and 30 and 60 min after aortic unclamping (T2 ,T3).Results The two groups were comparable with regard to sex, age, body weight, height, cardiac function and CPB and aortic cross-clamping time. The plasma concentrations of HH-FABP and MDA were significantly increased after aortic unclamping (T2,3) compared to the baseline (T0) in both groups but were significantly lower in study group than in control group (P