Surgical treatment for 37 patients with acute type A aortic dissection involving coronary arteries / 中华胸心血管外科杂志

Objective To summarize the treatment experience and strategies of patients with acute type A aortic dissection involving coronary arteries in order to improve the efficacy of such patients.Methods Between March 2013 and April 2016,we recruited 37 patients with coronary involvement caused by acute type A aortic dissection,26 men,11 women;mean age (49.7 ± 10.4) years.All procedures were done on an emergency basis within 24 hours after the patient's arrival.Results Acute type A aortic dissection with coronary involvement is a more complex operation associated with high in-hospital mortality(18.9％,7/37) and low short-term survival(64.9％,13/37).There were 9 patients underwent coronary artery bypass graft after completion of the root procedure because of ventricular wall motion abnormality(7 patients) and new ST-segment elevation (2 patients) during weaning from cardiopulmonary bypass.Four of them were survival during follow-up due to the success from rescue coronary artery bypass graft.Conclusion Acute type A aortic dissection with coronary involvement is associated with high in-hospital mortality and low short-term survival.If patients suffered abnormal ventricular wall motion or new ST-segment elevation during weaning from cardiopulmonary bypass,rescue coronary artery bypass graft is essential to salvage these critically ill patients.

The research of individual identify by comparison of auricle / 中国法医学杂志

Objective To study the characteristics of measurement points in auricle and to make a method of individual identification by auricle. To make an accurate, simple and reliable individual identification recognition to forensic anthropology by the auricle in the videos and pictures. Methods To select measurement points by the auricle pictures of the 148 adults of Han nationality -from 19 to 22 years old- beyond one month and to analysis the data by SPSS statistical software, analyzing the various factors that influence on the measurement result, then to calculate the ability of recognition, and to confirm the each index difference and the reference value range between the two batch of photos in the end. Results The 6 measurement points were retained by statistical test from the 10 measurement points. The result is stable, and the variation coefficient of each index is not quite different. Conclusion To confirm reference range of the 6 observation points so that to determine whether the two auricle pictures belong to the same individual is accurate and feasible method.

Bilateral ultrasound-guided supraclavicular brachial plexus block in shoulder joint release surgery for shoulder periarthritis / 南方医科大学学报

<p><b>OBJECTIVE</b>To observe the anesthetic efficacy and safety of bilateral ultrasound-guided supraclavicular brachial plexus block in patients undergoing arthrolysis for shoulder periarthritis.</p><p><b>METHODS</b>Twenty-seven patients (ASA class I-II) undergoing bilateral shoulder joint release surgery and 24 ml received bilateral ultrasound-guided supraclavicular brachial plexus block anesthesia with 0.4% ropivacaine and 0.8% lidocaine. The visual analogue scale (VAS) scores for shoulder joint pain were recorded before and after anesthesia. The efficacy of axillary nerve, dorsal scapular nerve and suprascapular nerve block was evaluated, and the anesthetic effect and complications was assessed during surgery. Before and after anesthesia, the range of left and right diaphragmatic muscle movement was measured when the patient took a quiet breath and a deep breath.</p><p><b>RESULTS</b>The patients showed no significant variations in MAP, HR, or SpO₂after anesthesia. The VAS scores of shoulder joint pain during anteflexion, abduction, posterior extension, rotation, posterior extension and medial rotation were significantly lowered after anesthesia (P<0.05), but the left and the right diaphragm movement range showed no significant difference between quiet breath and deep breath (P>0.05). The rates of complete block of the axillary nerve and dorsal scapular nerve was 100%, and that of suprascapular nerve was 92.6%. Partial phrenic nerve block occurred in 1 case with mild local anesthetic toxicity in another.</p><p><b>CONCLUSIONS</b>Bilateral ultrasound-guided supraclavicular brachial plexus block in patients has excellent analgesic effect in should joint release surgery with good safely.</p>

Dexmedetomidine improves oxygenation during one-lung ventilation in balanced anesthesia with propofol-fentanyl in adults / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the effect of dexmedetomidine on oxygenation function in adult patients with balanced anesthesia by propofol-fentanyl under one-lung ventilation (OLV).</p><p><b>METHODS</b>Twenty-two patients undergoing thoracic operation were randomly divided into the study group and control group, both receiving propofol and fentanyl balanced anesthesia. In the study group, additional infusion of dexmedetomidine (0.3 µg/kg loading dose, 0.3 µg·kg(-1)·h(-1) maintenance dose) was administered, and the patients in the control group received only normal saline. Arterial blood samples were obtained at 4 time points from each patient during anesthesia for blood gas analysis.</p><p><b>RESULTS</b>In the study group, the pH values remained stable, the oxygenation index tended to decline progressively, but the incidence of hypoxemia was low; in the control group, the pH value and oxygenation index both declined progressively with a higher incidence of hypoxemia.</p><p><b>CONCLUSION</b>Dexmedetomidine can better maintain the oxygenation function of OLV patients in balanced anesthesia by propofol and fentanyl, and its mechanism may be related to the decreased dose of propofol used.</p>

Surgery for aortic root aneurysm and mitral valve disease through the aortic incision / 中华胸心血管外科杂志

ObjectiveTo explore the experiences of treatment of aortic root aneurysm and mitral valve disease through the incision of aorta.MethodsFrom Mar.2009 to Dec.2010, sixteen patients with aortic root aneurysm and mitral valve disease were operated by transaortic incision.After the leaflets of aortic valve were excised, mitral valve replacement or plasty was performed.There were 13 males and 3 females.The age ranged from 18 to 75 years old with a mean of (40 ± 10) years.The operation procedures included Bentall plus mitral valve replacement in 12 patients, Bentall plus mitral valve plasty in 1,Bentall + total arch replacement + stent elephant trunk + mitral valve plasty in 1, Bentall plus mitral valve plasty and CABG in 1.In 12 patients underwent mitral valve replacement, 11 were using continuous suture and interrupt mattress suture in 1.Four patients underwent mitral valve plasty, the procedure of banding mitral valve leaflets junctions was used.All patients were followed up through telephone and out-patient service.Transthoracic echocardiogram was performed before discharge and 3-, 6-,12-months after operation.Follow-up including cardiac function, valvular and perioperative complications.Results There were 2 re-thoractomy because of bleeding.One patient with pulmonary infection was cured by antibiotics.No death occurred in hospital.Patients were followed-up for 1 to 19 months with a mean of (7 ±5) months.No death occurred during follow-up period.There were no valve-related complications (embolism, bleeding, mitral valve dysfunction).Heart function was improved in all patients and graded as class Ⅰ to Ⅱ (NYHA).Two patients had trace regurgitation after mitral valve plasty when discharged.One patient had mild mitral valve regurgitation was found after mitral valve replacement.There was no further valve exacerbation for above 3 patients during follow-up period.ConclusionTransanrtic mitral valve operation is feasible in patients with aortic root aneurysm and mitral valve disease.