摘要:目的: 探討本次汶川大地震中擠壓綜合征的診斷和治療的有效方法。 方法 :對8例擠壓綜合征患者依據病史、癥狀、體征及實驗室檢查結果進行診斷,并主要針對急性腎衰和局部創傷給予綜合治療。 結果 :7例完全治愈,1例基本治愈,沒有死亡病例,優良率100%。 結論 :以補液、利尿和全身營養支持為主的綜合治療配合血液透析可很好地控制病情發展,促進轉歸;一旦明確診斷,應盡早實施局部骨筋膜室切開減壓或截肢術。Abstract: Objective: To study the treatment of crush syndrome after the Wenchuan earthquake. Methods : The crush syndrome was diagnosed in 8 cases based on the medical history, symptoms, physical examinations and laboratory findings. The amputation was performed on 2 patients. Partial bone compartment open decompression was done on 4 patients. And hemodialysis were used in two of them. Meanwhile the acute renal dysfunction and the local injuries were treated correspondingly. Results : Seven cases were completely recovered, 1 case was recovered partly. Conclusion : Fluid, diuretic and general nutritionbased treatment with hemodialysis if necessary can control disease progression and promote the patients recovery. Once crush syndrome was diagnosed, partial bone compartment open decompression or amputation should be implemented as soon as possible.
目的 評價非體外循環冠狀動脈旁路移植術(OPCAB)同期行左心室室壁瘤折疊術的臨床效果。 方法 選擇2007年1月至2011年1月期間北京安貞醫院資料完整的冠狀動脈旁路移植術(CABG)同期行室壁瘤手術患者114例進行對比研究,其中在體外循環心臟停搏下行 CABG加室壁瘤切除術76例(Ⅰ組),男57例、女19例,年齡(63.4±7.8)歲;在非體外循環心臟不停跳下行CABG加室壁瘤折疊術38例(Ⅱ組),男32例、女6例,年齡(60.6±8.9)歲。除Ⅰ組患者室壁瘤占左心室較Ⅱ組大外(42.2%±13.6% vs. 26.5%±12.3%, t=5.499,P=0.000),其余臨床資料相比差異無統計學意義。比較兩組患者手術效果及并發癥發生情況,并進行隨訪6個月。 結果 Ⅰ組中死亡2例,其中1例死于術后惡性心律失常,1例死于肺部感染;Ⅱ組1例死于圍術期心肌梗死。兩組患者術后胸腔引流量、二次開胸止血、呼吸機輔助時間和放置主動脈內球囊反搏(IABP) 例數等差異無統計學意義(P>0.05)。兩組患者術后早期及術后6個月復查心臟超聲心動圖,左心室舒張期末內徑(LVEDD) 均較術前明顯減小[Ⅰ組: (54.0±7.8) mm amp;(56.0±8.1) mm vs. (59.6±6.6) mm,Ⅱ組: (52.0±7.2) mm amp; (53.6±5.3) mm vs. (57.9±5.4) mm];左心室射血分數(LVEF) 顯著增加(Ⅰ組:43.5%±3.2% amp; 55.7%±3.7% vs. 38.0%±7.4%,Ⅱ組:44.7%±2.8% amp; 57.0%±3.5% vs. 41.0%±6.6%),但兩組間比較差異無統計學意義(P>0.05)。 結論 非體外循環心臟不停跳CABG同期行室壁瘤折疊術安全有效,可能更適用于室壁瘤較小的患者。