【摘要】 目的 評估對于曾有急性心肌梗死的室性心動過速（VT）患者，導管消融（RA）減少植入式心臟轉復除顫器（ICD）放電轉律治療的療效和安全性。 方法 計算機檢索Pubmed、EMbase、Cochrane圖書館、中國生物醫學文獻光盤數據庫、中文科技期刊全文數據庫、CNKI數字圖書館，納入RA+ICD和單獨使用ICD對比治療VT患者的隨機對照臨床試驗，對納入的研究進行質量評價和Meta分析。 結果 共納入2篇最近發表在國外一流雜志上面的臨床隨機對照研究，一篇發在《新英格蘭雜志》，另外一篇發在《柳葉刀》。RA+ICD組納入116例患者，其中有23例（20%）因為再發VT或者心室顫動（Vf）而進行了ICD放電轉律治療；ICD組納入119例患者，其中有49例（41%）因為再發VT或者Vf而進行了ICD放電轉律治療。Meta分析結果顯示，RA+ICD的組合相對于單獨運用ICD來說，需要進行ICD放電轉律治療的人數較少，OR=0.33，95%CI（0.18～0.61），P=0.000 4。 結論 目前研究認為射頻消融可能可減少需進行ICD放電轉律治療的人數，以后需要更多更大樣本量的研究進一步證實該結果。【Abstract】 Objective To assess the efficacy and safety of radiofrequency catheter ablation (RA) for the prevention of defibrillator therapy with implantable cardioverter defibrillator (ICD) for patients who have had acute myocardial infarction with ventricular tachycardia (VT). Methods Randomized controlled trials on patients with VT who underwent RA and ICD versus ICD alone were searched from Pubmed, EMbase, the Cochrane Central register of controlled trials, China Biology Medicine database, Chinese Science and Technology Journal database and the CNKI digital library. Quality assessment and Meta analysis were carried out for the researches sought out from these databases. Results Two randomized controlled studies published on The New England Journal of Medicine and the Lancet were included in our study. RA plus ICD were used in 116 cases, among whom 23 underwent ICD shocks due to reoccurrence of VT or ventricular fibrillation (Vf). Single ICD was used in 119 cases among whom 49 underwent ICD shocks due to reoccurrence of VT or Vf The result of Meta analysis showed that the number of patients needing ICD shocks after RA plus ICD treatment was significantly lower than that after single ICD treatment. The statistical data of the comprehensive Meta analysis were OR=0.33, 95%CI (0.18-0.61), and P=0.000 4. Conclusion At present, it is believed that RA can be used for the prevention of defibrillator therapy, while the result should be confirmed by large sample research in the future.
Objective To systematically evaluate the efficacy and safety of sirolimus-eluting stents (SES) versus bare-metal stents (BMS) in treating patients with ST-segment elevation myocardial infarction. Methods The databases such as PubMed (1960 to Mar. 2011), EMbase (1980 to Mar. 2011), the Cochrane Central Register of Controlled Trials (1989 to Mar. 2011), CBM (1979 to Mar. 2011), VIP (1989 to Mar. 2011) and CNKI (1979 to Mar. 2011) were searched to collect all the randomized controlled trials (RCTs) on SES versus BMS in patients with ST-segment elevation myocardial infarction. After the data extraction and methodological quality evaluation, meta-analysis was conducted with RevMan 4.2 software. Results A total of 7 RCTs were included. Among 2 555 patients involved, 1 282 were in the SES group, while the other 1273 were in the BMS group. The results of meta-analyses showed that SES was superior to BMS in the target-lesion revascularization (OR=0.27, 95%CI 0.16 to 0.45, Plt;0.000 01) and target-vessel revascularization (OR=0.33, 95%CI 0.24 to 0.46, Plt;0.000 01). In contrast, there were no differences between SES and BMS in death, stent thrombosis and recurrence of myocardial infarction. Conclusion With the one-year clinical outcomes, SES is more effective than BMS in reducing the rate of target-vessel revascularization and target-lesion revascularization.
Objective
To summarize clinical outcomes of subxiphoid uniportal video-assisted thoracoscopic surgery for bilateral chest diseases simultaneously.
Methods
The clinical data of 60 patients with bilateral chest diseases treated by uniportal thoracoscopic surgery via subxiphoid approach in the Department of Thoracic Surgery, Affiliated Hospital of Zunyi Medical College from August 2016 to December 2017 were retrospectively analyzed. There were 35 males and 25 females, aged 25.5±8.8 years ranging from 13 to 51 years. There were 40 patients wtih palmar hyperhidrosis, and 20 patients with bilateral pulmonary bullae and onset of one-side pneumothorax. All patients adopted subxiphoid uniportal video-assisted thoracoscopic surgery. Among them 36 patients with palmar hyperhidrosis underwent resection of R3 bilateral sympathetic nerves, 1 resection of R4 bilateral sympathetic nerves, 3 resection of R3+R4 bilateral sympathetic nerves, and 20 patients with pulmonary bullae underwent bilateral bullectomy and pleurodesis.
Results
Fifty-five patients cured within 1 to 4 days and discharged after surgery. One patient with incision infection and pulmonary infection after bullectomy, cured and discharged after 3 weeks anti-inflammation and incision dressing change. Four patients with Grade B healing recovered after 1 to 2 weeks dressing change. During the follow-up, no pneumothorax or hand perspiration relapsed.
Conclusion
Subxiphoid uniportal video-assisted thoracoscopic surgery for simple bilateral chest disease simultaneously is safe and feasible, which not only avoids simultaneous trauma of bilateral punch, but also alleviates the pain of patients.
