付庆林医生的科普号

2014-07-23 10:11 来源：映象网 近日,新医一附院心外科通过急诊手术成功抢救一名生命垂危的“心脏破裂伤”女孩,目前该患儿已脱离生命危险,处于康复阶段,近日即将出院。 女孩是一名9岁的留守儿童。事发当日,患儿玩耍时不慎被电动自行车砸中致“胸部创伤”并短暂昏迷,家长急忙将患儿送往当地县医院,县医院医师考虑患儿病情危重,遂决定由120救护车急送新医一附院就诊。 虽然已是傍晚休息时间,又恰逢周末,刚由郑州开会归来的心外科主任付庆林博士得知患儿情况后不顾劳累、亲自应诊。患儿诊断为“心脏破裂伤:心包填塞”,病情危重,需立即行急诊手术清除心包腔内血块和积血,修补缝合心脏裂口,才能及早解除心包压塞征,控制出血,挽救生命。 患儿家长未带手术费用,怎么办,家属急的抱头痛哭。付庆林主任医师果断决定,通知医院总值班,申请先手术、后交费,抢救孩子生命要紧,孩子父母远在厦门,只有孩子的叔叔、奶奶陪诊,根据医疗核心制度要求,主管大夫电话通知了孩子父母,签字由孩子叔叔、奶奶代签。紧急通知已下班休息的麻醉医师、体外循环师、手术室护士,通知医院血库备足血液,同时由主管医生迅速护送患儿至手术室手术。手术由付庆林主任主刀,术中探查发现患儿左心耳根部约15mm的撕裂伤,大量持续性出血,血压下降至50/35mmHg,情况紧急;伤口压迫止血,迅速建立体外循环,由于心脏伤口位于心脏后面,并且邻近重要的冠状动脉,术野暴露极其困难,易损伤冠状动脉而导致严重后果。由于术前准备充分,在手术、麻醉、体外循环、护理人员的共同努力下,成功克服了失血性休克、心脏骤停、冠脉损伤等风险,手术成功了,小女孩得救了,虽然已是午夜时分,但所有医护人员不知疲倦,非常高兴。术后患儿转至ICU治疗。目前患者已脱离生命危险,于普通病房行康复治疗,近日即可出院。 付庆林主任指出心脏外伤是难以准确估计的,很多重症病人在就诊前就已死亡;心脏外伤的部位以右心室最常见(约占47%),其次为左心室(34%)、右心房(14%)和左心房(10%)。该女孩为单纯的左心房撕裂伤,没有心包穿透伤,非常罕见且易误诊。“伤透心”女孩手术的成功实施,体现了新医一附院心外科诊疗水平的不断进步,体现了新医一附院处置紧急情况的完善体系及人性化服务。同时提醒各位家长,暑期一定要孩子远离危险,远离伤害。(刘永强宋鹏翀)

付庆林博士访谈录

Mending hearts around the worldFormer PMCC surgical resident Bobby Yanagawa and PMCC cardiac surgeon Dr. Robert James Cusimano communicate with Dr Qinglin Fu, Xinxiang Medical University staff in China’s Henan Province (Photo: Bobby Yanagawa).（原文出自多伦多大学网站：http://www.uhn.ca/corporate/News/Pages/mending_hearts_around_the_world.aspx）"It's another way to open people's minds and eyes up to what the world is really like."These words inspire Peter Munk Cardiac Centre surgeon Dr. Robert James Cusimano to make annual teaching trips to China. Every year the Xinxiang Medical University in Henan Province south of Beijing welcomes him as a teacher from abroad."They – even the staff surgeons – are so thirsty for knowledge, it's amazing. Whenever you see that kind of enthusiasm, it's good," said Dr. Cusimano.A Canadian history in ChinaAccording to Bobby Yanagawa, a Canadian doctor named William McClure founded and built Xinxiang Medical University in the late 1800s. Yanagawa is Dr. Cusimano's former surgical resident who has travelled to China with him.In 2006, Dr. Cusimano accepted an invitation to join the celebration for the hospital's 110thanniversary. He travelled with an anaesthesiologist from Toronto General Hospital who had been raised in the town of Xinxiang."I really enjoyed teaching them," said Dr. Cusimano.That first trip inspired a long-term project to help Xinxiang Medical University's knowledge-base grow. This area of China isn't as medically advanced as Beijing or Shanghai. One of Dr. Cusimano's goals has been to raise the standards of learning closer to Canadian levels."You do have to be careful about what you tell them," said Dr. Cusimano. He's been asked to perform a heart transplant in Xinxiang. "There's no way in the world they're going to be able to do that."For now, a complex procedure like a transplant would be too dangerous because of the lack of tools and support.Steadily, his Chinese students' expertise in handling complex surgeries is growing."I have noticed each time I go back that their levels of knowledge are better, "said Dr. Cusimano. "Just the fact that I go back every year is incentive enough for them to continue to raise their standards."That's one of the biggest challenges – making sure that the learning continues in China while he's in Canada."I've been trying to set up a clinical skills lab for them, so when I'm gone they can work on their skills. They call it the 'Cusimano Clinical Skills Lab,'" he said with a laugh. With a new clinical skills lab, the students would be able to practice physical skills, like stitching blood vessels.The teaching has been a two-way street and Dr. Cusimano's Chinese students have also taught him an important lesson."I've learned you can do a heck of a lot with much less than what we have here," said Dr. Cusimano.Double the learningEducation -- both in Canada and abroad -- has always been a priority for Dr. Cusimano. Two years ago, he started inviting his students to join him on his teaching trips. So far, he has taken three students with him."I think it was natural for him, an extension of his spirit of mentorship at the Peter Munk Cardiac Centre," said Yanagawa, who accompanied Dr. Cusimano on two recent trips."The idea is to open people's minds up to different ways of life, to the different educational experiences of residents who are the same age as them and to the challenges people have in different parts of the world," said Dr. Cusimano.Yanagawa's experiences in China have taught him about life abroad and just as importantly, his own skills and abilities."You see what people can do when they have such little resources. It humbles you," said Yanagawa. "You really do fall back on your basic training, all of which I learned at the University of Toronto."Yanagawa's visits sparked a passion to study and treat Rheumatic Valve Disease. This disease accounts for most cardiovascular-related deaths among young people in developing countries but no specific treatment exists. It isn't prevalent enough in Canada to be studied, explained Yanagawa.Dr. Cusimano helped Yanagawa secure a professorship at the Xinxiang Medical University, ensuring another Canadian will continue to visit and teach the medical community.As a professor of the Division of Cardiac Surgery in Xinxiang, Yanagawa will be able to study treatment methods for Rheumatic Valve Disease and educate local medical staff at the same time."They have committed to our collaboration and this is a great sign moving forward," he explained. "I am excited by what we can do together to better understand this important but neglected disease."Expanding knowledge enhances careWhile he hopes to continue his trips "for a long, long time," Dr. Cusimano's ultimate aim is that the Xinxiang Medical University will no longer need him."My goal for that area of China is that we're going to set up a really viable teaching lab and they're going to have that as a nucleus for teaching in that part of China. It's going to start with cardiac surgery, but then it's going to spread to other parts of surgery," said Dr. Cusimano."Hopefully people from other universities will one day go and learn there. I want to give them a formal way of learning and then I won't be needed anymore."Once the people of Xinxiang have enough knowledge to be independent in their healthcare teaching, Dr. Cusimano hopes to take his skills from the Peter Munk Cardiac Centre to another place in need. Yanagawa echoes these hopes."In Canada we are so fortunate to have so many resources," said Yanagawa. "Perhaps we should be getting out there more to see how the other 90 per cent live."Where will Dr. Cusimano go next?"Anywhere that will have me," he said.

1、做心脏血管手术有危险吗？答：随着医学科学技术的不断发展，心脏手术的危险性在逐渐减少。目前常见心脏手术的死亡率极低。复杂重症心脏手术的死亡率则要高些，这意味着绝大部分患者将通过手术获得好的疗效。医生会根据患者的具体情况将术中可能发生的各种风险向患者及家属谈清楚。作为患者应当始终充满信心，乐观接受手术。要知道，信心和勇气是战胜疾病的重要因素之一。2、手术前需要做什么准备？答：除了要保持乐观和充满信心的精神状态并加强营养，保证睡眠以维持良好的体力状态以外，练习深呼吸和咳嗽是最重要的两件事，它对您手术后恢复期防止肺膨胀不全及分泌物滞留起着重要作用。手术前应定时做这些练习，每天4-6次。做了这种练习，您手术后做时会感到容易很多。术后做这些因伤口疼痛会感到吃力，但是，一定要坚持以利于术后恢复及减少并发症的发生。3、术后患者在监护室治疗多长时间？答：一般会在监护室住1-2天就会转回普通病房，回到病房后，会继续得到重点护理，病情会一天一天好起来。对于病情比较重或比较复杂的手术，术后可能会在监护室住的时间长些，直到病情稳定。4、手术后能饮水吗？答：气管插管拔除后3-4小时，您就可以饮少量水。刚拔管的一段时间，有时会感到嗓子有点痛，过几天就会好转。5、术后什么时间开始进食？答：一般气管插管拔除后5-6 小时就可以进流食或半流饮食。第4-5天可吃普通食物。如果术后感觉不饿，请不要着急，这是正常现象，适当增加活动，您的食欲会逐渐增加。

一、概念：搭桥手术顾名思义，是取病人本身的血管（胸廓内动脉、下肢的大隐静脉等），将狭窄冠状动脉的远端和主动脉连接起来，让血液绕过狭窄的部分，到达缺血的部位，改善心肌血液供应，进而达到缓解心绞痛症状，改善心脏功能，提高患者生活质量及延长寿命的目的。这种手术也称为冠状动脉旁路移植术，是在充满动脉血的主动脉根部和缺血心肌之间建立起一条畅通的路径，因此，有人形象地将其称为在心脏上架起了“桥梁”，俗称“搭桥术”。二、作用：冠脉搭桥手术是为冠状动脉粥样硬化性心脏病患者实施的外科手术，重新建立血流通道，改善心肌血供，以消除症状，延长寿命。冠心病人术前经常规内科治疗无效，情绪不稳定，压力大，以导致心绞痛的多次发生。三、术前注意事项：1、不要剧烈活动。2、戒烟、戒酒、戒除饮食方面的不良习惯，糖尿病病人严密监测血糖和尿糖，限制脂肪饮食。3、进行深呼吸和有效咳嗽动作的训练，对有呼吸道感染的病人应积极治疗。4、每日两次低流量吸氧。5、行心血管造影术进行穿刺局部皮肤术后应注意穿刺部位有无出血和血肿形成，一般在穿刺局部腕带压迫12小时，卧床24小时。6、保持大便通畅。

冠状动脉搭桥术后注意事项一、冠脉搭桥术后的康复锻炼 术后尽早下床活动。这样可以最大限度的减少肺不张、肺部感染、下肢静脉血栓、肺栓塞、胃肠道功能紊乱、植物伸进功能紊乱、肌肉萎缩等并发症。因为心脏手术后患者往往有心功能损害和心律失常、手术后康复锻炼活动量大小要量力而行。在手术后两个月内锻炼最好在医生的指导下进行。康复锻炼有助于患者的心功能和全身状态的恢复、有利于刀口的愈合、控制血压、血糖和血脂。二、搭桥术后的药物治疗 冠脉搭桥术后，应长期应用抗血小板凝聚的药物，防止移植的血管内血栓形成，降低血液的粘稠度，改善微循环。一般应用阿司匹林，每日一次，每次0.1克；单独应用或同时使用氯吡格雷，75毫克每天一次。降血脂药物辛伐他汀有利用减少血管内脂质斑块形成，建议规律服用。三、搭桥术后的生活习惯改良 1、低钠饮食。2、低脂饮食。3、适量摄入蛋白质。4、多吃绿色蔬菜和新鲜的水果，有利于心肌的代谢，改善心肌的功能和血液循环，促使胆固醇的排泄，防止高血压的发展。5、忌食用兴奋神经的食物如：酒、烟茶和咖啡等。

风湿性心脏病换瓣术后注意事项人造心脏瓣膜主要分为两大类。一是机械瓣，二是生物瓣。前者是采用高级合成材料制成的，而后者是人工合成的高级材料和经过复杂化学处理的生物组织而制成。换瓣术后早期注意：1.继续服用医生所开药物，包括抗凝药（由于人工瓣膜不是人体本身组织，血液容易在人造瓣膜及其周围发生凝固，形成血栓，影响人工瓣膜的功能；如果血栓脱落造成血管栓塞，对人有很大的危险；生物瓣术后抗凝六个月，机械瓣需终生抗凝，定期复查凝血功能，根据化验结果调整抗凝药物剂量），强心利尿药，抗心律失常药。2.预防感染。3.注意保持适当活动，不可整日卧床静养。4.安排好自己早期保养生活。5.注意加强营养，不宜吃太咸的食物；心功能差者限制饮水，不宜进食大量稀饭和汤类；对抗凝药物影响的食物（菠菜，胡萝卜，猪肝等）不可过多或长期食用。6.术后3个月应到医院进行一次详细检查（包括体检、心电图、胸部X关片、超声心动图等），根据检查结果调整用药。心脏瓣膜病常伴有心房纤颤：术后3个月仍有房颤，心脏功能恢复较好时可到医院进行除颤治疗。如果房颤顽固，历史较长，除颤不成功患者不必勉强除颤，以免发生危险，可在进行抗凝治疗的同时服用洋地黄制剂控制心率不致过快或不慢即可。换机械瓣后有时可听到类似钟表的金属声，属于正常现象，不必介意。

直播时间：2021年09月30日19:00主讲人：付庆林主任医师郑州大学第一附属医院心血管外科问题及答案：问题：去年四月底做的开胸手术先天性房缺肺动脉高压手术右心偏大一年后复查的还是右心偏大三尖瓣中度反流，要紧不视频解答：点击这里查看详情>>>问题：三尖瓣下移，需要做手术吗？视频解答：点击这里查看详情>>>问题：您好，五岁，室间隔膜部瘤，基底部6.5毫米，其间1.8中断，杂音不显，不易生病，必须手术？侧切？封堵视频解答：点击这里查看详情>>>问题：吃卡维地洛片一次半片，一天俩次，血压控制不住，能加量吗视频解答：点击这里查看详情>>>问题：37岁，心口一直疼，晚上睡觉总闷醒，白天好一些，心电图有频发性早搏，供血不足，视频解答：点击这里查看详情>>>问题：付主任好，宝宝两岁做的手术，啥时候去复查呢视频解答：点击这里查看详情>>>问题：付大夫你好，现在住院治疗脑梗，左心有30一50汽泡需要什么时间做手术视频解答：点击这里查看详情>>>