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題 名 | Surgical Treatment for Coronary Heart Disease Associated with Polycythemia Vera--A Case Report=合併真性紅細胞增多症之冠心病病患的開刀治療--一病例報告 |
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作 者 | 袁師敏; 呂鋒; 郭加強; | 書刊名 | Acta Cardiologica Sinica |
卷 期 | 14:3 民87.07-09 |
頁 次 | 頁138-142 |
分類號 | 416.262 |
關鍵詞 | 冠心病; 真性紅細胞增多症; 冠狀動脈繞道手術; Coronary heart disease; Polycythemia vera; Aortocoronary bypass; |
語 文 | 英文(English) |
中文摘要 | 背景:真性紅細胞增多症是一種少見的疾患,在心血管外科病患中尤為罕見。 方法和結果:本篇描述一例冠心病、心肌梗塞後假性室壁瘤合併真性紅細胞增多症之54歲之女性病患。前二項診斷依據冠狀動脈造影和杜卜勒超音波,而後一項的診斷則依據國際真性紅細胞增多症研究組所制定之診斷標準,包括總血容量、動脈,血氧飽和度、白血球和血小板的計數等。術前給予藥物的化療,爾後行冠狀動脈繞道手術及假性室壁瘤的切除手術。 圍手術期出現兩個有趣的問題:一是體外循環期間的肝素用量及預充液量大為超出其常規用量;另一則是術後5天的手術切口的皮下出血。二者之因果關係也一併檢討。 結論:即使合併有真性紅細胞增多症,冠心病、梗塞後假性室壁瘤仍然是開刀治療的指征。體外循環期間的超常規的肝素用量和預充液量應屬于此類病患之特點。術後的皮下出血考量為切口的直接感染。 |
英文摘要 | Background. Polycythemia vera is an uncommon medical problem; it is particularly unusual in cardiovascular surgery patients. Methods and Results. This report describes a 54-year-old woman with coronary heart disease and postinfarction ventricular pseudoaneurysm associated with polycythemia vera. Of her diagnoses, the former two were made by coronary arteriogram and Doppler echocardiography; the latter was confirmed based on Polycythemia Vera Study Group protocols including hemovolumetric test, arterial blood oxygen saturation as well as leukocyte and platelet counts. Chemical therapy was conducted before operation. Revascularization of the myocardial ischemia and repair of postinfarction ventricular pseudoaneurysm were performed, thereafter. Two more events of interest were found during the perioperative period: one was the higher extracoporeal heparin dose and priming volume; the other was subcutaneous hemorrhage five days after the operation. Causality between them was also discussed. Conclusions. For patients with coronary heart disease, postinfarction ventricular pseudoaneurysm indicates need for a surgical approach, even if polycythemia vera is associated. Higher extracoporeal heparin dose and priming volume might be a peculiarity in such patients, as in the present case. Postoperative subcutaneous hemorrhage was considered to be from a straight-forward wound infection, unrelated to the hematology. |
本系統中英文摘要資訊取自各篇刊載內容。