中国心外科发展现状的幻灯朱晓东、英语

1,CardiacSurgeryinChinaCurrentstatusandSomeCharacteristics,ZhuXiaodongFuwaiCardiovascularInstitute2004.10,2,CHINA:Adevelopingcountrywithahugepopulationof1.3billions*,EventhegrowingpaceofthepopulationhasgraduallysloweddownIncreasingrate:stillashighas0.7%peryearOutof16.6millionsofnewborns100,000babieswithCHD(6.7)areaddedeachyear*ReportoftheMinistryofPublicHealth.2001,3,PotentialPatientswhomayneedcardiacsurgery:,Myocardialinfarction2.967millions*Rheumaticvalvulardisease2.235millionsCongenitalheartdisease1.80-1.95millions（6.7innewborns)Idiopathiccardiomyopathy1.60millions*OthersTotal8millions*GuDongfeng.PrevalenceofcardiovasculardiseasesinChina42ndconferenceoncardiovasculardiseaseepidemiologyandprevention2002.04Hawaii*YubaoZouetal.AmJMedicine2004,116:14-8,4,Distributionofdifferentkindsofheartoperations,Ingeneral:Numberone:Congenital(60%-65%)Second:Valvesurgery(20%-25%);Third:Coronarysurgery(10%-20%）*CABG50%infewunitsFuwaiHospital：(19772003)25,279cases,Congenital,CABG,Valves,5,CABGhasgraduallysurpassedvalveoperations,Fu-WaiHospital,6,LimitedMedicalresourcesThecapacityofcardiacsurgery,Thereareabout900cardiothoracicunits(includingabout500heartunits)Nearly80,000heartoperationsin200313bigheartcenters(1000openhearts/year)(阜外,安贞,新华,上海中山,长海,武汉协和,亚心,霍英东,湘雅,沈军区,华西,四医大,三医大),7,Ourmission:Millionsofheartoperations/y,AnotherhundredofheartcentersasbigasFu-waihearthospitalorasgoodasTHIshouldbebuiltupinChina.Awholenetworkofserviceandareliableinsurancesystemnationwidealsoshouldbeestablished.,8,1.Increasingnumberofbaby-patients,苏肇伉：心血管病国际论坛2004.09北京characteristic,349operationsofcomplicatedcongenitalheartdiseases.57under6monthsofage徐志伟)*：*晚期心脏病外科治疗研讨会，上海2004,SurgeryofCongenitalHeartDisease,9,2.Morecomplicatedanomalies,About25arecomplicatedcasesOveralloperativemortality-10%to15Unlikewesterncountries,mostcyanoticcasesareTetralogyofFallot(mortality1.1%-5%)Becauseofsmallpercentageofneonates.Inaseriesof115neonatesofcongenitalheartdiseasenearly50%ofthemwereTGA*苏肇伉：心血管病国际论坛2004.09北京,SurgeryofCongenitalHeartDisease,Continue,10,ImprovementofCoronarySurgery,FirstCABG1974GuoJiaqiang,11,10%-20%oftotalnumberofheartoperationsingeneral(infewheartcenters,thepercentageofCABGhasbeenashighas50%)Operativemortality:2%-3%inbigcenters,ThenumberofCABG,FWH,12,Off-pumpCoronarybypassNumberofOPCABhasbeenincreasingOutoftotalnumberofCABG,20%-30%areoff-pumpingeneral.Aseriesof1198cases(79.5%oftotalCABG)Mortality1.2%Earlyresultsweresatisfactory,Itwas46%atFWH2003,13,PromotionMVR-21y,16,ValveRepair,AmongthemitralvalveoperationsOnlyaround10%-repairAvarietyofplasticringsareusedAlfieriedgetoedgetechnique:forischemicmitralregurgitationTV：Exclusively-reconstructiontechniqueDeVegaorRingAVrepair:OnlylimitedindicationsAS,Prolapseofleaflets,AV-ringdilatation,17,MinimallyInvasiveProceduresforheartvalvesurgery,RightthoracotomyPartialsternotomyBeatingheartwithECCEndoscopyassisted,11%,FuWaiHospitalData:19972000),18,SurgeryofAorticAneurysm,Theaorticarchreplacementwasstarted-1960thTheoperativemortalityofdissectinganeurysmhascomedownto6.8%-10.1%recently.Surgery+Intra-vascularinterventionElephantprocedure60cases(FWH1997-2003)Ascendingaortaandtotalarchreplacementcombinedwithstentedgraftimplantationintothedescendingaorta,19,SurgicalTreatmentforEndstageHeartFailure,Basicallythereare3approaches:1.Heart,heart-lungtransplantationVeryeffectiveandimportantVerylimitednumbersofar.Heartandheart-lungtransplantsarelessthan200casesMoreheartcentershavestartedhearttransplantinmanyprovincesrecently.,20,AnewdesignatFWHThe3rdGenerationofVADMegneticactivatedsubaorticpump,SurgicalTreatmentforEndstageHeartFailure,continue,2.Ventricularassistdevice(VAD)Novacor,BAS,Meados,BerlinHeartItistooexpensiveandcomplextechnically,21,SurgicalTreatmentforEndstageHeartFailure,3.CelltransplantationItisnowonlyinthestageofbasicresearch,andveryfewprimaryclinicaltrial.Mostly:Usingmarrowstemcells(putstemcellsintocoronaryartery),Continue,22,Summary,China,asadevelopingcountry,therearesomecharacteristicsincardiacsurgery.1.hugeandcontinuegrowingpatientpopulation.2.Increasingcoronaryheartdisease,CABGismovingtothesecondlargestgroupincardiacsurgery.3.Rheumaticisthemaincauseofheartvalvedisease.Verysmallpercentageoftissuevalvesareused.4.ThemajorityofcyanoticcongenitalheartdiseaseisTetralogyofFallot,23,Summarycontinue,CardiacsurgeryinChinaisnowatitsfullspeedofdevelopment.Fromthepointoftechnologyinthefieldofcoronaryandvalvularsurgery,thereisnos