Ochsner Journal最新文献_第7页

The Relationship Between Grit and Resilience in Emergency Medical Service Personnel 急诊医务人员砂砾与复原力的关系

IF 1.2 Q2 MEDICINE, GENERAL & INTERNAL

Ochsner Journal

Pub Date : 2019-09-21 DOI: 10.31486/toj.18.0144

M. Musso, D. Tatum, D. Hamer, Rebecca Hammarlund, Leslie Son, Pamela M McMahon

Background: Emergency medical service (EMS) personnel are regularly exposed to traumatic incidents and experience higher rates of symptoms of posttraumatic stress disorder (PTSD) than the general population. Grit is a construct proposed to be associated with achievement, but it has demonstrated preliminary evidence of an association with resilience. The current study examined the relationship between grit and resilience among EMS workers. Methods: A link to an online survey was sent to East Baton Rouge Parish Emergency Medical Services personnel via an email distribution list. Demographic variables and the following self-report measures were assessed: the PTSD Checklist for DSM-5 (PCL-5), the Grit Scale, the Brief COPE scale, and the Professional Exposure to Traumatic Experiences scale (modified from the Life Events Checklist). Results: PCL-5 scores were significantly and negatively correlated with the Grit Scale score (r=–0.57, P<0.01). Hierarchical regression revealed that grit and coping mechanisms were predictive of self-reported PTSD symptoms (adjusted R2=68.7%, F(15,67)=9.81, P<0.001). Examination of the coefficients revealed that lower total Grit Scale scores and higher scores on the following Brief COPE scales were significant predictors of PCL-5 scores: denial, substance abuse, disengagement, and self-blame. Conclusion: This study examined the relationship between grit and resilience, measured by self-reported PTSD symptoms. Our results demonstrate a significant relationship between grit and resilience. Grit is related to, but distinct from, other constructs that predict resilience, such as coping mechanisms. Large prospective studies could have significant implications for hiring practices and building grit in existing personnel to bolster resilience.

背景：急救医疗服务（EMS）人员经常接触创伤事件，创伤后应激障碍（PTSD）症状的发生率高于普通人群。Grit是一种被认为与成就有关的结构，但它已经证明了与韧性有关的初步证据。目前的研究调查了EMS员工的毅力和韧性之间的关系。方法：通过电子邮件分发列表将一个在线调查的链接发送给东巴吞鲁日教区紧急医疗服务人员。评估了人口统计学变量和以下自我报告措施：DSM-5创伤后应激障碍检查表（PCL-5）、Grit量表、Brief COPE量表和职业创伤经历暴露量表（根据生活事件检查表修改）。结果：PCL-5评分与Grit量表评分呈显著负相关（r=-0.57，P<0.01）。分层回归显示，毅力和应对机制可预测自我报告的PTSD症状（校正R2=68.7%，F（15,67）=9.81，P＜0.001）。对系数的检查显示，较低的Grit量表总分和较高的Brief COPE量表分数是PCL-5分数的重要预测因素：否认、药物滥用、脱离接触和自责。结论：本研究通过自我报告的创伤后应激障碍症状来检验毅力和韧性之间的关系。我们的研究结果表明，毅力和韧性之间存在显著的关系。Grit与其他预测韧性的结构有关，但与之不同，比如应对机制。大型前瞻性研究可能会对招聘实践和培养现有人员的毅力以增强韧性产生重大影响。

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引用次数: 24

Remembering Dr. Ed Frohlich 记住埃德·弗罗利希博士

IF 1.2 Q2 MEDICINE, GENERAL & INTERNAL

Ochsner Journal

Pub Date : 2019-09-01 DOI: 10.31486/toj.19.5009

R. Amedee

> Winter is an etching, spring a watercolor, summer an oil painting, and autumn a mosaic of them all. > > –Stanley Horowitz This edition of the Journal includes a strong collection of original research manuscripts, including a timely article by Halton, Roberts, and Denton entitled “Factors

冬天是一幅蚀刻画，春天是一幅水彩画，夏天是一幅油画，秋天是一幅马赛克画。本期《华尔街日报》收录了大量的原创研究手稿，其中包括一篇由霍尔顿、罗伯茨和丹顿撰写的题为《因素》的及时文章

引用次数: 0

Fever and Leg Pain: Consider ALL the Diagnoses 发烧和腿痛:考虑所有的诊断

IF 1.2 Q2 MEDICINE, GENERAL & INTERNAL

Ochsner Journal

Pub Date : 2019-06-20 DOI: 10.31486/toj.18.0122

Lesley N. Desmond, Matthew Fletcher, R. Warrier

Background: Acute lymphoblastic leukemia (ALL) is the most common childhood cancer diagnosed in the United States. The disease causes a decrease in hematopoiesis, so children often present with symptoms related to anemia, thrombocytopenia, and leukopenia. Symptoms for this malignancy may have significant overlap with other conditions such as osteomyelitis. Case Report: A 2-year-old male with no significant medical history presented with lower extremity pain and fever. Initial investigations, including imaging and complete blood count, led physicians to diagnose bilateral osteomyelitis. The patient was prescribed a course of antibiotics; however, his symptoms returned. Eventually, a bone marrow aspiration showed CD99 membrane–positive small round blue cell tumors. The patient was diagnosed with ALL. He was successfully treated with chemotherapy and is now in remission. Conclusion: This case demonstrates the importance of a broad differential diagnosis for a child presenting with leg pain and fever.

背景：急性淋巴细胞白血病（ALL）是美国诊断的最常见的儿童癌症。这种疾病会导致造血功能下降，因此儿童经常出现贫血、血小板减少和白细胞减少等症状。这种恶性肿瘤的症状可能与骨髓炎等其他疾病有显著重叠。病例报告：一名2岁男性，无明显病史，表现为下肢疼痛和发烧。包括影像学和全血细胞计数在内的初步调查使医生诊断出双侧骨髓炎。给病人开了一个疗程的抗生素；然而，他的症状又回来了。最终，骨髓穿刺显示CD99膜阳性的小圆蓝细胞肿瘤。患者被诊断为急性淋巴细胞白血病。他成功地接受了化疗，目前病情缓解。结论：该病例证明了对儿童腿部疼痛和发烧进行广泛鉴别诊断的重要性。

引用次数: 1

Reverse Takotsubo Cardiomyopathy in a Patient With Prior Apical Takotsubo Cardiomyopathy: Challenging the Beta Receptor Gradient Theory 既往根尖Takotsubo心肌病患者的逆行Takotsubo心肌病:挑战β受体梯度理论

IF 1.2 Q2 MEDICINE, GENERAL & INTERNAL

Ochsner Journal

Pub Date : 2019-03-20 DOI: 10.31486/toj.18.0027

A. Rashed, Mohamed Shokr, A. Subahi, Fayez Siddiqui, A. Alkatib, L. Afonso

Background: Classic Takotsubo cardiomyopathy has been described as transient apical dyskinesia following major stress that is believed to be related to catecholamine surges. Atypical variants have been described, including the rarer reverse Takotsubo cardiomyopathy. Discrepant gradients of the beta-2 adrenoceptors are thought to determine the different anatomic variants. Case Report: A 43-year-old female presented with chest pain and a mild troponin elevation. Echocardiography and coronary angiography were consistent with stress-induced apical Takotsubo cardiomyopathy. Eight months later, the patient was admitted with a similar presentation; however, workup revealed stress-induced reverse Takotsubo cardiomyopathy. Conclusion: Recurrent Takotsubo cardiomyopathy involving different anatomic regions of the left ventricle is a rare phenomenon yet appears to be similar to typical Takotsubo cardiomyopathy in presentation and hospital course. Chronic therapy with beta blockers and angiotensin-converting enzyme inhibitors did not prevent a recurrence in this patient, suggesting that optimum treatment needs to be determined. Takotsubo cardiomyopathy affecting different myocardial segments may recur in the same patient, implying that the adrenoceptor distribution theory needs further refinement.

背景:典型的Takotsubo心肌病被描述为主要应激后的短暂性心尖运动障碍，被认为与儿茶酚胺激增有关。非典型变异已被描述，包括罕见的逆行Takotsubo心肌病。β -2肾上腺素受体的梯度差异被认为决定了不同的解剖变异。病例报告:一名43岁女性，表现为胸痛和轻度肌钙蛋白升高。超声心动图和冠状动脉造影与应激性心尖Takotsubo心肌病一致。8个月后，患者以类似的症状入院;然而，检查显示压力诱导的逆行Takotsubo心肌病。结论:复发性Takotsubo心肌病累及左心室不同解剖区域是一种罕见的现象，但在表现和住院过程上与典型的Takotsubo心肌病相似。使用受体阻滞剂和血管紧张素转换酶抑制剂进行慢性治疗并不能预防该患者的复发，这表明需要确定最佳治疗方法。影响不同心肌节段的Takotsubo心肌病可能在同一患者中复发，提示肾上腺素能受体分布理论有待进一步完善。

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引用次数: 1

Impella-Induced Incessant Ventricular Tachycardia 叶轮诱发的不间断室性心动过速

IF 1.2 Q2 MEDICINE, GENERAL & INTERNAL

Ochsner Journal

Pub Date : 2019-03-20 DOI: 10.31486/toj.18.0018

Amir Kaki, A. Subahi, Mohamed Shokr, Walid Ibrahim, A. Yassin, R. Hasan, M. Alraies, T. Schreiber

Background: The Impella 2.5 and Impella Cardiac Power (CP) devices (ABIOMED) are used to provide mechanical circulatory support for high-risk percutaneous coronary interventions or cardiogenic shock as a bridge to recovery or destination therapy. The Impella device has shown both efficacy and safety in patients presenting with cardiogenic shock. Performing clinical and hemodynamic assessments of patients presenting with cardiogenic shock is an important step to determine if mechanical circulatory support with an Impella device is indicated. Case Report: A 62-year-old male presented with cardiogenic shock requiring Impella device support. Two days later, the patient developed incessant ventricular tachycardia. Transthoracic echocardiography showed that the Impella device had migrated out of the ventricular cavity. Once the position of the Impella device was adjusted, ventricular tachycardia immediately resolved. Conclusion: Our case emphasizes the importance of using imaging modalities such as transthoracic echocardiography to ensure correct positioning of an Impella device in the left ventricle to avoid complications.

背景:Impella 2.5和Impella Cardiac Power (CP)装置(ABIOMED)用于为高风险经皮冠状动脉介入治疗或心源性休克提供机械循环支持，作为恢复或终点治疗的桥梁。Impella装置在出现心源性休克的患者中显示出有效性和安全性。对出现心源性休克的患者进行临床和血流动力学评估是确定是否需要使用Impella装置进行机械循环支持的重要步骤。病例报告:一名62岁男性表现为心源性休克，需要Impella设备支持。两天后，患者出现不间断室性心动过速。经胸超声心动图显示Impella装置已移出心室腔。一旦调整了Impella装置的位置，室性心动过速立即得到解决。结论:我们的病例强调了使用诸如经胸超声心动图等成像方式来确保Impella装置在左心室的正确定位以避免并发症的重要性。

引用次数: 4

Primary Squamous Cell Carcinoma of the Thyroid 原发性甲状腺鳞状细胞癌

IF 1.2 Q2 MEDICINE, GENERAL & INTERNAL

Ochsner Journal

Pub Date : 2019-03-20 DOI: 10.31486/toj.18.0002

Blake S. Raggio, J. Barr, Zahraa Ghandour, P. Friedlander

Background: Primary squamous cell carcinoma of the thyroid (PSCCT) is a rare malignancy of the head and neck, with fewer than 60 cases reported in the literature. We report a case of PSCCT and provide a brief review of the literature. Case Report: A 66-year-old female with a history of a hemithyroidectomy for a benign thyroid lesion presented with 3 months of progressively worsening compressive symptoms and shortness of breath. Physical examination revealed right-sided thyromegaly and right-sided true vocal fold immobility. Preoperative imaging with ultrasound and computed tomography scan confirmed an enlarged right thyroid, as well as right anterior cervical lymphadenopathy, subglottic stenosis, and bilateral pulmonary nodules. Fine needle aspiration of the thyroid was suggestive of carcinoma. Intraoperative findings of gross tracheal invasion during a planned completion thyroidectomy prompted limited resection and impromptu tracheotomy. Histopathologic and immunohistochemical evaluation confirmed a squamous cell carcinoma of thyroid origin. Further oncologic workup with core lung biopsy and positron emission tomography scan demonstrated metastasis to the lung and cervical spine. Palliative chemotherapy was begun, but the patient died 1 week into therapy. Conclusion: PSCCT is a rare but aggressive malignancy of the head and neck. Histopathologic and immunohistochemical evaluations are essential for diagnosis. While locoregional surgery and radiation therapy may improve the length of survival, the prognosis of patients with PSCCT is poor. Physicians should be mindful of this unique but deadly disease process, as early diagnosis and rapid treatment initiation are essential to optimize treatment outcomes.

背景:原发性甲状腺鳞状细胞癌(PSCCT)是一种罕见的头颈部恶性肿瘤，文献报道的病例不到60例。我们报告一例PSCCT，并提供简要的文献回顾。病例报告:一名66岁女性，因甲状腺良性病变行甲状腺切除术，3个月来表现为压迫性症状逐渐加重，呼吸急促。体格检查显示右侧胸腺肿大，右侧真声带不动。术前超声和计算机断层扫描证实右侧甲状腺肿大，右侧颈前淋巴结病变，声门下狭窄，双侧肺结节。甲状腺细针穿刺提示癌。术中发现气管侵犯在计划完成甲状腺切除术提示有限切除和临时气管切开术。组织病理学和免疫组织化学检查证实为甲状腺源性鳞状细胞癌。进一步的肿瘤检查，核心肺活检和正电子发射断层扫描显示转移到肺和颈椎。开始姑息性化疗，但患者在治疗1周后死亡。结论:PSCCT是一种罕见但侵袭性的头颈部恶性肿瘤。组织病理学和免疫组织化学评价是诊断的必要条件。虽然局部手术和放疗可以延长PSCCT的生存期，但PSCCT患者的预后很差。医生应注意这一独特但致命的疾病过程，因为早期诊断和快速开始治疗对于优化治疗结果至关重要。

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引用次数: 5

Prevalence of Infertility Among Patients With Isthmocele and Fertility Outcome After Isthmocele Surgical Treatment: A Retrospective Study 峡部膨出患者不孕症患病率及峡部膨出手术治疗后生育结果:一项回顾性研究

IF 1.2 Q2 MEDICINE, GENERAL & INTERNAL

Ochsner Journal

Pub Date : 2019-03-20 DOI: 10.31486/toj.18.0048

S. Calzolari, G. Sisti, Dora Pavone, E. Ciocia, Natalia Bianchini, M. Cozzolino

Background: An isthmocele is a diverticulum on the anterior wall of the uterine isthmus at the site of a cesarean delivery scar. We evaluated the prevalence of infertility among patients with isthmocele, the resolution of symptoms, and infertility outcomes after hysteroscopic isthmoplasty. Methods: We conducted a retrospective study of 35 consecutive patients with symptomatic isthmocele between 2010 and 2015 at Hospital Piero Palagi in Florence, Italy. Patients with symptomatic isthmocele had postmenstrual abnormal uterine bleeding, sovrapubic pain, and infertility. Results: The study population was divided into Group A – Fertile Patients (n=19) and Group B – Infertile Patients (n=16) according to the prevalence of infertility after the diagnosis of isthmocele. Group B was subdivided into Group B1 (became pregnant, n=9) and B2 (did not become pregnant, n=7) according to infertility resolution after isthmocele treatment. We found statistically significant differences between Groups A and B regarding the number of cesarean sections (P=0.0205), the grade of isthmocele (P=0.0421), and body mass index (P=0.0001). In the subgroup analysis, we found statistically significant differences between Groups B1 and B2 for age (P=0.0151), grade of isthmocele (P=0.0361), and cervical dilatation (P=0.0293). Conclusion: We identified a subgroup of patients at higher risk of being infertile after the diagnosis of isthmocele and a subgroup of patients who could benefit the most in terms of fertility after minimally invasive hysteroscopic surgery.

背景:子宫峡部憩室是子宫峡部前壁剖宫产瘢痕部位的憩室。我们评估了峡部膨出患者不孕症的发生率、症状的缓解以及宫腔镜峡部成形术后的不孕症结果。方法:我们对意大利佛罗伦萨Piero Palagi医院2010年至2015年间连续35例有症状的峡部囊肿患者进行回顾性研究。有症状性峡部膨出的患者有经后异常子宫出血、耻骨痛和不孕症。结果:根据诊断为峡部膨出后不孕症的发生率，将研究人群分为A组-不孕患者(n=19)和B组-不孕患者(n=16)。B组根据峡部膨出治疗后不孕症消退情况再分为B1组(已怀孕，n=9)和B2组(未怀孕，n=7)。我们发现A组和B组在剖宫产次数(P=0.0205)、峡部分级(P=0.0421)和体重指数(P=0.0001)方面存在统计学差异。在亚组分析中，我们发现B1组和B2组在年龄(P=0.0151)、峡部膨出程度(P=0.0361)和宫颈扩张(P=0.0293)方面存在统计学差异。结论:我们确定了一个诊断为峡部膨出后不孕风险较高的患者亚组和一个在微创宫腔镜手术后生育能力最大的患者亚组。

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引用次数: 19

Age-Related Macular Degeneration and Intracrine Biology: An Hypothesis. 老年性黄斑变性与内分泌生物学：一个假设。

IF 1.3 Q2 MEDICINE, GENERAL & INTERNAL

Ochsner Journal

Pub Date : 2016-01-01

Richard N Re

This laboratory has studied the intracellular actions of angiotensin II and other signaling proteins that can act in the intracellular space-peptides/proteins we have called intracrines. Moreover, we have suggested that general principles of intracrine action exist and can help explain the progression of some chronic degenerative diseases such as diabetic nephropathy and congestive heart failure. Here, a similar analysis is carried out in the case of age-related macular degeneration. We propose that intracrine mechanisms are operative in this disorder. In particular, we hypothesize that intracrine loops involving renin, angiotensin II, transforming growth factor-beta, vascular endothelial growth factor, bone morphogenetic protein-4, and p53, among other factors, are involved. If this analysis is correct, it suggests a commonality of mechanism linking chronic progressive renal diseases, congestive heart failure, and macular degeneration.

本实验室研究了血管紧张素 II 和其他信号蛋白在细胞内的作用，这些蛋白可以在细胞内空间发挥作用--我们称之为内激肽/蛋白。此外，我们还提出了内啡肽作用的一般原理，有助于解释一些慢性退行性疾病（如糖尿病肾病和充血性心力衰竭）的发展过程。在此，我们对老年性黄斑变性进行了类似的分析。我们认为，内分泌机制在这种疾病中起作用。特别是，我们假设肾素、血管紧张素 II、转化生长因子-β、血管内皮生长因子、骨形态发生蛋白-4 和 p53 等因子参与了内循环。如果这一分析是正确的，则表明慢性进行性肾脏疾病、充血性心力衰竭和黄斑变性之间存在机制上的共性。

引用次数: 0

A Metaanalysis of Interventions to Improve Adherence to Lipid-Lowering Medication. 对改善降血脂药物依从性的干预措施进行元分析。

IF 1.2 Q2 MEDICINE, GENERAL & INTERNAL

Ochsner Journal

Pub Date : 2016-01-01

Richard E Deichmann, Michael D Morledge, Robin Ulep, Johnathon P Shaffer, Philippa Davies, Mieke L van Driel

Background: Inadequate patient adherence to a medication regimen is a major factor in the lack of success in treating hyperlipidemia. Improved adherence rates may result in significantly improved cardiovascular outcomes in populations treated with lipid-lowering therapy. The purpose of this metaanalysis was to evaluate the effectiveness of interventions aimed at improving adherence to lipid-lowering drugs, focusing on measures of adherence and clinical outcomes.

Methods: We searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, PsycINFO, and the Cumulative Index to Nursing and Allied Health Literature databases through January 14, 2015, and also used the results from previous Cochrane reviews of this title. Randomized controlled trials of adherence-enhancing interventions for lipid-lowering medication in adults in an ambulatory setting with measurable outcomes were evaluated with criteria outlined by the Cochrane Handbook for Systematic Reviews of Interventions.

Results: Twenty-seven studies randomly assigning 899,068 participants to a variety of interventions were analyzed. One group of interventions categorized as intensified patient care showed significant improvement in adherence rates when compared to usual care (odds ratio 1.93; 95% confidence interval [CI] 1.29-2.88). Additionally, after <6 months of follow-up, total cholesterol decreased by a mean of 17.15 mg/dL (95% CI 1.17-33.14), while after >6 months total cholesterol decreased by a mean of 17.57 mg/dL (95% CI 14.95-20.19).

Conclusion: Healthcare systems that can implement team-based intensified patient care interventions, such as electronic reminders, pharmacist-led interventions, and healthcare professional education of patients, may be successful in improving adherence rates to lipid-lowering medicines.

背景：患者对药物治疗方案的依从性不足是高脂血症治疗不成功的一个主要因素。提高患者的依从性可显著改善降脂治疗人群的心血管预后。本荟萃分析旨在评估旨在提高降脂药物依从性的干预措施的有效性，重点关注依从性和临床结果的测量：我们检索了截至 2015 年 1 月 14 日的 Cochrane Central Register of Controlled Trials、MEDLINE、EMBASE、PsycINFO 和 Cumulative Index to Nursing and Allied Health Literature 数据库，同时还使用了之前 Cochrane 就此标题进行的综述结果。根据《科克伦干预措施系统综述手册》中列出的标准，对门诊环境中成人降脂药物依从性增强干预措施的可测量结果进行了随机对照试验评估：对 27 项研究进行了分析，这些研究将 899,068 名参与者随机分配给各种干预措施。其中一组被归类为加强患者护理的干预措施与常规护理相比，在坚持率方面有显著改善（几率比 1.93；95% 置信区间 [CI] 1.29-2.88）。此外，6 个月后，总胆固醇平均下降了 17.57 mg/dL (95% CI 14.95-20.19)：结论：医疗保健系统如能实施以团队为基础的患者强化护理干预措施，如电子提醒、药剂师主导的干预措施以及对患者进行医疗保健专业教育，可能会成功提高降脂药物的依从率。

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引用次数: 0

Catheter Ablation to Treat Supraventricular Arrhythmia in Children and Adults With Congenital Heart Disease: What We Know and Where We Are Going. 导管消融治疗先天性心脏病儿童和成人室上性心律失常：我们所知道的和我们的未来。

IF 1.2 Q2 MEDICINE, GENERAL & INTERNAL

Ochsner Journal

Pub Date : 2016-01-01

Patricia E Thomas, Scott L Macicek

Background: Catheter ablation has been used to manage supraventricular arrhythmia in children since 1990. This article reviews the history of catheter ablation used to treat arrhythmia in children and discusses new frontiers in the field. We also address ablation in adult patients with a history of congenital heart disease (CHD) that was diagnosed and initially treated in childhood.

Methods: We conducted an evidence-based literature review to gather available data on ablation for supraventricular tachycardia in children and adult patients with CHD.

Results: Ablations can be performed safely and effectively in children. Complication rates are higher in children <4 years and <15 kg. In one study, the overall success rate of radiofrequency ablation in pediatrics was 95.7%, with the highest success rate in left free wall pathways (97.8%). Recurrence was higher in septal pathways. Cryoablation has been reported to have a 93% acute success rate for atrioventricular (AV) nodal reentrant tachycardia and septal pathways with no risk of AV block and a 5%-9% risk of recurrence. Three-dimensional mapping, intracardiac echocardiography, remote magnetic navigation, and irrigated catheter ablation are new technologies used to treat pediatric and adult patients with CHD. The population of adult patients with CHD is growing, and these patients are at particularly high risk for arrhythmia. A paucity of data is available on ablation in adult patients with CHD.

Conclusion: Electrophysiology for pediatric and adult patients with CHD is a rapidly growing and progressing field. We benefit from continuous development of ablation techniques for adults with structurally normal hearts and have the unique challenge and responsibility to ensure the safe and effective application of these techniques in the vulnerable population of pediatric and adult patients with CHD.

背景：自 1990 年以来，导管消融术一直被用于治疗儿童室上性心律失常。本文回顾了导管消融用于治疗儿童心律失常的历史，并讨论了该领域的新前沿。我们还讨论了有先天性心脏病（CHD）病史的成年患者的消融治疗问题，这些患者在儿童时期就已确诊并接受了初步治疗：我们进行了循证文献综述，收集了儿童和患有先天性心脏病的成年患者室上性心动过速消融术的现有数据：结果：儿童可以安全有效地进行消融术。儿童的并发症发生率较高：儿童和成人心脏病患者的电生理学是一个快速发展和进步的领域。我们受益于针对心脏结构正常的成人患者的消融技术的不断发展，同时也面临着独特的挑战和责任，即确保这些技术在儿童和成人先天性心脏病患者这一弱势群体中安全有效地应用。

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引用次数: 0