Objective To compare merits and shortages between minimally invasive small incision surgical repair and interventional device closure for isolated secundum atrial septal defect (ASD). Methods A retrospective analysis was made on clinical results of 69 patients with isolated secundum ASD from January 2004 to June 2006. Among them 37 patients underwent minimally invasive small incision surgical repair on the beating heart (Small Incision Group) and 32 patients underwent interventional device closure of ASD (Interventional Group). Results There were no deaths in either group. The small incision surgical repair was successfully completed in all the 37 patients, with the procedure time, cardiopulmonary bypass time, and hospital stay being 145.86?27.84 min, 35.11?8.45 min, and 15.46?3.09 d, respectively. Major and minor complications occurred in 2 and 6 patients, respectively. The hospitalization costs was 21 900?3600 yuan. In the Interventional Group, the closure was successfully performed in 30 out of 32 patients. The procedure time and hospital stay were 88.59?7.75 min and 10.81?5.02 d, respectively. Major and minor complications occurred in 1 and 2 patients, respectively. The hospitalization costs was 27 800?3900 yuan. Follow-up observations were performed in the Small Incision Group for 3~12 months in 20 patients and for 12~30 months in 17 patients, and in the Interventional Group for 3~12 months in 16 patients and for 12~30 months in 14 patients. No residual shunt was found. Conclusions Both of minimally invasive methods are safe and effective for isolated secundum ASD. Small incision surgical repair involves lower costs, higher successful rate, and broader indications, whereas interventional device closure offers shorter hospital stay, milder trauma, and better cosmetic results.

Objective To evaluate the preventive effects of dezocine on postoperative hyperalgesia in patients after remifentanil-based anesthesia.Methods One hundred ASA Ⅰ or Ⅱ patients,aged 20-64,weighing 45-65 kg,undergoing laparoscopic cholecystectomy,were randomly divided into 4 groups ( n =25 each): fentanyl group (group F),low-dose dezocine group (group D1 ),medium-dose dezocine group (group D2 ) and high-dose dezocine group (group D3 ).Anesthesia was induced with midazolam,propofol,remifentanil and cisatracurium.The patients were mechanically ventilated after tracheal intubation.Anesthesia was maintained with target-controlled infusion of remifentanil (target effect-site concentration 4 μg/L), intravenous infusion of propofol 4-6mg· kg-1· h-1 and intermittent intravenous injection of cisatracurium 0.03 mg/kg.Groups D1,D2 and D3 received intramuscular injection of dezocine 0.1,0.2,0.3 mg/kg at 30 min before the end of surgery respectively and group F received intravenous injection of fentanyl 1 μg/kg at 15 min before the end of surgery.The emergence time and extubation time were recorded.Visual analog scale(VAS),Bruggrmann comfort scale(BCS) and sedation and agitation scale (SAS) at immediately,1 h,2 h after emergence from anesthesia (T0,1,2),and the incidence of respiratory depression,nausea and vomiting and urinary retention after extubation were recorded.Results Compared with group F,the emergence time and extubation time were shortened,the incidence of respiratory depression and nausea and vomiting was decreased in groups D1,D2 and D3,VAS score was increased and BCS score was decreased at T0-2 in group D1,VAS score at T0 was increased,while VAS score at T1,2 and SAS score at T0-2 was decreased in groups D2 and D3 ( P ＜ 0.05).Compared with group D2,SAS score was decreased at T0-2,while the incidence of respiratory depression was increased in group D3 ( P ＜ 0.05 ).No patient showed urinary retention in the four groups.Conclusion Intramuscular injection of dezocine 0.2 mg/kg at 30 min before the end of surgery can reduce postoperative hyperalgesia with little side effects in patients after remifentanil-based anesthesia.