先天性心脏病患儿术前营养不良对术后住院预后的影响

目的 旨在探索先天性心脏病外科手术患儿术前营养状况与术后预后之间的关系.方法 回顾性分析2019年1-4月,在该院接受先天性心脏病外科手术的0～5岁患儿的临床资料.营养状态是根据世界卫生组织(WH O)儿童生长标准,使用年龄别体重z值(WAZ)来确定的.WAZ≤-2的儿童定义为营养不良.预后指标包括住院死亡率、医院感染...     

呼吸机通气下超声诊断先天性心脏病术后膈肌麻痹的自身交叉对照研究

目的探索先天性心脏病术后患者在呼吸机通气情况下超声诊断膈肌麻痹的可行性。方法 2013年1月1日至2016年4月30日我院542例先天性心脏病外科手术后,难以脱离呼吸机或者怀疑存在膈肌麻痹的患者,分别在呼吸机持续气道正压通气(CPAP)模式下和完全自主呼吸状态下,以超声检查膈肌功能诊断是否存在膈肌麻痹。其中男327例、女215例,年龄(14±32)个月。对比在呼吸机CPAP模式下与在完全自主呼吸状态下超声诊断的结果。结果完全自主呼吸状态下,82例患者诊断为膈肌麻痹,其中右侧39例,左侧25例,双侧18例,其他均为正常;CPAP模式下,82例患者诊断膈肌麻痹,其中右侧38例,左侧25例,双侧19例,其他均为正常。超声在CPAP模式下诊断先天性心脏病术后膈肌麻痹的结果,与在完全自主呼吸状态下对比,敏感性为100.0%,特异性为99.9%。结论在呼吸机通气状态下用超声检查诊断先天性心脏病术后患者是否存在膈肌麻痹结果准确可行。     

Postoperative management of patients with repair of anomalous origin of the left coronary artery from the pulmonary arterya report of 30 cases

Background Anomalous origin of the left coronary artery from the pulmonary artery(ALCAPA)is a rare congenital anomaly.It demonstrated the combined effects of the absence of a normal coronary flow with a coronary steal and the profound ischemia that can produce left ventricular dysfunction and mitral regurgitation.We here introduce the postoperative management of patients with repair of anomalous origin of the left coronary artery from the pulmonary artery,with an emphasis on its outcome.Methods Records of 31 patients with anomalous origin of the left coronary artery from the pulmonary artery receiving surgery from 1998 to 2010 were reviewed retrospectively,10 of which were treated with the mitral valve surgically at the same time.The age of patients was 4 months to 16 years(median,1 year)and weight of those was 5 to 53 kilograms(median,7.8 kilograms),all of which were diagnosed of anomalous origin of the left coronary artery from the pulmonary by echocardiography and cardiac catheterization.After surgery,electrocardiogram,echocardiography,arterial blood pressure,transcutaneous oxygen saturation and central venous pressure were monitored.Common postoperative complications in our group were analysed.And preoperative and postoperative data including area of mitral regurgitation,left ventricular systolic diameter and left ventricular distolic diameter were obtained.Cardiopulmonary bypass time and mechanical ventilation time of postoperative patients with no pneumonia were compared with those with pneumonia.Binary logistic regression was applied for the analysis of the risk factors of postoperative pneumonia.Results Of 31 patients,30 survived after surgery with early mortality of 3.23%.One patient died of severe low cardiac output syndrome.Mechanical ventilation time was 4 hours to 168 hours hours(mean,39.68 ± 50.52 hours;median,18 hours).ICU stay was 16 hours to 425 hours(mean,111.65 ± 127.03 hours;median,44 hours).In our group,common postoperative complications were myocardial ischemia(n = 12,36.4%),infection(n = 11,33.3%)including pneumonia(n = 10,30.3%),postoperative tachyarrhythmia(n = 5,15.2%),low postoperative cardiac output(n = 2,6.1%),endocarditis(n = 1,3.0%).Compared with preoperative data,postoperative data including area of mitral regurgitation,left ventricular systolic diameter and left ventricular distolic diameter decreased remarkably(P < 0.01),with left ventricular ejection fraction significantly improved(P < 0.05).Compared with mechanical ventilation time of patients with no postoperative pneumonia,time of those with pneumonia apparently prolonged(P < 0.01)while cardiopulmonary bypass time extended(P < 0.05).Mechanical ventilation time was a risk factor of postoperative pneumonia(OR = 1.041,OR 95%CI =(1.010,1.073).Conclusions Proper therapy strategies according to the knowledge of the ALCAPA disease and the change of postoperative pathology and physiology play an important role in avoiding the postoperative complications and improving postoperative outcomes.     

盆底功能锻炼结合中药治疗复发性阴道炎

目的:探讨以盆底功锻炼能为主的仿生物理治疗结合中药对降低复发性阴道炎复发率的影响。方法:选择门诊就诊,复发性阴道炎患者150例,随机分为3组:Ⅰ组:采用盆底功能锻炼结合中药,盆底治疗每周2次,10次为1个疗程共1个疗程,并于经后第3天服中药,连服7 d,共3个月。Ⅱ组:采用盆底功能锻炼,每周2次,10次为1个疗程共1个疗程;Ⅲ组(对照组):不给予上述方法任何治疗,观察3组患者3、6个月盆底肌力变化及阴道炎的复发率。结果:Ⅰ组、Ⅱ组的盆底肌力治疗前后有提高,差异有统计学意义,Ⅲ组盆底肌力无变化,Ⅰ组、Ⅱ组治疗后盆底肌力与Ⅲ组对比,差异有统计学意义。Ⅰ组、Ⅱ组3、6个月的阴道炎复发率明显低于Ⅲ组的复发率,6个月的复发率Ⅰ组低于Ⅱ组,差异有统计学意义。结论:以盆底功能锻炼为主的仿生物理治疗结合中药能明显降低复发性阴道炎的复发率。     

术前血清尿酸水平与三尖瓣手术后急性肾损伤的相关性研究

目的：探究术前血清尿酸与三尖瓣外科术后急性肾损伤（acute kidney injury,AKI）发生的相关性。方法：回顾性分析广东省人民医院2018年1月至2019年6月，在体外循环下三尖瓣外科手术患者的临床资料。以术前血清尿酸水平的四分位数进行分组，通过单因素和多因素Logistic回归模型结合限制性立方样条模型分析术前尿酸水平与术后AKI的相关性及剂量反应曲线关系。结果：研究共纳入230例患者，有43例（18.7%）患者发生术后AKI。在校正多种因素的影响后，RCS分析提示术前血清尿酸水平与术后AKI发生呈现线性关系（非线性检验P=0.0778)。多因素Logistic回归分析提示，尿酸每增加10μmol/L，术后发生AKI的风险增加5%(OR=1.05,P=0.186)。发生术后AKI的风险，以Q1组患者为参照，Q2组患者是4.6倍（OR=4.62,P=0.0952）;Q3组是8.0倍（OR=8.01,P=0.0147）;Q4组是7.9倍（OR=7.92,P=0.0165）。尿酸浓度分组越大，术后发生AKI的风险越高（趋势性检验P=0.0114）。结论：AKI是三尖瓣外科术后常...