心血管手术后的心房颤动

心房颤动（简称房颤）是心血管外科手术后的常见并发症，发生率可达４０％。高龄患者的发生率明显上升。一般发生在术后２４～７２ｈ，术后４８ｈ达高峰。虽然术后房颤通常并不导致长期后遗症，但有潜在的血栓栓塞并发症、血液动力学损害以及住院时间延长。１发病率其与术...     

老年人开胸手术后心血管并发症的处理

开胸手术后心血管并发症近年明显增加 ,老年人循环呼吸功能减退 ,常有并存病 ,因而开胸手术的并发症发生率更高 ,及时处理好并发症是降低开胸手术病死率的主要手段之一。1　资料与方法1992年 5月～ 1996年 5月因胸部疾病而住院病人共 2 716例 ,其中 3 16例老年人行开胸手术。年龄 65～ 88岁 ,男2 90例 ,女 2 6例。恶性组 193例 ,其中食管贲门癌 113例 ,肺癌 80例 ,良性病组12 3例 ,其中胸外伤 5 9例 ,支气管扩张 41例 ,肺大疱致气胸 2 3例。术前均做胸正侧位片、胸部ＣＴ、心脏彩超、各种生化检查。对食管贲门癌还行胃肠造影、胃镜等检查。…     

Fontan手术后早期并发症分析

Fontan手术越来越多地应用于复杂紫绀型先天性心脏病的治疗，并取得较好的临床疗效。我院自1984年1月至2001年12月共施行134例Fontan手术，作者回顾性分析术后并发症及处理的经验。     

神经精神系统并发症

神经精神系统并发症在肝移植术后较为常见,包括移植后脑病(也称肝移植术后谵妄样精神障碍)、癫痫、脑血管病、中枢神经系统感染(颅内感染)、周围神经病变等。发生率为8％～47％,大多发生在移植后1个月之内,可增加围手术期病死率。现就肝脏移植后神经精神系统并发症的有关问题进行分析。     

体外循环心脏直视手术后灌注肺的早期诊断

观察了14例体外循环下心脏直视手术后灌注肺患者的X线影像学变化。结果术后10～36h双肺斑片状阴影加重,有斑片融合及大片状模糊阴影;术后24-72h两肺内有广泛的片状阴影,严重者几乎完全实变呈白肺。认为体外循环心脏术后早期X线胸片检查及定期复查对灌注肺的诊断及治疗具有重要价值。     

尿毒症神经精神系统并发症

尿毒症神经精神系统并发症主要包括中枢神经系统、周围神经系统和植物神经系统以及精神改变等几个方面。在未经透析的尿毒症患者中，８２％有神经精神症状，５６％患者的神经精神症状发生在肾功能损害两年以内。发病机制尿毒症神经精神损害的发病机制至今不甚明了，可能是...     

糖尿病患者体外循环心脏手术后早期脑损伤的临床研究

目的　探讨糖尿病患者行体外循环心脏手术后早期脑损伤的情况。方法　随机选择行瓣膜置换术的糖尿病患者 16例为实验组 ,非糖尿病患者 2 0例为对照组。在体外循环结束后 5小时抽血 ,采用 EL ISA法检测血清 S10 0 B蛋白浓度 ,以判断脑损伤的发生。结果　实验组和对照组的术后早期脑损伤发生率分别为 94 %和6 5 % ,有显著性差异 (P<0 .0 5 )。结论　糖尿病患者在体外循环术后脑损伤的发生率明显高于非糖尿病患者。为减少糖尿病患者术后脑损伤的发生 ,术前必须严格控制血糖 ,术中严密观察血糖变化 ,术中和术后及时应用胰岛素控制血糖。     

心内直视手术后早期出血再手术10例分析

报告１０例心内直视手术患者因术后早期出血过多而再手术（３例心包填塞）。出血的主要原因是血小板减少，凝血因子不同程度的降低，纤溶酶活性增加，术中损伤邻近血管，切口缝合不严，电凝止血时烧焦切缘组织等。１０例再手术过程中，经相应处理均获痊愈。     

肝移植患者术后早期心血管并发症

肝移植已成为终末期肝病和暴发型肝功能衰竭的一种有效治疗方式。但由于手术本身的特点和术前患者的基础状况较差,术后易并发心血管系统的并发症,并影响全身各器官功能,进而影响预后。本文重点阐述肝移植术后早期心血管并发症—高血压、心力衰竭、心肌缺血和肺动脉高压的原因及其防治策略。     

心血管手术体外循环前心室颤动的原因及对策

目的 :了解心血管手术体外循环前心室颤动 (室颤 )的可疑因素及其致颤相关性。　　方法 :分析既往 15年病例 ,按术前病情、麻醉管理、抢救及转归等进行病历摘要和归总。　　结果 :2 46 5 1例中体外循环前发生室颤 34例 (1.379‰ ) ,先天性心脏病发生率 0 .90 8‰ ,风湿性心脏病 2 .418‰ ,差异显著。心功能 级、二次手术发生率 (15 .931‰ )显著增高。　　结论 :术前准备不足、麻醉管理不当是室颤最主要和最常见的诱因 ,不良刺激和意外损伤是重要的直接致颤原因。围术期综合管理水平的提高 (术前准备、麻醉管理和手术操作 )对降低室颤发生率和致死率有重要意义     

Combined Application of Circulatory Assist Devices Following Cardiac Arrest in Patients after Cardiac Surgery

Objectives To evaluate retrospectively the potential benefits of combined utilization of various assisted circulation devices in cardiac arrest patients who did not respond to conventional cardiopulmonary cerebral resuscitation (CPCR). Methods Assisted circulation devices, including emergency cardiopulmonary bypass (ECPB), intra-aortic balloon pump (IABP), and left ventricular assist device (LVAD), were applied to 16 adult patients who had cardiac arrest 82 min-56 h after open heart surgery and did not respond to 20 min or longer conventional CPCR. ECPB was applied to 2 patients, ECPB plus IABP to 8 patients, ECPB plus IABP and LVAD to 6 patients. Results One patient recovered fully and one patient died. Of the other 14 patients, 13 resumed spontaneous cardiac rhythm and one did not; none of them could be weaned from ECPB. Further treatment of the 14 patients with combinations of assisted circulation devices enabled 6 patients to recover. One of the 7 recovered patients died of reoccurring cardiac arrest after 11 days; the other 6 were discharged in good condition and were followed up for 3 -49 months (mean =22 months). Of the 6 discharged patients one suffered cerebral embolism during LVAD treatment, resulting in mild limitation of mobility of the right limbs; the other 5 never manifested any central nervous system complications. There was no late deaths giving a 37.5% (6/16) long-term survival rate. Conclusions ECPB could effectively reestablish blood circulation and oxygen supply, rectify acidosis, and improve internal milieu. The combined utilization of ECPB, IABP, and LVAD reduces the duration of ECPB, improves the incidence of recovery, and offers beneficial alternatives to refractory cardiac arrest patients.     

离心泵在心血管领域中的应用——附66例临床病例总结

目的：评估离心泵在临床常规体外循环、急症体外循环及辅助循环手术中的使用情况。方法：本文回顾性地分析了阜外心血管病医院自１９９１年至１９９５年间６６例使用离心泵的心血管疾病患者的相关资料。全组病例包括择期心脏直视手术患者５８例（占８８％），急症及辅助循环手术８例（占１２％）。结果：择期手术患者脱离体外循环成功率９８％；其中２例冠状动脉旁路移植术及心室壁瘤切除术患者术后左心功能衰竭转为辅助循环。急症及辅助循环手术患者脱离体外循环成功率６０％。结论：随着离心泵在体外循环中的应用，长时间辅助循环的成功率逐渐增高，为心脏外科及介入治疗术后需要进行长时间心脏辅助的患者提供了新途径；同时提示辅助循环成功率与病例选择时机有密切关系。     

Increments in Circulating Homocysteine before and after Coronary Artery Bypass Surgery in Diabetic and Non-diabetic Patients

This study aims to assess total plasma homocysteine levels in diabetic and non-diabetic patients who underwent coronary artery bypass grafting (CABG) and to determine the effect of cardiopulmonary bypass (CPB) on homocysteine levels. Twenty diabetic and twenty non-diabetic patients who had CABG were enrolled in the study. Plasma samples for the assays were obtained before and after the CPB and on sixth day following the operation. Diabetic patients seemed to have higher levels of plasma total homocysteine in pre-CPB, post-CPB, and postoperative sixth day blood samples. There was a significant difference in total homocysteine levels between pre-CPB and post-CPB both in diabetic and non-diabetic patients. Although an association between the preoperative plasma total homocysteine levels and the frequency of 1-year graft occlusion could not be demonstrated, our data claims attention to the increased homocysteine levels during CPB, which sustained until the sixth day after the surgery.     

Colorectal Surgery in Cirrhotic Patients: Assessment of Operative Morbidity and Mortality

Purpose  The morbidity from colorectal surgery can be high and increases for patients with cirrhosis of the liver. This study was designed to assess morbidity, mortality, and prognostic factors for patients with cirrhosis undergoing colorectal surgery. Methods  From 1993 to 2006, 41 cirrhotic patients underwent 43 colorectal procedures and were included. Both univariate and multivariate analyses were performed to identify variables influencing morbidity and mortality. Results  Postoperative morbidity was 77 percent (33/43). Postoperative mortality was 26 percent (11/43) among whom six patients (54 percent) underwent emergency surgery. Four factors influenced mortality on univariate analysis: presence of peritonitis (P < 0.05), postoperative complications (P < 0.04), postoperative infections (P < 0.01), and total colectomy procedures (P < 0.02). On multivariate analysis, the only factor influencing mortality was postoperative infection (P < 0.04). The only factor influencing morbidity was the existence of preoperative ascites (P < 0.04). Conclusions  Colorectal surgery for cirrhotic patients has a high risk of morbidity and mortality. This risk is associated with the presence of infection, ascitic decompensation, and the urgent or extensive nature of the procedure. The optimization of patients through selection and preparation reduces operative risk.     

国产抑肽酶的临床应用

心脏外科手术中，体外循环转流能破坏血小板及凝血系统的功能。近年来有研究表明，抑肽酶作为一种蛋白酶抑制剂，有良好的抑制纤溶系统及保护血小板的功能，我们将５８例患者随机分成两组，观察术中和术后血小板功能、输血量和胸腔引流量、ＡＣＴ及尿量。研究表明，抑肽酶对血小板功能具有保护作用，可减少术后出血及库血用量，减少因出血和输血所引发的一系列并发症。本研究未发现应用国产抑肽酶所造成的副作用。