乌司他丁和抑肽酶对体外循环小儿炎性反应及心肌损伤的影响

目的研究乌司他丁和抑肽酶对体外循环（CPB）小儿炎性反应及心肌损伤的影响。方法选择拟行CPB的先天性心脏病患儿90例,随机分成6组,每组15例：对照组（C组,不使用乌司他丁及抑肽酶）、小剂量乌司他丁组（UL组,乌司他丁1万U/kg）、大剂量乌司他丁组（UH组,乌司他丁2万U/kg）、小剂量抑肽酶组（AL组,抑肽酶7．5万KIU/kg）、大剂量抑肽酶组（AH组,抑肽酶15万KIU/ kg）、小剂量乌司他丁复合小剂量抑肽酶组（UL＋AL组,乌司他丁1万U/kg＋抑肽酶7．5万KIU/kg）。乌司他丁或/和抑肽酶按各组要求剂量在转机前一次性加入预充液中。于CPB前（T1）、升主动脉开放5 min（T2）、CPB结束后30 min（T3）、4 h（T4）抽取动脉血,测定血浆IL-6、IL-8、IL-10、TNF-α、cTnI浓度及CK-MB活性,记录术后辅助通气时间、24 h引流量、心脏复跳情况及围术期多巴胺使用情况。结果与C组比较,在T2～T4时,UH组、AH组、UL＋AL,组血浆IL-6、IL-8、TNF-α、cTnI浓度及CK-MB活性降低;AH组、UL＋AL组IL-10增高（P＜0．05）;UL＋AL组心脏自动复跳率（100％）增高,血管活性药物使用率较低,术后辅助通气时间较短（P＜0．05）;AH组术后出血量较少（P＜0．05）。结论大剂量乌司他丁、大剂量抑肽酶及小剂量乌司他丁复合小剂量抑肽酶,均可通过抑制CPB炎性反应、减轻小儿心肌损伤,小剂量乌司他丁复合小剂量抑肽酶效果更佳。     

抑肽酶对非体外循环冠脉搭桥术病人凝血功能和血小板功能的影响

目的 研究抑肽酶对非体外循环冠脉搭桥术（OPCAB）病人凝血功能及血小板功能的影响。方法 择期行OPCAB病人32例，ASAⅢ或Ⅳ级，年龄46～75岁，体重65．92kg，随机分为2组（n=16）：对照组（C组）和抑肽酶组（A组）。C组不用任何抗纤溶药物，A组将抑肽酶200万KIU溶于100ml生理盐水中，自切皮开始静脉输注，30min内输注完毕，另外100万KIU以20．30万KIU／h速率输注至术毕。分别于切皮前1min、肝素化前1min（此时已用抑肽酶200万KIU）、术毕、术后6h和术后24h经颈内静脉采血5ml，用流式细胞仪测定血小板膜糖蛋白GPⅡb／Ⅲa和血小板α颗粒膜蛋白-14．0（CD62p），用比浊法测定部分凝血活酶时间（Am）、凝血酶原时间（PT）和纤维蛋白原，用硅藻土激活剂测定激活全血凝固时间（ACT）。记录术后24h出血量。结果 组间GPⅡb／Ⅲa、PT和ACT比较差异无统计学意义（P〉0．05）。与C组比较，A组CD62p肝素化前1min、术毕和术后6h降低，Am肝素化前1min和术毕时延长，术后24h出血量减少（P〈0．01）。结论 抑肽酶抑制OPCAB病人血小板激活和内源性凝血系统，减少术后出血。     

术前应用抑肽酶对脑膜瘤切除术患者围术期凝血功能的影响

目的 评价术前应用小剂量抑肽酶对脑膜瘤切除术患者围术期凝血功能的影响。方法60例择期行脑膜瘤切除术患者，年龄18～60岁，ASAⅠ或Ⅱ级，随机分为对照组（Ⅰ组）、抑肽酶50万KIU组（Ⅱ组）、100万KIU组（Ⅲ组）和200万KIU组（Ⅳ组），每组15例。Ⅱ～Ⅳ组以100ml／h的速率于麻醉诱导后持续输注相应剂量抑肽酶（溶于50ml生理盐水中）。分别在入室后（基础值）、抑肽酶输注完成时、取瘤时、术毕、术后24h测定血常规和凝血功能各指标。结果各组一般资料、手术时间、尿量、输液量、出血量、肿瘤体积比较差异无统计学意义（P〉0．05）。与基础值比较，四组术中及术后红细胞计数、血红蛋白、红细胞压积、血小板计数均降低，术后白细胞计数升高，术中血浆凝血酶原时间、纤维蛋白原、凝血速率均延长或降低，Ⅲ、Ⅳ组术中活化凝血活酶时间延长，Ⅳ组术中血小板功能增强（P〈0．05）；与Ⅰ组比较，Ⅲ、Ⅳ组术毕及术后时白细胞升高，Ⅱ～Ⅳ组术中活化部分凝血活酶时间延长，Ⅳ组术中血小板功能增强（P〈0．05）。结论脑膜瘤切除术患者术前应用100万和200万KIU抑肽酶可使APTT延长，200万KIU抑肽酶对血小板功能有保护作用。     

抑肽酶在体外循环心脏手术中的局部应用

目的 探讨体外循环(CPB)心脏手术中在采取综合性血液保护措施的基础上(转流中预充小剂量抑肽酶4～5万KIU/kg、手术失血和术后机器余血回输),再局部应用抑肽酶的血液保护效果.方法 体外循环心脏手术病人20例随机分为对照组(C组10例)、局部应用抑肽酶组(A组10例).手术后0、2、6h分别测定纵隔心包引流液中D-二聚体(D-D)含量、组织型纤溶酶原激活物(t-PA)活性、组织型纤溶酶原激活物抑制物(PAI)活性、蛋白C(PC)含量,记录各组术后纵隔心包引流量、24h血红蛋白丢失量.结果 局部应用抑肽酶组引流液中D-D含量、t-PA活性、PC含量均显著低于对照组(P＜0.01、P＜0.05、P＜0.01),PAI活性高于对照组(P＜0.05),术后24h纵隔心包引流量、血红蛋白丢失量也较对照组明显降低(P＜0.05,P＜0.01).结论 在常规采用综合性血液保护措施的基础上,局部应用抑肽酶可收到更佳的血液保护效果.     

曲马多对全子宫切除术患者血浆细胞因子的影响

目的:观察曲马多对血浆中细胞因子白细胞介素-6(IL-6)、IL-10和IL-2的影响,评价曲马多对硬膜外麻醉下行全子宫切除术患者的促炎和抗炎效应及免疫功能的作用。方法:30例选择性全子宫切除或全子宫加双附件切除术患者,ASAⅠ~Ⅱ级,随机分为对照组(C组)和曲马多组(T组),每组15例,两组均以安氟醚和硬膜外阻滞联合进行全身麻醉。对照组术中未给予任何镇静药物;曲马多组在切皮前静脉注射曲马多1·5mg/kg,继以微泵持续输注至手术结束,输注速度为0·5mg·kg-1·h-1。分别于手术前及术后各时间点抽取患者外周静脉血。结果:两组患者术后血浆中IL-6和IL-10的浓度与术前(基础值)相比均明显升高(P<0·01),曲马多组患者血浆中IL-10水平则在术后24h明显高于对照组(P<0·05)。曲马多组患者血浆中IL-2的浓度在术后6h与术前相比明显升高(P<0·01),并在术后6h和24h显著高于对照组(P<0·01),而对照组患者血浆中IL-2的浓度在术后保持低水平,至24h较术前显著降低(P<0·01)。结论:静脉输注曲马多对全子宫切除手术后IL-6/IL-10的细胞因子反应具有显著影响,并可引起IL-2生成增加,因此曲马多可有效减轻全子宫切除手术引起的免疫应答失调和应激水平。     

收肌管阻滞联合膝关节周围局部浸润麻醉对全膝关节置换术病人术后炎症反应的影响

目的评价收肌管阻滞联合膝关节周围局部浸润麻醉对全膝关节置换术病人术后炎症反应的影响。方法择期行全膝关节置换术病人60例, 年龄54～76岁, 性别不限, ASA分级Ⅱ或Ⅲ级, 采用随机数字表法分为2组(n=30):收肌管阻滞组(A组)和收肌管阻滞联合膝关节周围局部浸润麻醉组(AL组)。2组气管插管完成后, 采用0.5%罗哌卡因15 ml行收肌管阻滞;AL组在术中截骨完成后由术者行膝关节周围局部浸润麻醉。术毕行病人自控收肌管阻滞镇痛, 配方:罗哌卡因400 mg, 用0.9%氯化钠注射液稀释到200 ml, 背景输注速率5 ml/h, PCA剂量5 ml, 锁定时间30 min。VAS评分> 4分时, 按压镇痛泵后30 min仍未缓解, 则肌肉注射盐酸哌替啶100 mg进行镇痛补救。分别于麻醉诱导前即刻(T0)、术后24、48和72 h(T1-3)采集外周静脉血标本, 采用ELISA法检测血清IL-6和IL-10的浓度。分别于T1-3时评定患肢肌力;记录术后72 h内病人满意度评分、镇痛补救情况及不良反应发生情况。结果与A组比较, AL组术后各时点血清IL-6浓度降低, 血清IL-...     

抑肽酶对体外循环心脏手术患者细胞因子的影响

目的 观察不同剂量抑肽酶对体外循环心肺转流（CPB）期间促炎细胞因子TNF-α、IL-6和抗炎细胞因子IL-10血浆浓度的影响及作用差异。方法 32例瓣膜置换术病人随机分为三组：对照组、小剂量抑肽酶组和大剂量抑肽酶组。分别于CPB前、CPB结束、停CPB后2小时取桡动脉血测定TNF-α、IL-6、IL-10血浆水平。结果 于CPB结束、停CPB后2小时,大剂量组TNF-α、IL-6血浆水平低于相应点小剂量组,而IL-10血浆水平高于小剂量组。结论 大剂量抑肽酶较小剂量抑肽酶能更有效地抑制TNF-α、IL-6释放、促进IL-10释放,对其抗炎性能有益,抑肽酶的抗炎作用存在量效关系。     

罗比卡因背景输注下有或无吗啡负荷剂量对硬膜外PCA效应影响的比较

目的　研究妇科手术后病人在罗比卡因 (Rop)不同背景剂量输注下 ,有或无吗啡 (Mor)负荷剂量对硬膜外PCA效应的影响。方法　选择经腹子宫全切术病人 12 0例 (ASAⅠ～Ⅱ级 )随机分成六组 ,通过三通管硬膜外给予背景剂量 0、2、4、6、4和 6ml/h 0 2 %Rop输注 ;另一泵镇痛液为0 0 1%Mor ,前四组 (C0 、C2 、C4 、C6组 )以LP模式 (负荷剂量 +PCA)加强镇痛 ,后两组 (C4N和C6N组 )以P模式 (仅用PCA)辅助 ,观察镇痛评分、运动阻滞及不良反应等情况。结果　六组镇痛效果均达到满意程度 ,其质量分数C0 组 0 0 5 ) ;各组低血压和心动过缓发生率无统计学差异 ,均无呼吸抑制。结论　妇科经腹手术后以 0 2 %Rop 4～ 6ml/h背景剂量输注 ,可采用有或无负荷剂量模式 ,     

乌司他丁对非体外循环冠状动脉旁路移植术病人围术期炎性反应的影响

目的观察乌司他丁对非体外循环冠状动脉旁路移植术(OPCABG)病人围术期炎性反应的影响。方法拟行OPCABG的病人24例,采用随机、双盲方法分为对照组(C组)和乌司他丁组(U组),每组12例。静脉注射咪达唑仑0.1mg/kg、芬太尼10～20μg/kg、哌库溴铵0.1mg/kg麻醉诱导后气管插管,机械通气,吸入1%～2%异氟烷、间断静脉注射芬太尼(2～5μg/kg,总量最高为50μg/ kg)、持续静脉输注哌库溴铵0.03～0.05mg·kg~(-1)·h~(-1)维持麻醉。U组麻醉诱导后开始恒速静脉输注乌司他丁6 000U/kg(30min内输完),然后以1 000 U·kg~(-1)·h~(-1)的速率持续静脉输注至手术结束。C组采用的同样方法输注等容量的生理盐水。分别在切皮前即刻(T_1)、冠状动脉全部吻合结束后0.5h (T_2)、术后2h(T_3)、6h(T_4)、18h(T_5)采集静脉血,测定血浆白细胞介素-6(IL-6)、IL-10、终末补体复合物(TCC)的浓度及CD11b/CD18的表达。结果与T_1比较,C组在T_(3,4)时IL-6浓度、T_3时IL-10浓度升高,T_(2-4)时CD11b/CD18表达升高,2组在T_2时TCC浓度均升高(P<0.05或0.01);与C组比较,U组在T_3时IL-6、IL-10浓度降低,在T_(2～4)时CD11b/CD18表达降低(P<0.05或0.01)。结论乌司他丁可在一定程度上抑制OPCABG病人围术期IL-6、IL-10浓度及CD11b/CD18表达的升高,具有减轻炎性反应的作用。     

乌司他丁在婴幼儿心肺转流心脏直视手术中的应用

目的 比较乌司他丁（UTI）和抑肽酶在婴幼儿心肺转流（CPB）心内直视手术期间对炎性介质和细胞因子的抑制作用以及对呼吸系统总顺应性的影响。方法 48例室间隔缺损（VSD）患儿随机分为四组：U组,UTI 10 kIU／kg;Ap组,抑肽酶100 klU／kg;UA组,UTI 5 kIU／kg加抑肽酶100 kIU／kg和C组（对照组）,每组12例。于麻醉诱导后（T4）、CPB结束（T2）和术后2h（T3）采血检测白细胞介素-6（IL-6）、IL-8、IL-10和肿瘤坏死因子α（TNF-α）。并同时监测血液动力学和呼吸系统总顺应性（Crs）等。结果 CPB期间C组和Ap组的IL-6、IL-8血浆水平增高幅度较为显著（P〈0．01）。且术后恢复较慢;IL-10在T2时除Ap组仅有轻微改变外,其余三组均升高（P〈0．01）,至T3时仍呈升高趋势;各组TNF-α的血浆水平升高均较为显著（P〈0．01）,尤以C组为甚。血浆细胞因子和炎性介质的改变与呼吸功能呈负相关,U组Crs变化轻微,其他各组Crs均显著降低。结论 UTI能安全有效地应用于婴幼儿,通过抑制CPB心脏直视手术患儿围术期促炎细胞因子的释放,减轻CPB引起的急性炎症反应,改善呼吸系统顺应性而具肺保护功能。其作用较抑肽酶显著。     

Long-term evaluation of EC-IC bypass patency

Summary The EC-IC Bypass Study Group could not detect any benefit from surgery compared to medical management in the prevention of stroke in 1985 [15]. During the past years surgical revascularization was re-evaluated and considered as an appropriate treatment for a small subgroup of patients with recurrent focal cerebral ischaemia and impaired haemodynamics. This retrospective study examines the long-term benefit and patency rate of bypass.We present a follow-up of 5.6 years of 47 patients, all of whom underwent byupass surgery after 1985. Forty patients suffered recurring transient ischaemic attacks due to uni- or bilateral internal carotid artery occlusion. Examination included neurologic status, TCD with CO₂ or Diamox challenge, angiography, CT and SPECT scans.Neurological improvement was seen in 23% of patients with better results after early surgery, a worsening in 22% suffering further ischaemic events on a postoperative average of 2.8 years. Patency rate for vein graft material was 50%, for the STA-MCA procedure 91%. Occlusion of the vein graft occurred on an average after 1.4 years, other anastomosis after 2.7 years.We conclude that only few patients derived long-term benefit from EC-IC bypasses. Functioning of the bypass worsens over time, suggesting a role for surgery predominantly in the first year of ischaemic events due to insufficient collateral supply. Actual indications for bypass surgery may be patients with failure of maximal medical therapy and progressive ischaemia and haemodynamic compromise.     

Early results of off-pump coronary artery bypass

Objective: The purpose of this study is to compare the operative results of off-pump coronary artery bypass (OPCAB) and on-pump (conventional) coronary artery bypass (CCAB), to clarify qualitative problems and whether OPCAB is less invasive or not. Methods: OPCAB was consecutively performed in 63 patients and CCAB in 63 patients between July 1998 and December 2003. Results: The mean number of bypass grafts was 2.43 ±0.82 in the OPCAB group and 2.70±0.71 in the CCAB group (p=0.096). In-hospital mortality was 0% in the OPCAB group and 3.2% in the CCAB group. The incidence of perioperative myocardial infarction was 0% in the OPCAB group and 3.2% in the CCAB group. The incidence of postoperative major complications was significantly lower in the OPCAB group than in the CCAB group (OPCAB group=4 complications, CCAB group=13 complications). Cerebrovascular accidents occurred in 1.6% of patients in both groups. The incidence of sternal infection or mediastinitis was 0% in the OPCAB group and 3.2% in the CCAB group. The early patency rate of graft was 94.0% in the OPCAB group and 92.8% in the CCAB group, and was not significantly different (p=0.822). Conclusion: Operative mortality and major complications after surgery in OPCAB were lower than that in CCAB. The early patency rate in OPCAB was as good as that in CCAB. It is considered that OPCAB is less invasive and the quality of bypass in OPCAB is as good as that in CCAB.     

Infrageniculate thin-walled PTFE bypass: Preliminary study of 53 cases

Between May 1, 1983 and May 1, 1985, 53 patients whose mean age was 75 years, and who presented with rest pain or ischemic changes had infrageniculate insertion of femoropopliteal or femorotibial thin-walled polytetrafluoroethylene (PTFE-TW) bypasses. Occlusive atherosclerotic disease was present in all patients. Postoperative follow-up ranged from 6 to 30 months. One patient died in the immediate post-operative period whereas 15 others died later during follow-up. There was one case of prosthetic sepsis. No anastomotic aneurysms occurred. Actuarial analysis of overall patency rates in significant population samples showed that 88% and 68% of bypasses were functional at one month and two years, respectively. The overall rate of early amputation was 17%. Overall limb salvage was 67% at 30 months. In patients over 75, 85% of bypasses were patent at one year whereas life expectancy for one year in this same group of patients was 49%. Although this is a preliminary study, results obtained with this new material suggest that an average gain of 20% in patency rates can be expected compared to those recorded with standard PTFE prostheses. The PTFE-TW vascular prosthesis may be the material of first choice for the geriatric patient in order to promote early hospital discharge and return to the home environment. Even though long-term patency rates of venous grafts are better, we believe that the use of PTFE-TW prostheses in elderly patients with limited life expectancy may be preferred.     

Combined aortobifemoral and femoropopliteal bypass in the management of patients with extensive atherosclerosis

Certain patients have atherosclerosis in both aortoillac and femoropopliteal segments of the arterial tree and thus do not have a good result from reconstruction of the aortoiliac segment. No method has been developed to identify these patients and we do not know whether, by combining a femoropopliteal bypass with an aortobifemoral bypass, the results can be improved. We present a series of 153 patients with severe multilevel occlusive disease treated by simultaneous reconstruction and followed for up to 6.5 years. The cumulative patency of the femoropopliteal bypasses was 80% at four years. Functional and symptomatic improvement was excellent, and operative mortality was low when one considers the age and poor general condition of the patients.     

Effect of Location and Speed of Diagnosis on Anastomotic Leak Outcomes in 3828 Gastric Bypass Cases

Introduction Leaks after Roux-en-Y gastric bypass are a major cause of mortality. This study attempts to define the relationship between the leak site, time from surgery to detection, and outcome. Methods Retrospective review of 3,828 gastric bypass procedures. Results Of the leaks (3.9% overall), 60/2,337 (2.6%) occurred after open gastric bypass, 57/1,080 (5.2%) after laparoscopic gastric bypass, and 33/411 (8.0%) after revisions. Overall leak-related mortality after Roux-en-Y gastric bypass was 0.6% (22/3,828). Mortality rate from gastrojejunostomy leaks (38 in the open gastric bypass, and 43 in the laparoscopic) was higher in the open group than the laparoscopic group (18.4 vs 2.3%, p = 0.015). Median time of detection for a gastrojejunostomy leak in the open group was longer than in the laparoscopic group (3 vs 1 days, Wilcoxon score p < 0.001). Jejunojejunostomy (JJ) leak was associated with a 40% mortality rate. Initial upper gastrointestinal series did not detect 9/10 jejunojejunostomy leaks. Median detection time was longer in the jejunojejunostomy leak group than the gastrojejunostomy leak group (4 vs 2 days, p = 0.037). Discussion Leak mortality and time of detection was higher after open gastric bypass than laparoscopic gastric bypass. GBP patients with normal upper gastrointestinal (UGI) studies may harbor leaks, especially at the JJ or excluded stomach. Normal UGI findings should not delay therapy if clinical signs suggest a leak. This paper was presented at The Society for Surgery of the Alimentary Tract, 47th Annual Meeting at Digestive Disease Week 2006, May 20–24, 2006, Los Angeles, California.     

Cardiopulmonary bypass recommendations in adults: the northern New England experience

Using a regional cardiopulmonary bypass (CPB) registry, we compared the practice of CPB at eight northern New England institutions to recently published recommendations. We examined CPB practice among 3597 adult patients undergoing isolated coronary artery bypass grafting surgery from January 2004 to June 2005. Registry variables were used to compare regional CPB practice to recommendations on topics of neurologic protection (pH management, avoidance of hyperthermia, minimizing return of pericardial suction blood, aortic assessment, arterial line filtration), maintenance of euglycemia, reduction of hemodilution, and attenuation of the inflammatory response. We report overall regional practice (regional minimum, maximum). All centers used alpha-stat pH management and arterial line filters. Avoidance of hyperthermia (temperature < 37degrees C) was achieved during 23.4% of procedures (regional minimum, 1.5%; maximum, 83.2%). Minimizing return of pericardial suction blood was achieved in 23.7% of cases (0.7%, 93.6%). Aortic assessment was performed during 45.7% of procedures (1.3%, 98.9%). Maintenance of euglycemia (< 200 mg/dL) was accomplished in 82.7% (57.1%, 97.9%) of cases. Hemodilution (hematocrit < 23% on CPB) was lower for men 32.4% (20.6%, 52.3%) than women 77.9% (64.7% 88.9%). Men were less likely to receive red blood cell transfusions in the operating room (11.0%; 1.8%, 20.9%) than women (54.6%; 30.1%, 70.6%). In an effort to attenuate the inflammatory response, surface coated circuits were used in 83.3% of procedures (8.8%, 100%). During this time, gaps existed between regional CPB practice and recently published recommendations. We continue to prospectively measure CPB practice relating to these recommendations to monitor and improve the care provided to our patients.     

浅低温体外循环冠脉搭桥患者术中氧供和氧耗变化

观察浅低温体外循环冠脉搭手术期间患者氧供和氧耗的变化特点。方法：冠脉搭桥术患者３０例,小剂量芬太尼辅以异氟醚和异丙酚维持麻醉,于麻醉后切皮瓣、开胸后体外循环前,体外循环３０分钟、６０分钟停机后２０仲,手术结束六个时点,观测氧供（ＤＯ２）、氧耗（ＶＯ２）氧摄取率（Ｏ２ＥＲ）、混合静脉血氧饱和度（ＳｖＯ２）、动脉血乳酸（ＢＬ）及血流动力学等变化。结果：和体外循环前相比,体外循环中和体外循环后除ＳｐＯ２     

Perforated marginal ulcer after gastric bypass for obesity: a systematic review

Marginal ulcers are a recognized complication of gastric bypass procedures for obesity. Perforated marginal ulcer (PMU) is a life-threatening complication of marginal ulcers. We performed a systematic review to understand the presentation, management, and outcomes of PMUs. PubMed, Google Scholar, and Embase databases were searched to identify all studies on PMUs after gastric bypass procedures. A total of 610 patients were identified from 26 articles. The mean age was 39.8±2.59 years, and females represented most of the cohort (67%). The mean body mass index was 43.2±5.67 kg/m². Most of the patients had undergone a Roux-en-Y gastric bypass (98%). The time gap between the primary bariatric surgery and the diagnosis of PMU was 27.5±8.56 months. The most common presenting symptom was abdominal pain (99.5%) and a computed tomography scan was the diagnostic modality used in 72% of the patients. Only 15% of patients were on prophylactic proton pump inhibitors or H2 blockers at the time of perforation, and 41% of patients were smoking at the time. Twenty-three percent of patients were on nonsteroidal anti-inflammatory drugs. Laparoscopic omental patch repair of the perforation (59%) was the most used technique; 18% of patients underwent open surgery, and 20% were managed non-surgically. Thirty-day mortality was 0.97%; it was 1.21% (n=5) and 0% (n=0) in those who were managed surgically and nonsurgically, respectively. Ulcers recurred in 5% of patients. In conclusion, PMU is a surgical emergency after gastric bypass that can result in significant morbidity and even mortality. This is the first systematic review in scientific literature characterizing this condition.     

体外循环与非体外循环冠状动脉旁路移植术补钾影响因素的比较

目的 探讨常规冠状动脉旁路移植术(CCABG)与非体外循环冠状动脉旁路移植术(OPCABG)围术期钾离子变化特点与补钾影响因素.方法 50例接受CABG患者,分为CCABG组和OPCABG组,每组25例.术中根据血气结果补钾,维持血清钾离子浓度在4.0～5.0mmol/L.记录并比较两组术中及术后液体出入量、补钾量、单位时间补钾量(补钾量/手术时间)、尿钾浓度、尿排钾量(总尿量×平均尿钾浓度)以及心肺转流(CPB)指标,分析两组术中补钾量的独立影响因素.结果 CCABG组术中补钾量及单位时间补钾量均高于OPCABG组,但其CPB前后单位时间补钾量低于OPCABG组(P＜0.05);CCABG组桥血管数、手术时间、术中尿量、尿排钾量及术后24 h补钾量均大于OPCABG组,术中平均尿钾浓度和最低体温低于OPCABG组(P＜0.05).多元线性回归分析显示尿量和入室血钾浓度是OPCABG组术中补钾量的独立影响因素;年龄和CPB转机时间是CCABG组术中补钾量的独立影响因素(P＜0.05).结论 CABG围术期需积极补钾.OPCABG中应根据基础血清钾水平结合尿量尽早开始补钾;CCABG中应根据CPB时间合理补钾.     

Unilateral iliac artery occlusive disease: A randomized multicenter trial examining direct revascularization versus crossover bypass

This randomized trial compared the patency of direct unilateral aorto- or iliofemoral prosthetic bypass with that of crossover femorofemoral or iliofemoral bypass in unilateral atheromatous occlusive disease of the iliac artery. Between May 1986 and March 1991, 143 patients were enrolled in this study (74 crossover and 69 direct revascularizations). Cardiovascular risk factors, preoperative symptoms, and atheromatous lesions were similar in both groups. Patients were followed by Duplex scanning with systolic pressure index measurements. Routine digital subtraction arteriograms were obtained postoperatively and separately, when hemodynamic anomalies developed. Mean follow-up was 22 months. One patient with direct revascularization died postoperatively. Primary patency of direct revascularizations was 89.8% at 48 months compared with 52% for crossover bypass. This difference was statistically significant. Secondary patency of direct and crossover revascularization at 48 months was 92.9% and 93.6%, respectively (not significant). Even though crossover bypasses seem attractive because of their technical simplicity and low morbidity, our results suggest that direct revascularizations are preferable in the young patient with no major operative risks, while crossover bypasses remain indicated in patients at risk.Presented at the Annual Meeting of the Société de Chirurgie Vasculaire de Langue Française, June 20–21 1991, Marseille, France.