纱布填塞联合延迟关胸在心脏直视术后严重渗血中的应用

延迟关胸主要用于心脏外科术后血流动力学状态不稳定、严重心律失常及切口大量渗血等情况〔1〕。纱布填塞常用于肝脏手术或肝脏破裂出血、产科严重出血等情况。2005年9月~2006年6月,我科对2例双瓣膜置换术后切口严重渗血,常规止血方法难以控制的情况下,采用纱布填塞联合延迟关胸的方法止血,取得了满意效果,报告如下。1对象与方法2例均为女性患者,年龄分别为48岁和50岁,均有风湿性心脏病史20余年,无出血病史。术前心功能均为(NYHA)Ⅲ级,凝血功能基本正常。2例患者均在全麻体外循环下行双瓣膜机械瓣膜置换术。例1在心脏复跳后检查各切口时,…     

一氧化氮在心血管外科中的应用

自 198 7年 Moncada发现血管内皮细胞产生的内皮衍化舒张因子 (EDRF)的本质即一氧化氮 (NO)后 ,NO便成为现代生物学和医学研究中十分活跃的领域 ,并展示方兴未艾之势。在心血管系统 ,NO除介导内皮依赖性血管舒张外 ,近年还发现对平滑肌细胞增殖、迁移、合成胶原和分泌细胞因子以及心肌收缩等过程也起调节作用。而 NO生成不足与过盛与许多疾病病理生理及治疗有关。本文对近几年 NO在心血管外科中的研究进展做如下综述。1　 NO对心、血管的生物学效应NO在维持恒定的血管张力和稳定的血压中有重要的生理作用。 NO是一种很强的舒血管物…     

急性血细胞分离技术在心血管外科中的应用

目前,绝大部分的心血管外科手术需要在体外循环(cardiopulmonarybypass;CPB)的支持下进行,而体外循环是一较强的非生理过程,对血液成份尤其是细胞成份可产生明显的稀释、激活和破坏作用,从而增加术后出血及异体血液制品的输注量。近年来,一些学者开始在心血管外科围体外循...     

纱垫填塞在腹腔难控性大出血中的应用

目的总结腹腔难控性大出血的临床救治经验。方法对8例腹腔难控性大出血应用纱垫填塞损伤控制外科技术救治方案。结果 8例腹腔难控性大出血患者均有效止血手术存活。术后36~72 h取出纱垫,无再出血发生。结论纱垫填塞损伤控制外科技术救治腹腔难控性大出血有效,是基层医护人员易掌握的应急抢救技术。     

他汀类调节血脂药在心血管外科中的应用

近来许多研究表明他汀类调节血脂药除降脂的作用外还具有良好的心血管保护作用 ,本文就其作用机理及其在心血管外科中的应用做一综述。     

心血管外科技术在肿瘤切除术中的应用

2002年5月至2004年4月,我们在14例肿瘤切除术中,应用了心血管外科技术（包括体外循环、血液临时转流或阻断下血管成形和人造血管置换等）,使肿瘤切除率和手术安全性大大提高.现报告如下.     

CBL教学在心血管外科留学生实习教学中的应用

目的 探讨以病例为引导的教学模式(case-based learning,CBL)在本科留学生心血管外科临床实习中的应用.方法 选择2014级在西安交通大学第一附属医院心血管外科实习的本科留学生20人为研究对象,随机分为对照组(传统教学法,10人)和CBL教学组(10人).对照组以PPT的方式进行讲授,而CBL教学组通...     

直肠癌根治术中纱布填塞压迫止血治疗骶前静脉出血的护理

骶前静脉出血是直肠癌根治术术中最危险的并发症,严重时可危及患者生命。2000年12月~2010年12月,我院直肠癌根治术中共发生骶前静脉出血5例,均采用纱布填塞压迫止血,均痊愈出院。现将护理方法报告如下。     

心血管外科中血气和酸碱稳态理论与应用

<正>心血管外科围手术期间,患者呼吸受呼吸机控制,体外循环期间心肺功能被人工心肺机所替代,血气酸碱稳态人为调控,加之,低温的使用也深刻影响血气和酸碱稳态。因而,血气和酸碱稳态管理对保证心血管手术的安全有特殊意义。准确的动态监护血气酸碱稳态可综合反映机体心肺功     

卡孕栓联合自制纱条宫腔填塞在产后出血中的应用

目的 探讨卡孕栓联合宫腔填塞纱条控制产后出血（PPH）的临床效果.方法 将172例PPH患者随机分为对照组131例和治疗组41例.两组均予子宫按摩、催产素及米索前列醇等常规止血方法,在此基础上,治疗组予卡孕栓联合宫腔填塞止血.结果 治疗组产后2 h及24 h出血量均少于对照组（P＜0.05）;无继发自制纱条PPH或严重感染,均避免了子宫切除.结论 卡孕栓联合宫腔填塞纱条治疗简单、安全、快速、有效,是治疗PPH、保留子宫的有效方法之一,值得推广.     

Selective Vagotomy and Drainage in Surgery for Massive Gastroduodenal Bleeding

Over the period 1966 to 1968 inclusive, 87 patients were operated on for massively bleeding ulcer, with a mortality of 14%. During the years 1960 to 1965, the same department had a mortality of 30 % in a corresponding patient group. In suitable patients, vagotomy and drainage with suture ligation of massively bleeding duodenal ulcer was associated with a low mortality. In such cases the vagotomy may be done selectively just as well as by transection of the vagal trunks. The size of the ulcer and the severity of the ulcerative changes are factors disadvantageous to, or contraindicating the choice of, this type of operation. Resection remains the procedure of choice in cases in which pyloroplasty is difficult to perform.     

心血管外科术后意识障碍和急性心血管事件的病因分析及治疗体会

目的:探讨心血管外科术后意识障碍和急性心血管事件患者的致病因素、疾病经过和相关并发症的治疗。方法:回顾性分析2010-01至2011-02间,39例心血管外科术后早期严重意识障碍的患者,观察分析本组患者的病种与手术方式,术者与手术例数分布,以及术后呼吸机辅助时间和特殊治疗经过等指标。结果:39例患者中,有11例在术后早期出现意识障碍伴谵妄躁动,其中2例患者合并典型的急性心血管事件。与39例患者相关的18位主刀术者中,单个主刀术者完成的手术例数从1例至6例不等。其中在9位主刀术者完成的9例(每人1例)患者中,术后早期有5例出现意识障碍伴谵妄躁动和1例急性心血管事件,而1位主刀术者完成的6例患者中,术后早期仅1例出现意识障碍伴谵妄躁动。全组患者经过镇静、脱水和中枢神经代谢支持等综合治疗,均痊愈。结论:心血管外科术后因脑血管和冠状动脉气栓导致的意识障碍和急性心血管事件应予以重视和明确诊断,以利于预防和减少此类并发症的发生。手术过程中对排除心室腔和大血管内残余气体的重视程度,必要的监测和引导设备,手术技巧和规范操作等因素与术后气栓密切相关。气栓的量和所累及脏器功能损害程度直接影响患者的疾病过程和预后。     

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     

Heart Rate as a Risk Factor for Cardiovascular Disease

Almost all the epidemiological studies that aimed to answer the question of the relationship between heart rate and all-cause or cardiovascular morbidity and mortality reported that a high heart rate was associated with a higher risk of all-cause mortality and cardiovascular events. This relationship has been found to be generally stronger in men than among women. The increase in the cardiovascular risk, associated with the acceleration of heart rate, was comparable to the increase in risk observed with high blood pressure. It has been shown that an increase in heart rate by 10 beats per minute was associated with an increase in the risk of cardiac death by at least 20%, and this increase in the risk is similar to the one observed with an increase in systolic blood pressure by 10 mm Hg. It has also been shown that heart rate recorded in elderly men has a strong predictive value in survival to a very old age. Taken together, these results indicate that the risk associated with accelerated heart rate is not only statistical significant but also clinically relevant and that it should be taken into account in the evaluation of the patients. Although the association between elevated heart rate and cardiovascular morbidity and mortality has been demonstrated in a large number of epidemiological studies, tachycardia has remained a neglected cardiovascular risk factor until very recently. For the first time, the recent guidelines of the European Society of Cardiology and the European Society of Hypertension indicate than an accelerated heart rate is considered as an independent risk factor and potentially as a target for pharmacologic therapies, especially in high-risk patients.     

Cardiovascular Effects of Metabolic Surgery on Type 2 Diabetes

Introduction Cardiovascular, together with renal disease, claims a significant proportion of morbidity and mortality in association with type 2 diabetes mellitus (T2DM) and obesity. To improve the long-term renal and cardiovascular outcome, there is the incorporation of bariatric surgery (BS), which seems to be a pivotal intervention.Areas Explored Cohort studies and randomized controlled trial (RCT) research of BS among patients with T2DM, were conducted by screening, and then information on renal effects and the cardiovascular outcome was gathered. Metabolic surgery (MS) and BS reduce both mortality and the risk of cardiovascular disorder, chronic kidney diseases and albuminuria. MS refers to a surgical approach, the primary intent of which is the control of metabolic alterations/hyperglycemia in contrast to BS which is a mere weight-reduction therapy. Patients suffering from poor glycaemic control and other macro and micro-vascular diseases will benefit from a surgical approach. The approach implicates hypertension glomerular remission, gut microbiota shift, reduced renal inflammation and fewer instances of chronic cardiac remodelling.Conclusion MS is beneficial where the main aim is to attain significant and long-lasting weight loss results. The RCTs have depicted the superiority which surgical mechanisms hold over medically-based therapy, for enhancing glycaemic control, and achieving remission of diabetes. This type of surgery improves life quality, reduces incidences of other obesity and diabetes related diseases like microvascular disases, sleep apnea, fatal disorder, and fatty liver disease.     

Nutrition as a Vehicle for Cardiovascular Translational Research

It is becoming increasingly evident that poor nutrition plays an important role in inducing cardiovascular disease. Just as importantly, data now support the contention that appropriate nutritional interventions may have just as important an effect in preventing or delaying the appearance of cardiovascular disease. If this is indeed true, then it is critical that these advances in our knowledge of the effects of nutritional interventions be translated into effective strategies to combat cardiovascular disease. It is argued in this paper, with a few specific examples, that the translation of nutritional interventions can provide powerful approaches to alleviating the clinical challenges currently facing us today in the cardiovascular field. Furthermore, the value-added economic advantages of translating nutritional strategies on a wide scale into the public become another intriguing argument to further support investigations in this growing field.     

Ideal Cardiovascular Health in adolescents: Findings from Study of Cardiovascular Risks in Adolescents

Background and aimWe assessed the Ideal Cardiovascular Health (CVH) in Brazilian adolescents according to demographics and socioeconomic characteristics.Methods and resultsThis is a cross-sectional study with data from the Study of Cardiovascular Risks in Adolescents (ERICA), with a nationwide representative sample of 36,956 Brazilian adolescents, aged 12–17 years, enrolled in public and private schools. The CVH metrics considered were body mass index (BMI), physical activity, smoking, healthy diet score, blood pressure, fasting plasma glucose, and total cholesterol. The demographics and socioeconomic characteristics analyzed were sex, age, race/skin color, and type of school attended. The study design was considered, and the significant difference determined by the non-overlapping of 95% Confidence Interval. The mean ideal CVH score was 4.0, higher for females, adolescents aged 15–17 years, and students from private schools. The prevalence of ideal fasting plasma glucose was 96%, of non-smoking 95.6%, of ideal blood pressure 75.5%, of ideal BMI 73.2%, of ideal total cholesterol 55.4%, of ideal physical activity 45.2%, and only 0.5% had an ideal diet. The prevalence of ideal CVH metrics varied according to demographics and socioeconomic characteristics.ConclusionFemales, older adolescents, and students who attended private school had a better CVH. Demographics and socioeconomic characteristics were associated with CVH metrics. The low ideal proportions found for diet and physical activity are of concern and reinforce the need for food and nutritional educational actions designed to promote healthy behaviors in adolescence to prevent the development of cardiovascular diseases.     

Role of Using a Thromboelastometry-Based Protocol for Transfusion Management in Combined Coronary Artery Bypass Grafting and Valve Surgery: A Randomized Clinical Trail

The aim of this study was to evaluate the impact of using a thromboelastometry-based protocol on transfusion requirements in patients undergoing combined coronary artery bypass grafting (CABG) and valve surgery. 80 adult patients scheduled for elective combined CABG and valve surgery were included in this clinical trial study. Patients were randomly allocated to the thromboelastometry (ROTEM) (n = 40) or control groups (n = 40). In the ROTEM group, transfusion was directed according to a thromboelastometry—based protocol. In the control group, transfusion was conducted according to the routine practices including conventional coagulation testing and clinical judgments. Finally, transfusion requirements were compared between groups. Use of thromboelastometry- based protocol resulted in 67% reduction in blood products units’ consumption as well as 23% in the percentage of patients transfused. This reduction was especially evident in relation to fresh frozen plasma (FFP) and platelet consumption. No significant differences were found both in the percentage of patients receiving RBC and number of transfused RBC units. Using thromboelastometry tests incorporated a protocol results in reduction of transfusion requirements in patients undergoing elective combined CABG and valve surgery.