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【目的】探讨盐酸右美托咪定对老年患者行非体外循环冠脉搭桥术后早期认知功能的影响。【方法】收集111例符合纳入标准的老年行非体外循环冠脉搭桥手术患者随机分为两组,其中观察组56例,麻醉诱导后静脉注射盐酸右美托咪定;对照组55例,麻醉诱导后注射等量0.9%氯化钠注射液。评价比较两组术前与术后简易智力状态检查表(MMSE)评分、术后认知功能障碍(POCD)发生率及不良反应发生率。【结果】两组患者手术情况顺利,术前两组患者 MMSE 评分相比较差异无显著性( P >0.05)。两组术后6 h和术后1 d 的 MMSE 评分明显低于术前,且差异有显著性( P <0.05),但观察组术后6 h 和术后1 d 的MMSE 评分明显高于对照组,且差异有显著性( P <0.05);观察组术后6 h 和1 d 的 POCD 发生率明显低于对照组,且差异有显著性( P <0.05)。但两组术后3 d 的 MMSE 评分和 POCD 发生率相比较差异均无显著性( P >0.05)。观察组术中低血压发生率和心动过缓发生率明显高于对照组( P <0.05)。【结论】盐酸右美托咪定可预防老年行非体外循环冠脉搭桥手术患者 POCD 的发生,值得临床推广应用。 相似文献
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目的应用常规超声结合冠脉血流显像技术观察分析冠状动脉搭桥术前后内乳动脉桥及远段左前降支血流动力学改变.方法行冠状动脉搭桥术患者46例,于手术前后超声检查左内乳动脉,其中38例患者检查左前降支远段.结果术后内乳动脉桥起始段显示率95.65%, 由术前收缩期优势型转变为术后舒张期优势型频谱.左前降支远段血流信号表现为流速及流速时间积分增加.结论常规超声结合冠脉血流显像技术可为冠状动脉搭桥术后随访提供一种无创的方法. 相似文献
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目的:观察体外循环冠脉搭桥术患者围术期各阶段尿NAG水平变化特征。方法:选择近期在我院住院接受体外循环冠脉搭桥术治疗患者53例,40例同期非体外循环冠脉搭桥术患者为对照组,入选对象分别于手术前、手术后即刻、手术后2h和术后24h各接受了尿NAG浓度检测。结果:两组患者手术前、手术后2h和术后24h各时期尿NAG指标分布接近,没有明显区别(P均〉0.05),但在手术后即刻时期体外循环组尿NAG检测值均明显高于对照组(P〈0.01)。结论:体外循环冠脉搭桥术患者手术后早期有肾功能损伤。 相似文献
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合并糖尿病对冠脉搭桥手术近期结果的影响 总被引:2,自引:0,他引:2
目的:通过对糖尿病人与非糖尿病人冠脉搭桥手术术前、术后资料的回顾性分析,探讨糖尿病人行冠脉搭桥手术的高危因素、效果和风险。方法:2000年1月-2005年1月行冠脉搭桥手术1469例,其中合并2型糖尿病人(A组)375例,非糖尿病人(B组)1094例。比较两组病人的术前情况:年龄,性别构成,既往史,冠脉病变程度,左室EF值;术中情况:术中合并瓣膜手术、室壁瘤切除和IABP使用情况,使用动脉桥和静脉桥数;术后情况:术后近期引流量,未输血率,监护室时间和术后总住院时间以及手术死亡率,房颤发生率,呼吸功能不全,肾功能不全,心衰;围手术期情况:围手术期心梗,出血重新开胸止血,胸骨裂开重新清创缝合以及下肢伤口愈合不良的发生率。结果:2型糖尿病组(A组)IABP使用率,平均搭桥数平均引流量,监护室时间,术后住院时间,死亡率,二次开胸止血,术后发生房颤,呼吸功能不全,肾功能不全,中风发生率,心衰发生率,围手术期心梗发生率,略大于B组,但差异无显著性(P〉0.01),胸骨裂开重新固定率,伤口愈合不良发生率A组明显大于B组(P〈0.01)。结论:糖尿病合并冠脉搭桥手术,具有较高的风险和术后并发症的发生率。 相似文献
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目的 以血清高敏C-反应蛋白为炎症标志物,对比传统体外循环冠脉搭桥术评价非体外循环冠脉搭桥术后全身炎症反应。方法入选36例冠状动脉粥样硬化性心脏病患者,分体外循环冠脉旁路移植组15例,非体外循环冠脉旁路移植组21例,采用胶乳比浊法测定人选者围术期血清高敏C反应蛋白水平,评价两组术式的对全身的炎症反应情况。结果两组患者血清高敏C-反应蛋白水平术前无明显差异(P〉0.05),非体外循环冠状动脉旁路移植组术中肝素化后1h与术前比较无明显差异(P〉0.05),12h后开始升高(P〈0.05),24h达到峰值(P〈0.01)。体外循环冠状动脉旁路移植组体外循环后1h后与术前比较即开始升高(P〈0.05),体外循环12h后明显升高(P〈0.05),24h达到峰值(P〈0.01)。两组血清高敏C-反应蛋白水平的总体变化趋势相似,但OPCAB组相对处于低水平(P〈0.05)。结论非体外循环冠状动脉旁路移植术后血清高敏C-反应蛋白水平明显低于体外循环冠状动脉旁路移植术;非体外循环冠状动脉旁路移植术能有效减轻缺血再灌注损伤和全身炎症反应。 相似文献
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目的评价非体外循环下冠脉搭桥术的临床效果。方法 2008-07-2010-09共行非体外循环下冠脉搭桥术32例。均行胸骨正中切口,取左乳内动脉、大隐静脉,使用CTS局部心肌表面固定器及中空冠状动脉内分流栓,在心脏不停跳下连续缝合完成搭桥手术。结果手术成功31例,术后心功能明显改善,随访1个月~2 a患者心绞痛及胸闷均明显缓解;死亡1例。搭桥1~4根,平均2.5根。结论非体外循环下冠脉搭桥术是一种手术创伤小、安全、手术并发症少和临床效果很好的手术技术,适合单支、双支、多支冠心病患者,尤其适合高危重症不能、不愿接受体外循环的患者。 相似文献
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目的:比较常规体外循环冠状动脉搭桥术和非体外循环冠脉搭桥术后血清肌钙蛋白Ⅰ水平变化,探讨两种术式心肌保护差别。方法:选择48例冠脉搭桥患者,其中体外循环冠状动脉搭桥术组24例,非体外循环冠脉搭桥术组24例,分析两组肌钙蛋白Ⅰ的血浆浓度变化。结果:两组术前临床资料无差别;体外循环冠状动脉搭桥术组术后观察期内血浆肌钙蛋白Ⅰ较非体外循环冠脉搭桥术组明显升高(P〈0.01)。结论:非体外循环冠脉搭桥术组心肌损伤低于体外循环冠状动脉搭桥术组。 相似文献
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经胸冠脉血流显像评价冠脉搭桥术后桥管远端血流动力学状态 总被引:1,自引:0,他引:1
目的应用经胸冠脉血流显像评价冠脉搭桥术后乳内动脉桥管远端血流状态,为评价远期桥管通畅性研究提供影像学依据。
方法分别在术前及术后超声探测左乳内动脉血流动力学参数,并与术中即时血流监测技术所测血流量进行比较。
结果术后左乳内动脉血流频谱舒张期峰值速度(Vd)、舒张期流速时间积分(VTId)及舒张期与收缩期流速时间积分比值(VTId/VTIs)均高于术前(P<0.001);术后经胸超声测得左乳内动脉桥管远端血流量[(35.7±13.9)ml/min]高于术中即时血流监测技术测得乳内动脉桥管吻合口近段的血流量[(30.5±9.9)ml/min],P<0.05。
结论术后左乳内动脉血流频谱由收缩期优势变为舒张期优势;术后经胸超声测得左乳内动脉血流量与术中即时血流监测技术测值相关性良好;经胸冠脉血流显像可以为冠脉搭桥术后乳内动脉桥管功能的随访提供一个可靠的、无创的方法。 相似文献
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《Expert review of cardiovascular therapy》2013,11(3):395-403
The superiority of the left internal mammary artery over the saphenous vein graft led many surgeons to adopt bilateral internal mammary artery (BIMA) as a good surgical option for further improving late outcome of patients undergoing myocardial revascularization. However, routine use of BIMA was limited by some potential drawbacks: the increase of deep sternal wound problems, especially in diabetic patients; the shortness of right internal mammary artery (RIMA), which limited its utilization as an in situ graft; the low patency rate if grafted to the right coronary artery; and the longer operative time. The skeletonization of the internal mammary artery along with a better glucose control in diabetic patients significantly reduced the incidence of deep sternal problems. Another problem to solve was finding the optimal target of the RIMA. The general consensus is that RIMA appears to be more efficient if grafted to the lateral wall. The Y or T configuration of double mammary arteries could be more helpful to reach the lateral target vessels. Finally, recent reports clearly demonstrate the superiority of BIMA over single internal mammary artery in terms of survival or quality of life. The latter finding has also been reported in diabetic patients. 相似文献
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The superiority of the left internal mammary artery over the saphenous vein graft led many surgeons to adopt bilateral internal mammary artery (BIMA) as a good surgical option for further improving late outcome of patients undergoing myocardial revascularization. However, routine use of BIMA was limited by some potential drawbacks: the increase of deep sternal wound problems, especially in diabetic patients; the shortness of right internal mammary artery (RIMA), which limited its utilization as an in situ graft; the low patency rate if grafted to the right coronary artery; and the longer operative time. The skeletonization of the internal mammary artery along with a better glucose control in diabetic patients significantly reduced the incidence of deep sternal problems. Another problem to solve was finding the optimal target of the RIMA. The general consensus is that RIMA appears to be more efficient if grafted to the lateral wall. The Y or T configuration of double mammary arteries could be more helpful to reach the lateral target vessels. Finally, recent reports clearly demonstrate the superiority of BIMA over single internal mammary artery in terms of survival or quality of life. The latter finding has also been reported in diabetic patients. 相似文献
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BACKGROUND: Differences between men and women in complication rates after cardiac surgery have been reported. The rate of one of the most severe postoperative complications, sternal wound infection, has not been compared between the sexes. OBJECTIVE: To compare the frequencies of 21 risk factors for sternal wound infection between men and women. METHODS: Records of 306 patients who had cardiac surgery between 1989 and 1999 at 3 different hospitals in the southwestern and southeastern United States were reviewed for 21 risk factors. Of the 306 patients, 115 (25 women and 90 men) had experienced a sternal wound infection and 191 randomly selected patients (52 women and 139 men) had not. RESULTS: Three risk factors occurred at significantly different rates in men and women. Smoking and use of a single internal mammary artery for grafting were more common in men than women. Women were older than men at the time of cardiac surgery. Logistic regression analyses showed that the 3 dichotomous risk factors (use of single internal mammary artery for grafting, smoking, age > 70 years) that univariate analysis indicated were significantly related to sex could also be used to predict infection group. CONCLUSIONS: This study contributes to the awareness of the possible differences between men and women in the risk of sternal wound infection developing after cardiac surgery. Although 3 risk factors occurred at significantly different rates in men and women, further research is needed to determine the effects that these differences in risk factors may have on the occurrence of sternal wound infection in men and women. 相似文献
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Doa El-Ansary Roger Adams Lorelle Toms Mark Elkins 《Physiotherapy theory and practice》2013,29(1):27-33
Several cases of sternal instability have been noted in patients following coronary artery bypass graft surgery attending our cardiac rehabilitation programme. The purpose of this prospective study was to identify factors associated with sternal instability following sternotomy involving saphenous vein grafts (SVG) and unilateral or bilateral internal mammary artery (IMA) grafts. A rating scale for quantifying sternal instability was developed and used by the physiotherapists to assess all patients. Inter-therapist and intra-therapist reliabilities for the scale were calculated and these were 0.97 and 0.98 (ICC) respectively. Twenty-four patients who underwent coronary artery bypass grafting with a sternotomy incision presented with the complication of sternal instability 6-8 weeks following surgery. They represented 16.3% of the 147 patients presenting for cardiac rehabilitation who had undergone surgery interstate over an 18-month period. Sternal symptoms reported were pain, crepitus, and/or clicking at rest or on trunk and upper limb motion. Risk factors to wound healing such as obesity, diabetes, bilateral IMA grafting, osteoporosis, repeat operations, and prolonged post-operative mechanical ventilation were noted. A significantly higher proportion of patients with bilateral IMA grafting (31.5%) as opposed to unilateral IMA grafting (14.3%) had sternal instability (P <. 05). Quantifying the degree of sternal instability may play a role in identifying management options, patient progression and the point of intervention. 相似文献
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P. G. Ferdinande G. Beets A. Michels E. Lesaffre P. Lauwers 《Intensive care medicine》1988,14(6):623-627
Pulmonary function tests were measured in 33 male patients undergoing elective coronary artery bypass surgery. Three modes of surgical technique were used: Bilateral internal mammary artery graft (BIMA), single internal mammary artery graft (SIMA) and saphenous vein grafts (VS). Following parameters were recorded: patient's age, length, body weight, preoperative forced vital capacity (FVC) and forced expiratory volume at one second (FEV 1), preoperative end-diastolic pressure and function of the left ventricle, smoking habitus, the fact that the pleural cavity was entered, duration of the cardiopulmonary bypass period, perioperative fluid balance and postoperative FVC and FEV 1 on the first eight postoperative days. In the BIMA group two pleural cavities, the SIMA group one pleural sac and the VS group none of the pleural cavities was entered. The BIMA group was younger (50.1±7.6 versus 57.7±7.28 and 60.1±6.9 years (p< 0.05)) than the SIMA and VS group. Postoperative external blood loss was lower in the VS group compared to the SIMA and BIMA groups (839±255 ml versus 1346±654 ml and 1259±396 ml (p< 0.05)). The FVC shows a dramatic decrease especially on the second postoperative day and was most markedly diminished in the BIMA and SIMA compared to VS (31%±9% and 35%±8% versus 45%±10% of preoperative values (p< 0.05)). Full recovery of the FVC was not achieved eight days after surgery: BIMA and SIMA showing the same tendency versus VS (61%±10%, 60%±8% versus 71%±8% preoperative FVC (p< 0.05)). FEV 1 had the same evolution: on the second postoperative day a significant reduction for BIMA and SIMA versus VS group (32%±10%, 34%±8% versus 46%±9% of preoperative values (p< 0.05)) and incomplete recovery after eight days (59%±8% (BIMA), 59%±11% (SIMA) versus 69%±7% (VS) (p< 0.05)). No statistical difference between SIMA and BIMA group could be shown for FVC and FEV 1. We conclude that coronary artery bypass surgery causes a substantial decrease in FVC and FEV 1 especially when one or two pleural cavities are violated. The reduction of FVC in BIMA is so important that this technique should be restricted to patients with adequate pulmonary reserves. 相似文献