心内直视术后患者应用心内膜临时起搏器的护理体会

心内直视术后,患者应用心内膜临时起搏器可提高心脏收缩频率,增加心输出量,改善血液循环,防止组织器官供血不足,并能增加冠状动脉血流量,促进窦性心率恢复,显著降低了病死率。安置心内膜临时起搏器操作简便,使用器械简单,有利于紧急抢救。本文报告4例心内直视术后出现严重心律失常,在紧急情况下果断采用心内膜临时起搏器挽救患者生命,并经过一段时间药物配合治疗,痊愈出院。     

心内直视手术后行无创机械通气患者误吸的护理干预

目的总结预防心内直视手术后无创机械通气患者误吸的护理经验。方法回顾性分析138例心内直视手术后出现低氧血症行无创机械通气患者的临床资料。结果 138例患者中3例发生了误吸,其中2例为胃内容物反流,1例为进食过程中食物呛咳至呼吸道内。结论专业的术后护理可以降低此类患者发生误吸的概率。     

Dobutamine,isoprenaline and dopamine in patients after open heart surgery

Dobutamine, a new synthetic catecholamine, has been developed as a more specific inotrope and is reported to have less effect on heart rate and peripheral vascular resistance than other catecholamines. Reports of its effects after cardiotomy have cast doubt on this idea. We have compared the haemodynamic effects of dobutamine with isoprenaline (Group I) and with dopamine (Group II) in early postcardiotomy patients. In both groups a dose response curve was evaluated (dopamine and dobutamine were given at 1.25, 2.5, 5.0 and 10.0 g/kg/min; isoprenaline at 0.005, 0.01, 0.02 and 0.04 g/kg/min). In Group I both drugs caused significant increases in cardiac index at the highest dose level only. At that level isoprenaline was associated with a significantly higher heart rate than dobutamine and a significantly lower systemic vascular resistance. Similarly, in Group II, both drugs caused significant increases in the cardiac index only at the highest dose level. However, the heart rate at this dose was significantly higher with dobutamine. Dopamine caused no changes in heart rate at any dose level. Neither drug was associated with any alteration of systemic vascular resistance. No changes in stroke volume, left atrial pressure or pulmonary vascular resistance were found in either group. The rise in cardiac output was caused mainly by tachycardia.     

Hemodynamic and metabolic effects of dobutamine in 18 patients after open heart surgery

Low cardiac output syndrome frequently follows cardiopulmonary bypass (CPB) surgery. In the present study, we used dobutamine to increase cardiac index (CI) and oxygen delivery (DO2) in 18 patients after open heart surgery. Using increasing doses of dobutamine up to 10 micrograms/kg.min-1, we observed statistically significant (p less than .01) increases in mean CI (2.50 +/- 0.10 to 3.56 +/- 0.18 L/min.m2) and in mean heart rate (HR) (83 +/- 3 to 105 +/- 3 beat/min). Mean systemic vascular resistance index decreased significantly (p less than .01) in all patients (2271 +/- 101 to 1648 +/- 83 dyne.sec/cm5.m2). Pulmonary vascular resistance index did not change in the ten coronary artery bypass graft patients, but decreased significantly (p less than .01) in the eight valve replacement patients (561 +/- 98 to 421 +/- 79 dyne.sec/cm5.m2). Mean DO2 increased in all patients, although there was no concomitant increase in oxygen consumption (VO2) in four patients. We observed a significant (p less than .01) increase in mean VO2 in the remaining 14 patients (110 +/- 6 to 148 +/- 12 ml/min.m2), in spite of significant decreases in PaO2 and increases in right-to-left intrapulmonary shunting. Although increases in HR and ventricular arrhythmias may limit its use, dobutamine increases CI and DO2 in patients after CPB. In the present study, dobutamine's varying metabolic effect exemplifies the need for close monitoring of hemodynamic and metabolic variables when using vasoactive drugs in the postoperative period.     

Use of the rubber dam after open heart surgery

The presence of the rubber dam has specific implications for nursing practice. Advantages and complications of the rubber dam, as well as the implications, are discussed in this article.     

Prolonged mechanical ventilation of infants after open heart surgery

Records of 140 infants younger than 2 yr of age who had undergone open heart surgery were studied to evaluate the duration of postoperative mechanical ventilation (MV), to determine the relationship between prolonged MV and mortality, and to identify variables predisposing the patient to prolonged MV. MV was required beyond the first postoperative day in 56 infants, and was prolonged for at least 7 days in 19 infants. Mortality was approximately the same (16% to 17%) whether or not MV was required for more than 7 days. Preoperative and intraoperative variables associated with longer MV included younger age, longer cardiopulmonary bypass time, longer aortic cross-clamp time, and preoperative MV. Multiple predisposing factors increased the probability of prolonged MV. Postoperative variables including premature extubation and a second surgical procedure also were associated with prolonged MV. The consequences of prolonged MV may be minimized by early nutritional support, aggressive surveillance for treatable complications, and avoidance of premature extubation.     

Procalcitonin kinetics in pediatric patients with systemic inflammatory response after open heart surgery

Objective To evaluate procalcitonin and C-reactive protein as markers of inflammation severity and their value in predicting development of organ failure after pediatric open heart surgery.Design Prospective, observational, clinical study.Setting Single university hospital.Patients Thirty-three pediatric patients with systemic inflammatory response syndrome (SIRS; n = 19) and SIRS+organ failure (SIRS+OF; n = 14) following open heart surgery were included.Measurements and results Plasma procalcitonin and C-reactive protein levels were measured before and after the operation, and 1, 2, 3, and 4 days after surgery. Patients were evaluated daily to assess organ failure. Postoperative procalcitonin levels in the SIRS+OF group were significantly higher than in the SIRS group. C-reactive protein levels were similar between the groups throughout the study period. Peak procalcitonin levels were found to be positively correlated with aortic cross-clamp and cardiopulmonary bypass times, duration of mechanical ventilation, intensive care unit and hospital stay, mortality and organ failure development. Peak procalcitonin was found to be a good predictor of postoperative organ failure development and mortality. However, the predictive value of peak C-reactive protein for organ failure and mortality was found to be weak. Double-peak procalcitonin curves were observed in SIRS+OF patients with infection during the intensive care unit stay.Conclusion In the SIRS+OF group peak procalcitonin levels were found to be highly predictive for mortality and organ failure development, whereas C-reactive protein levels were not. Daily procalcitonin measurements in SIRS+OF patients may help identify the postoperative infection during the follow-up period.     

The effect of dopamine on hepatic-splanchnic blood flow after open heart surgery

Summary Dopamine (3,4 dihydroxyphenylethylamine) increases cardiac output and in particular the renal blood flow at the expense of other regional vascular beds not yet defined. Since the results of dopamine-induced changes in splanchnic perfusion are inconsistent, the effect of 6 mcg/kg/min dopamine was studied in 9 patients early after open heart surgery.Estimated hepatic blood flow (EHBF) was calculated from the concentration-time slopes of Indocyanine Green (ICG, Cardiogreen^R) in arterial and hepatic venous blood following single intravenous injection. Blood volume was measured using⁵¹Cr tagged red cells. Cardiac output was determined according to the Fick method.6 mcg/kg/min dopamine caused a mean EHBF-increase of 82%, from 492±64 to 824±80 ml/min/m² (P<0.001).Related to the corresponding increase in cardiac index (CI) from 2.6±0.2 to 3.8±0.3 l/min/m² (P<0.001), the EHBF/CI-ratio changed from 18.5 to 21.7% (P<0.025). The arterial-hepatic venous oxygen difference was reduced from 7.40±0.53 to 4.91±0.60 Vol% (P<0.001).It was concluded that splanchnic perfusion does not contribute to the preferential increase of renal blood flow under dopamine under the above mentioned conditions. Dopamine had the most beneficial effect on EHBF in two cases where the latter was severely reduced.     

心脏直视手术后患者胃管风险评估及护理对策

目的通过评估和分析心脏直视术后患者留置胃管的护理风险,制定有效的护理对策,确保患者安全。方法对316例心脏直视手术后患者进行详细的留置胃管风险评估和分析,并针对每条风险,制定和实施有效的护理对策。结果316例患者未发生胃管相关不良事件,护理结局良好。结论正确评估心脏直视术后患者留置胃管风险,并采取积极有效的护理措施,可以减少或避免护理不良事件发生,使患者安全得到最大保障。