住院期康复治疗对心脏外科手术后患者运动能力的影响

目的 探讨住院期心脏康复对心脏外科手术后患者运动能力的影响。 方法 纳入符合标准的心脏瓣膜病和冠心病患者42例,按随机数字表法分成康复组（22例）和对照组（20例）。对照组在常规治疗的基础上,予以术前教育和术前呼吸指导;康复组在对照组的基础上,行住院期心脏康复治疗。2组干预前后均行2min踏步试验（2-MST）及左室射血分数（LVEF）测定,观察2组患者的住院时间。出院1个月后电话随访,用退伍军人特定活动问卷（VSAQ）估测2组患者出院1个月后的运动能力。 结果 干预后,2组患者左室射血分数分别为（53.73±9.29）%和（56.25±11.01）%,组间差异无统计学意义(P>0.05）。康复组出院时2min踏步次数［（79.41±10.99）次］明显高于对照组［(71.25±14.21)次］,差异有统计学意义(P<0.05）;出院1个月后康复组的运动能力METs（5.77±1.46）也显著高于对照组(4.75±1.34)METs,组间差异有统计学意义(P<0.05）。出院时2min踏步次数与入院时2min踏步次数呈正相关（r=0.869,P<0.01）,出院1个月后运动能力与入院时2min踏步次数呈正相关（r=0.752,P<0.01）。康复组的住院时间［（15.59±3.08）d］较对照组显著缩短［（18.45±3.63）d］,差异有统计学意义(P<0.01）。 结论 住院期心脏康复可以明显改善心脏外科手术后患者的运动能力,缩短住院时间;2min踏步试验方法简单且实用,可用于心脏外科手术后患者早期运动能力评估。     

心脏外科术后心脏骤停开胸心肺复苏术

目的总结心脏外科术后心脏骤停开胸心肺复苏术(CPR)的经验。方法回顾分析1990-01～2004-02我院共64例心脏外科术后心脏骤停再开胸CPR的患者。结果2574例心脏外科手术64例由于心脏骤停而行开胸CPR,发生率为25%,31例心脏成功复跳占48%,33例复苏失败占52%,6例复苏成功者死于医院,总复苏成功率为390%。结论CPR是心脏外科手术后心脏骤停CPR的有效方法,而充分的准备及适当的开胸时间是成功的有利因素。     

冠状动脉临界病变患者心肺运动试验的特点及临床意义

目的 回顾性分析冠状动脉临界病变患者心肺运动试验的临床特点和功能能力的变化。方法 回顾分析北京博爱医院2015年1月至2020年1月行冠状动脉造影并同期行心肺运动试验测试的患者,其中冠脉临界病变组184例,非冠心病组73例。比较两组症状、基线资料、实验室和超声心动图数据、心肺运动试验结果,并观察1年内主要心血管事件。结果 与非冠心病组相比,冠脉临界病变组男性比例显著升高(χ2=15.857, P <0.001),有吸烟史(χ2=9.067, P=0.003)、高血压病史(χ2=15.087, P <0.001)、高脂血症病史(χ2=13.507, P <0.001)的比例明显升高;糖化血红蛋白(Z=2.431, P=0.015)和超敏C-反应蛋白(Z=2.108, P=0.035)水平偏高;达到无氧阈比例明显偏低(χ2=10.702, P=0.001);无氧阈时的心率和呼吸交换率降低(Z> 2.156, P <0.05);两组1年后主要心血管事件发生率无显著性差异(P=1.000)。结论 冠脉临界病变患者心肺功能有所降低,应控制吸烟、高血压、高脂血症、糖尿...     

成人心脏外科术后疼痛调查

本文采用视觉模拟评分法，选择大剂量静脉芬太尼复合吸入麻醉、体外循环下心内直视手术后病人，自拟除气管导管开始至拔管后６天，对其疼痛、焦虑等进行调查。结果表明，疼痛以切口主，咳嗽及活动时加重；疼痛强度在拔除气管导管后１２￣３６小时显著高于平均水平（Ｐ〈０．００３６，ｔ检验）；疼痛程度与焦虑相关（ｒ＝０．５６咳动／０．５７安静，Ｐ〈０．０５）。聚在分析的结果提示，成人心血管外科手术后，约５５％的病例疼痛     

心脏外科术后疼痛护理的研究进展

心脏外科手术是外科领域非常重要的分支。常见的心脏疾病均可通过心脏外科手术治疗,但因心脏外科手术创面较大,导致患者术后出现存在不同程度的疼痛反应,严重影响后期治疗及术后康复。剧烈疼痛可能会诱发其他疾病,甚至危及患者的生命。因此,做好心脏外科术后患者的疼痛护理、缓解其疼痛程度、改善其心理状态、促进术后恢复是临床亟需解决的问题。本文就心脏外科术后疼痛的基本特征、主要诱因、对身体带来的负面影响、评估方法及护理方法作一综述,以期为应对心脏外科术后疼痛提供些许参考。     

心脏外科术后康复训练疗效评价：（附42例临床观察报告）

心脏外科术后的3个月是克服手术创伤进行康复训练的重要阶段,这对加速心脏生理功能恢复,减少术后各种并发症的发生,预防病情复发,缩短疗、休养时间,最大限度地恢复患者生活与工作能力,为重返工作岗位创造体力条件是至关重要的。我们对近年来收住     

103例心脏外科术后患者并发静脉血栓栓塞症的护理

总结103例心脏外科术后患者并发静脉血栓栓塞症(VTE)的护理体会.严密观察病情变化、维持血流动力学稳定;加强抗凝、溶栓期间的观察和护理、重视患肢的管理;给予针对性的健康教育,从而促进疾病的转归,减少VTE的复发.     

心肺运动试验对冠状动脉轻度狭窄患者的评价研究

目的探讨心肺运动试验（cardiopulmonary exercise testing,CEPT）对冠状动脉轻度狭窄患者的评估价值。方法35例胸痛患者,按冠状动脉CT结果分为冠状动脉狭窄组（狭窄程度50%-70%）20例和冠状动脉正常组15例。2组患者均行CEPT检查,观察并比较2组无氧阈值、二氧化碳通气当量、摄氧通气当量、氧耗量、二氧化碳排出量、呼吸频率、运动中通气量、心率、肺泡通气量、潮气量、死腔通气量等指标。结果冠状动脉狭窄组无氧阈值（（12.10±0.23）mL/（kg·min））低于冠状动脉正常组（（14.47±1.28）mL/（kg·min））（P〈0.05）,二氧化碳排出量（（1.07±0.21）L/min）高于冠状动脉正常组（（0.81±0.04）L/min）（P〈0.01）。结论 CEPT可通过检测无氧阈值和二氧化碳排出量来判断冠状动脉狭窄对心肌的影响。     

心脏外科术后二次开胸止血36例分析

为减少体外循环心内直视手术后二次开胸止血及出现相关并发症的概率，要充分重视术中外科止血。现对我院2000—01～2005—06心脏手术后二次开胸止血36例分析如下。     

运动疗法在心脏术后患者中的作用

目的探讨运动疗法在心脏术后康复中的作用.方法21例心脏手术后患者均接受功率自行车或/和跑台训练为主的康复训练,并采用常规心电运动试验对康复训练前后的各项指标进行比较.结果运动训练后,运动时间和最大运动负荷显著增加,安静时,心率、血压(包括收缩压和舒张压)、心率-血压乘积均显著下降(P<0.05,P<0.01),安静时心电图最大ST段压低明显改善(P<0.01);同等负荷量运动时,心率、血压、心率-血压乘积及运动诱发的最大ST段压低与安静状态时有相似的改变(P<0.05,P<0.01).结论心脏术后的康复训练有助于增加体能,减轻心肌缺血,增加心肌储备功能,从而改善了患者的生活质量.     

血管升压素治疗心脏外科术后血管扩张性休克效果的Meta分析

目的探讨血管升压素对心脏外科术后血管扩张性休克患者的治疗价值。 方法检索中国知网、万方医学数据库、PubMed数据库、Embase数据库、Springer Link数据库、Cochrane图书馆等关于应用血管升压素治疗心脏外科术后血管扩张性休克患者的随机对照临床试验（RCT）。检索时限为1980年1月至2018年12月。主要结局指标：病死率;次要观察指标为ICU住院时间、平均动脉压（MAP）、严重不良事件发生率、心房颤动发生率。由2名研究者分别进行文献筛选、数据提取和质量评价。应用RevMan 5.3软件进行Meta分析,绘制漏斗图分析各研究间的发表偏倚。 结果共检索出相关文献458篇,根据纳入和排除标准,最终纳入4项RCT研究,共计458例患者;其中1项研究被认为偏倚风险较低,3项研究存在中度偏倚风险。Meta分析结果显示：与对照组相比,血管升压素不能显著改善心脏外科术后血管扩张性休克患者的病死率[伏势比（OR）=0.95,95%CI：0.55~1.64,P=0.85]及ICU住院时间[均数差（MD）=-0.41,95% CI：-1.40~0.57,P=0.41];可以提升患者的平均动脉压（MAP）（MD=7.77,95% CI：2.59~12.94,P=0.003）;不增加患者严重不良事件的发生率（OR=0.89,95% CI：0.49~1.60,P=0.69）;有降低患者心房颤动发生率的趋势,但差异无统计学意义（OR=0.19,95% CI：0.03~1.04,P=0.06）。 结论现有证据表明,血管升压素不能显著改善心脏外科术后血管扩张性休克患者的病死率和ICU住院时间,但有助于改善患者的MAP且可能会降低其心房颤动的发生率。     

The delirium observation screening scale recognizes delirium early after cardiac surgery

Background

Ddelirium or acute confusion is a temporary mental disorder which occurs frequently among hospitalized elderly patients. Patients who undergo cardiac surgery have an increased risk of developing delirium. Prevention or early recognition of delirium is essential. The Delirium Observation Screening (DOS) scale was developed to facilitate early recognition of delirium by nurses' observations during routine clinical care.

Aim

The aim of this study was to validate the DOS scale in accordance with the diagnosis of the psychiatrist, using the DSM-IV criteria as the gold standard.

Methods

In this observational study, the DOS scale was used to assess whether 112 patients who underwent elective cardiac surgery had developed a postoperative delirium. The psychiatrist was consulted to confirm or refute the diagnosis delirium. Wilcoxon's Rank Sum Test was utilized to compare patients with and without delirium on duration of hospital stay. A Receiver Operating Characteristic Curve of the DOS scale was constructed with accompanying Area Under the Curve (AUC).

Results

Based on the diagnosis of the psychiatrist, the incidence of delirium following cardiac surgery was 21.4% and the mean duration of delirium was two and a half days. The time to discharge was 11 days longer in patients with delirium. In 27 of the 112 patients a DOS score of > = 3 was found, that indicates delirium. The sensitivity and specificity of the DOS scale was 100% and 96.6% respectively. The AUC was 0.98.

Conclusion

The DOS scale is a very good instrument to facilitate early recognition of delirium by nurses' observation of patients who undergo cardiac surgery. Early recognition will expedite good postoperative management such as implementation of appropriate interventions, and may decrease negative consequences caused by postoperative delirium.     

The two-minute walk test as a measure of functional capacity in cardiac surgery patients

OBJECTIVE: To examine construct validity and sensitivity of the two-minute walk test (2MWT) in cardiac surgery patients. DESIGN: Measurements were made in patients preoperatively, during the postoperative in-hospital stay, and 6 to 8 weeks after discharge from hospital. SETTING: Ambulatory and hospitalized care. PARTICIPANTS: Patients (N=122; mean age +/- standard deviation, 63+/-9 y) undergoing coronary artery bypass grafting. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The 2MWT, New York Heart Association (NYHA) functional classification for cardiac disease, the Nottingham Extended Activities of Daily Living scale, and the Medical Outcomes Survey 36-Item Short-Form Health Questionnaire (SF-36). RESULTS: Distance walked in 2 minutes decreased significantly postoperatively (from 138+/-26 m to 84+/-33 m, P<.001), but increased again at follow-up (151+/-31 m, P<.0001). Distance walked on the 2MWT correlated significantly to SF-36 (physical function subscale) preoperatively (r=.44) and at follow-up (r=.48) (P<.001). There was a significant difference in distance walked between those with NYHA class I and II compared with those classified as III or IV (P=.04). However, there was no significant difference in distance walked in 2 minutes between those who developed cardiac or pulmonary complications postoperatively (P> or =0.2). CONCLUSIONS: The 2MWT was sensitive to change after cardiac surgery and showed moderate correlation with measures of physical functioning in this population. However, the 2MWT could not identify those who developed complications in the postoperative period.     

运动疗法在心脏术后康复中的作用

目的：探讨运动疗法在心脏术后康复中的作用。方法：21例心脏手术后患者均接受功率自行车或／和跑台训练为主的康复训练，并采用常规心电运动试验对康复训练前后的各项指标进行比较。结果：运动训练后，运动时间和最大运动负荷显著增加，安静时，心率、血压（包括收缩压和舒张压）、心率－血压乘积均显著下降（P＜0．05，P＜0．01），安静时心电图最大ST段压低明显改善（P＜0．01）；同等负荷量运动时，心率、血压、心率－血压乘积及运动诱发的最ST段压低与安静状态时有相似的改变(P＜0．05，P＜0．01）。结论：心脏术后的康复训练有助于增加体能，减轻心肌缺血，增加心肌储备功能，从而改善了患者的生活质量。     

Treatment of mediastinitis in children after cardiac surgery

Twenty-three cases of mediastinitis after cardiac surgery in children were treated by us between 1973 and 1976.Three patients died within 6 hours of admission. Treatment used in the twenty other cases are discussed. The mean age of the patients was three years and three months.The mediastinitis was evident an average of twelve days after extracoporeal circulation. A staphylococus was always responsible for the infection. Treatment was a combination of surgery, antibiotics and respiratory and nutritional supplies.The surgical treatment consisted of a careful mediastinal cleansing with resection of the sternal edges. In fifteen patients the thorax was closed after surgery, and an irrigation system installed using a solution of 4% Dakin in physiologic saline. Recovery was simple in 5 patients. In the 10 other patients of this group the thorax had to be reopened; one patient died after 90 days from Serratia marcescens endocarditis.The thorax was left open initially in five patients: one patient of this group died from candida endocarditis.All patients needed endotracheal ventilation through a nasotracheal tube (7 to 90 days of ventilation).Treatment with bactericidal antibiotics was pursued for three months and a monotherapy was kept for nine months.After reviewing the observed complications, our methods and results are compared with others in the literature.     

HLA-DR as a marker for increased risk for systemic inflammation and septic complications after cardiac surgery

Objective This study investigated the predictive value of a decrease in monocyte HLA-DR expression as an early marker for postoperative SIRS and septic complications. We hypothesized that decreased HLA-DR levels in the first 24 h after cardiac surgery is not related to postoperative SIRS/sepsis. We also compared HLA-DR levels of patients with postoperative complications to those with an uncomplicated course.Design and setting Prospective observational study in a tertiary care postoperative intensive care unit.Patients Eighty five consecutive patients undergoing cardiac surgery.Measurements and results Expression of HLA-DR on monocytes was analyzed by flow cytometry using a new quantitative and well standardized technique. Arterial blood samples were collected before induction of anesthesia, immediately after admission to the ICU, and on the first postoperative day. Postoperative HLA-DR expression was significantly decreased in all patients. There were no significant differences in HLA-DR expression during the first 24 h after surgery in patients with uncomplicated course and those developing SIRS or septic complications.Conclusions In patients undergoing cardiac surgery the monitoring of pre- and immediate postoperative HLA-DR levels during the first 24 h does not help to predict increased risk for postoperative SIRS/sepsis or infectious complications.An editorial regarding this article can be found in the same issue ()     

注射用复合辅酶预处理对心脏病人非心脏手术的心肌钙蛋白与心肌酶学的影响

目的 观察注射用复合辅酶（贝科能）对心脏病人非心脏手术围手术期的心肌酶谱和心肌钙蛋白的变化,从而研究贝科能的心脏保护作用。方法30例心脏病人非心脏手术即全麻下行单纯胆囊切除术的病人,美国麻醉医师协会（ASA）分级Ⅱ-Ⅲ级,随机双盲分成A、B两组,分别静滴贝科能和生理盐水,然后常规诱导。监测心电图（ECG）,心率（HR）,血压（BP）。分别于入室后（T0）,手术开始1h（T1）,术后8h（T2）,术后24h（T3）采集血液2．5ml,定量测定心肌钙蛋白T（cTnI）,及肌酸激酶（CK）和肌酸激酶同工酶（CK—MB）。结果 A组病人cTnI、CK及CK—MB在术后8h及术后24h结果与入室后结果对比均增高（P〈0．05）有显著差异。B组病人cTnI、CK及CK—MB在术后1h,术后8h及术后4h与入室后结果对比均增高（P〈0．05）,有显著差异,其中cTnI在术后8h及24h的结果与入室后对比有非常显著差异（P〈0．01）。与A组病人对比,术后1 h、8 h及24 h的cTnI与A组比较有非常显著差异（P〈0．01）,CK及CK—MB与A组比较有显著差异（P〈0．05）。结论 贝科能能减轻心肌损害,降低心脏病人术后心肌缺血以致心血管意外的发生率,在围术期应用有一定的临床意义。     

Hemodynamic effects of amrinone in children after cardiac surgery

The hemodynamic effects of amrinone were assessed in seven children following cardiac surgery. Amrinone was administered as a bolus of 1 mg kg^–1 body wt., followed by continuous infusion at 10 g kg^–1 min^–1 for 1 h and two stepwise increases to 20 and 40 g kg^–1 min^–1 for 30 min each. Hemodynamic data were obtained and plasma concentrations of amrinone measured 1 h after the bolus dose and immediately before each increment of the infusion rate. Amrinone levels ranged from 0.7 to 2.3 mgl^–1. Administration of amrinone lowered systemic vascular resistance from 20.0±4.3 to 16.5±4.6 mmHgl^–1 min^–1m^–2 (p<0.05) and reduced mean arterial pressure from 71.7±9.5 to 62.6±13.5 mmHg (p<0.05) at the highest infusion rate, confirming the known vasodilative effect of the drug. However, these effects did not result in a statistically significant increase in stroke volume (35.0±7.5 to 35.5±7.0 ml m^–2, NS) or cardiac index (3.10±0.50 to 3.20±0.40 l min^–1 m^–2). One additional patient, in whom a higher loading dose was tried in order to achieve a higher plasma concentration, developed systemic hypotension. A correlation was established between the plasma concentrations of amrinone and the percentage decrease in systemic resistance (r=0.70,p<0.05). These results suggest that in children after open heart surgery, amrinone acts primarily as a systemic vasodilator, with questionable inotropic effect. Accordingly, its use should be restricted to children with severe cardiac failure and documented highly elevated afterload.     

亚低温对心脏外科术后低心排的治疗评价

目的 探讨亚低温对心脏外科术后低心排的治疗价值及其疗效.方法 选择2009年5月至2011年2月本院心脏外科术后应用大剂量血管活性药物及主动脉内球囊反搏术(IABP)治疗仍存在低心排,而给予亚低温治疗的患者12例.监测患者亚低温治疗前后心排血指数(Cl)、混合静脉血氧饱和度(S-vO2)、尿量的变化等.结 果在应用亚低温治疗过程中,将患者膀胱温度降至33～ 35℃以降低组织的氧需求.与治疗前比较,经亚低温治疗后患者CI(ml·s-1·m-2)明显增加(38.34±5.00比30.01±5.00),S-vO2明显升高(0.64±0.07比0.54±0.08),尿量(ml·kg-1·h-1)明显增加(3.0±2.1比1.5±1.1,均P＜0.05);而心率、平均动脉压、动脉血氧分压则无明显改变.结论 亚低温治疗可有效改善心脏外科术后低心排患者循环功能,且操作简单.     

心脏外科重症监护病房医院感染的临床探讨

目的研究心外科重症监护病房（CICU）中医院感染的发生情况。方法选取我科2002年1月至2004年12月收治1263例心脏手术后患者，对术后医院感染发生率和不同病种、手术方式、手术时间、CICU入住时间与医院感染发生关系以及细菌学培养结果进行统计学分析。结果大血管组及冠心组术后医院感染发生率分别为52．3％和26．2％，明显高于风心组与先心组，呼吸系统感染发生率为4．9%，高于其他系统医院感染的发生率，体外循环术后医院感染率13．2％，高于非体外循环术后感染率6．2％（P〈0．01）。手术时间长于4h者，术后医院感染的发生率为39．3％，高于手术时间小于4h者（P〈0．01）。术后CICU中住院达1周以上者术后发生医院感染率约为58．4％，远高于术后CICU中住院日期小于1周者（P〈0．001）。结论体外循环术后、手术时间大于4h及在心外重症监护病房内时间超过1周者医院感染的发生率高，对此类患者注意防止医院感染的发生。