婴幼儿心内直视术拔除气管插管后并发喉头水肿的护理

本文报告婴幼儿内直视手术拔除气管插管后并发喉头肿16例，通过分析术前，术中，术后原因，经超声雾化吸入，高流量面罩吸氧，对症治疗及精心护理后，均痊愈出院。     

婴幼儿心脏直视手术的体外循环管理体会

体外循环是影响婴幼儿心脏直视手术近期效果的主要因素之一。报告近３年行婴幼儿心脏直视手术１０２例,死亡６例,另９６例中虽部分并发低心排出量综合征（ＬＣＯＳ）、急性呼吸窘迫综合征（ＡＲＤＳ）、急性肾功能衰竭（ＡＲＦ）及脑损害等并发症,但经救治均恢复正常。表明膜式氧合器的应用、合理的预充和血液稀释、科学的体外循环管理、适当的温度控制及有效的心肌保护措施,对减少婴幼儿体外循环术后并发症、降低死亡率具有重要     

体外循环心脏术后急性肝功能损害的危险因素分析

目的：通过分析体外循环心脏手术后肝功能损害的危险因素，认识心脏手术后肝功能损害的发生规律及特点。方法：对397例体外循环心脏手术后发生肝功能损害的相关因素进行单因素和多因素分析。结果：单因素分析显示：高龄、风湿性心脏病、慢性病毒性肝炎、术前右心衰、肝淤血、黄疸、腹水、术后严重感染、乳酸酸中毒、低心排血量及低氧血症等因素可能会导致术后急性肝功能损害的发生；多因素分析显示：术前就有肝功能损害、手术中体外循环时间长（超过2h）、手术出血多导致血制品输入量超过1000ml、术后低心排血量以及低氧血症是术后急性肝功能损害发生的独立危险因素。结论：体外循环心脏手术后肝功能损害是多种因素共同作用的结果，应提高对围术期肝功能损害危险因素的认识，正确指导临床治疗，从而避免术后急性肝功能衰竭的发生。     

心脏外科术后肺部并发症危险因素分析

目的:分析心脏外科术后肺部并发症的围手术期危险因素及其影响。方法:分析1995年1月～2002年2月间连续2084例正中切口右房-升主动脉体外循环心脏外科手术术前、术中及术后相关因素,观察它们在围手术期肺部并发症中的作用。结果:共有136例肺部并发症(6.5%)。肺部并发症的术前危险因素包括女性(相对危险度OR=1.49)、吸烟(OR=1.64)、慢性阻塞性肺部疾病(OR=2.36),术中危险因素包括应用冷心脏停搏液(OR=1.56),术后危险因素包括需要血管活性药物支持(OR=2.00)、2次开胸(OR=2.08)、主动脉内球囊反搏(OR=2.39)、胸腔积液(OR=2.63)、术后脑血管意外(OR=5.45)、膈神经损伤(OR=8.09)、以及术后肾功能衰竭需用肾透析(OR=12.87)。围手术期肺部并发症不是围手术期死亡的危险因素。结论:心脏外科术后多种围手术期危险因素增加术后肺部并发症的发生,特别是术后脑血管意外、膈神经损伤、以及肾功能衰竭需要肾透析对围手术期肺部并发症的发生影响最为明显。对此类患者需特别注意保护肺功能,以减少并发症的发生。围手术期肺部并发症不是围手术期死亡的危险因素。     

心脏直视术后中老年患者纵隔感染的危险因素分析

目的 探讨经心脏直视术后纵隔感染的危险因素及临床意义.方法 我院于2010-2012年间共施行1369例心脏直视手术,选取102例经胸骨正中切口患者,其中61例为术后出现纵隔感染患者,将102例患者的年龄、性别、吸烟史、肥胖、糖尿病、高血压、术后肺部感染、心脏病家族史、体外循环时间进行logistic分析,筛选出纵隔感染的危险因素.结果 吸烟史、糖尿病、术后肺部感染、体外循环时间为心脏直视术后纵隔感染的危险因素.结论 充分评估纵隔感染的危险因素,以便术前及术后采取针对化治疗措施,为避免术后纵隔感染提供临床参考依据.     

改良Fontan术后心律失常及危险因素

目的分析改良Ｆｏｎｔａｎ手术后心律失常及其危险因素，以期降低术后心律失常的发生率。方法对１９８４～１９９６年间１１１例患者术后心律失常发生类型及发生因素进行分析。结果房性心动过速（房速）发生率最高，占心律失常的４３．９％；非阵发性交界性心动过速次之，占２８．８％。房速者术后中心静脉压显著升高，右房与肺动脉连接者术后房速及非阵发性交界性心动过速的发生率均显著高于全腔静脉与肺动脉连接者。结论术后中心静脉压明显升高及右房与肺动脉连接术式是影响术后心率失常的主要危险因素。     

老年脊椎手术患者全麻术后再次气管插管的危险因素分析

目的分析导致老年脊椎手术患者全麻术后再次气管插管的危险因素。方法回顾性分析中山市中医院麻醉科2010年1月至2015年12月行脊椎手术的老年患者670例,根据患者气管拔管后是否再次气管插管分为再次气管插管组11例和非气管插管组659例,记录患者基本情况并对危险因素进行分析。采用SPSS 18.0统计软件对数据进行分析,单因素和多因素logistic回归分析再次气管插管的危险因素。结果术后需再次气管插管发生率为1.64%(11/670)。单因素分析结果表明性别、体质量指数(BMI)、美国麻醉医师协会(ASA)分级、术前脉搏氧饱和度(Sp O2)、合并术前2周上呼吸道感染、慢性阻塞性肺疾病(COPD)、急诊手术、手术部位、术后30 min血红蛋白≤90 g/L、手术时间与术后再次气管插管有关(P0.05)。多因素logistic回归分析结果表明,ASA分级≥Ⅲ(OR=9.65,95%CI 2.362~29.384,P0.05)、手术时间≥4 h(OR=9.485,95%CI 1.620~88.002,P0.05)、合并COPD(OR=13.25,95%CI 5.852~37.251,P0.05)是老年脊椎手术患者全麻术后再次气管插管的危险因素。结论 ASA分级≥Ⅲ、手术时间≥4 h、合并COPD是老年脊椎手术患者全麻术后再次气管插管的危险因素。     

心脏外科术后谵妄的术前危险因素研究进展

谵妄表现为一种急性的、波动性的认知变化,具有注意力不集中、思维混乱和意识改变的特点,是心外科术后常见并发症之一,同时会导致患者术后多种不良后果。随着接受心外科手术的患者越来越多,术后谵妄的预防已经成为一个重要课题。心外科医生须早期识别术前危险因素,确定高危患者,预防术后谵妄的发生。现围绕近年来关于心脏外科术后谵妄的术前危险因素的相关研究进行综述。     

大动脉转位患者动脉调转术后死亡的危险因素分析

目的 分析接受动脉调转术(ASO)治疗大动脉转位(TGA)患者发生住院期间死亡的危险因素.方法2004年1月至2007年12月,入选169例实施ASO的TGA患者,其中男性129例,女性40例,年龄(11.71±26.3)个月.患者分为室间隔完整组(室间隔完整型TGA患者56例)和室间隔缺损组(室间隔缺损型TGA患者113例).对ASO术后发生住院期间死亡的危险因素进行多元logistic回归分析.结果ASO术后发生住院期间死亡19例(11.24%),住院期间病死率由2004年的16.67%下降到2007年的3.92%.2004至2007年,室间隔完整组与室间隔缺损组各年的住院期间病死率差异均无统计学意义.多元logistic回归分析显示,ASO治疗TGA后住院期间死亡的危险因素为:体重≤3 kg(OR:4.571,P=0.0409)、合并室间隔缺损(OR:4.444,P=0.0406)、复杂畸形TGA(OR:4.321,P=0.0140)、Planche分型为非正常型(OR:4.867,P=0.0104)、Leiden分型为非A型(OR:3.045,P=0.0243).结论体重≤3 kg、合并室间隔缺损、复杂畸形TGA、冠状动脉异常是ASO治疗TGA后发生住院期间死亡的危险因素.

Abstract：

Objective To analyze the in-hospital mortality and factors affecting in-hospital mortality for patients with transposition of the great arteries (TGA) undergoing arterial switch operation (ASO).Methods Between January 2004 and December 2007, ASO was performed in 169 patients [129 male, 40 female; mean age (11.71± 26. 3) months] with TGA. The patients were divided in intact ventricular septum group( n = 56): TGA with intact ventricular septum and ventricular septal defect group (n = 113 ):TGA with ventricular septal defect. Multiple logistic regression analysis was performed to identify the risk factors of in-hospital mortality. Results The overall in-hospital mortality was 11.24% (19/169). The yearly in-hospital mortality was similar between intact ventricular septum group and ventricular septal defect group. With the improvement of perioperative treatment, the in-hospital mortality decreased from 16.67% in 2004 to 3.92% in 2007. The multivariate analysis revealed that body weight ≤3 kg( OR:4. 571, P =0. 0409), complicating ventricular septal defect( OR:4. 444,P =0. 0406), complex TGA( OR:4. 321 ,P =0. 0140), coronary anomalies( OR:4. 867,P =0. 0104) and non-type A coronary arteries( OR:3. 045,P =0. 0243) were independent predictors for poor early postoperative survival. Conclusion Body weight ≤3 kg,complicating ventricular septal defect, complex TGA, coronary anomalies are independent predictors for increased in-hospital mortality in patients with transposition of TGA and undergoing arterial switch operation.     

大动脉转位患者动脉调转术后死亡的危险因素分析

Objective To analyze the in-hospital mortality and factors affecting in-hospital mortality for patients with transposition of the great arteries (TGA) undergoing arterial switch operation (ASO).Methods Between January 2004 and December 2007, ASO was performed in 169 patients [129 male, 40 female; mean age (11.71± 26. 3) months] with TGA. The patients were divided in intact ventricular septum group( n = 56): TGA with intact ventricular septum and ventricular septal defect group (n = 113 ):TGA with ventricular septal defect. Multiple logistic regression analysis was performed to identify the risk factors of in-hospital mortality. Results The overall in-hospital mortality was 11.24% (19/169). The yearly in-hospital mortality was similar between intact ventricular septum group and ventricular septal defect group. With the improvement of perioperative treatment, the in-hospital mortality decreased from 16.67% in 2004 to 3.92% in 2007. The multivariate analysis revealed that body weight ≤3 kg( OR:4. 571, P =0. 0409), complicating ventricular septal defect( OR:4. 444,P =0. 0406), complex TGA( OR:4. 321 ,P =0. 0140), coronary anomalies( OR:4. 867,P =0. 0104) and non-type A coronary arteries( OR:3. 045,P =0. 0243) were independent predictors for poor early postoperative survival. Conclusion Body weight ≤3 kg,complicating ventricular septal defect, complex TGA, coronary anomalies are independent predictors for increased in-hospital mortality in patients with transposition of TGA and undergoing arterial switch operation.     

上腹部术后心肺并发症的危险因素分析

目的:探讨上腹部手术后心肺并发症的影响因素。方法:回顾性分析397例上腹部手术患者的临床资料(分为心肺并发症组和无心肺并发症组),对比分析2组患者的年龄、性别、吸烟史、手术时间、肺功能指标、心电图、超声心动图及麻醉方式8个相关因素,以及这些因素与术后心肺并发症的关系。结果:397例患者中59例发生心肺并发症;心肺并发症组患者年龄平均(63.5±6.9)岁,手术时间(3.2±0.9)h,无心肺并发症组患者年龄平均(39.5±9.5)岁,手术时间(2.3±0.6)h,2组患者的差异有统计学意义(P<0.05)。术前第1秒用力呼气量占预计值百分比(FEV1)%,第1秒用力呼气量与用力肺活量比值(FEV1/FVC)%,最大通气量占预计值百分比(MVV)%、心功能异常、全麻患者术后发生心肺并发症的危险性增加(P<0.05)。结论:年龄、手术时间、心肺功能异常及麻醉方式可能是上腹部手术患者发生术后心肺并发症的危险因素。     

心脏手术后患者院内获得性肺炎的危险因素

心脏手术是心血管疾病的主要干预手段之一,其术后感染并发症最常见为院内获得性肺炎。本文综述了近年来国内外多篇关于心脏手术患者发生院内获得性肺炎的危险因素的研究报道。主要的危险因素包括:气管插管、机械通气辅助呼吸、仰卧体位、抑酸药物滥用、停留鼻胃管、吞咽功能障碍或神经功能障碍、镇痛药物使用、输血、手术时间或体外循环时间较长、急诊手术、高血压、术后心房颤动、ICU停留时间延长、低白蛋白血症、C反应蛋白升高、术前广谱抗生素的使用、高龄、慢性心功能不全、糖尿病、肝硬化及慢性肾衰竭等。     

新生儿先天性心脏病术后呼吸机相关性肺炎危险因素分析

目的 分析先天性心脏病（先天心）新生儿围手术期合并呼吸机相关性肺炎（ventilator-associated pneumonia,VAP）的发病危险因素;为预防和控制VAP提供科学依据。方法 对47例先天心新生儿外科手术治疗呼吸机支持48小时后所发生的17例VAP行回顾性分析,用logistic回归分析方法,筛选VAP发病的可能危险因素。结果 本组VAP发生率为38.6％,其发生率与呼吸机治疗,镇静药、麻醉药和肌松药应用的时间差异有统计学意义,呼吸机延长1日VAP增加2.314倍。与体重、性别、疾病的类型和体外循环无关。结论 呼吸机使用时间是新生儿先天心术后合并VAP的关键因素,应尽早脱离呼吸机治疗,去除气管插管,以便减少VAP的发生。对已筛选的可能危险因素,需通过临床试验进一步证实。     

先天性心脏病婴幼儿外科治疗对策分析(附115例报告)

目的 探讨婴幼儿先天性心脏病外科围术期处理对策.方法我院于2008年6月至2011年12月对115例患先天性心脏病的婴幼儿实施外科手术治疗,男性73例,女性42例,年龄3个月至3岁,体重3.5～20.0 kg;其中室间隔缺损(VSD)54例,法洛四联症(TOF)14例,室间隔缺损合并房间隔缺损(VSD+ASD)10例,房间隔缺损(ASD)9例,动脉导管未闭(PDA)8例,肺动脉瓣狭窄(PS)7例,室间隔缺损合并动脉导管未闭(VSD+PDA)5例,完全型肺静脉异位引流(TAPVC)4例,右室双出口(DORV)3例,主动脉缩窄合并室间隔缺损(CoA+VSD)1例.结果全组死亡5例,死亡率为4.3%.死亡原因:低心排出量综合征1例,肺高压危象2例,呼吸道梗阻2例.结论先天性心脏病患儿在婴幼儿期外科治疗可以取得满意疗效,根据婴幼儿生理、病理特点采取个体化治疗对策是成功的关键.     

Original Article--Surgical site infections following pediatric cardiac surgery in a tertiary care hospital: Rate and risk factors

BackgroundSurgical site infections [SSIs] are the second most common type of healthcare-associated infections and leading cause of postoperative morbidity and mortality in pediatric cardiac surgery. This study aims to determine the rate of, risk factors for, and most common pathogen associated with the development of SSIs after pediatric cardiac surgery.MethodsPatients aged ≤14 years who underwent cardiac surgery at our tertiary care hospital between January 2010 and December 2015 were retrospectively reviewed.ResultsThe SSI rate was 7.8% among the 1510 pediatric patients reviewed. Catheter-associated urinary tract infection [CAUTI] [odds ratio [OR] 5.7; 95% confidence interval [CI] 2.3–13.8; P < 0.001], ventilator-associated pneumonia [VAP] [OR 3.2; 95% CI 1.4–7.2; P = 0.005], longer postoperative stay [≥25 days] [OR 4.1; 95% CI 2.1–8.1; P < 0.001], and a risk adjustment in congenital heart surgery [RACHS-1] score of ≥2 [OR 2.4; 95% CI 1.2–5.6; P = 0.034] were identified as risk factors for SSIs. Staphylococcus aureus was the most common pathogen [32.2%].ConclusionsSSI risk factors were longer postoperative stay, CAUTI, VAP, and RACHS-1 score of ≥2. Identification and confirmation of risk factors in this study is important in order to reduce the rate of SSIs following cardiac surgery.     

Incidence and risk factors of delirium in patients after cardiac surgery: Modifiable and non-modifiable factors

BackgroundPost cardiac surgery delirium is a severe complication. This study tried to evaluate the early postoperative delirium risk factors and to identify which of them can be modified in order to optimize perioperative management.MethodsIt is a prospective observational study. 250 consecutive cardiac surgery patients took part in the study. Cardiac surgery, the anesthetic regiment and the postoperative management were standardized. The incidence and the risk factors of the postoperative delirium were analyzed by univariate and multivariate analysis. Delirium was assessed with screening scale – The Confusion Assessment Method for the intensive care unit every 12 h postoperatively.ResultsDelirium developed in 52 patients (20.8%). Univariate analysis of the variables confirmed that older age (p = 0.0001), the higher EuroSCORE II value (p = 0.0001), longer CPB time (p = 0.0001), longer ACC time (p = 0.0001), and the sufentanil dose (p = 0.010) were strongly independently associated with postoperative delirium. The benzodiazepine administration was shown to be an intermediate predictor for developing postoperative delirium (p = 0.055).ConclusionsAdvanced age, higher EuroSCORE II value, longer CPB and ACC times, and higher sufentanil doses during anesthesia were all predictors for the development of postoperative delirium. The only modifiable risk factor was the use of larger doses of sufentanil which is related with the duration of the operation. New preventive strategies and use of reduced dose of sufentanil intraoperatively, or the use of different opioid should be studied and applied in order to reduce the incidence of the postoperative delirium.     

心血管植入型电子器械更换患者无症状囊袋感染相关危险因素研究

目的研究心血管植入型电子器械（cardiac implantable electronic device,CIED）更换患者囊袋的无症状感染发生率及相关危险因素。方法连续人选2011年1月至2012年3月在卫生部北京医院及阜外心血管病医院行CIED更换术并除外临床诊断囊袋感染或起搏导线相关感染性心内膜炎患者127例,分别进行血培养和囊袋组织培养,并收集相关临床特征及检查指标,进行单因素及多因素回归分析。结果127例行CIED更换的患者,咀培养均为阴性,囊袋组织培养阳性率为15．8％,最主要的致病菌为凝同酶阴性葡萄球菌（14例,70％）。单因素分析发现男性、恶性疾病、应用抗血小板药物、更换频次有统计学意义。多因素Logistic回归分析发现更换频次、既往抗生素使用、抗血小板药物使用为无症状囊袋感染的独立危险因素。结论临床上无任何感染表现的CIED植入患者中,隐匿性囊袋感染发生率为15．8％,其独立的危险因素是更换频次、既往抗牛素使用、抗血小板药物使用。     

成人心脏外科术后感染调查及危险因素分析

据报道,心脏外科手术后感染的发病率达5％～21％。对心脏外科术后感染情况进行分析,调查引起感染的病原菌及其耐药情况,掌握本单位本地区耐药菌的发生和发展的趋势是非常必要的,可以对临床抗生素的应用提供指导,制订治疗感染的经验性治疗方案,减少耐药菌的产生。