冠状动脉杂交技术对比冠状动脉旁路移植术在冠状动脉再血管化中的meta分析

目的 评价冠状动脉再血管化杂交技术（HCR）与冠状动脉旁路移植术（CABG）在冠心病治疗中的有效性和安全性。方法 检索MEDLINE,EMBASE数据库,中国知网,Corchrane图书馆及二次资源。检索词：杂交技术、冠状动脉旁路移植术、经皮冠状动脉支架置入术、一站式冠状动脉杂交术、分站式冠状动脉杂交术。采用比值比（odd ratio, OR）和95%可信区间（95% confidence interval, CI）作为评价HCR和CABG的主要心脑血管事件发生率（死亡率、卒中发生率、心肌梗死发生率、目标血管再血管化率、主要的心脑血管事件发生率、新发的心房颤动发生率以及红细胞输注率）有无差异的指标;用均数差（median difference,MD）和 95%CI作为评价机械通气时间、ICU时间、总住院时间有无差异的指标。统计学分析应用RevMan 5.2进行异质性检验及Meta分析。结果 在检索到的文献中共有17篇文献满足条件,总计8 608例患者。行HCR的患者和非体外循环CABG的患者比较,在死亡率［OR=0.77, 95%CI（0.42, 1.41）, I2（0%）,P=0.39］、心肌梗死发生率［OR=0.78, 95%CI（0.40,1.52）, I2（0%）,P=0.47］、卒中发生率［OR=0.67, 95%CI（0.34,1.33）, I2（0%）,P＝0.26］、主要的心脑血管事件发生率［OR=0.74, 95%CI（0.53,1.03）, I2（0%）,P=0.07］、目标血管再血管化率［OR=2.41, 95%CI（0.91,6.38）, I2（0%）,P=0.08］以及新发的心房颤动发生率［OR=0.92, 95%CI（0.70,1.22）, I2（29%）,P=0.56］方面差异无统计学意义;在红细胞输注率［OR=-0.16, 95%CI（-0.22,-0.09）, I2（34%）,P＜0.01］方面有所降低;在机械通气时间［OR=-6.25,95%CI（-9.01,-5.32）, I2（22%）,P＜0.01］、ICU时间［OR=-18.58, 95%CI（-23.65,-13.52）, I2（45%）,P＜0.01］、总住院时间［OR=-0.3, 95%CI（-0.46,-0.15）, I2（6%）,P＜0.01］方面,时间均有所缩短。结论 HCR安全可行,且较CABG具有一定优势。     

经皮冠状动脉介入术后应用国产和进口氯吡格雷安全性比较的系统评价

目的：系统评价国产氯吡格雷（泰嘉）与进口氯吡格雷（波立维）在接受冠状动脉介入术（PCI）患者中的安全性差异。方法采用Cochrane系统评价方法,计算机检索中国期刊全文数据库、中文科技期刊数据库、中国生物医学文献数据库等三大中文文献数据库,追踪检索已获得文献或相关研究提供的参考文献。对纳入文献进行质量评价和资料提取后,采用系统评价专用软件Review manager 4.2进行Meta分析。结果根据纳入标准和排除标准,最终有20个临床研究纳入Meta分析,包括4392例经皮冠状动脉介入患者,其中泰嘉组2066例,进口波立维组2326例。Meta分析主要结果显示,有11个研究报道了术后12个月的主要心血管不良事件（MACE）发生率,经异质性检验,I2=0%,表明研究结果间无统计学异质性,采用固定效应模型合并分析,泰嘉组和波立维组之间的MACE发生率无统计学差异（OR=1.00;95% CI：0.75～1.34;P=0.99）;有11个研究报道了术后12个月的不良反应发生率,经异质性检验,I2=0%,表明研究结果间无统计学异质性,采用固定效应模型合并分析,泰嘉组和波立维组之间的不良反应发生率无统计学差异（OR=1.14;95%CI：0.82～1.59;P=0.44）。结论经皮冠状动脉介入术后使用泰嘉和波立维的MACE和不良反应的发生等方面无明显差异,为泰嘉替代波立维抗血小板治疗提供了一定的循证医学证据。     

封堵治疗与药物治疗卵圆孔未闭隐源性卒中的疗效Meta分析

目的:系统评价卵圆孔封堵治疗与药物治疗隐源性卒中(CS)的疗效与安全性。方法:计算机检索各数据库,纳入关于卵圆孔封堵治疗与药物治疗CS的随机对照研究,进行Meta分析。结果:共纳入10篇文献,包括4 584例患者。与药物治疗相比,PFO封堵治疗后复发性卒中发生率降低(OR 0.47,95%CI 0.33～0.65;异质性P=0.18,I2=29%);两种治疗方案发生TIA风险(OR 1.02,95%CI 0.54～1.94;异质性P=0.03,I2=57%)、出血风险(OR 0.95,95%CI 0.57～1.58;异质性P=0.32,I2=14%)和死亡风险(OR 1.35,95%CI 0.40～4.55;异质性P=0.03,I2=59%)差异均无统计学意义,封堵治疗组新发房颤或房扑的发生率增高(OR 5.73,95%CI 3.08～10.67;异质性P=0.28;I2=20%)。结论:PFO封堵治疗在预防复发性卒中方面优于药物治疗,但封堵治疗可能会增加新发房颤或房扑的发生率。     

硬膜外镇痛对减少心脏手术术后并发症的有效性及安全性系统评价

目的 系统评价心脏手术中实施硬膜外镇痛对减少心脏手术术后并发症的有效性和安全性。 方法 计算机检索PubMed、SCI、EMbase、The Cochrane Library、CNKI和CBM等数据库,全面收集硬膜外镇痛减少心脏手术术后并发症的随机对照试验（RCT）,检索时限均为建库至2012年10月,并追溯纳入研究的参考文献。由两位研究者按照纳入与排除标准独立筛选文献、提取资料和评价质量后,采用RevMan 5.0软件进行Meta分析。 结果 共纳入14个RCT,1 942例患者。Meta分析结果显示：联合硬膜外镇痛组在减少心肌缺血及梗死发生率［RR=0.63,95%CI（0.41,0.96）,P=0.03］、呼吸系统并发症发生率［RR=0.55,95%CI（0.40,0.75）,P=0.000 1］、室上性心律失常发生率［RR=0.64,95%CI（0.47,0.88）,P=0.005］和机械通气时间［MD= –2.15,95%CI（–3.72,–0.58）,P=0.00 7］方面均优于单独使用全身麻醉组,且差异均有统计学意义。 结论 基于当前证据,术后硬膜外镇痛可降低心脏手术患者术后心肌缺血及梗死、呼吸系统并发症、室上性心律失常发生率并减少机械通气时间。但目前缺乏评估硬膜外镇痛不良事件（主要为硬膜外血肿）发生率的数据。受纳入研究数量与质量限制,临床上在选择是否使用硬膜外镇痛之前,应该对患者各方面情况进行综合考虑。     

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。     

利伐沙班与伊诺肝素比较预防骨科大手术后深静脉血栓的Meta分析

目的系统评价利伐沙班与伊诺肝素预防骨科大手术后深静脉血栓的疗效。方法计算机检索MEDLINE、EMbase、Cochrane图书馆临床对照试验资料库(2009年第3期)、Current Controlled Trials、The National Reseach Register、中国生物医学文献数据库、中国期刊全文数据库,并手工检索相关领域杂志。检索不受语种限制,时间均从建库至2009年12月。纳入利伐沙班与伊诺肝素(低分子肝素)比较预防骨科大手术后深静脉血栓的随机对照试验(RCT),进行资料提取和质量评价后,采用RevMan5.0.25软件进行Meta分析。结果共纳入7个RCT,包括15458例患者。Meta分析结果显示:利伐沙班与伊诺肝素比较,能减少主要疗效终点风险达60%[RR=0.40,95%C(I0.28,0.57),P<0.00001],能减少主要的次要疗效终点风险达71%[RR=0.29,95%C(I0.15,0.56),P<0.00001],能减少其他疗效终点风险达56%[RR=0.44,95%CI(0.29,0.66),P<0.00001];治疗期间严重出血事件的发生率两者相似[RR=1.16,95%CI(0.68,1.999),P=0.59],次要安全性终点发生率两者也相似。结论利伐沙班预防骨科大手术后深静脉血栓的疗效肯定,能显著降低术后发生深静脉血栓风险。     

心脏震荡波对冠状动脉疾病影响的Meta分析

目的 系统评价心脏震荡波对冠状动脉疾病的影响。方法 计算机检索PubMed、Cochrane Library、Wed of Science、EMbase、Clinical Trails.gov、CNKI、WanFang Data、VIP和CBM数据库,搜集有关心脏震荡波治疗冠状动脉疾病的随机对照试验和队列研究,检索时限均从建库至2022年8月。由2位评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.4.1和Stata 15.0软件进行Meta分析。结果 共纳入11个研究,包括519例患者。Meta分析结果显示：与对照组相比,心脏震荡波治疗能降低再住院率[RR=0.38,95%CI(0.25,0.57),P<0.01],提高运动时间[SMD=0.93,95%CI(0.17,1.70),P=0.02],改善加拿大心血管学会（CCS）心绞痛分级[MD=-0.62,95%CI（-0.73,-0.51）,P<0.01]、纽约心脏协会（NYHA）心功能分级[MD=-0.60,95%CI（-0.85,-0.35）,P<0.01]、左室射血分数[MD=4....     

衰弱与术后谵妄发生风险关系的Meta分析

目的 系统评价衰弱与术后谵妄发生风险的关系。 方法 计算机检索PubMed、Embase、CENTRAL、Webof Science、中国知网、中国生物医学文献数据库、维普和万方数据库,收集国内外关于衰弱与术后谵妄发生关系的前瞻性队列研究,检索时限为建库至2017年3月。由两名评价者根据纳入排除标准独立筛选文献、提取资料后,采用纽卡斯尔-渥太华量表评价纳入研究的质量,并采用RevMan 5.3软件进行Meta分析。 结果 最终纳入8项前瞻性队列研究, 共846例患者。Meta分析结果显示, 与非衰弱组患者相比, 衰弱组术后谵妄的发生风险增加［OR=3.63,95%CI（2.06,6.40）,P＜0.001］。亚组Meta分析结果显示,①衰弱评估工具：用衰弱表型与多维度衰弱标准评估为衰弱的患者术后发生谵妄的风险增加［OR=5.81,95%CI（3.54,9.77）,P＜0.001］、［OR=1.76,95%CI（1.06,2.92）,P=0.03］;②年龄：衰弱会增加60～74岁患者术后谵妄的发生风险［OR=5.05,95%CI（3.14,8.12）,P＜0.001］,衰弱与年龄≥75岁患者术后谵妄发生风险无关［OR=1.73,95%CI（0.99,3.00）,P=0.05］;③手术类型：衰弱增加心血管手术与非心血管手术患者术后谵妄发生风险［OR=3.40,95%CI（1.64,7.05）,P＜0.001］、［OR=4.95,95%CI（2.41,10.16）,P＜0.001］。 结论 衰弱可增加术后谵妄发生风险,但受纳入研究数量限制,研究结论尚需开展大样本、多中心的前瞻性队列研究加以验证。     

光动力疗法治疗皮肤鲍温病的系统评价

目的系统评价光动力疗法（photodynamic therapy,PDT）治疗皮肤鲍温病的疗效与安全性。方法计算机检索PubMed、OVID、Cochrane图书馆临床对照试验库、CBM和CNKI等电子数据库,纳入PDT治疗皮肤鲍温病的随机对照试验（RCT）。检索时间从1966年1月至2010年3月。检索语种限中、英文。对纳入RCT进行质量评价,提取有效数据,采用RevMan 5.0.23版软件进行Meta分析。结果共纳入5个RCT,共354例患者,496处皮损,其中试验组皮损237处,对照组皮损259处。Meta分析结果显示：PDT组的治愈率高于安慰剂组[RR=4.16,95%CI（1.69,10.25）]或外用氟尿嘧啶软膏治疗组[RR=1.38,95%CI（1.12,1.71）],而与冷冻治疗组无显著差别;PDT组的美容效果评价优于冷冻组[RR=1.48,95%CI（1.18,1.87）]或外用氟尿嘧啶软膏治疗组[RR=1.51,95%CI（1.05,2.15）];PDT组的复发率低于安慰剂治疗组[RR=0.29,95%CI（0.10,0.86）],但与冷冻组或外用氟尿嘧啶软膏组无显著差异。以红光为光源的PDT组治愈率高于绿光光源组的PDT[RR=1.29,95%CI（1.02,1.65）],复发率低于后者[RR=0.20,95%CI（0.05,0.87）]。两次光照治疗方案与单次光照治疗方案的治愈率及美容效果评价无显著差异。PDT治疗的不良反应包括不同程度的疼痛、局部感觉异常、局部炎症反应、色素沉着、结痂。结论现有有限证据表明,PDT治疗皮肤鲍温病的疗效优于安慰剂、冷冻或外用氟尿嘧啶软膏等对照治疗,复发率低于安慰剂,不良反应与对照组相似;红光-PDT治疗疗效优于绿光-PDT,复发率低,而不良反应两者相似;两次光照治疗方案与单次光照治疗的疗效无明显差异,但前者疼痛明显。     

门冬氨酸钾镁预防心脏手术后心律失常疗效的Meta分析

目的系统评价门冬氨酸钾镁预防心脏手术后心律失常的临床疗效。方法计算机检索PubMed、EMbase、The Cochrane Library(2014年第5期)、CNKI、VIP和WanFang Data,查找门冬氨酸钾镁预防心脏手术后心律失常的随机对照试验(RCT),检索时限均为从建库至2014年5月。由2位评价员按照纳入与排除标准独立筛选文献、提取资料和评价纳入研究的方法学质量后,采用RevMan 5.2软件进行Meta分析。结果最终纳入9个RCT,共825例患者。Meta分析结果显示:1与对照组相比,手术前后及时给予门冬氨酸钾镁补充钾、镁离子能明显减少心律失常的发生[OR=0.25,95%CI(0.09,0.69),P=0.008],两组差异有统计学意义。2与对照组相比,手术前后及时给予门冬氨酸钾镁补充钾、镁离子能减少早搏[OR=0.08,95%CI(0.03,0.23),P<0.000 01]和心动过速的发生率[OR=0.29,95%CI(0.17,0.49),P<0.000 01],降低24小时低心排发生率[OR=0.27,95%CI(0.10,0.72),P=0.009],提高自动复跳率[OR=12.16,95%CI(4.82,30.68),P<0.000 01],两组差异均有统计学意义。4两者在改善房颤[OR=0.05,95%CI(–0.16,0.05),P=0.34]和室颤[OR=1.24,95%CI(0.73,2.13),P=0.43]方面无明显差异。结论门冬氨酸钾镁能有效预防心脏手术后心律失常发生,同时对心肌具有一定保护作用,但在改善患者术后房颤、室颤发生率方面与常规治疗无明显差异。受纳入研究数量和质量所限,上述结论尚待进一步开展更多大样本、多中心、高质量的RCT加以验证。     

Incidence, timing, symptoms, and risk factors for atrial fibrillation after cardiac surgery.

BACKGROUND: Atrial fibrillation is the most common complication after cardiac surgery and a major cause of morbidity and increased cost of care. OBJECTIVES: To examine the incidence, timing, symptoms, and risk factors for atrial fibrillation after cardiac surgery. METHODS: A total of 302 patients were continuously monitored for atrial fibrillation with standard hardwire and telemetry devices during hospitalization after coronary artery bypass graft and/or valve surgery and with wearable cardiac event recorders for 2 weeks after discharge from the hospital. After discharge, patients recorded and transmitted their rhythm by telephone daily and whenever they had symptoms suggestive of atrial fibrillation. RESULTS: Of the 302 patients, 127 (42%) had atrial fibrillation; 41 had it after discharge, and for 10 it was their first episode. The first episode occurred at a mean of 2.9 days after surgery (SD, 3.1; range, day of surgery to 21 days after surgery). Although palpitations was the most common symptom (17%), most episodes of atrial fibrillation (69%) were not associated with symptoms. Independent predictors of atrial fibrillation were age 65 years or greater, history of intermittent atrial fibrillation, atrial pacing, male sex, white race, and not having hyperlipidemia. Independent predictors of atrial fibrillation after discharge from the hospital were having atrial fibrillation while hospitalized, valve surgery, and pulmonary hypertension. CONCLUSIONS: Atrial fibrillation is common after cardiac surgery and often occurs after discharge from the hospital and without accompanying symptoms. Outpatient monitoring may be warranted in patients with characteristics that place them at increased risk for atrial fibrillation.     

Impact of prophylactic postoperative beta-blockade on post-cardiothoracic surgery length of stay and atrial fibrillation

BACKGROUND: Previous studies have shown that post-cardiothoracic surgery atrial fibrillation (AF) increases the risk of hospital length of stay (LOS), overall mortality, pulmonary edema, and need for a balloon pump. A meta-analysis of 2 previous trials showed a nonsignificant reduction in LOS with postoperative beta-blockers but only encompassed 1200 patients, with few valve surgery patients, and neither study used a hospital within the US. OBJECTIVE: To evaluate the impact of postoperative beta-blockers on LOS and AF. Secondary endpoints of overall mortality, pulmonary edema, and need for an intra-aortic balloon pump (IABP) were also evaluated between groups. METHODS: This was a prospective cohort evaluation of all patients undergoing cardiothoracic surgery at our institution between October 1999 and October 2003. Patients receiving prophylactic postoperative beta-blockers were matched (1:1) with patients not receiving prophylaxis for age >70 years, valvular surgery, history of AF, gender, and use of preoperative digoxin and beta-blockers. RESULTS: Patients (n = 1660) receiving postoperative beta-blockade had a reduction in LOS (mean +/- SD 10.22 +/- 11.38 vs 12.40 +/- 15.67; p = 0.001) and AF (23.5% vs 28.4%; p = 0.02). Mortality, pulmonary edema, and need for IABP were reduced by >50% (p < 0.001; p = 0.001; p < 0.001, respectively), while myocardial infarction and stroke were not significantly impacted. CONCLUSIONS: In this observational cohort study, prophylactic postoperative beta-blocker use was associated with shorter hospital LOS by an average of 2.2 days and a 17.3% lower incidence of AF. It may also be associated with reductions in overall mortality, pulmonary edema, and need for an IABP.     

Incidence of atrial fibrillation after mild or moderate hypothermic cardiopulmonary bypass

OBJECTIVES: Atrial fibrillation remains a significant source of morbidity after coronary artery bypass grafting (CABG). Whether cardiopulmonary bypass (CPB) temperature influences the occurrence of postoperative atrial fibrillation in CABG patients has not been specifically examined. In the present study, we reviewed postoperative data from patients who were prospectively randomized to mild or moderate hypothermic CPB for elective CABG to determine the incidence of postoperative atrial fibrillation. DESIGN: Randomized, single center, observational study. SETTING: Tertiary university medical center. PATIENTS: Adults undergoing elective CABG surgery. INTERVENTIONS: Enrolled patients were prospectively randomized to mild (34 degrees C [93.2 degrees F]) or moderate (28 degrees C [82.4 degrees F]) hypothermic CPB. MEASUREMENTS AND MAIN RESULTS: The incidence of postoperative atrial fibrillation was determined by review of ICU and hospital records. There was a significantly higher incidence of atrial fibrillation in the moderate compared with the mild hypothermic CPB group. Patients who had postoperative atrial fibrillation were significantly older than those without atrial fibrillation. Furthermore, a significant increase in the relative risk of developing postoperative atrial fibrillation was found for both age and CPB temperature. CONCLUSIONS: Our results indicate that the temperature of systemic cooling during CPB is an important factor in the development of atrial fibrillation after CABG surgery. In addition, this study confirms that increasing age is a significant determinant of postoperative atrial fibrillation.     

老年患者肝胆手术后房颤发生与超敏C-反应蛋白关系的分析及护理干预

目的了解老年患者肝胆手术后房颤发生与超敏C-反应蛋白的关系。方法老年肝胆手术患者115例,根据术后是否出现房颤持续5min以上分为房颤组和非房颤组,分析超敏C-反应蛋白水平。结果术后36例患者发生房颤;房颤组术后第1天、第2天超敏C-反应蛋白水平分别为(131.92±25.48)ng/ml、(113.06±22.68)ng/ml,明显高于非房颤组的(115.09±21.53)ng/ml、(95.27±20.76)ng/ml。结论老年患者肝胆手术术后发生房颤与超敏C-反应蛋白水平密切相关,需做好预防护理。     

ECG monitoring after cardiac surgery: postoperative atrial fibrillation and the atrial electrogram

Atrial fibrillation is one of the most common complications after cardiac surgery and is associated with adverse outcomes such as increased mortality, neurological problems, longer hospitalizations, and increased cost of care. Major risk factors for the development of postoperative atrial fibrillation include older age and a history of atrial fibrillation. beta-Blockers are the most effective preventive therapy, although sotalol and amiodarone can also be used for prophylaxis. In the postoperative period, the nurse plays an important role in the early detection of atrial fibrillation by the recording of an atrial electrogram, which is easily obtained from the bedside monitor. Because an atrial electrogram records larger atrial activity than ventricular activity, it can be invaluable in establishing the diagnosis of postoperative atrial fibrillation. Once atrial fibrillation begins, treatment can be started with either rhythm conversion or rate-controlling medications.     

心房颤动外科治疗的研究进展

心房颤动是常见的心律失常之一,致残率和致死率较高,迷宫Ⅲ型手术是其外科治疗的金标准。以新型能源消融线路替代迷宫Ⅲ型手术"切与缝"线路的迷宫Ⅳ型手术,可降低手术对心脏造成的损伤,获得满意的窦性心律转复率,在临床应用日益广泛。近年来,随着医学技术的进步,改良迷宫手术、微创迷宫手术及杂交迷宫手术也在临床逐渐开展。本文就心房颤动外科治疗的研究进展综述如下。     

卡配因参与风心病房颤患者心房纤维化过程

目的检测Calpain I、Calpain II、caspase-12在风湿性心脏病心房颤动患者心房组织中的表达,探讨其在心房纤维化发展中的作用及其对房颤发生、维持的作用。为临床慢性房颤患者心房纤维化及心房结构重构的防治提供新的靶点。方法取32例风湿性心脏病行外科换瓣手术患者左心房组织,分为A组：永久性房颤组（Permanent AF组）16例,B组：阵发性或持续性房颤组（Paroxysmal or persistent AF组）10例,C组：窦性心律组（Sinus rhythm组）6例。采用免疫组化法测Calpain I、Calpain II、caspase-12在左心房组织中的表达并计算其灰度值,心肌胶原染色采用VG染色,光镜下观察组织纤维化程度,并计算胶原容积积分（CVF）。结果风湿性心脏病心房颤动患者calpain I、calpain II、caspase-12在左心房组织表达明显增多（P〈0.05）,calpain I、calpain II与CVF呈正相关。结论 calpain I、calpain II通过促进心肌细胞凋亡促进了风湿性心脏病心房颤动心房纤维化过程。     

心脏手术后谵妄危险因素的 Meta 分析

目的：通过Meta综合分析明确心脏手术后谵妄的危险因素。方法制定原始文献的纳入标准、排除标准及检索策略,检索多个中英文文摘数据库和全文数据库。对检索的文献进行质量评价后,应用RevMan4．3分析软件分析,采用固定效应或随机效应模型计算合并后的综合效应。结果15篇文献符合纳入及排除标准。经Meta分析,年龄;房颤史、2型糖尿病史、脑血管病史、术前血肌酐水平异常、贫血及抑郁;实施瓣膜手术或同时实施冠状动脉旁路移植术及瓣膜联合手术、手术时间延长;术后机械通气时间延长、镇静剂及术后房颤具有综合效应,为心脏手术后谵妄的独立预测因子。结论房颤史及术后房颤、瓣膜手术或同时实施CABG手术及瓣膜手术及手术时间延长是心脏手术后谵妄独特的危险因素,而炎症反应与医源性环境因素与术后谵妄的关系,证据尚不充分。     

心胸外科术后患者失眠原因分析及护理干预

目的 了解和探讨心胸外科术后患者失眠原因,以最大程度改善此类患者的睡眠质量,减少失眠困扰,促进术后恢复.方法 采用问卷调查法对398例心胸外科术后失眠患者的睡眠状况及失眠原因进行调查分析.结果 导致失眠的因素依次为心理因素、疼痛、尿管及引流管刺激、环境、护士治疗护理、经费等.结论 对心胸外科手术患者护理中要增加对患者睡眠的评估;加强心理护理;及时作好术后镇痛处理;争取患者亲属的积极配合;减少仪器、环境对患者感官的刺激因素;调整好治疗护理时间等,以期提高患者的睡眠质量,促进术后早日康复.

Abstract：

Objective To understand and explore the reasons of insomnia in post-cardiothoracic surgery and provide some suggestions to promote their postoperative recovery.Methods A questionnaire survey was performed to investigate the status of sleeping quality and the reasons of insomnia in 398 patients in post-cardiothoracic surgery.Results The major reasons accounting for post-operative insomnia were in sequence of psychological factors, operation-related pain, the upset of urine and drainage tube, clinical environment, disturbances from nursing interventions, and medical costs, respectively.Conclusions It is vital to assess the post-operative insomnia of patients in the department of cardiothoracic surgery. In order to improve their post-operative sleeping quality and promote recovery, it is advisable for nurses to strengthen psychological nursing interventions, manage timely analgesia for operative-related pain, try to get the cooperation of family members, reduce the disturbance of apparatus and surroundings, and adjust the time of nursing.     

Surgical Treatment of Supraventricular Tachycardia: A Five-Year Experience

Two hundred and eight patients underwent operative therapy of supraventricular tachycardia between June 1984 and June 1986. There were 196 patients with Wolff-Parkinson-White syndrome, one with AV nodal reentry, two with atrial flutter, one with ectopic atrial tachycardia, three with paroxysmal sinus tachycardia, and five with atrial fibrillation. Map guided or direct surgery was performed in all patients except the three with atrial fibrillation. Direct surgery was generally successful with failures including one patient with Wolff-Parkinson-White syndrome, one with atrial flutter, and the three patients with paroxysmal sinus tachycardia. There was no mortality. Major complications were uncommon and included three resternotomies for bleeding, one chylopericardium. Six patients required reoperation.