617例婴幼儿心脏直视术后的治疗体会

目的探讨婴幼儿心脏直视术围手术期的合适治疗方法。方法对1992年12月-2002年3月共617例婴幼儿围手术期治疗的临床资料进行统计分析。结果本组死亡39例，死亡6．32％，术后发生并发症99例，发生率为16．0％。结论婴幼儿心脏直视术围手术期的治疗，重点在于输液成分和量的控制、血管活性药物的合理应用以及呼吸道的管理、防止多器官衰竭的发生。     

血液心脏停搏后不良反应少于晶体停搏

已有不少小样本随机对照试验比较了血液或晶体停搏液在心脏手术中的心肌保护作用。由于血液的成分比晶体停搏液更接近于正常生理状态，因此在心脏手术中可带来显著的临床益处。为明确血液是否能降低术后不良反应，加拿大多伦多Surmybrook和女子学院Guru等检索了MEDLINE、EMBASE和Cochrane对照试验登记数据库，对相关数据进行荟萃分析，并将分析结果在Circulation[2006，114（1 Suppl）：I331]上发表。     

24例婴幼儿心脏术后呼吸道护理配合体会

目的总结婴幼儿心脏术后呼吸道护理配合经验。方法回顾性分析我院于2018年1月-2018年4月收治的24例婴幼儿心脏手术患者,探讨婴幼儿心脏术后呼吸道护理要点。结果24例婴幼儿患者经过术后护理全部痊愈出院。结论密切观察患儿状态,正确操作呼吸机,确保气管插管的正确位置,保证患儿呼吸道通畅,及时进行膨肺吸痰,可有效降低患儿并发症的发生,从而可提高手术成功率,促进患儿的早期康复。     

晶体停跳液和含血停跳液的临床应用研究

目的：观察晶体停跳液和含血停跳液对心肌的保护作用。方法：２０例择期性心脏瓣膜替换术患者分别用晶体停跳液（１０例）和含血停跳液（１０例）灌注的结果进行分析。结果：两组在直视手术中心脏停跳良好。围术期血液动力学指标，平均动脉压、中心静脉压、心率无明显差异。心肌摄氧率大致相同。但晶体停跳液组的冠状动脉乳酸摄取率明显低于含血停跳液组，而含血停跳液组的血浆肌酸激酶及其同功酶的水平明显低于晶体停跳液组。电子显微镜观察可见晶体停跳液组右心房心肌的超微结构（线粒体、肌丝）严重损坏，而含血停跳液组对其有明显保护效果。含血停跳液组自动复跳率（６０．５％）明显高于晶体停跳液组（４４．９％）。结论：含血停跳液有很多优点，如临床安全性、心肌酶释放减少、超微结构损伤轻等。     

回收式自体输血与异体输血对心脏手术患者凝血功能及血液流变学指标的影响

目的 观察回收式自体输血与异体输血对心脏手术患者凝血功能及血液流变学的影响。方法 回顾性分析,采集我院2019年6月至2022年1月期间收治的心脏手术患者的基线资料,异体组（45例,异体血回输）,回收组（45例,回收式自体输血）,对比两组凝血功能、血液流变学及不良反应。结果 回收组输血后1 d、5 d活化部分凝血活酶时间（APTT）、凝血酶原时间（PT）、D-二聚体（D-D）表达低于异体组,纤维蛋白原（FIB）高于异体组（P<0.05）;输血后1 d,异体组高切全血黏度（HSBV）、低切全血黏度（LSBV）、全血黏度及血细胞比容均下降（P<0.05）,回收组HSBV、LSBV、红细胞聚集指数（EAI）、全血黏度及血细胞比容下降（P>0.05）;回收组总发生率低于异体组（P<0.05）。结论 回收式自体输血对心脏手术患者凝血功能及血液流变学影响均较小,且安全可靠。     

心脏瓣膜手术中冷氧合血与冷晶体停跳液保护心肌作用的比较(附20例报告)

将20例行心脏瓣膜置换术的患者随机分为两组，分别在体外循环期间采用冷氧合血停跳液及冷晶体停跳液。通过监测围术期，术后24h的血流动力学变化，心脏自动复跳率及复跳时间，开放主动脉后6h心肌肌钙蛋白T（cTnT)的变化，术后标准Ⅱ导联心电图变化和临床强心药物使用及患者在危重监测病房（ICU）停留时间等，对比观察两组的心肌保护效果。结果：冷氧合血停跳液组（氧合血组）的心脏自动复跳率及自动复跳时间优于冷晶体停跳液组（冷晶体组）；开放主动脉后6h cTnT含量少于冷晶体组，两组术中及术后24h内血流动力学变化无差异。认为冷氧合血停跳液的心肌保护效果优于冷晶体停跳液。     

不同保存液对自体静脉移植后血管内膜增生的影响

目的:探讨晶、胶体保存液对自体静脉移植后血管内膜增生的影响,以筛选出优良的移植血管保存液.方法:建立大鼠自体静脉移植模型,分为2组:晶体液保存组,术中移植静脉以晶体液保存;胶体液保存组, 术中移植静脉以胶体液保存.分别于术后第1 天、3天、1周、2周、4周、6周取材.对移植血管应用苏木精-伊红染色,进行组织形态学观察;应用免疫组织化学法观察增殖细胞核抗原(PCNA)、P21在移植后不同时期的表达情况.结果:晶体液保存组的静脉较胶体液保存组增厚明显;PCNA表达高峰在1～2周,晶体液保存的静脉表达较胶体液保存的静脉明显;P21在1～2周时表达水平较低,其后逐渐升高,至4周时达高峰,在同一时点,胶体液保存的静脉较晶体液保存的静脉表达明显.结论:自体静脉移植血管保存中,胶体保存液优于晶体保存液.     

心脏术后早期感染的诊断和治疗

体外循环下心内直视手术的感染发生率各家报道不一,最低为0.8%～1.5%,高者达8%～11%。常见的严重感染有以下几种: 一、呼吸道感染患者术前有上呼吸道感染而未彻底控制,术后因机体免疫功能减低而致感染进一步发展;术中肺     

不同急性肾损伤时期行CVVH治疗对心脏术后患者多脏器功能的影响

目的探讨不同急性肾损伤(AKI)时期行持续性静—静脉血液滤过(CVVH)治疗对心脏术后患者多脏器功能的影响。方法对60例行心脏体外循环术后出现AKI患者的临床资料进行回顾性分析,将患者随机分为3组,其中对速尿治疗敏感、未行CVVH治疗32例(对照组),对速尿治疗不敏感、行CVVH治疗28例[Ⅰ期12例(H1组),Ⅱ期16例(H2组)。观察并比较各组心、肺、肝、肾功能的相关指标。结果三组比较,H2组血肌酐明显降低,H1组平均动脉压明显升高(P均<0.05);H1组、H2组中心静脉压、氧合指数、总胆红素、直接胆红素变化无统计学差异(P均>0.05)。对照组谷丙转氨酶升高,H1组、H2组升高后有下降趋势(P均<0.05)。结论不同AKI时期行CVVH治疗对心脏术后患者的多脏器功能影响各异,速尿治疗不敏感的Ⅰ期患者行CVVH治疗,有心、肾保护作用。     

Effects of postoperative dietary intake on functional recovery of patients undergoing cardiac surgery

Background and aim

Among elderly patients undergoing cardiac surgery, malnutrition is very common and related to muscle wasting known as sarcopenia. Cardiac surgery causes a further decline of nutritional status due to reduced dietary intake (DI); however, the impact of postoperative DI on functional recovery is unclear.

婴幼儿心内直视手术中监测血清肌钙蛋白I的临床价值

目的探讨先天性心脏病（CHD）患儿血清肌钙蛋白I（cTnI）在心内直视手术中的变化及临床意义。方法采用酶联免疫吸附法（ELISA）检测15例先天性心脏病患者cTnI在心内直视手术中的浓度变化。结果cTnI的浓度在主动脉开放即刻，主动脉开放后2、6、24h均较术前升高，差异有统计学意义（P〈0．05）。主动脉开放后再灌注2h左右出现一个明显的峰值，以后逐渐下降，无双峰，cTnI峰值浓度范围为0．83-7．41（4．20±0．93）μg／L。cTnI浓度随主动脉阻断时间增加而增高，其与主动脉阻断时间之问存在明显的相关性（y=5．008x＋22．327，r=0．8831，P=0．003）。结论cTnI的浓度可以作为判定先天性心脏病患儿心内直视手术中心肌损伤程度的重要指标，cTnI浓度升高越明显，提示术中心肌损伤程度越大。     

心脏手术中经食道超声心动图检查的老年患者术后吞咽痛研究

目的 探讨老年患者心脏手术中经食道超声心动图检查(TEE)后吞咽痛的影响因素.方法 将2010年11月至2012年8月我院96例心脏手术中经食道超声心动图检查的患者分为两组,其中≥65岁组60例,＜65岁组36例,收集患者的临床资料并随访,使用疼痛数字等级定量表评估术后吞咽痛.比较两组患者术后吞咽痛的特点,并运用Logistic回归分析方法探讨老年患者心脏手术后吞咽痛的影响因素. 结果 与＜65岁组相比,≥65岁组术后吞咽痛发生率高(88.3％对66.7％,P＜0.025)、疼痛评分高(2.6±1.7)分和(1.4±0.9)分(P＜0.01).Logistic回归分析显示,全麻前口服利多卡因胶浆、口咽黏膜损伤、TEE留置时间是老年患者术后吞咽痛的影响因素(P＜0.01). 结论 老年患者心脏手术中TEE后吞咽痛发生率高,疼痛程度重.应在全麻前口服利多卡因胶浆,减少口咽黏膜损伤,缩短TEE留置时间以缓解患者术后吞咽痛.     

Selective use of superficial temporal artery cannulation in infants undergoing cardiac surgery

Arterial cannulation is routinely performed in children undergoing cardiac surgery to aid the intraoperative and intensive care management. Most commonly cannulated peripheral site in children is radial artery, and alternatives include posterior tibial, dorsalis pedis, and rarely superficial temporal artery (STA). Two specific situations in cardiac surgery where STA cannulation and monitoring was useful during the surgical procedure are reported. To our knowledge, such selective use of STA pressure monitoring has not been reported in the literature previously. Our experience suggests that STA monitoring can be useful and reliable during repair of coarctation of aorta or administration of anterograde cerebral perfusion in patients having associated aberrant origin of the right subclavian artery.     

成人瓣膜手术体外循环中应用不同利尿剂对电解质的影响

目的:观察托拉塞米与呋噻米用于成人瓣膜手术体外循环(cardiopulmonary bypass,CPB)中对电解质的影响。方法:随机选取择期CPB下行瓣膜置换术患者60例,分为托拉塞米组(A组)30例,呋噻米组(B组)30例,分别在CPB前、升主动脉阻断后15min、升主动脉开放15min、CPB停机时和术后2h抽取静脉血进行血气分析,记录K+、Na+、Mg++及Ca++离子浓度。同时记录2组患者转机中尿量及自动复跳率。结果:2组患者转机前、阻断升主动脉后15minK+、Na+、Mg++及Ca++离子浓度差异无统计学意义(P>0.05);A组患者开放升主动脉后15min血K+明显高于B组,差异有显著性统计学意义(P<0.01),Mg++、Ca++差异无统计学意义(P>0.05);停机时及术后2h,2组患者血K+、Na+、Mg++及Ca++差异无统计学意义(P>0.05)。2组患者转中尿量及自动复跳率差异无统计学意义。结论:托拉塞米可以用作CPB下瓣膜置换术的利尿剂,但要注意防止复跳时的高钾。     

新活素对体外循环心内直视手术后肾功能损害患者心、肾功能的影响

目的观察新活素对体外循环心内直视手术后肾功能损害患者心、肾功能的影响。方法32例体外循环术后肾功能损害患者随机分为2组,治疗组在常规治疗的基础上予新活素（重组人脑利钠肽）静脉注射治疗;对照组仅予常规强心、利尿。观察治疗前后尿量、血肌酐（SCr）、估算的肾小球滤过率（eGFR）、左心室射血分数（LVEF）、中心静脉压（CVP）、收缩压（SBP）的变化。结果对照组尿量、CVP、SCr、eGFR较治疗前有改善,其中4例患者行CRRT治疗,死亡1例（6．25％）。与对照组相比,治疗组治疗后48h的SCr、eGFR、CVP均显著优于对照组（P〈0．01）,LVEF改善优于对照组（P〈0．05）。治疗组肾功能恢复14例（87．5％）,2例肾功能无明显改善改行CRRT治疗。结论体外循环心内直视手术后肾功能损害患者加用新活素能有效地改善心、肾功能。     

婴幼儿体外循环术中自体血液回收对血液成分及凝血功能的影响

目的：观察体外循环中采用自体血液回收输注后对婴幼儿血液成分及凝血功能的影响。方法：随机将80例患儿分为观察组和对照组各40例。观察组使用血液回收机,将术中及体外循环机器余血全部回收处理,并于术后6小时内回输至患儿体内。对照组不使用血液回收机,术中及体外循环机器余血弃用。收集两组患儿性别,年龄,体重,术中体外循环时间,主动脉阻断时间;术前、术后15min、24h、第5天的血色素(Hb)、红细胞压积(Hct)、血小板(PLT);术前、术后15min、24h、72h凝血酶原时间(PT)、国际标准化比值(INR)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、凝血酶时间(TT)、D-D二聚体(D-D)、纤维蛋白原降解产物(FDP);术后24h引流量,围术期异体血使用率、围术期红细胞使用量、术后凝血酶原复合物(PCC)使用率。结果：两组患儿性别、年龄、体重、术中体外循环时间及主动脉阻断时间比较差异无统计学意义(P＞0.05)。两组患儿术前Hb、Hct、PLT、PT、INR、APTT、FIB、TT、D-D、FDP比较差异无统计学意义(P＞0.05)。两组患儿各时点两组患儿术后15minPT、INR、APTT、TT、D-D、FDP与术前比较差异有统计学意义(P＜0.05);两组患儿术后不同时点PT、INR、APTT、FIB 、TT、D-D、FDP组间比较差异无统计学意义(P＞0.05)。两组患儿术后15min的Hb、Hct组间比较差异有统计学意义(P＜0.05);两组患儿术后24h、术后第5天的Hb、Hct、PLT与术前比较差异无统计学意义(P＞0.05),组间比较差异无统计学意义(P＞0.05)。两组患儿库血使用率与库血使用量比较差异有统计学意义(P＜0.05);两组患儿术后24h引流量和PCC使用率组间比较差异无统计学意义(P＞0.05)。结论：小儿心脏体外循环手术后使用自体血液回收在不同时点的凝血功能指标与不使用自体血液回收相比较无明显差异。使用自体血液回收可明显减少异体血使用率和使用量,且不增加并发症,可在小儿心脏手术中积极应用。     

Impact of early postoperative activities on postoperative recovery in patients undergoing abdominal surgery: A protocol for systematic review and meta-analysis

Introduction:A refined nursing process is utilized to formulate a detailed early postsurgical activity plan. The postsurgical activity aims to conduct focused and planned interventions to address the early postoperative activities of patients, enhance the awareness and compliance of the patients through the early postsurgical activities. Currently, in traditional clinical practice, there is no clear evidence showing the effect of initial postsurgical actions related to the rehabilitation of inpatients undertaking abdominal operations. The present study will systematically evaluate how initial postsurgical actions impact the rehabilitation of patients undertaking abdominal operation through the analysis of relevant domestic and foreign literature.Objective:Analyze the how initial postsurgical actions impact the rehabilitation of abdominal surgery inpatients.Methods and analysis:The present systematic study will retrieve randomized controlled trials and case-control studies from online databases. The retrieved studies will describe the initial postsurgical activities in inpatients undergoing abdominal surgery. Accordingly, the following databases are searched for the aforementioned types of studies: Cochrane library, China National of Knowledge Infrastructure, Web of Science, PubMed database, WanFang database, and Embase database. Studies from inception to August 19, 2021 will be searched. The quality evaluation and data extraction for the studies that will satisfy the inclusion criteria will be conducted by 2 independent researchers. A meta-analysis on the postoperative indicators will be performed using RevMan 5.3.5 software.     

Perioperative point of care platelet function testing and postoperative blood loss in high-risk cardiac surgery patients

Postoperative coagulopathic bleeding is common in cardiac surgery and associated with increased morbidity and mortality. Platelet function is affected by multiple factors, including patient and procedural characteristics. Point-of-care (POC) multiple electrode aggregometry (MEA) can rapidly detect and quantify platelet dysfunction and could contribute to optimal patient blood management.

In patients undergoing CABG and heart valve surgery platelet function was assessed using POC MEA at four different perioperative timepoints in response to stimulation with four specific receptor agonists (ADP, AA, COL, TRAP). Postoperative bleeding was recorded during 24 h after surgery. Regression analyses were performed to establish associations between perioperative platelet function and postoperative blood loss.

Ninety-nine patients were included in the study. Fifty-nine patients (60%) were on antiplatelet therapy (APT) at time of surgery. ADP- and AA-induced platelet aggregation declined during CPB and after decannulation from CPB, with a maximum decrease of 55% for ADP (35 vs. 77 AU at baseline; P < 0.001) and 78% for ASPI (14 vs. 64 AU at baseline; P < 0.001). A linear relationship was present between ADP-induced platelet aggregometry at baseline and postoperative blood loss (r = ?0.249; P = 0.015). In aspirin users, the maximum decline in platelet function between baseline and CPB decannulation was related to postoperative blood loss (r = 0.308; P = 0.037). In multivariate analysis, a reduced ADP platelet function prior to surgery remained associated with postoperative blood loss (r = ?0.239; P = 0.012).

Reduced ADP-induced platelet aggregation at baseline is associated with increased postoperative blood loss in high-risk cardiac surgery patients.     

Development and validation of a nomogram model for early postoperative hyperlactatemia in patients undergoing cardiac surgery

BackgroundPostoperative hyperlactatemia (POHL) is common in patients undergoing cardiac surgery, associated with adverse outcomes. The aim of this study was to identify predictors for POHL after cardiac surgery and to develop and validate a predictive model.MethodsAdult patients who underwent open heart surgery at our institution between 2016 and 2019 were retrospectively included. The patients were randomly divided into training and validation groups at a 2:1 ratio. Multivariate logistic regression was performed to identify independent predictors for POHL in the training set. A nomogram was then constructed and was validated in the validation set.ResultsPOHL developed in 713 of the 5,323 patients (13.4%). The mortality rate was higher in patients with POHL compared with patients without that (9.5% vs. 2.1%, P<0.001). Age, white blood cell (WBC) count, left ventricular ejection fraction, renal insufficiency, cardiac surgery history, red blood cell (RBC) transfusion, and cardiopulmonary bypass (CPB) time were identified as independent risk factors. The nomogram based on these predictors indicated good discrimination in both the training (c-index: 0.787) and validation (c-index: 0.820) sets. The calibration was reasonable by both visual inspection and goodness-of-fit test. The decision and clinical impact curves demonstrated good clinical utility.ConclusionsWe identified 7 independent risk factors and derived a prediction model for POHL in patients undergoing cardiac surgery. The model may contribute significantly to early risk assessment and clinical intervention.