肾功能分级在成人心脏术后肾功能衰竭的应用

Objective To evaluate the ability of the RIFLE classification to predict hospital mortality in adult patients who underwent cardiac surgery. Methods From October Ist 2006 to December 31st 2006, five hundred and nine adult patients who underwent coronary artery bypass grafting and/or valve operation were enrolled in this study. Renal function was assessed daily according to the RIFLE classification, meanwhile, APACHE Ⅱ score and SOFA score were also evaluated, as well as the maximum scores were recorded. Results Mean duration of ventilation support was 18(14 - 19) hours, the time of ICU stay was 1.4 ± 1.0 days, and the time of postoperative hospital stay was 12. 0(10.0- 15.0) days. 167 patients (32. 8%) incurred postoperative ARF according to the RIFLE classification. The overall mortality was 4. 3% (22/502). A significant increase (P < 0. 01) was observed for mortality based on RIFLE classification. By applying the area under the receiver operating characteristic curve, the RIFLE classification had more powerful discrimination power [0. 933, (95% CI 0. 872 -0. 995) ,P <0. 001]. Conclusions ARF is one of the major complications in postcardiotomy patients. Analytical data suggested the good discriminative power of the RIFLE classification for predicting inpatient mortality of adult postoperative patient with ARF, and the RIFLE classification is simple and practically performed. According to the RIFLE classification, patients with RIFLE class I or class F incur a significantly increased risk of in-hospital mortality compared with those who never develop ARF.     

心脏术后机械循环辅助患者医院感染调查分析

目的调查心脏手术后接受各种机械循环辅助治疗的患者,医院感染及病原菌耐药性。方法回顾性分析心脏外科2006年1月-2010年12月,990例心脏手术后,接受主动脉内气囊反搏(IABP)机械循环辅助治疗患者的临床资料。结果 990例心脏手术患者,共计97例患者发生医院感染,感染率为9.8%;分离各种病原菌106株,其中呼吸道56株占52.8%,血液46株占43.4%,其他部位感染4株占3.8%;主要病原菌为不动杆菌属29株占27.4%,铜绿假单胞菌15株占14.2%,肺炎克雷伯菌5株占4.7%,表皮葡萄球菌28株占26.4%,金黄色葡萄球菌14株占13.2%,白色假丝酵母菌9株占8.5%;不动杆菌属显示多药耐药性,碳青霉烯类抗菌药物、头孢哌酮/舒巴坦以及哌拉西林/他唑巴坦,对其他革兰阴性杆菌显示良好敏感性,未发现耐万古霉素葡萄球菌。结论心脏术后接受机械循环辅助治疗的患者医院感染发病率高,采取集束化治疗可降低感染率及病死率。     

肾功能分级在成人心脏术后肾功能衰竭的应用

Objective To evaluate the ability of the RIFLE classification to predict hospital mortality in adult patients who underwent cardiac surgery. Methods From October Ist 2006 to December 31st 2006, five hundred and nine adult patients who underwent coronary artery bypass grafting and/or valve operation were enrolled in this study. Renal function was assessed daily according to the RIFLE classification, meanwhile, APACHE Ⅱ score and SOFA score were also evaluated, as well as the maximum scores were recorded. Results Mean duration of ventilation support was 18(14 - 19) hours, the time of ICU stay was 1.4 ± 1.0 days, and the time of postoperative hospital stay was 12. 0(10.0- 15.0) days. 167 patients (32. 8%) incurred postoperative ARF according to the RIFLE classification. The overall mortality was 4. 3% (22/502). A significant increase (P < 0. 01) was observed for mortality based on RIFLE classification. By applying the area under the receiver operating characteristic curve, the RIFLE classification had more powerful discrimination power [0. 933, (95% CI 0. 872 -0. 995) ,P <0. 001]. Conclusions ARF is one of the major complications in postcardiotomy patients. Analytical data suggested the good discriminative power of the RIFLE classification for predicting inpatient mortality of adult postoperative patient with ARF, and the RIFLE classification is simple and practically performed. According to the RIFLE classification, patients with RIFLE class I or class F incur a significantly increased risk of in-hospital mortality compared with those who never develop ARF.     

老年开胸术患者围手术期的呼吸道护理

探讨70岁以上老年开胸术患者围手术期的呼吸道护理经验。认为强化围手术期呼吸道功能训练,加强患者指导及术后呼吸道管理,是减少并发症发生、提高手术和综合治疗成功率的关键。     

肾功能分级在成人心脏术后肾功能衰竭的应用

Objective To evaluate the ability of the RIFLE classification to predict hospital mortality in adult patients who underwent cardiac surgery. Methods From October Ist 2006 to December 31st 2006, five hundred and nine adult patients who underwent coronary artery bypass grafting and/or valve operation were enrolled in this study. Renal function was assessed daily according to the RIFLE classification, meanwhile, APACHE Ⅱ score and SOFA score were also evaluated, as well as the maximum scores were recorded. Results Mean duration of ventilation support was 18(14 - 19) hours, the time of ICU stay was 1.4 ± 1.0 days, and the time of postoperative hospital stay was 12. 0(10.0- 15.0) days. 167 patients (32. 8%) incurred postoperative ARF according to the RIFLE classification. The overall mortality was 4. 3% (22/502). A significant increase (P < 0. 01) was observed for mortality based on RIFLE classification. By applying the area under the receiver operating characteristic curve, the RIFLE classification had more powerful discrimination power [0. 933, (95% CI 0. 872 -0. 995) ,P <0. 001]. Conclusions ARF is one of the major complications in postcardiotomy patients. Analytical data suggested the good discriminative power of the RIFLE classification for predicting inpatient mortality of adult postoperative patient with ARF, and the RIFLE classification is simple and practically performed. According to the RIFLE classification, patients with RIFLE class I or class F incur a significantly increased risk of in-hospital mortality compared with those who never develop ARF.     

踔厉前行 促进学科发展——纪念《中国体外循环杂志》创刊20周年

<正>由中国人民解放军总医院主管和主办的《中国体外循环杂志》于2003年3月15日正式出版发行,她的创办是我国体外循环(extracorporeal circulation,ECC)专业成为一门学科的重要标志,从此我国ECC从业人员有了自己专属的学术载体。今天20岁的她亭亭玉立,桃李年华。她不仅仅是我国ECC从业人员的学术思想阵地,也是我国ECC与体外生命支持(extracorporeal life support,ECLS)技术的迅猛发展历程的重要见证者和记录者。     

体外膜氧合在成人心脏术后合并严重急性呼吸衰竭患者中的应用

目的 评估静脉-静脉体外膜氧合（V-V ECMO）在成人心脏术后合并严重急性呼吸衰竭（ARF）患者中应用的有效性。方法 收集本中心2018年7月至2021年12月期间,成人心脏术后合并严重急性呼吸衰竭接受V-V ECMO辅助的患者资料,分析该群患者住院存活率以及ECMO相关并发症等情况。结果 总共收集13例患者,76.9%为男性,平均年龄为65.2岁,ECMO平均辅助时间为145.2 h;11例成功脱离机械辅助,脱机率为84.6%,8例存活出院,出院存活率为61.5%;死亡病例中,3例死于多脏器衰竭,2例死于呼吸衰竭。结论 V-V ECMO在成人心脏术后合并严重ARF患者中的应用,可明显降低住院死亡率且并未增加ECMO相关并发症的发生,V-V ECMO在该群患者中的应用是安全且有效的。     

心脏手术患者体外膜肺氧合撤机后系统性炎症反应状况分析

目的:本研究旨在探讨体外膜肺氧合(ECMO)撤机后发生的系统性炎症反应(SIRS)和感染的发生率,影响因素及临床结局,以及是否有方法可以将SIRS从感染当中区分出来。方法:应用回顾性研究来分析ECMO撤机后的SIRS反应。SIRS的诊断标准为以下3条中包含两条及两条以上:发热、白细胞计数改变,血管活性药物用量加大。患者被分为两组:感染组Group I(n=14)和真炎性反应组Group TS(n=27)。分析撤机后感染率,真炎性反应率,院内生存率,ECMO前、中、后与感染相关的危险因素。结果:在83例成功ECMO脱机的患者中, 42例(50.6%)患者未见明显炎症反应(Group NO SIRS),41例(49.4%)患者发现存在撤机后炎症反应(Group SIRS)。在危险因素类似的情况下,其院内生存率分别是:NO SIRS(92.9%),Group TS(81.5%),Group I(42.9%)。结论:ECMO撤机后近50%患者发生炎症反应,其中约1/3患者被证实存在感染。感染患者的白细胞峰值以及体温峰值明显更高,尤其是白细胞高于30×10^9/L水平的患者。感染患者的生存率很低仅42.9%,不足非感染患者的50%。     

Ⅰ型血泵左心辅助循环动物实验研究

为了对Ⅰ型血泵进行深入研究以便在此基础上进行改进，我们选择９只心脏正常犬进行左心辅助动物实验，以验证该泵的血液动力学输出性能、对心脏的辅助功能及对血液的破坏程度。在动物实验中，血泵放入胸腔内，进口通过静脉插管经左心房耳插入左心房，出口经过动脉插管插入升主动脉。输液、测试、辅助管路接通后，控制血泵的辅助流量为心输出量的２５～３０％左右。结果显示：１．辅助流量在５００～６００ｍｌ／ｍｉｎ时，主动脉收缩压可达１３０ｍｍＨｇ，证明Ⅰ型血泵输出性能满足辅助时生理血液动力学要求。２．辅助后，主动脉舒张压和心脏总输出量均升高，提示此血泵对冠状动脉血流量的增加及心脏泵血具有辅助功能。３．辅助４小时后，血浆中游离血红蛋白含量由２．４ｍｇ／ｄｌ升高到３．１ｍｇ／ｄｌ，纤维蛋白未发生明显变化，说明此血泵对血液有较轻的破坏     

del Nido心脏停搏液对成人心脏大血管手术中长时间主动脉阻断患者的心肌保护作用

目的探讨del Nido心脏停搏液对成人心脏大血管手术中长时间主动脉阻断患者的安全性和心肌保护效果。方法回顾性收集2018年3月至2023年3月在北京安贞医院行体外循环下成人心脏大血管手术且主动脉阻断时间>90 min的患者, 根据术中使用停搏液种类分为两组, del Nido心脏停搏液组(DC组)和冷含血心脏停搏液组(BC组)。收集患者临床资料, 通过倾向性评分匹配校正患者年龄、性别、合并症、左心室射血分数等术前基线资料。对两组患者术中转流时间、阻断时间、停搏液总量、灌注次数、术后30 d死亡率、术后重症监护病房(ICU)时间、气管插管时间、术后并发症、左心室射血分数、肌钙蛋白等资料进行比较。结果通过倾向性评分匹配, 最终共纳入306例患者, 男223例, 女83例, 年龄(52.0±12.3)岁;DC组153例, BC组153例。与DC组相比, BC组的主动脉阻断时间[M(Q1, Q3)]更长[109(100, 150)min比102(91, 133)min, P<0.001], 自动复跳率更低[51.6%(79/153)比86.9%(133/153), P<0....