规范发展体外膜氧合循环辅助支持

正体外膜氧合(extracorporeal membrane oxygenation,ECMO)或体外生命支持(extracorporeal life support,ELSO)技术作为一种可经皮快速置入同时提供循环和呼吸辅助的高级体外生命支持形式,广泛用于急性循环和/或呼吸衰竭、难治性心跳骤停(cardiac arrest,CA)的辅助治疗。我国ECMO技术虽然起步较晚,但近年来发展迅猛,短时间大有迅速     

经外周静脉置入中心静脉导管的全程护理管理

目的总结经外周静脉置入中心静脉导管全程护理管理的体会。方法对50例经外周静脉置入中心静脉导管患者实施评估、计划、执行、协调、监督、评价的全程护理管理。结果50例患者一次穿刺成功100%、置管成功率100%;置管期间出现穿刺点出血1例、机械性静脉炎2例、导管阻塞1例,患者对护理工作满意度99%。结论全程护理管理可提高护理人员整体水平,提高经外周静脉置入中心静脉导管成功率。     

冠状动脉旁路移植术后体外膜肺氧合患者远期疗效及预后风险因素分析

目的探讨冠状动脉旁路移植术(CABG)后应用股动静脉体外膜肺氧合(VA-ECMO)辅助患者的远期疗效, 量化心脏术后VA-ECMO患者的生存结局, 识别远期死亡的危险因素。方法回顾性连续纳入2012年6月至2016年12月期间在北京安贞医院心脏外科ICU因单独CABG后心源性休克接受VA-ECMO治疗的108例患者, 其中男84例, 女24例;中位年龄62(55, 67)岁, 中位体质量指数25(23, 27)kg/m2。37例(34%)有左主干病变, 56例(52%)行不停跳CABG。按照ECMO后3年生存结局分为生存组(35例)和死亡组(73例), 对比分析两组患者各临床指标差异, Cox回归分析识别ECMO后3年死亡的相关风险因素。结果 108例中, 65例(60%)成功脱离ECMO, 49例(45%)生存出院, 35例(32%)生存至ECMO撤机后3年。中位ECMO辅助时间、ICU滞留时间、住院时间分别为4(3, 5)天、8(5, 12)天、20(13, 29)天。多因素Cox回归分析结果显示, 与ECMO后3年死亡独立相关的因素包括高龄(HR=1.06, 95%CI:1.03...     

多管齐下, 多方合作——推动我国体外循环规范化

自上世纪50年代体外循环发明以来, 作为开展心脏外科手术的必要手段之一, 体外循环技术获得了飞速发展。在胸心外科前辈的努力下, 体外循环很快引入我国。因历史原因, 发展一度停滞, 20世纪80年代开始, 体外循环与我国整体发展一样日新月异。当前新冠疫情影响较大, 截至2020年, 我国年心血管外科手术例数仍然超过22万例, 其中体外循环下手术总量150 132例[1]。     

《中国体外循环专业技术标准》——体外循环质量控制的基石

在我国体外循环技术临床使用63年和中国生物医学工程学会体外循环分会成立18年之际,经来自我国主要心脏中心的体外循环及心血管外科专家历经一年多时间的共同努力,克服了疫情对专家之间沟通的影响,完成了我国第一部体外循环专业技术指南———中国体外循环专业技术标准(2021版)(简称体外循环标准)。     

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.     

K_(ATP)通道开放剂与心肌保护

ＫＡＴＰ通道是钾离子通道中的一种。目前已在体内多种组织中发现 ,如胰腺、脑、心脏、血管和骨骼肌等。 1983年Ｎｏ ｍａ〔1〕首先发现心血管系统的ＫＡＴＰ通道后 ,许多研究发现其在心肌保护机制中起着重要的调控作用 ,利用ＫＡＴＰ通道开放剂(ＰＣＯ)进行心肌保护逐渐成为研究热点。ＫＡＴＰ通道的生理学特点ＫＡＴＰ通道是一类受细胞内ＡＴＰ生理浓度抑制的钾离子通道 ,ＡＴＰ通过与细胞内膜结合 ,缩短ＫＡＴＰ通道的开放时间 ,当细胞内ＡＴＰ浓度较低到一定程度时通道可开放 ;当细胞内ＡＴＰ浓度为 2 0～ 10 0 μｍｏｌ/Ｌ时 ,ＫＡＴＰ…     

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.     

绵羊植入左心室辅助装置在体实验手术管理

目的探讨绵羊植入左心室辅助装置(left ventricular assist device,LVAD)在体实验手术管理的特殊要求。方法依照北京市实验动物管理条例,参考美国动物管理及使用委员会关于植入式LVAD实验动物评判标准和国际上LVAD动物实验经验,进行国产植入式LVAD绵羊在体存活实验。成年绵羊在心脏不停跳状态下完成LVAD植入手术,针对手术的特性,制定术前、围术期及术后的管理措施。结果成功实施6例绵羊植入式LVAD在体实验,1例LVAD在植入25 d后停止运转,1例实验动物在术后第3天因肺部感染死亡,其余4例实验动物植入后存活状态良好,达到在体实验30 d的实验预期。结论术前的精心准备、遵循严格的手术操作规程、术后早期严密的监护、术后精心护理以及选择合理的抗凝策略可有效的提高绵羊植入式LVAD慢性存活实验的成功率。