冠脉搭桥病人的术后监护体会

目的:探讨冠状动脉搭桥术后监护。方法:回顾性分析55例冠状动脉搭桥患者术后监护资料。结果:55例患者中,2例死亡,病死率3.6%;8例出现并发症,发生率14.55%。结论:冠状动脉搭桥术后加强循环系统、呼吸系统等监护措施,加强基础护理,可降低并发症,提高手术治愈率。     

冠脉旁路移植术围术期应用IABP治疗患者的临床护理

目的探讨应用主动脉内球囊反搏(IABP)治疗重症冠心病患者的经验。方法回顾性分析2012年6月-2016年2月我科行CABG术或CABG合并瓣膜置换手术442例临床资料,围术期使用IABP 54例,根据IABP置入时间的不同分为A、B两组,A组为术前置入或停机时置入组共54例,B组为术后出现低心排或恶性心律失常等时置入组25例。分析比较两组患者术前的临床资料,术后死亡率、住院时间、IABP辅助时间,呼吸机辅助时间,ICU停留时间、左心室射血分数、其他辅助装置使用比例、室颤发生率及预后情况。结果两组术后死亡病例、住院时间、ICU停留时间、呼吸机辅助时间、IABP辅助时间,EF改善率和正性肌力药物维持时间等观察指标比较,差异均有统计学意义(P0.05)。结论对于行CABG的危重患者,IABP是安全且行之有效的辅助循环手段之一,患者有IABP应用指征时,应果断尽早应用。护士应掌握使用IABP的基本知识与临床技术,从而确保IABP良好的治疗效果。     

Diazoxide may protect endothelial glycocalyx integrity during coronary artery bypass grafting

Abstract

Objectives. Plasma hyaluronan and syndecan-1 levels represent shedding of the endothelium glycocalyx during ischemia and edema. Diazoxide, a K_ATP-channel opener, has been shown to decrease myocardial edema during coronary artery bypass grafting (CABG). We evaluated whether Diazoxide exerts an impact on plasma hyaluronan and syndecan-1 levels during CABG. Design. Representative blood samples for hyaluronan and syndecan-1, before, during and after surgery, were obtained in 13 out of 16 patients that had a history of stable coronary artery disease undergoing CABG with or without Diazoxide. Electron microscopy from biopsies procured from the right atrium in 9 patients was performed to confirm ultrastructural differences among patients before and during CABG. Results. Ultrastructural differences were apparent between individual patients already before operation at base line reflecting differences in the severity of myocardial ischemia and edema. A significant decrease of hyaluronan and syndecan-1 values was observed in patients with Diazoxide after surgery (p < 0.04). Significant correlation of Plasma hyaluronan and syndecan-1 levels was observed in patients with Diazoxide but not in controls (p < 0.005, Spearman rank rho). Conclusion. Diazoxide may have an impact on levels of peripheral plasma hyaluronan and syndecan-1 after CABG, suggesting decreased shedding of the endothelial glycocalyx layer.     

Volumetric comparison of autogenous bone and tissue-engineered bone replacement materials in alveolar cleft repair: a systematic review and meta-analysis

The goal of reconstruction of the alveolar cleft in patients with cleft lip and palate is to improve the quality of tissue, the structural stability, and increase the volume of bone. This study is a systematic review with meta-analysis of volumetric bony filling using autogenous bone and various tissue-engineered bone substitutes. We made an electronic search on MEDLINE, EMBASE, SCOPUS, WEB OF SCIENCE, “grey” publications (materials and research produced by organisations outside traditional channels for commercial or academic publishing and distribution), and relevant cross references according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies that reported the outcomes of volumetric grafting were included in the meta-analysis. Of 1276 studies, 26 were included in the meta-analysis. Pooled analysis of 25 studies that used autogenous bone showed a significant reduction in the volume of the cleft equivalent to 62.0% bone fill (95% CI 54.3 to 69.6), in contrast to 10 studies that used a tissue-engineered material and reported bone filling of 68.7% (95% CI 54.5 to 82.8). The estimated sizes of pooled effects across studies showed that there was no significant difference between the two major intervention groups (p value 0.901). Our statistical analysis showed that autogenous bone grafts did not differ significantly from tissue-engineered materials in their ability to fill clefts.Systematic review registration: International Prospective Register of Systematic Reviews, PROSPERO (CRD42017065045).