抗凝血酶Ⅲ降低对心血管术后血栓风险的预测价值

目的：分析抗凝血酶Ⅲ降低对心血管术后血栓风险的预测价值。方法：选取2019年1月—2022年11月中国医学科学院阜外医院深圳医院收治的210例行心血管手术患者为研究对象,根据术后是否发生血栓进行分组,血栓组100例,无血栓组110例。收集两组临床资料,比较两组血小板五项参数、D-二聚体、血浆纤维蛋白原、国际标准化比值及抗凝血酶Ⅲ水平,分析抗凝血酶Ⅲ降低对心血管术后血栓风险的预测价值。结果：血栓组抗凝血酶Ⅲ低于无血栓组,差异有统计学意义（P<0.05）;但两组年龄、性别、心功能分级、病情、基础疾病、体重指数、血小板五项参数、D-二聚体、血浆纤维蛋白原、国际标准化比值比较,差异无统计学意义（P>0.05）。经受试者工作特征（ROC）曲线分析,抗凝血酶Ⅲ预测心血管术后血栓风险的阈值为60.3%,即当抗凝血酶Ⅲ<60.3%时,心血管手术患者术后血栓形成风险显著增加,AUC面积为0.646,通过抗凝血酶Ⅲ预测心血管术后血栓风险特异度（85.46%）较高,但敏感度（55.32%）较低。结论：抗凝血酶Ⅲ降低可作为心血管手术术后评估血栓风险的有效指标,当抗凝血酶Ⅲ<60.3%时...     

婴幼儿先天性心脏病体外循环术后肺部并发症的相关因素及护理

目的：探讨婴幼儿先天性心脏病（简称先心痛）体外循环（CPB）术后肺部并发症发生的相关因素及护理.方法：回顾性分析本院2007年6月-2009年12月间成活的264例婴幼儿先心痛CPB术后肺部情况资料,并针对出现的问题,进行统计分析,总结相关因素及护理方法.结果：通过统计学软件的分析,发现引起肺部并发症的因素除患儿的个体情况及CPB因素外,术后呼吸系统的监护及循环维护非常重要等,各方面数据显示P＜0.05有统计学意义.结论：根据CPB术后患儿的具体情况,采取有效的护理措施是预防和护理治疗肺部并发症的关键.     

左西孟旦在重症瓣膜病术中缺血预处理中的应用分析

目的观察左西孟旦在重症瓣膜病术中缺血预处理中的应用。方法重症心脏瓣膜病病人30例,采用随机方法分为两组,预处理组15例,于麻醉开始即静脉泵入左西孟旦,剂量为每分钟0.1～0.2μg/kg,维持用药24小时;对照组15例,未使用左西孟旦。观察两组病人手术中麻醉情况、体外循环(CBP)停机过程和ICU恢复情况。结果病人均顺利实施瓣膜手术,其中预处理组1例病人术后并发呼吸功能衰竭、肺部感染、多器官功能衰竭死亡,对照组1例病人抗凝后并发脑出血、多器官功能衰竭死亡,其余病人均康复出院。预处理组和对照组30天死亡率分别为6.7%和6.7%,CBP时间分别为(114.43±23.3)分钟和(138.7±20.2)分钟,呼吸机辅助时间分别为(31.2±10.3)小时和(23.00±11.0)小时,ICU时间分别为(116+56.5)小时和(92.13±54.5小时,术后LVEF分别为(48.29±8.2)%和(49.63±7.92)%,术后肌酐分别为(119.43±18.1)μmol/L和(113.75±10.3)μmol/L,术后BNP分别为(8682.0±443.05)pg/ml和(4677.25±207.74)pg/ml,术后心胸比分别为(0.67±0.08)和(0.63±0.06),两组比较差异无统计学意义(P0.05)。二组病人心肌组织中细胞色素C、Caspase-9、Caspase-3的蛋白含量比较,差异无统计学意义(P0.05)。用药组在术后1周LVEF得到改善(40.1±10.0)和(48.29±8.2),差异有统计学意义(P值0.05)。两组病人不同时间点炎症因子比较,差异无统计学意义(P0.05)。结论重症瓣膜病缺血预处理中使用左西孟旦进行预处理对围术期病人预后无明显影响。     

主动脉外气囊隔膜泵心脏辅助装置的动物实验

目的 探讨主动脉外气囊隔膜泵心脏辅助治疗对心肌梗死后犬的影响,观察主动脉外反向搏动辅助的有效性及可行性.方法 结扎冠状动脉左前降支制作急性心肌梗死心衰动物模型12只,随机分为辅助组和对照组各6只.观察心肌梗死后两组动物1～6 h血流动力学指标、梗死面积和血液形态学等指标变化.结果 辅助组6只犬全部存活,对照组死亡3只(50%).辅助组经反搏辅助后平均压,心输出量,心指数优于对照组(P＜0.05),但对血细胞有破坏.结论 主动脉外气囊隔膜泵反向搏动心脏辅助能显著地改善心肌梗死动物血流动力学,减少死亡,破坏血细胞是其不足之处.

Abstract：

Objective The aim of this study was to determine the effect of a new method of cardiac assistant therapy with an extra-aortic balloon pump on the experimental dogs in which myocardial ischemia or infarction were induced, and to ob serve its effectiveness and feasibility. Methods Twelve animal models of myocardia 1 infarction were established with the method of left anterior descending coronary artery ligation. They were divided randomly into two groups, six in the experimental group and six in the untreated group. The end points observed were the differences between the two groups in the blood pressure, cardiac function, myocardial enzymes, infarction size and routine blood variables before procedure, 1,2, 3, 4, 5 and 6 hours after myocardial infarction. Results All six dogs in the experimental group were survived, with a mortality rate of 0.The number of death in the control group was three, with a mortality rate of 50%. Measurements such as mean blood pressure,cardiac output, cardiac index in the experimental group were better than those in the control group ( P ＜ 0.05 ). Mean heart rate before myocardial infarction in the experimental group was 156 beats per minute, as compared with 148 beats per minute in the control group, and was 128 vs. 67 beats per minute respectively six hours after myocardial infarction. The cardiac output was 3.48 vs. 4.98 liters per minute before myocardial infarction and was 6.10 vs. 0.85 liters per minute six hours after myocardial infarction. The average pressure was 94 mm Hg vs. 99 mm Hg before myocardial infarction and was 70 mm Hg vs. 33 mm Hg six hours after myocardial infarction. Conclusion The extra-aortic balloon pump significantly improved the hemodynamic variables of the experimental animals after myocardial infarction and reduced mortality. Injury to the blood cells may be the potential disadvantage.     

The cardiac assistant effect of extra-aortic balloon pump on animals

<正>Objective The aim of this study was to determine the effect of a new method of cardiac assistant therapy with an extra-aortic balloon pump on the experimental dogs in which myocardial ischemia or infarction were induced,and to observe its effectiveness and feasibility. Methods Twelve animal models of myocardia,1 infarction were established with the method of left anterior     

左心室辅助装置在小儿中的应用进展

左心室辅助装置(LVAD)已成功应用于成人心源性休克及围术期低心排量综合征的治疗,取得了良好的疗效,但在小儿临床中的应用仍较局限。现将有关LVAD在小儿中的应用进行综述,着重分析LVAD的适应证和应用情况,简单介绍小儿LVAD的应用难点,可能的并发症。随着小儿LVAD使用经验的增加,更加微型可提供长期辅助支持装置的问世,对于小儿复杂先天性心脏病术后低心排综合征、心脏移植过渡期等,应用LVAD治疗可起到良好的效果。     

急性A型主动脉夹层患者术后谵妄发生的危险因素分析

目的探讨急性主动脉夹层患者术后谵妄发生的相关危险因素。方法回顾性分析173例急性A型主动脉夹层患者的围术期临床资料,其中男151例,女22例,年龄45.4±10.3岁。根据患者术后是否出现谵妄,分为谵妄组与非谵妄组,分析术后谵妄发生的独立危险因素。结果全组出现术后谵妄共72例,发生率为41.6%。单因素及多因素Logistic回归分析显示,深低温停循环时间(OR=11.17,95%CI为2.61~43.08)、术后最低氧合指数(OR=2.86,95%CI为1.43~5.72)、机械通气时间(OR=4.52,95%CI为1.36~15.59)、高钠血症(OR=3.51,95%CI为1.03~8.37)、咪达唑仑用量(OR=1.48,95%CI为1.07~2.04)是Stanford A型主动脉夹层患者术后谵妄的独立危险因素。结论术后谵妄在Stanford A型主动脉夹层患者术后中有较高的发生率,深低温停循环时间、术后最低氧合指数、咪达唑仑用量、机械通气时间、高钠血症是主动脉夹层患者术后谵妄发生的独立危险因素。