体外循环心内直视术后应激性溃疡的个体化防治

目的：探讨体外循环心内直视术后应激性溃疡个体化围手术期的防治措施与疗效观察。方法：选取2008年12月-2013年12月本院体外循环心内直视心脏手术后并发应激性溃疡的30例患者为研究对象,其中心内直视术：心脏瓣膜置换术22例,冠状动脉搭桥术5例,先天心脏病矫治术2例,大血管手术1例。回顾性分析其临床资料,包括术前危险因素评估,术中减少胃肠道缺血时间因素,术后应激性溃疡的预防、早发现、早干预以及预后影响因素,总结其防治方法,进而观察疗效。结果：本组30例患者均行保守治疗,其中1例患者联合手术治疗;经治疗后,29例痊愈出院,治愈率为96.7%,1例因术后出现多器官功能衰竭而死亡,死亡率为3.3%。结论：术前详细询问有无消化系统病史,术中尽量缩短体外循环和手术时间,术后常规应用质子泵抑制剂和胃肠黏膜保护剂以及尽早进食,对明确并发应激性溃疡者,采取早发现、早干预的综合个体化治疗;对并发出血者,根据患者个体情况积极采取药物、内镜及手术治疗,可有效预防并降低术后应激性溃疡发生率,提高体外循环心内直视术后应激性溃疡的治愈率。

Individual Prevention of Stress Ulcer after Open Heart Surgery with Cardiopulmonary Bypass

Objective： To explore the efficacy of prevention measures and open heart surgery with cardiopulmonary bypass stress ulcer individualized perioperative.Method：30 patients with stress ulcer after open heart cardiac surgery in our hospital from December 2008 to December 2013 were selected for the study. Within its center open heart surgery： 22 cases of heart valve replacement surgery, coronary artery bypass surgery 5 cases, 2 cases of congenital heart disease correction surgery, major vascular surgery 1 case. The clinical data was retrospective analyzed, including preoperative risk factors, intraoperative reduction gastrointestinal ischemia time factors, postoperative stress ulcer prevention, early detection, early intervention, and prognostic factors were assessed, summarized its control methods, and the efficacy was observed.Result：30 patients were underwent conservative treatment, one patient combined surgery; after treatment, 29 patients were cured, the cure rate was 96.7%, one case of postoperative patients with multiple organ failure and death, mortality was 3.3%.Conclusion：Detailed history of the digestive system before ask whether intraoperative vitro cycle as short as possible central and operative time, postoperative routine use of proton pump inhibitors and gastrointestinal mucosal protective agents and early eating for stress ulcer clear to take early detection, comprehensive individualized treatment early intervention; concurrent bleeding, according to the patient individual circumstances and actively take medication, endoscopic and surgical treatment, which can effectively prevent and reduce the incidence of postoperative stress ulcer, improve after undergoing open heart bypass stress ulcer cure rate.