心血管外科术后意识障碍和急性心血管事件的病因分析及治疗体会

目的:探讨心血管外科术后意识障碍和急性心血管事件患者的致病因素、疾病经过和相关并发症的治疗。方法:回顾性分析2010-01至2011-02间,39例心血管外科术后早期严重意识障碍的患者,观察分析本组患者的病种与手术方式,术者与手术例数分布,以及术后呼吸机辅助时间和特殊治疗经过等指标。结果:39例患者中,有11例在术后早期出现意识障碍伴谵妄躁动,其中2例患者合并典型的急性心血管事件。与39例患者相关的18位主刀术者中,单个主刀术者完成的手术例数从1例至6例不等。其中在9位主刀术者完成的9例(每人1例)患者中,术后早期有5例出现意识障碍伴谵妄躁动和1例急性心血管事件,而1位主刀术者完成的6例患者中,术后早期仅1例出现意识障碍伴谵妄躁动。全组患者经过镇静、脱水和中枢神经代谢支持等综合治疗,均痊愈。结论:心血管外科术后因脑血管和冠状动脉气栓导致的意识障碍和急性心血管事件应予以重视和明确诊断,以利于预防和减少此类并发症的发生。手术过程中对排除心室腔和大血管内残余气体的重视程度,必要的监测和引导设备,手术技巧和规范操作等因素与术后气栓密切相关。气栓的量和所累及脏器功能损害程度直接影响患者的疾病过程和预后。

The Cause and Treatment in Conscious Disturbance and Acute Cardiovascular Events in Patients After Cardiovascular Surgery

Objective: To investigate the cause,treatment and prognosis in patients with conscious disturbance and acute cardiovascular events after cardiovascular surgery. Methods: We retrospectively analyzed 39 patients with conscious disturbance and acute cardiovascular events at the early post operation stage from January 2010 to February 2011 in our hospital.We studied the type of disease,method of operation with the performing surgeon,and we also analyzed the length of mechanical ventilation time and the special treatment after the operation. Results: There were 11/39 patients with early post-operational deliration and agitation,2 of them accompanied by acute cardiovascular events.There were 18 surgeons involved in 39 operations,and one surgeon performed from 1 to 6 operations unevenly.Among them,for 9 surgeons conducted 9 operations,5 patients accompanied with early post-operational deliration and agitation,1 patient had acute cardiovascular event.While for the same surgeon performed 6 operations,only 1 patient had early post-operational deliration and agitation.With proper treatment as sedation,dehydration and the supportive therapy in central nervous system,all patients recovered. Conclusion: The post operational conscious disturbance and acute cardiovascular events incurred by air embolism should be highly recognized and clearly diagnosed.The occurrence of aeroembolism is closely related to eliminating the remaining air bubble in ventricular chamber and great vessels,monitoring and guiding equipments and the skill of operating surgeon.The degree of air embolus and the dysfunction of involved organs are directly related to patients’ prognosis.