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胸大肌肌皮瓣修复头颈肿瘤术后及放疗后并发症

抗癫痫药物对颈内动脉内膜剥脱术后脑高灌注综合征的防治体会

目的探讨颈内动脉内膜剥脱术（CEA）围手术期应用抗癫痫药物对防治CEA后脑高灌注综合征（CHS）的效果。 方法选择2012年4月-10月有CHS危险因素的CEA患者75例，随机分为治疗组（37例）和对照组（38例）。对照组患者应用抗血小板药物、他汀类药物治疗，治疗组患者在对照组的基础上，于术前3 d开始口服丙戊酸钠缓释片，观察其术后1周、3个月的临床表现。 结果治疗组患者术后1周出现CHS相关表现11例（29.7%），无癫痫发作（0.0%）；术后3个月CHS相关表现全部消失，仍无癫痫发作。对照组患者术后1周出现CHS相关表现23例（60.5%），癫痫发作3例（7.9%）；术后3个月后13例（35.1%）仍有轻度CHS相关表现，无癫痫发作。两组比较差异有统计学意义（P < 0.05）。 结论围手术期应用抗癫痫药物可有效降低CEA后出现CHS相关表现和癫痫发作概率。

Comparative Study on Adaptive Support Ventilation and Synchronized Intermittent Mandatory Ventilation in Ventilation Weaning in Patients after Fast-Track Coronary Artery Bypass Grafting

Objective To investigate whether the respiratory support weaning based on adaptive support ventilation ( ASV) could reduce the duration of mechanical ventilation in patients after fast-track coronary artery bypass grafting ( CABG) . Methods After CABG during the same fast-track general anesthesia, 46 patients were randomly assigned to an ASV group or a synchronized intermittent mandatory ventilation ( SIMV) group as control. The duration of mechanical ventilation, hemodynamic parameters, and airway pressures were recorded. Meanwhile, the variables and the number of the arterial blood gas were recorded. Results The duration of mechanical ventilation was shorter in the ASV group than that in the control group [ 196( 152-286) ] min vs. 253( 196-498) min, P lt;0. 05] . The duration of ICUstay was shorterin the ASV group than that in the control group [ ( 14. 5 ±0. 7) h vs. ( 16. 8 ±0. 4 ) h, P lt;0. 01] . Fewer arterial blood analyses were performed in the ASV group than those in the control group [ 5 ( 4-7) vs.7( 6-9) , P lt; 0. 05] . Conclusions A ventilation weaning protocol based on ASV is practicable. It may accelerate tracheal extubation, shorten the length of ICU stay, and simplify ventilation management in patients after fast-track CABG.

Perioperative Management of Anomalous Origin of the Left Coronary Artery from Pulmonary Artery

ObjectiveTo summarize perioperative management experience of 16 patients undergoing surgical correction of anomalous origin of the left coronary artery from pulmonary artery (ALCAPA). MethodsWe performed a retrospective analysis of 16 patients who received surgical correction of ALCAPA between January 2005 and December 2013 in Cardiovascular Center of Children's Hospital of Fudan University. There were 6 males and 10 females with their age ranging from 2 months to 13 years (mean age of 23.25±0.63 months) and body weight ranging from 5 to 30 kg (mean body weight of 19.77±0.75 kg). All the patients underwent direct implantation of the anomalous coronary artery into the ascending aorta, and received comprehensive management regarding left ventricular ejection fraction (LVEF), heart rate, blood pressure, arterial blood gas, urinary volume, blood lactic acid and central venous pressure. ResultsPostoperative complications were low cardiac output syndrome (LCOS) in 9 patients (including intractable LCOS in 2 patients) and arrhythmia in 1 patient. One patient with intractable LCOS and arrhythmia died postoperatively with the mortality of 6.25%. Cardiopulmonary bypass time was 85-260 (135.61±35.01) minutes, aortic cross-clamping time was 40-97 (57.32±16.02) minutes, mechanical ventilation time was 34-187 (106.34±41.62) hours, length of CICU stay was 2-21 (8.13±5.02) days, and hospital stay was 12-51 (22.14±5.00) days. Postoperative LVEF and left ventricular fractional shortening were significantly higher than preoperative values (P < 0.05). ConclusionKey points for successful surgical correction of ALCAPA include meticulous perioperative management, preoperative heart function improvement, prevention of postoperative complications and use of new techniques.