Objective To explore the efficacy of prone positioning ventilation in patients with acute respiratory distress syndrome (ARDS) after acute Stanford type A aortic dissection (STAAD) surgery. Methods From November 2019 to September 2021, patients with ARDS who was placed prone position after STAAD surgery in the Xiamen Cardiovascular Hospital of Xiamen University were collected. Data such as the changes of blood gas, respiratory mechanics and hemodynamic indexes before and after prone positioning, complications and prognosis were collected for statistical analysis. ResultsA total of 264 STAAD patients had surgical treatment, of whom 40 patients with postoperative ARDS were placed prone position. There were 37 males and 3 females with an average age of 49.88±11.46 years. The oxygen partial pressure, oxygenation index and peripheral blood oxygen saturation 4 hours and 12 hours after the prone positioning, and 2 hours and 6 hours after the end of the prone positioning were significantly improved compared with those before prone positioning ventilation (P<0.05). The oxygenation index 2 hours after the end of prone positioning which was less than 131.42 mm Hg, indicated that the patient might need ventilation two or more times of prone position. Conclusion Prone position ventilation for patients with moderate to severe ARDS after STAAD surgery is a safe and effective way to improve the oxygenation.
目的 总结 14 例原位心脏移植的治疗经验。 方法 回顾性分析 2006 年 1 月至 2015 年 9 月我院行原位心脏移植术终末期心脏病患者的临床资料，其中男 11 例、女 3 例，年龄 22～62（46.7±10.1）岁。4 例使用抗 Tac 单克隆抗体诱导治疗，10 例使用巴利昔单克隆抗体诱导治疗。采用 4℃ 组氨酸-色氨酸-酮戊二酸（HTK）液保护供心。2 例采用经典式原位心脏移植，12 例采用双腔静脉法行心脏移植。术后采用环孢素或他克莫司+吗替麦考酚酯+激素三联抗排斥方案。 结果 术后早期 1 例因多器官功能衰竭合并严重感染死亡。早期并发症有：败血症 1 例，硬膜外血肿 1 例，急性肾功能不全 1 例，移植物右心功能不全 2 例，低心排血量并需要体外膜肺氧合支持 1 例。术后长期随访：截至 2016 年 6 月，2 例失访，1 例于术后 30 个月因自行停服抗排斥药物死于急性排斥，1 例于术后 36 个月死于肺癌。余 9 例存活 9～121 个月，生活质量良好。 结论 心脏移植是治疗终末期心脏病的有效方法，熟练的手术技巧、合理的免疫抑制治疗，围术期管理经验、密切监测和治疗感染和排斥及患者依从性均影响着心脏移植的效果。
ObjectiveTo investigate the renal function recovery and perioperative risk factors for chronic kidney disease in patients after acute Stanford type A aortic dissection (ATAAD) repair. MethodsA retrospective study was conducted on patients who underwent ATAAD repair at the Xiamen Cardiovascular Hospital, Xiamen University from 2020 to 2021, and their clinical data were analyzed. ResultsA total of 255 patients were included, with 200 males and 55 females, and an average age of 52.80±12.46 years. The incidence of acute kidney injury (AKI) after ATAAD repair was 56.1%. Dissection involving the renal artery [OR=2.144, 95%CI (1.234, 3.765), P=0.007], intraoperative urine output [OR=0.761, 95%CI (0.625, 0.911), P=0.004], and intraoperative red blood cell transfusion [OR=1.288, 95%CI (1.088, 1.543), P=0.004] were significantly associated with early AKI after ATAAD repair. Long-term renal function follow-up data were available for 232 patients, among whom 40 (17.2%) patients developed chronic kidney disease (CKD). Independent predictors for CKD included lower body mass index [OR=0.827, 95%CI (0.723, 0.931), P=0.003], preoperative cardiac tamponade [OR=5.344, 95%CI (1.65, 17.958), P=0.005], preoperative renal hypoperfusion syndrome [OR=12.629, 95%CI (5.003, 35.373), P<0.001], postoperative peak serum creatinine time>3 d [OR=7.566, 95%CI (2.799, 22.731), P<0.001], and AKI grade [grade 1: OR=4.418, 95%CI (1.339, 15.361), P=0.016; grade 2: OR=8.345, 95%CI (1.762, 40.499), P=0.007; grade 3: OR=9.463, 95%CI (2.602, 37.693), P<0.001]. ConclusionAKI related to ATAAD repair can recover in the early postoperative period, but both the duration and severity of AKI will affect long-term renal function. In addition, patients' nutritional status, preoperative cardiac tamponade, and renal hypoperfusion syndrome are also independent risk factors for long-term renal dysfunction.