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Application of Three-dimensional CT Angiogram in Perioperative Evaluation for Patients Underwent Transapical Aortic Valve Implantation——The Initial Experience from West China hospital

ObjectiveTo introduce the role of three dementional computed tomograph (3D-CT) for patients underwent transcatheter aortic valve implantation (TAVI) procedure in perioperative evaluation. MethodsFrom April 2014 to June 2015, we retrospectively analyzed clinical data of 28 patients with severe aortic stenosis underwent successful TAVI procedure using new second-generation device, who were enrolled in this study including 12 males and 16 females at mean age of 72.8±4.5 years. We used 3D-CT to get the perioperative relative evaluation, including valve morphology and calcification degree, annular diameter, aoronary ostium height, ascending aorta, aortic sinus diameter, left ventricular-aortic angle, optimal intraoperative angiogram projection angle. Based on the evaluation by 3D-CT image, the prosthesis size, balloon size, best intraoperative imaging projection angle and approach of apex were then chosen. ResultsAll patients with severe aortic stenosis underwent successful TAVI procedure with mean logistic Euro-SCORE I:26.2%±7.9%. CT image revealed that mean aortic annular diameter was 24.6±1.8 mm with mean valve prosthesis size 25.8±1.1 mm and pre-dilation balloon size 23.1±1.2 mm and 76.8% patients were of tricuspid aortic valve with severe calcification and 25% patients were of asymmetric calcification. Optimal intraoperative angiogram image was achieved in 92.9% patients with the help of preoperative CT image. There was a statistic difference in mean transvalvular gradient after valve implantation (54.1±15.3 mm Hg vs. 13.1±8.5 mm Hg, P<0.05). And there was no mortality or severe complication postoperatively. Conclusion3D-CT image palys an important role during perioperative evaluation of TAVI procedure and it can be helpful for Chinese doctors to operate TAVI successfully.

全身麻醉下介入治疗低级别颅内动脉瘤术前不留置尿管的可行性研究

目的　探讨颅内低级别（Hunt-Hess分级为0～Ⅲ级）动脉瘤患者在介入治疗围手术期不留置导尿管的可行性，为临床实践提供指导。 方法　2010年6月－2011年6月，对符合纳入标准的132 例颅内动脉瘤患者，术前经患者及家属知情同意并根据自愿原则，按是否留置导尿管分为两组。观察组（n=67）术前不安置尿管，对照组（n=65）则在全身麻醉下留置尿管，观察两组术中躁动对手术的影响及术后排尿情况。 结果　两组术中均未发生因尿急引起的躁动。术后观察组2 h内自行排尿58 例，2～4 h内排尿6例，需放置尿管3例（4%）；对照组 24 h内拔出尿管52 例，其余24 h后拔出，最长留置12 d，3例出现肉眼血尿（4%），12例出现尿路感染（12%）。 结论　颅内低级别动脉瘤患者介入围手术期可不留置导尿，既可提高患者舒适度，又能较好降低泌尿道感染率。

风湿性心脏病合并慢性粒细胞白血病围手术期护理一例

无痛纤维支气管镜检查围手术期护理

目的　总结无痛纤维支气管镜检查围手术期护理要点。 方法　对2011年11月－2012年5月行无痛纤维支气管镜检查的335例患者的围手术期护理方法进行回顾分析。 结果　335例患者均顺利完成检查，仅1例出现低氧血症但无麻醉意外发生，患者平均检查时间为（12.9 ± 2.27）min。 结论　采取积极有效的围手术期护理措施，能有效降低无痛纤维支气管镜检查患者围手术期相关并发症的发生率。

新生儿先天性巨结肠根治术的围术期护理

【摘要】　目的　总结新生儿先天性巨结肠的围术期护理。　方法　对2008年1月-2009年7月收治的30例先天性巨结肠患儿术前、术中及术后的护理资料进行回顾性分析。　结果　30例患儿手术成功，经精心护理均痊愈出院，达到预期的效果。　结论　先天性巨结肠在新生儿时期即行根治手术，手术前后的护理是治疗的重要环节。术前予以肠道的准备充分、术后采取精心对症的护理措施，加强病情观察，加强营养支持，重视肛周护理，是保证手术成功的重要因素。

胸腹主动脉瘤Ⅳ型行外科及腔内微创术围手术期护理

【摘要】　目的　总结对胸腹主动脉瘤IV型行血管外科和腔内微创术治疗患者的护理要点及经验。　方法　2007年11月-2008年1月对收治的1例胸腹主动脉瘤IV型行血管外科和腔内微创术患者，术前做好心理护理，控制血压，完善术前相关检查等；术后做好生命体征的监测、预防术后吻合口出血、支架移位、内漏、肠坏死、肾功能衰竭等并发症发生的各项护理工作。　结果　患者无并发症发生，痊愈出院，治疗和护理效果满意。　结论　围手术期实施正确恰当的护理是保证手术和治疗效果的关键。

口腔颌面部恶性肿瘤切除及面动脉逆行皮瓣修复术围手术期护理

【摘要】　目的　总结口腔颌面部恶性肿瘤切除及面动脉逆行皮瓣修复术围手术期的护理经验。　方法　对2008年10月-2009年10月收治的9例行口腔颌面部恶性肿瘤切除及面动脉逆行皮瓣修复术患者的临床资料进行回顾性分析，评价围手术期护理效果。　结果　经积极治疗及时有效的护理9例患者均痊愈出院。　结论　对症的围手术期护理，是口腔颌面部恶性肿瘤切除及面动脉逆行皮瓣修复术患者治愈的重要保证。

Analysis of Prophylactic Use of Antimicrobial Drugs in Perioperative Patients

【摘要】　目的　了解外科围手术期预防性使用抗菌药物现状，评估其用药合理性。　方法　随机抽取2009年1-12月265例外科手术患者病历，根据《抗菌药物临床应用指导原则》和《卫生部办公厅关于抗菌药物临床应用管理有关问题的通知》对抗菌药物使用进行合理性评价。　结果　265例外科手术患者均使用了抗菌药物，使用率为100%，外科围手术期预防用抗菌药物不合理率为63.89%，存在的主要问题是用药指征过宽、起点过高、手术前预防用药时间不当、术后预防用药时间过长及盲目联合用药。　结论　外科围手术期抗菌药物预防性使用不合理现象突出，应积极开展合理使用抗菌药物培训，加强抗菌药物使用管理，规范围手术期抗菌药物的使用，从而提高外科围手术期抗菌药物使用合理性。【Abstract】　Objective　To know the status of prophylactic use of antimicrobial agents in perioperative patients, and to evaluate the medication rationality.　Methods　The medical records of 265 patients who underwent the surgeries from January to December 2009 were randomly extracted, and the medication rationality was evaluated according to "Guiding Principles of Clinical Use of Antibiotics" and "Notice of Medical Department Office about Antibiotics Clinical practice Management Related Questions".　Results　All of the 265 perioperative patients were treated with antimicrobial drugs with a utilization rate of 100.00%, and the unreasonable rate of perioperative prophylactic use of antimicrobial agents was 63.89%. The main reasons included over-extended medication indications, high starting points, inappropriate time points of prophylactic medication, long duration of prophylactic medication and unreasonable drug combination.　Conclusion　The perioperative prophylactic use of antimicrobial agents is clinically unreasonable. It is necessary to carry out training on the rational use of antimicrobial agents to enhance the management of antimicrobial drug use and regulate the use of antimicrobial agents in perioperation.

Prophylactic Application of Antibiotics during the Perioperative Period of Type I Incisions

【摘要】　目的　了解围手术期预防性应用抗菌药物的现状并评价其合理性。　方法　采用回顾性调查的方法，随机抽查2009年1-12月500例Ⅰ类切口围手术期患者资料，填写设计的《外科围手术期预防性应用抗菌药物调查表》，对预防用药的适应证、用药种类、联合用药、给药时机及持续时间进行统计分析。　结果　500例中，未使用抗菌药物5例，预防性使用抗菌药物495例，不合理或欠合理80例（16.00%）。预防性使用抗菌药物总例次为540，其中头孢菌素类453例次（83.89%），青霉素类（包括酶抑制剂）26例次（4.81%），喹诺酮类44例次（8.15%），林可酰胺类17例次（3.15%）。头孢唑啉钠使用178例次（32.96%）居第1位，头孢替唑钠使用151例次（27.96%）。　结论　Ⅰ类切口手术围手术期预防性使用抗菌药物较为合理，但仍存在用药指征把握不严，抗菌药物的选择、使用时间较长等问题，有待进一步规范化管理。【Abstract】　Objective　To evaluate the prophylactic application of antibiotics during the perioperative period of type I incisions.　Methods　The clinical data of 500 patients with type I incisions from January to December of 2009 were retrospectively analyzed by self-designed questionnaire survey. The indication of antibiotics usage, choice of antibiotics categories, combination of antibiotics,giving time and length of antibiotics usage were analyzed.　Results　In 500 patients, only 5 were not given antibiotics, 80 (16%) were given antibiotics unnecessarily. In 540 patients who had underwent the antibiotic administration, 453 (16%) were administrated with cephalosporins, 44 (8.15%) were with fluoroquinolones, 26 (4.81%) were with penicillins, and 17 (3.15%) were with lincomycins. Cefazolin, the most used antibiotics, was given in 178 patients (32.96%)。Ceftezole was given in 151 patients (27.96%). 　Conclusion　The prophylactic application of antibiotics during the perioperative period of type I incisions is basically rational, however, there were also some problems, such as using antibiotics unnecessary, mischoice of antibiotics and using antibiotics too long. Thus, we need management of prophylactic antibiotics usage.

Perioperative Use of Antibiotic：1268 Cases Analysis

目的：了解成都地区抗菌药物的使用现状，分析围手术期抗感染用药情况，并作出客观评价。方法：根据《抗菌药物临床应用基本原则》，回顾性分析2004年12月至2006年12月成都地区8家医院1268份围手术期病历。结果：围手术期患者使用抗菌药物用于预防术后感染的时间超过了抗菌药物临床应用指导原则规定的比例占91.40%，联合用药的比例占总病历数的53.56%，7.81%的患者在手术过程中应用去甲万古霉素、庆大霉素等冲洗伤口以预防感染。结论：围手术期抗菌药物的使用基本合理，但是存在频繁且长时间应用的问题，应当加强抗菌药物应用的管理。