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右腋下垂直小切口心脏不停跳心内直视手术135例

目的 探讨右腋下垂直小切口心脏不停跳手术治疗先天性心脏病的方法。 方法 2003年11月～2006年6月，采用右腋下小切口在心脏不停跳下施行心脏手术135例；其中室间隔缺损（VSD）68例，房间隔缺损（ASD）61例(ASD合并左上腔静脉4例)，VSD+ASD 5例，冠状动静脉瘘1例。 结果 全组无手术死亡。平均住院时间8d。术后发生右肺不张2例，右侧气胸1例，切口液化2例。术后随访122例，随访时间1个月～2年，除2例VSD患者术后发生残余漏外，其余患者均恢复良好。 结论 对单纯ASD、VSD患者选择右腋下垂直小切口，在心脏不停跳下施行心内直视手术，安全可靠、手术时间短、创伤轻、恢复快、切口美观。

胸骨正中小切口在心脏直视手术中的应用

目的 介绍胸骨正中小切口在心脏手术中的应用效果. 方法 风湿性心瓣膜病或先天性心脏病患者40例,分别在常规体外循环或常温心脏不停跳下行心内直视术.做胸骨下端正中小切口,长5～9cm,保留胸骨柄的连续性. 结果 手术均顺利进行,术后无严重并发症发生,循环稳定,恢复快,瘢痕隐蔽.心脏不停跳手术患者,术后辅助呼吸和使用正性肌力药物的时间明显缩短. 结论 胸骨正中小切口可以安全的应用于多种常规和心脏不停跳心内直视手术,适应范围广、创伤小、手术效果好和美容效果佳.

心内直视术后长时间应用呼吸机支持的原因与防治

目的 探讨心内直视术后的患者长时间应用呼吸机的原因及其防治方法。方法 将30例心内直视术后的患者分为两组，不能脱离呼吸机组(n=19)和二次插管组(n=11)，两组患者应用呼吸机均超过3天，从术前心功能、心胸比率、体外循环、主动脉阻断时间和术后并发症等方面对两组进行了原因分析和比较。结果 心内直视术后需长时间应用呼吸机原因与术前心功能、心胸比率、体外循环和主动脉阻断时间、术后并发心、肺、脑、多器官功能衰竭等有密切关系。不能脱离呼吸机组患者术后主要发生心、脑及多器官功能衰竭等并发症，14例痊愈，5例死亡。二次插管组主要合并心脏和呼吸系统并发症，全部治愈。结论 术前心、肺功能准备充分，尽可能缩短体外循环和主动脉阻断时间，预防和综合治疗心、肺、脑等重要脏器并发症及合理应用呼吸机支持治疗，对促进患者的早日康复具有重要意义。

Nursing Experiences of Invasive Blood Pressure Monitoring for Patients Having Undergone Open-heart Surgery

Clinical Application of Combined Treatment with Probiotics and Lactulose after Open Heart Surgery under Cardiopulmonary Bypass: A Control Study

Objectives To investigate the effect of the combined treatment with probiotics and lactulose of gastrointestinal function and postoperative infection after open cardiac surgery. Methods We retrospectively analyzed the clinical data of 264 patients underwent cardiopulmonary bypass in our hospital between August 2013 and June 2014. There were 129 males and 135 females at the mean age of 53.06±10.97 years. We divided those patients into a treatment group and a control group. In the treatment group, there were 58 males and 63 females at the mean age of 52.29±14.31 years. They took probiotics and lactulose from the first day to the seventh day after operation. In the control group, there were 71 males and 72 females at the mean age of 52.29±14.31 years. They didn’t take probiotics or lactulose after the surgery. Procalcitonin (PCT) and lipopolysaccharides (LPS) concentrations were measured before operation, at 24 hours postoperatively, at 72 hours and on the seventh day. We recorded the condition of postoperative infection, gastrointestinal disorders and relative informations. Results The PCT and LPS concentrations in the treatment group after 72 hours postoperatively were statistically lower than those of the control group (1.04±5.39 ng/ml vs. 3.51±4.28 ng/ml, P=0.04; 11.28±4.34 EU/ml vs. 21.59±7.34 EU/ml, P=0.03). The PCT and LPS concentrations in the treatment group were also statistically lower than those of the control group on the 7th day postoperatively (0.17±2.79 ng/ml vs. 1.98±4.62 ng/ml，P=0.04; 6.74±6.38 EU/ml vs. 15.96±4.61 EU/ml, P=0.01). The ICU stay time (43.25±14.36 h vs. 63.47±24.46 h, P=0.01) and postoperative hospital stay time (15.07±4.52 d vs. 21.08±6.49 d, P=0.02) were significantly less in the treatment group than those in the control group. The morbidity of infection and the morbidity of gastrointestinal disorders of the treatment group were statistically less than those of the control group (1.65% vs. 5.59%, P=0.00; 2.48% vs. 6.99%, P<0.001), and there was no statistical difference in mortality between the two groups (1.65% vs. 2.10%, P=0.12). Conclusions The combined treatment with probiotics and lactulose can improve the postoperative inflammatory reaction, gastrointestinal function, and reduce the morbidity of infection.