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心瓣膜置换术后心室颤动的高危因素分析

目的 探讨心瓣膜置换术后心室颤动(VF) 发生的高危因素及其可能的防治措施. 方法 回顾性收集968例心瓣膜置换术患者的临床资料,按术后是否发生VF分为两组,VF组:58例,术后均发生VF;对照组:从910例未发生VF的患者中随机选择70例作为对照.选择术前临床指标、超声心动图(UCG)、心肺转流术(CPB)、心瓣膜病变类型和术式、术后24小时循环及电解质状况等指标,用Logistic回归方法分析术后发生VF的高危因素. 结果 年龄≥65岁、心胸比率≥0.8、NYHA心功能Ⅳ级、急诊或再次手术、主动脉阻断时间≥120分钟、术后24小时循环不稳定、低钾、低镁等电解质紊乱是其发生的独立危险因素. 结论 VF是心瓣膜置换术后的早期严重并发症;患者的年龄、心脏基础病变的严重程度、围术期的处理可以影响术后VF的发生;早期手术、缩短主动脉阻断时间、维持术后24小时内循环稳定、防止电解质紊乱和缺氧、酸中毒的发生,是预防心瓣膜置换术后VF发生的有效措施.

心瓣膜置换术患者围术期尿NAG/Cr变化及乌司他丁对肾的保护作用

目的　了解心瓣膜置换术患者围术期尿 N-乙酰 - β- D-氨基葡萄糖苷酶 (NAG) /肌酐 (Cr)的变化 ,观察乌司他丁对肾的保护作用。　方法　 5 3例心瓣膜置换术患者用抽签法随机分为两组。实验组 :2 3例 ,给乌司他丁 2 0 0 0 0U/ kg,分 3次静脉注射 ;对照组 :30例 ,静脉注射生理盐水 2 0 m l。分别于术前 30 min,主动脉阻断前 5 min,主动脉开放后 5 min,手术结束 ,术后第 1、3、5 d检测尿 NAG/ Cr值、血尿素氮 (BU N)和血 Cr等指标。　结果　两组患者的尿NAG/ Cr值均于手术开始后升高 ,于主动脉开放后 5 min和手术结束时达到高峰 ;主动脉开放后 5 min、手术结束时和术后第 1d,实验组患者尿 NAG/ Cr值明显低于对照组 (Plt;0 .0 5 )。尿 NAG/ Cr值与体外循环 (CPB)时间、主动脉阻断时间和 TM- 5 0 (平均灌注压低于 5 0 mm Hg的时间压力积分 )呈正相关 (r=0 .5 6 0 ,0 .4 93,0 .5 0 5 ;Plt;0 .0 5 )。　结论　CPB...更多时间、主动脉阻断时间和 TM- 5 0可影响尿 NAG/ Cr,乌司他丁对心瓣膜置换术患者围术期的肾损伤有一定的保护作用。

The Affecting Factors on Sinus Rhythms Maintenance after Electric Cardioversion for Atrial Fibrillation in Patients after Cardiac Valve Replacement

Objective To explore the affecting factors on sinus rhythm maintenance after electric cardioversion for patients with atrial fibrillation (Af) after cardiac valve replacement. Methods One hundred fifty two valvular disease patients with Af after cardiac valve replacement were randomized to 2 groups: Amiodarone group and control group (without anti arrhythmic drugs) after cardioversion. Af recurrence was observed during one year follow up. Results (1) No significant difference of Af recurrence betwe...

心瓣膜置换术后患者围术期死亡原因分析

摘要： 目的 分析心瓣膜置换术后患者围术期死亡的原因，探讨降低围术期病死率的措施。 方法 回顾性分析2004年1月至2009年1月广西医科大学第一附属医院行心瓣膜置换术后死亡的54例患者的临床资料，男28例，女26例；年龄20～65岁(45.5±11.6岁)。全组均在全身麻醉低温体外循环(CPB)下行心瓣膜置换术，其中37例行中低温(26~28 ℃)心脏停搏手术,17例行浅低温(31～33 ℃)心脏不停跳手术。对围术期死亡的原因进行分析。结果 术中死亡15例,手术死亡率1.78%(15/845)；其余39例患者的死亡时间为术后3 h~106 d（8.2±17.2 d）,死亡原因主要为低心排血量综合征(LCOS)、不能停CPB、心脏及主动脉出血、呼吸功能衰竭、肾功能衰竭、恶性心律失常和多器官功能衰竭等。 结论 选择恰当手术时机、充分术前准备、改善心功能，术中谨慎操作、良好心肌保护、术后加强监护，可提高手术成功率。

鲁登巴赫综合征合并多瓣膜联合病变外科治疗一例

心瓣膜置换术1407例临床分析

目的 为了不断提高心瓣膜置换术的成功率,总结其围手术期的临床经验. 方法 回顾性分析我院1976～2000年,1 407例心瓣膜置换术的手术技术、术后处理以及死亡原因等. 结果 本组二尖瓣置换术(MVR)806例,主动脉瓣置换术(AVR)232 例,三尖瓣置换术(TVR)4例,双瓣膜置换术(DVR)333 例;再次二尖瓣置换术(Re - MVR)22例,再次主动脉瓣置换术(Re-AVR)6例,再次双瓣膜置换术(Re-DVR)4例.全组共死亡72例,总死亡率5.12%;1996年后死亡14例,死亡率1.87%. 结论 提高手术技术、改进心肌保护方法、加强围术期管理等,可大大降低死亡率.

151例老年患者心脏瓣膜置换术护理

目的:分析60 岁以上老年心脏瓣膜置换术围术期的护理特点。方法:2000 年1 月～2007 年2 月对我科收治的151 例老年心脏瓣膜病患者(60～72 岁)实施心瓣膜置换术,其中二尖瓣置换95 例,主动脉瓣置换19 例,二尖瓣和主动脉瓣双瓣置换术37 例,110 例置入机械瓣,41 例置入生物瓣。结果:本组死亡5 例占3.3%,4 例死于低心排综合征,1 例死于心室颤动,切口感染1 例,纵隔感染2 例,肺部感染5 例,均作相应处理痊愈出院。出院随访3～52 个月,每年236 人次,心功能恢复Ⅰ级82例,Ⅱ级46例。结论:手术技巧的提高和围术期针对老年人的生理特点,加强呼吸循环神经系统的监护对提高生存率,促进早日康复有十分重要的意义。

心瓣膜置换术后纵隔引流液回输对库血用量及血浆心肌酶的影响

目的 探讨体外循环心瓣膜置换术后早期纵隔引流液回输对异体库血需要量和血浆心肌酶学指标的影响。方法 连续将30例心瓣膜置换术后前4小时纵隔引流液量超过400ml的患者，随机分为纵隔引流液回输组(回输组)和对照组，每组各15例。记录术后24小时异体库血用量和检测术后4小时、12小时、24小时和48小时循环血液中肌酸磷酸激酶(CPK)、肌酸磷酸激酶同工酶(CPK-MB)、乳酸脱氢酶(LDH)和心肌肌钙蛋白I(cTnI)水平。结果 回输组术后24小时异体库血用量明显少于对照组(P＜0.01)；而术后12小时和24小时血浆CPK，CPK-MB和LDH明显高于对照组(P＜0.01)。两组cTnI差别无显著性意义(P＞0.05)。结论 心瓣膜置换术后早期纵隔引流液的回输是减少术后异体库血用量的一种有效方法，但可引起术后24小时内血浆CPK，CPK-MB和LDH显著升高，而不影响cTnI水平。

Modified Del Nido cardioplegia versus St.Thomas cardioplegia for myocardial protection in adult patients with combined valve replacement

Objective To analyze the effect of myocardial protection between modified Del Nido cardioplegia and St. Thomas Hospital Cardioplegia in adult patients with aortic valve and mitral valve replacement. Methods From January 2014 to June 2016, 140 patients underwent aortic valve and mitral valve replacement in our hospital. According to different cardioplegia, the patients were divided into two groups including a modified Del Nido cardioplegia group (70 patients, 37 males, 33 females at mean age of 53.13±9.52 years) and a St. Thomas cardioplegia group (70 patients, 32 males, 38 females, at age of 50.71±9.29 years). We collected clinical data of the patients before operation (T1), 2 h after aortic unclamping (T2), 24 h after operation (T3) and 48 h after operation (T4). Indexes of muscle enzymes including blood center creatine kinase (CK), creatine kinase isoenzyme (CK-MB) concentration and liver function indexes including urea nitrogen (BUN), creatinine (Cr), alanine aminotransferase (ALT), aspartate aminotransferase (AST) concentrations, and compared the postoperative and follow-up clinical data. Results There was no statistical difference in age, weight, gender, ejection fraction baseline data between the two groups (P>0.05). All patients were successfully completed combined valve replacement under cardiopulmonary bypass. The cardiopulmonary time was no statistical difference between the two groups (P>0.05). However, compared with St. Thomas cardioplegia group, modified Del Nido group was less in perfusion (1.19±0.39vs. 2.99±0.75, P<0.001), shorter in aortic clamping time (P=0.003). No statistical difference was found in defibrillation rate after resuscitation between the two groups (P=0.779). Biochemical indicators were not statistically different at different time points between the two groups (P>0.05). Conclusion Modified Del Nido cardioplegia has the same effect on myocardial protection with St. Thomas cardioplegia in adult patients. It reduces the frequency of reperfusion, and shortens the clamping time. There is no additional injury in the important organs such as liver, kidney. Modified Del Nido cardioplegia myocardial protection ability in adult heart valve surgery is feasible.

Effects of Rocuronium on Myocardial Oxygen SupplyDemand in Patients with Rheumatic Heart Disease during Induction of Anaesthesia

摘要:目的: 在风湿性心脏病患者瓣膜置换术中,评价罗库溴铵在麻醉诱导期间对患者心肌氧供和氧耗平衡的影响。 方法 :选择86例在中低温体循环下行瓣膜置换术的患者,采用随机双盲法分配成罗库溴铵组(n=42例)和维库溴铵组(n=41例)。给予咪唑安定(005～01 mg/kg)及芬太尼(10～15μg/kg)及等效剂量的罗库溴铵06 mg/kg或维库溴铵01 mg/kg(Org. Comp)进行麻醉诱导。监测麻醉诱导前至插管后10分钟(1次/1分)期间两组患者心肌氧供和氧耗的变化。 结果 :与基础值相比,罗库溴铵组患者在插管后5分钟期间心率增加了174%～135%,动脉收缩压增加了1694%～143%,平均动脉压增加了151%～132%。同期心率收缩压乘积增加了2267%～1396% (〖WTBX〗P lt;005)。心率和动脉血压在插管后1～7分钟期间明显高于同期的维库溴铵组患者(〖WTBX〗P lt;005)。 结论 :在ASA ⅢⅣ级、心功ⅡⅢ级风心病瓣膜病变患者进行瓣膜置换术中, 06 mg/kg罗库溴铵有潜在增加患者心肌耗氧量的作用。Abstract: Objective: To evaluate the effects of rocuronium on myocardial oxygen supplydemand in patients with rheumatic heart disease (RHD) during induction. Methods : 86 patients of either sex (ASA status ⅢⅣ; New York Heart Association classes ⅡⅢ) scheduled for valve replacement surgery were included in this randomized clinical trial (RCT). SwanGanz catheter was placed via right internal jugular vein before the induction of anaesthesia. Anaesthesia was induced with midazolam 00501mg.kg-1 and fentanyl 1015 μg·kg-1. The patients were randomized to receive either rocuronium 06 mg·kg-1 (group R, 〖WTBX〗n= 42) or vecuronium 01 mg·kg-1 (group V, 〖WTBX〗n= 41) to facilitate tracheal intubation when bispectral index (BIS) value dropped to 60 All data were recorded at the time before anaesthesia (Tb), loss of consciousness (Ts), administration of muscle relaxant (Tm), 1 min after administration of muscle relaxant (T1), when trainoffour stimulation (TOF) reached 0 (T2) and 1,2,3,4,5,7,10 min after tracheal intubation (T39).〖WTHZ〗Results : Heart rate (HR) increased by 174%135%, systemic arterial systolic pressure (SAP) increased by 1694%143%, mean arterial systolic pressure (MAP) increased by 151%132% and product of heart rate and arterial systolic pressure(RPP) increased 2267%1396% respectively during 5 minutes after intubation as compared with baseline in group R, which were significantly higher than those in group V during 5 minutes after intubation (〖WTBX〗P lt;005). Conclusion : An intubation dose of rocuronium should be used cautiously in patients with rheumatic heart disease (ASA status ⅢⅣ; NYHA classes IIⅢ).