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冠状动脉旁路移植同期行二尖瓣成形术治疗缺血性二尖瓣关闭不全

目的 总结缺血性二尖瓣关闭不全（ＩＭＲ）患者同期行冠状动脉旁路移植术（CABG）和二尖瓣成形术的临床经验，以提高手术疗效。 方法 对36例ＩＭＲ行ＣＡＢＧ加同期二尖瓣成形术患者的临床资料进行回顾性分析。共移植血管93支，平均每例2.58支。二尖瓣成形采用Carpentier环6例，Duran环14例，交界褥式环缩16例；edge to edge技术6例，后叶楔形切除2例。 结果 住院死亡5例（13.89%）,死亡原因：低心排血量、循环功能衰竭、肾功能衰竭和脑梗死。术后随访21例，失访10例，随访时间26.4±5.6个月，远期死亡3例。生存患者心功能分级（NYHA）Ⅰ级14例，Ⅱ级3例，Ⅲ级1例。随访期间复查超声心动图提示：二尖瓣无反流或微量反流4例，轻度反流13例，中度反流4例；心功能明显改善。 结论 对冠状动脉多支病变合并中度IMR患者应慎重选择二尖瓣成形手术，单纯CABG可能是首选的治疗方案。CABG同期行二尖瓣成形术治疗IMR早期效果较好，远期复发率高，但多数患者不需再次手术治疗。

脂肪抽吸成形术体会

Association between anesthesia regimen and postoperative infection in patients undergoing cardiac surgery: A retrospective cohort study

Objective To evaluate the association between anesthesia regimen (volatile or intravenous anesthetics) and postoperative infection in adult cardiac patients undergoing cardiac surgery. MethodsThe clinical data of 496 elective adults undergoing cardiac surgery under cardiopulmonary bypass from June 2019 to June 2020 in West China Hospital of Sichuan University were retrospectively analyzed, including 251 females and 245 males with an average age of 54.1±11.4 years. American Society of Anesthesiologists grade was Ⅰ-Ⅲ. There were 243 patients in a volatile group with sevoflurane or desflurane, and 253 patients in an intravenous anesthesia group with propofol. The primary outcome was the incidence of infection within 30 days after cardiac surgery, including pulmonary infection, surgical site infection, sepsis, and urinary tract infection. The secondary outcomes were duration of mechanical ventilation, incidence of reintubation, ICU stay, postoperative length of hospital stay and total hospitalization cost. Results A total of 155 (31.3%) patients developed postoperative infection within 30 days, with an incidence of 32.9% in the volatile group and 29.6% in the intravenous anesthesia group. There was no statistical difference in the incidence of infection (RR=1.111, 95%CI 0.855 to 1.442, P=0.431) or the secondary outcomes (P>0.05) between the two groups. Conclusion The anesthesia regimen (volatile or intravenous anesthetics) has no association with the risk of occurrence of postoperative infection in adult patients undergoing elective cardiac surgery with cardiopulmonary bypass.

Effect of ventilation mode on pulmonary complications after thoracoscopic lung resection: A retrospective cohort study

Objective To evaluate the association between pressure-controlled ventilation-volume guaranteed (PCV-VG) mode and volume-controlled ventilation (VCV) mode on postoperative pulmonary complications (PPCs) in patients undergoing thoracoscopic lung resection. Methods A retrospective cohort analysis of 329 patients undergoing elective thoracoscopic lung resection in West China Hospital of Sichuan University between September 2020 and March 2021 was conducted, including 213 females and 116 males, aged 53.6±11.3 years. American Society of Anesthesiologists (ASA) grade wasⅠ-Ⅲ. The patients who received lung-protective ventilation strategy during anesthesia were divided into a PCV-VG group (n=165) and a VCV group (n=164) according to intraoperative ventilation mode. Primary outcome was the incidence of PPCs during hospitalization. Results A total of 73 (22.2%) patients developed PPCs during hospitalization. The PPCs incidence of PCV-VG and VCV was 21.8% and 22.6%, respectively (RR=0.985, 95%CI 0.569-1.611, P=0.871). Multivariate logistic regression analysis showed that there was no statistical difference in the incidence of PPCs between PCV-VG and VCV mode during hospitalization (OR=0.846, 95%CI 0.487-1.470, P=0.553). Conclusion Among patients undergoing thoracoscopic lung resection, intraoperative ventilation mode (PCV-VG or VCV) is not associated with the risk of PPCs during hospitalization.