【摘要】 目的 Ⅲ型主动脉夹层非体外循环腔内支架隔离术在围手术期应用硝普钠控制性降压易导致精神失常，总结相关护理经验。 方法 2009年7月-2010年2月确诊Ⅲ型主动脉夹层动脉瘤患者36例，围手术期应用硝普钠控制性降压，均采用非体外循环主动脉腔内隔离术治疗，排除手术、麻醉等因素所致脑损伤而产生的术后精神异常。 结果 有5例出现不同程度精神失常，经加用口服降压药，减少硝普钠泵入剂量，缩短硝普钠使用时间，经过精心治疗及护理，患者精神异常症状逐渐减轻直至消失。 结论 长期、大剂量应用硝普钠易导致精神失常，需加强护理，及时发现，及时处理。【Abstract】 Objective To summarize the nursing experiences for mental disorders caused by sodium nitroprusside used to cure hypertension in patients receiving off-pump intervention surgery for DeBackey Ⅲ aortic dissection. Methods From July 2009 to February 2010, 36 patients were diagnosed to have DeBackey Ⅲ aortic dissection in our department. All patients received off-pump intervention surgery. We used sodium nitroprusside to control hypertension during the operation. Mental disorders caused by brain damage from surgery, anesthesia and other factors were ruled out. Results Five patients suffered from psychiatric disorders. Oral antihypertensive drugs were used, and we reduced the dose and shortened the time of using sodium nitroprusside. After intensive treatment and care, the symptoms of mental disorders alleviated and disappeared. Conclusion Long-term and large dose of sodium nitroprusside can easily lead to mental disorders, which requires intensive care, timely detection and treatment.
Frailty is a syndrome characterized by vulnerability to stressors due to loss of physiological reserve. In recent years, many researches have confirmed that frailty is a risk factor for postoperative complications of cardiac surgery, such as readmission, adverse cardiovascular events, and death in elderly patients. This paper reviews the concept of frailty, the relationship between frailty and cardiac surgery, the frailty assessment and intervention strategy in perioperative period, aimed at providing decision making basis for the risk stratification and perioperative management of cardiac surgery in elderly patients.
ObjectiveTo systematically evaluate the risk factors for hypoxemia after coronary artery bypass grafting (CABG).MethodsEight electronic databases including PubMed, EMbase, CENTRAL, Web of Science, CNKI, CBM, VIP and Wanfang data were searched by computer to collect cochort and case-control studies about CABG and hypoxemia published from inception to March 2020. Two authors independently assessed the quality using the Newcastle-Ottawa Scale (NOS), and a meta-analysis was performed by RevMan 5.3 software.ResultsA total of 15 studies involving 4 277 patients were included in this study and among them 1 273 patients suffered hypoxemia. Meta-analysis showed that age (OR=1.55, 95%CI 1.22 to 1.96, P=0.000 3), smoking (OR=3.22, 95%CI 2.48 to 4.17, P<0.000 01), preoperative chronic pulmonary diseases (OR=4.75, 95%CI 3.28 to 6.86, P<0.000 01), diabetes (OR=2.49, 95%CI 1.86 to 3.33,P<0.000 01), left ventricular ejection fraction (OR=3.15, 95%CI 2.19 to 4.52, P<0.000 01), number of coronary artery lesions (OR=2.20, 95%CI 1.63 to 2.97, P<0.000 1) were independent risk factors for hypoxemia after CABG; body mass index (OR=1.31, 95%CI 0.97 to 1.77, P=0.08) and cardiopulmonary bypass time (OR=3.40, 95%CI 0.72 to 15.94, P=0.12) were not associated with hypoxemia.ConclusionCurrent evidence shows that age, preoperative chronic pulmonary diseases, smoking, diabetes, left ventricular ejection fraction, number of coronary artery are risk factors for hypoxemia after CABG, which can be used to identify high-risk patients and provide guidance for medical staff to develop perioperative preventive strategies to reduce the incidence of hypoxemia. The results should be validated by large-scale standard studies in the future.
ObjectiveTo systematically review the relationship between subclinical thyroid dysfunction and the risk of atrial fibrillation.MethodsDatabases including PubMed, EMbase, The Cochrane Library, Web of Science, CNKI, CBM, VIP and WanFang Data were electronically searched to collect cohort studies on associations between subclinical thyroid dysfunction and atrial fibrillation from inception to June 2020. Two reviewers independently screened literature, extracted data, and evaluated risk of bias of included studies. Meta-analysis was then performed using RevMan 5.3 software.ResultsA total of 11 studies involving 620 874 subjects and 19 781 cases were included. Meta-analysis showed that subclinical hypothyroidism was not associated with atrial fibrillation (adjusted RR=1.20, 95%CI 0.92 to 1.57, P=0.18) and subclinical hyperthyroidism could increase the risk of atrial fibrillation (adjusted RR=1.65, 95%CI 1.12 to 2.43, P=0.01). Subgroup analysis showed that for the community population, subclinical hypothyroidism was not associated with atrial fibrillation (adjusted RR=1.03, 95%CI 0.84 to 1.26, P=0.81); for cardiac surgery, subclinical hypothyroidism could increase the risk of atrial fibrillation (adjusted RR=2.80, 95%CI 1.51 to 5.19, P=0.001); subclinical hyperthyroidism could increase the risk of atrial fibrillation among patients with TSH≤0.1 mlU/L (adjusted RR=2.06, 95%CI 1.07 to 3.99, P=0.03) and TSH=0.1～0.44 mlU/L (adjusted RR=1.29, 95%CI 1.01 to 1.64, P=0.04). ConclusionsSubclinical hypothyroidism is not associated with atrial fibrillation and subclinical hyperthyroidism can increase the risk of atrial fibrillation. Due to limited quantity and quality of included studies, more high quality studies are needed to verify above conclusions.
Objective To systematically evaluate the risk factors for hypoxemia after Stanford type A aortic dissection (TAAD) surgery. Methods Electronic databases including PubMed, EMbase, The Cochrane Library, Web of Science, CNKI, Wanfang Data, VIP and CBM were searched by computer to collect studies about risk factors for hypoxemia after TAAD published from inception to November 2021. Two authors independently assessed the studies' quality, and a meta-analysis was performed by RevMan 5.3 software. ResultsA total of 19 case-control studies involving 2 686 patients and among them 1 085 patients suffered hypoxemia, included 21 predictive risk factors. The score of Newcastle-Ottawa scale≥7 points in 16 studies. Meta-analysis showed that: age (OR=1.10, 95%CI 1.06 to 1.14, P＜0.000 01), body mass index (OR=1.87, 95%CI 1.49 to 2.34, P＜0.000 01), preoperative partial pressure of oxygen in arterial blood/fractional concentration of inspiratory oxygen (PaO2/FiO2)≤300 mm Hg (OR=7.13, 95%CI 3.48 to 14.61, P＜0.000 01), preoperative white blood cell count (OR=1.34, 95%CI 1.18 to 1.53, P＜0.000 1), deep hypothermic circulatory arrest time (OR=1.33, 95%CI 1.14 to 1.57, P=0.000 4), perioperative blood transfusion (OR=1.89, 95%CI 1.49 to 2.41, P＜0.000 01), cardiopulmonary bypass time (OR=1.02, 95%CI 1.00 to 1.03, P=0.02) were independent risk factors for hypoxemia after TAAD surgery. Preoperative serum creatinine, preoperative myoglobin, preoperative alanine aminotransferase were not associated with postoperative hypoxemia. Conclusion Current evidence shows that age, body mass index, preoperative PaO2/FiO2≤300 mm Hg, preoperative white blood cell count, deep hypothermic circulatory arrest time, perioperative blood transfusion, cardiopulmonary bypass time are risk factors for hypoxemia after TAAD surgery. These factors can be used to identify high-risk patients, and provide guidance for medical staff to develop perioperative preventive strategy to reduce the incidence of hypoxemia. The results should be validated by higher quality researches.
ObjectivesTo systematically review the relationship between hypothyroidism and the risk of atrial fibrillation.MethodPubMed, EMbase, The Cochrane Library, Web of Science, CNKI, CBM, VIP and WanFang Data databases were electronically searched to collect cohort and case-control studies on the association between hypothyroidism and atrial fibrillation from inception to November 2019. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was then performed using RevMan 5.3 software.ResultsA total of 5 cohort studies involving 574 268 subjects and 18 059 atrial fibrillation cases were included. The results of meta-analysis showed that hypothyroidism was not associated with atrial fibrillation (OR=1.10, 95%CI 0.75 to 1.61, P=0.62). From subgroup analysis, no relationship was identified in community population (OR=0.97, 95%CI 0.72 to 1.29, P=0.82) and cardiac surgery patients (OR=1.22, 95%CI 0.58 to 2.53, P=0.60).ConclusionsHypothyroidism does not increase the risk of atrial fibrillation. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify the above conclusions.
ObjectiveTo analyze the changes of perioperative thyroid hormone in patients undergoing cardiac surgery under cardiopulmonary bypass, and to provide guidance for postoperative cardiac management.MethodsThe clinical data of 72 patients receiving cardiac surgery under cardiopulmonary bypass in our hospital from January to May 2019 were collected, including 35 males and 37 females, aged 19-72 (52.35±10.40) years. The changes of thyroid hormones before operation, 2 hours and 24 hours after operation were analyzed.ResultsThere was a statistical difference in thyroid stimulating hormone (TSH), triiodothyronine (T3), tetraiodothyronine (T4) and free tetraiodothyronine (FT4) between postoperative 2 hours and preoperation (P<0.05). There was a statistical difference in TSH, T3, free triiodothyronine (FT3), T4 and FT4 between postoperative 24 hours and preoperation (P<0.05). There was a statistical difference in TSH, T3, FT3 and T4 between postoperative 24 hours and 2 hours (P<0.05). Postoperatively T3 and FT3 decreased, TSH increased and then decreased while T4 and FT4 were within the normal range. Repeated measures analysis of variance showed a statistical difference of time effect in TSH, T3, FT3, T4 and FT4.ConclusionPatients with cardiac surgery under cardiopulmonary bypass have different thyroid hormones postoperatively compared with preoperatively. T3 and FT3 decrease, TSH increases and then decreases, while T4 and FT4 are in the normal range. The results require further large-scale, multi-center, high-quality clinical studies to be confirmed.