【摘要】 目的 探讨在重症监护病房（intonsive cane tmit，ICU）行选择性消化道脱污染（selective digestive decontamination，SDD）的临床实用价值。 方法 选取2007年1月—2010年1月危重症患者376例，随机分为两组，对照组予常规口腔护理治疗，治疗组予选择性消化道脱污染治疗，比较两组患者病情疗效的参数。 结果 治疗组院内获得性肺炎发生率为18.4%、院内获得性肺炎发生时间（7.2±3.2）d、人工气道（气管插管/切开）保留天数（10.5±3.8）d、机械通气天数（8.4±3.1）d、入住ICU天数（14.7±4.8）d、病死率11.6%；对照组院内获得性肺炎发生率为30.1%、院内获得性肺炎发生时间（5.6±3.6）d、人工气道（气管插管/切开）保留天数（12.5±4.6）d、机械通气天数（10.2±4.2）d、入住ICU天数（17.2±6.2）d、病死率19.4%；两组比较差异均有统计学意义（Plt;0.05）。 结论 在ICU内行选择性消化道脱污染可有效控制院内获得性肺炎，改善患者病情，减少住院天数，降低病死率。【Abstract】 Objective To discuss the clinical value of selective digestive decontamination in the intensive care unit (ICU). Methods From January 2007 to January 2010, 376 critically ill patients were randomly divided into two groups. Patients in the control group received conventional oral cavity nursing treatment, and those in the treatment group underwent the selective digestive decontamination. Then, we compared the curative effect parameters of these two kinds of procedures for the two groups of patients. Results For patients in the treatment group, the rate of hospital-acquired pneumonia (HAP) was 18.4%, the occurring time of HAP was (7.2±3.2) days, the time of retaining artificial gas channel (trachea cannula / incision) was (10.5±3.8) days, the time of mechanical ventilation was (8.4±3.1) days, ICU stay time was (14.7±4.8) days, and the mortality rate was 11.6%. For the control group, the correspondent parameters were respectively 30.1%, (5.6±3.6) days, (12.5±4.6) days, (10.2±4.2) days, (17.2±6.2) days, and 19.4%. The differences of these parameters between the two groups were significant (Plt;0.05). Conclusion For patients in the ICU, the selective digestive decontamination can effectively control the occurrence of HAP, improve patient conditions, reduce hospitalization time, and decrease mortality rate.
ObjectiveTo evaluate the early and mid-term results of robot-assisted coronary artery bypass grafting (RACAB) in the treatment of multi-vessel coronary artery disease (MV-CAD). Methods Patients with MV-CAD who underwent RACAB from April 2018 to December 2021 in our hospital were included. Patients who underwent hybrid coronary revascularization (HCR) which combined RACAB with percutaneous coronary intervention were allocated to a HCR-RACAB group, and patients who underwent multi-vessel RACAB were allocated to a MV-RACAB group. Perioperative and follow-up data were collected and compared between the two groups. Results A total of 102 patients were included, including 81 males and 21 females with a mean age of 61.7±10.8 years. Two (2.0%) patients were transferred to conventional CABG due to sudden ventricular fibrillation and pleura adhesion. In the remaining 100 patients who underwent RACAB, 100 left internal mammary arteries (LIMA) and 46 right internal mammary arteries (RIMA) were harvested with a 100.0% success rate. Besides, all patients undergoing RACAB achieved LIMA/RIMA-left anterior descending branch reconstruction, with an average number of 2.5±0.6 target vessels revascularized by stent or graft. One patient had perioperative myocardial infarction with an outcome of death. The incidence of major perioperative adverse events was 1.0%. There was no perioperative stroke or re-sternotomy for hemostasis. The mean follow-up time was 28.2 months, with a follow-up rate of 99.0% and an overall major adverse cardiac and cerebrovascular event (MACCE) rate of 7.0%, including 3 all-cause deaths (3.0%), 2 strokes (2.0%) and 3 re-revascularizations (3.0%). The HCR-RACAB group had fewer red blood cell transfusion (P=0.030) and intraoperative blood loss (P=0.037) compared with the MV-RACAB group, and there was no statistical difference in the incidence of major perioperative adverse events or MACCE between the two groups during the follow-up period (P>0.05). ConclusionRACAB can be safely applied in the treatment of MV-CAD with good early and mid-term outcomes. High-quality harvesting of LIMA/RIMA and aortic no-touch technique are crucial to achieve these results.