ObjectiveTo discuss the key nursing points for patients with infective endocarditis and congenital isolated kidney after valve replacement. MethodsIn December 2012, one infective endocarditis patient with isolated kidney underwent heart valve replacement in our hospital. In addition to actively preventing postoperative infection of the heart valve, our nursing focused mainly on the isolated kidney protection and monitoring, and the related complications. ResultsThe surgery was successful, and the isolated kidney was effectively protected. The patient recovered and was discharged from the hospital. ConclusionFor patients with congenital isolated kidney with infective endocarditis, patients' urine output per hour and 24 h discrepancy quantity should be closely observed after valve replacement surgery. It is also very important to intervene early and carry out comprehensive protection of the renal function.
【摘要】 目的 Ⅲ型主動脈夾層非體外循環腔內支架隔離術在圍手術期應用硝普鈉控制性降壓易導致精神失常，總結相關護理經驗。 方法 2009年7月-2010年2月確診Ⅲ型主動脈夾層動脈瘤患者36例，圍手術期應用硝普鈉控制性降壓，均采用非體外循環主動脈腔內隔離術治療，排除手術、麻醉等因素所致腦損傷而產生的術后精神異常。 結果 有5例出現不同程度精神失常，經加用口服降壓藥，減少硝普鈉泵入劑量，縮短硝普鈉使用時間，經過精心治療及護理，患者精神異常癥狀逐漸減輕直至消失。 結論 長期、大劑量應用硝普鈉易導致精神失常，需加強護理，及時發現，及時處理。【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.
目的探討纖維支氣管鏡（纖支鏡）在體外循環術后機械通氣患者中的應用。 方法回顧性分析2014年1～12月行纖支鏡檢查76例體外循環術后機械通氣患者的臨床資料，男45例、女31例，年齡21～71（42.8±6.3）歲。其中行二尖瓣置換術35例，主動脈瓣置換術11例，二尖瓣置換術+主動脈瓣置換術17例，冠狀動脈旁路移植術5例，升主動脈+主動脈全弓或半弓人工血管置換術8例。術前心功能Ⅱ級25例、Ⅲ級39例、Ⅳ級12例。術前合并中、重度肺動脈高壓13例，感染性心內膜炎5例。 結果76例患者中氣道大量分泌物59例，氣道嚴重充血、水腫明顯9例，痰痂阻塞氣管導管3例，血痂阻塞氣管導管2例，導管部分閉塞2例，氣道輕微滲血1例。59例經纖支鏡檢查吸出氣道分泌物后，肺部濕啰音較檢查前明顯減輕，呼吸狀態明顯好轉；其余17例也經纖支鏡檢查進行準確診斷和有效處理。本組患者在纖支鏡檢查中順利完成痰液標本采集共31例，未發生缺氧、心律失常和出血等操作并發癥。 結論體外循環術后機械通氣患者行纖支鏡檢查，在維持呼吸道通暢、正確指導抗生素應用、輔助診斷治療中有積極作用。
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.
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.