Composite grafting techniques is a commonly used strategy in coronary artery bypass grafting,especially suits elderly patients.It is an attractive myocardial revascularization strategy when the grafts are not sufficient to achieve complete myocardial revascularization.Furthermore,composite grafting in the presence of a diseased aortic wall seems a rational approach to reduce the incidene of postoperative neurological deficit or stroke by avoiding the manipulation of atherosclerotic aorta.Also,it gained excellent short and midterm results.This review provides an overview of the various surgical techniques,outcomes,concerns and controversies associated with composite grafting.
【摘要】 目的 探討膿毒性休克早期液體復蘇的臨床反應性。 方法 對2008年2月—2010年2月38例采用早期目標定向治療方案治療的膿毒性休克患者按是否存活進行分組，就中心靜脈壓、心率、平均動脈壓、輸液量、尿量、血乳酸等指標進行評價。 結果 38例采用早期目標定向治療方案治療6 h均達標，存活21例（55.26%），死亡17例（44.74%），兩組患者輸液總量及輸液種類差異無統計學意義（Pgt;0.05），存活組6、24 h尿量及血乳酸清除率明顯優于死亡組（Plt;0.05）。 結論 血乳酸清除率及尿量可作為膿毒性休克液體復蘇有效的臨床監測指標。【Abstract】 Objective To study the clinical response to early fluid resuscitation therapy in septic shock patients. Methods Thirty-eight septic shock patients received early goal-directed therapy (EGDT) in the ICU of our hospital from February 2008 to February 2010. The patients were divided into survival group (n=21) and dead group (n=17). Indexes like central venous pressure (CVP), heart rate (HR), mean arterial pressure (MAP), fluid input, urine output, and blood lactate were evaluated. Results Six hours after the EGDT, the results for the patients were all up to standard. There were 21 cases of survival (55.26%) and 17 cases of death (44.74%). The total fluid input and liquid types were similar in the two groups (Pgt;0.05). The urine output and lactate clearance at hour 6 and 24 for the survival group were better than that for the dead group (Plt;0.05). Conclusion The lactate clearance and urine output can be regarded as an surveillance indicator of fluid resuscitation for patients with septic shock.
ObjectiveTo investigate the value of esophageal activity examination under X-ray fluoroscopy and chest CT in evaluating the resectability of upper thoracic esophageal cancer.MethodsA total of 221 upper thoracic esophageal carcinoma patients underwent radical operation between 2009 and 2015 in our hospital were enrolled, including 141 males and 80 females with a median age of 59 (47-79) years. Preoperative routine esophageal activity examination under X-ray fluoroscopy and chest enhanced CT were performed to determine whether the tumor had external invasion. The results of the two methods were compared with that observed during the operation.ResultsThe number of patients with esophageal activity score 1-6 was 70, 85, 32, 29, 2 and 3, respectively. The area under the receiver operating characteristic (ROC) curve (AUC) of esophageal activity examination was 0.897 (95%CI 0.85-0.93, P<0.001), and the cut off value was >3. According to the ROC curve activity score, 4-6 points were considered as invasion, and 1-3 points were non-invasion. The sensitivity, specificity, accuracy and misdiagnosis rate of esophageal activity examination was 75.0%, 89.3%, 88.2%, 10.7%, respectively, and those of CT scan were 75.0%, 66.8%, 67.4%, 33.2%, respectively. Compared with CT scan, the specificity of esophageal activity examination was higher and the misdiagnosis rate was lower. Compared with the detection during the operation, 86.7% of patients with actual invasion of trachea and 85.7% of patients with actual invasion of other parts were in accordance with the esophageal activity examination results.ConclusionEsophageal activity examination under X-ray fluoroscopy can accurately predict the resectability of upper thoracic esophageal cancer, which is a useful supplement to chest CT examination, especially in the aspect of judging the relationship between lesions and the trachea.
Objective To evaluate the rescue intubation induced by ketamine and midazolam in patients with acute respiratory failure.Methods 81 patients with acute respiratory failure admitted between June 2010 and June 2012 were recruited in the study. They were randomly divided to a MF group to receive 0. 05 mg/kg of midazolam + 1 to 2 μg/kg of fentanyl ( n =41) , and aMK group to received 0. 05 mg/kg of midazolam + 0. 5 to 1 mg/kg of ketamine ( n =40) for rescue intubation. The APACHEⅡ score on initial24 hours after admission in ICU, length of ICU stay, and 28-day mortality were recorded. The differences in arterial blood pressure, heart rate, respiration rate, and blood oxygen saturation before intubation and 10 minutes after intubation were compared. Incidences of hypotension and other adverse events and difficult intubation were also recorded.Results The midazolamdose in the MK group was significantly less than that in the MF group ( P lt; 0. 01) . The blood pressure in both groups decreased. The systolic blood pressure dropped most significantly in the MF group ( P lt;0. 05) . The incidence of hypotension was 41. 5% in the MF group, significantly higher than that in the MK group ( 20. 0% , P lt;0. 05) . The incidence of hypotension had no correlation with midazolamdosage ( P gt;0. 05) . There was no significant difference in adverse events except for the arrhythmia between two groups. The length of ICU stay and 28-day mortality were similar in both groups ( P gt; 0. 05) . The incidence of difficult tracheal intubation was nearly 50% in both groups.Conclusions In patients with respiratory failure, rescue intubation induced by ketamine can reduce the dose of midazolam and reduce the incidence of hypotension without more complications. The optimal dose of ketamine in induced tracheal intubation requires further study.
目的 研究氯胺酮能否降低咪達唑侖誘導急診危重患者氣管插管對血壓的影響。 方法 將2010年6月－2011年12月收治的56例急診危重呼吸衰竭成年患者，隨機分成咪達唑侖+芬太尼（MF）組和咪達唑侖+氯胺酮（MK）組，氣管插管前咪達唑侖0.05 mg/kg靜脈注入，然后MF組芬太尼2 μg/kg靜脈注入，MK組氯胺酮0.5 mg/kg靜脈注入，待患者達鎮靜狀態后實施氣管插管。記錄用藥前和插管后10 min的收縮壓（SBP）、舒張壓（DBP）、平均動脈壓（MAP）、心率（HR）的變化，觀察低血壓的發生情況。 結果 實施藥物誘導氣管插管后血壓下降以MF組更明顯（P＜0.01）。低血壓發生率MF組為51.7%，MK組為18.5%，兩組比較差異有統計學意義（χ2=6.715，P=0.01）。 結論 急診危重患者氣管插管應用氯胺酮可減少咪達唑侖所致低血壓的發生率。