围术期神经认知障碍患者远期认知功能下降的研究进展

围术期神经认知障碍（PND）是老年患者围术期常见的并发症之一，表现为围术期注意力不集中、思维逻辑能力下降、学习记忆能力减退，严重影响患者术后康复。近年来，大量研究表明术前已存在或术后早期出现的认知功能损害与术后远期认知功能下降相关，而干预术后早期认知功能改变或可影响术后远期认知发展轨迹，因此探索术后早期认知功能改变的干预方法和相关机制至关重要。本文对PND患者术后12个月后患者认知功能的发展轨迹及影响因素进行综述，以提供干预术后早期认知功能改变的思路或方法。     

胸部肿瘤切除联合3D打印碳纤维胸壁重建术患者的护理

目的总结胸部肿瘤切除联合3D打印碳纤维胸壁重建术患者的围术期护理经验。方法对12例行胸部肿瘤切除联合3D打印碳纤维胸壁重建术的患者,加强肺部感染预防与护理、伤口及皮瓣护理、排异反应预防等围术期护理。结果 12例患者术后均未发生排异反应;术后早期并发肺部感染1例、心律失常1例、伤口愈合不良1例,经处理后均痊愈;其余患者术区伤口均Ⅰ期愈合;胸腔引流管留置时间为(6.00±0.56) d,住院时间为(14.50±4.89)d。结论 3D打印医用复合碳纤维材料可用于胸部肿瘤切除术后的胸壁重建修复,系统的围术期护理能有效缩短平均住院时间,改善患者预后。     

围手术期新发房颤与结直肠癌预后的关系

目的探讨围手术期新发房颤与结直肠癌患者预后的关系。方法回顾性分析2014年1月至2015年1月期间福建医科大学附属龙岩第一医院180例结直肠癌患者的临床资料, 其中围手术期新发房颤47例, 无围手术期新发房颤133例。结果围手术期新发房颤组中年龄、术后平均血清C反应蛋白水平均高于对照组, 差异均有统计学意义(t=-3.080, P=0.002;t=-2.184, P=0.030)。与对照组相比, 围手术期新发房颤组住院时间长、进食时间晚, 差异均有统计学意义(t=-5.072, P=0.001;t=-2.577, P=0.011)。多因素分析结果显示, 围手术期新发房颤、较高的术后平均血清C反应蛋白水平、肿瘤低分化、肿瘤分期晚是影响结直肠癌患者预后的独立危险因素(HR=1.835, P=0.018;HR=1.008, P=0.017;HR=1.950, P=0.046;HR=1.300, P=0.047)。围手术期新发房颤组与对照组中位生存时间分别为59.05个月和63.23个月, 差异有统计学意义(P=0.005)。结论在接受结直肠癌手术的患者中, 围手术期新发房颤的发生与高龄和较高...     

心脏外科术后新发心房颤动的围术期处理

新发心房颤动(房颤)是心脏外科术后常见并发症。传统观念认为术后房颤是继发于炎症或手术刺激的良性心律失常,然而大量研究表明术后房颤显著增加患者不良心血管事件的发生风险。因此,针对术后房颤采取有效的干预措施具有重要意义。本文将围绕心脏手术术后房颤的围术期处理展开讨论,总结最新研究结果。     

急性胃穿孔手术患者围术期护理体会

目的探讨急性胃穿孔围术期护理干预方法及效果。方法对40例急性胃穿孔患者行完善术前检查、心理支持、病情观察、预防并发症等围术期综合护理干预。结果患者均顺利完成手术,手术时间(42.21±5.69)min,术中出血量(45.62±5.92)m L,住院时间(7.94±2.31)d,并发症发生率为7.50%(3/40),均经对症处理后治愈,术后胃肠功能恢复良好。结论对急性胃穿孔患者行围术期精心综合护理干预措施,可减少术后并发症,促进患者早期康复。     

实施护理干预预防颅脑肿瘤患者压疮的体会

目的探讨对颅脑肿瘤术患者实施综合护理干预预防压疮发生的疗效。方法对接受颅脑肿瘤手术的35例患者给予术前压疮风险评估,术后早期预防压疮康复指导等综合护理。回顾性分析患者的临床资料。结果本组围术期仅发生2例(5.71%)压疮,给予对症处理后痊愈。结论在颅脑肿瘤患者围术期实施综合护理干预,可有效减少压疮发生。     

主动脉弓腔内修复术后卒中的防治研究进展

传统开放性主动脉弓修复手术存在较高的围术期并发症和死亡风险。主动脉弓腔内修复术（EAAR）为开放手术高风险患者提供了微创治疗选择。然而,与传统开放手术相比,EAAR仍具有较高的卒中风险。分支技术是腔内治疗主动脉弓部疾病最具应用前景的技术之一,尽管其早期卒中风险略高于传统开放手术,但对于高风险患者来说,这样的风险是可以接受的。导致术后卒中的主要原因包括固体栓塞、气体栓塞和脑灌注不足。术前评估、围术期监测、药物预防和优化术中操作是预防EAAR术后卒中发生的关键策略。对于已经发生卒中的患者,及时诊断和评估、药物治疗和必要的手术干预是治疗的基石,而多学科有效协作对于改善患者的病情和预后亦尤为重要。目前,EAAR术后卒中的防治仍有很大的研究空间,因此,笔者就EAAR术后早期卒中的发生率、发生机制、危险因素以及预防和治疗策略方面进行论述,以期为临床工作提供思路。     

40例卵巢囊肿腹腔镜下剥除术围手术期的护理方法

目的总结卵巢囊肿腹腔镜下剥除术围手术期的护理方法。方法对我科收治的40例卵巢囊肿患者实施腹腔镜下卵巢囊肿剥除术,围术期加强心理辅导、生命体征监护并及时做好疼痛和并发症的预防等护理干预。结果 40例患者手术均顺利完成。围术期未发生电灼伤、腹腔感染、出血,盆腔粘连及尿潴留等并发症。患者均康复出院。住院时间为(5.98±1.02)d。结论对接受腹腔镜下剥除术的卵巢囊肿患者,围术期实施全面护理干预,可有效减少术后并发症,提高手术治疗效果和促进患者早期康复。     

择期手术患者围手术期死亡原因文献分析

目的归纳研究择期手术患者围手术期死亡原因,为加强围手术期管理,防治术后并发症、降低死亡率提供参考。方法:以“围手术期”“术前”“术中”“术后”“死亡”为检索词,在中国知网、万方数据库、维普数据库进行系统检索,收集资料建立围手术期死亡原因数据库,对数据进行归纳分析。结果:患者围手术期死亡率排在前三位的专科手术类型分别是心血管手术(6.26%)、关节手术(3.89%)、肝胆胰十二指肠手术(3.76%)。排在前三位的围手术期死亡原因分别是多器官功能衰竭(20.96%)、低心排综合征(18.74%)、感染(15.03%)。结论:择期手术围手术期术后严重并发症是导致患者死亡的主要原因,加强患者围手术期管理,预防并积极处理术后并发症,对减少患者围手术期死亡率具有重要意义。     

老年人工全膝关节置换术患者围手术期的护理

目的分析老年人工全膝关节置换术患者围手术期的护理方法。方法对接受人工全膝关节置换术的46例老年患者围术期实施心理干预、康复训练指导、并发症的预防与观察等综合护理措施。结果 46例患者手术过程顺利,切口愈合良好,住院时间15～22 d,平均19. 29 d。患者均痊愈出院。术后随访8～12个月,未出现感染、早期脱位、内固定物松动等并发症。末次随访,患者膝关节功能均恢复良好。结论加强老年人工全膝关节置换术患者围术期的心理干预、康复训练指导和并发症的预防等综合护理,能有效降低术后并发症的发生,改善患者术后预后。     

A Study on the Occurrence and Prevention of Perioperative Stroke after Coronary Artery Bypass Grafting

Cerebral infarction after coronary artery bypass grafting (CABG) is a serious complication and a problem that remains unsolved. We will report the onset of cerebral infarction in CABG patients in our institution, and its cause, preventive method. The subjects of this research were 761 patients who underwent on-pump isolated CABG. Preoperative, intraoperative and postoperative factors, onset of cerebral infarction and atrial fibrillation were investigated. Postoperative cerebral infarction and postoperative atrial fibrillation were recognized in 1.4% and 24% of the patients, respectively. The risk factors for cerebral infarction were carotid artery stenosis, cardiopulmonary bypass time >180 min, postoperative atrial fibrillation, and β-blocker non-use. The risk factors for postoperative atrial fibrillation were 75 or higher years of age, chronic kidney diseases, emergency surgery, cardiopulmonary bypass time >180 min, intraoperative carperitide non-use, intraoperative landiolol hydrochloride non-use, preoperative angiotensin II receptor blockers (ARB) non-use, preoperative calcium antagonist use, preoperative statin use, postoperative β-blocker non-use, and postoperative aldosterone blocker non-use. The results of this study showed that cerebral infarction occurs frequently in patients who have developed atrial fibrillation, and it was considered that perioperative cerebral infarction can be prevented by perioperative β-blocker, carperitide, anticoagulation therapy and adequate extracorporeal circulation. Since preoperative, intraoperative and postoperative drug use is closely involved in the risk factor for postoperative atrial fibrillation, it was considered possible that adequate perioperative drug therapy can prevent atrial fibrillation and onset of cerebral infarction. (This article is a secondary publication of J Jpn Coron Assoc 2014; 20: 91–7.)     

Total knee arthroplasty in patients 90 years of age and older

With increasing longevity, more patients older than age 90 now are becoming candidates for total knee arthroplasty. This article reviews our experience with the perioperative morbidity and early outcomes in 12 patients older than age 90, undergoing 15 total knee surgeries. Postoperative Knee Society clinical and functional scores showed excellent outcomes, and the quality of life is enhanced. There were no significant surgical complications; however, there were several nonsurgical complications, including mental confusion (3), urinary retention (3), atrial fibrillation (2), atrial flutter (1), and gallstone retention and gastrointestinal bleed (1). Most of these complications stemmed directly from the preoperative medical condition. These are predictive and therefore may be recognized early and treated aggressively. Total knee surgery can be performed safely in patients older than 90 years old with excellent pain relief and enhanced quality of life. The surgeon should be aware of the patient's past medical history because this predisposes to postoperative morbidity.     

Impact of intravenous magnesium on post-cardiothoracic surgery atrial fibrillation and length of hospital stay: a meta-analysis

Postoperative atrial fibrillation can occur in 25% to 40% of patients undergoing cardiothoracic surgery. Although the majority of postoperative atrial fibrillation is benign, it has been associated with prolonged hospital length of stay. Magnesium prophylaxis against postoperative atrial fibrillation has been evaluated in several clinical trials; however these trials were small in size and therefore conveyed mixed or inconclusive results. In an attempt to better understand magnesium's role in this setting, we conducted a meta-analysis. A systematic literature search was conducted from January 1999 through August 2004 to identify trials of prophylactic magnesium in the setting of cardiothoracic surgery. The primary outcome measure was the incidence of postoperative atrial fibrillation. Trials were further analyzed based on cumulative doses of magnesium and perioperative time of initiation of prophylaxis, as well as length of stay. Seven randomized trials were identified. Upon meta-analysis, magnesium was found to prevent postoperative atrial fibrillation with an odds ratio of 0.66 and 95% confidence interval of 0.51 to 0.87. The incidence of postoperative atrial fibrillation was also significantly reduced in the low dose with an odds ratio of 0.36 and 95% confidence interval of 0.23 to 0.56, and in the preoperative groups with an odds ratio of 0.46 and 95% confidence interval of 0.31 to 0.67. Prophylactic magnesium reduced length of stay (n = 6 studies) by a weighted mean difference of 0.29 days, with a 95% confidence interval 0.54 to 0.05. Prophylactic magnesium reduced cardiothoracic surgery patients' risk of postoperative atrial fibrillation and length of stay. Administering lower doses and initiating prophylaxis in the preoperative period achieved the greatest reduction in postoperative atrial fibrillation.     

Atrial fibrillation occurring early after cardiovascular surgery: impact of the surgical procedure

Purpose

Postoperative atrial fibrillation/flutter (AF) is still the most common complication after cardiovascular surgery, and it is important to determine the risk factors in order to establish effective management for recent postoperative AF. This study investigated the clinical predictors of postoperative AF using a prospectively collected database.

Methods

A total of 418 patients underwent cardiovascular surgery and were enrolled in this study. The relationship between postoperative AF and perioperative factors was examined.

Results

Postoperative AF occurred in 134 patients (32.1 %). A univariate analysis showed that an older age, hypertension, perioperative transfusion, use of cardiopulmonary bypass and thoracic aortic surgery were significantly associated with postoperative AF. The incidence of fibrillation was 49.4 % (39/79) in patients having aortic surgery. A multivariate analysis revealed that an older age, transfusion, and aortic surgery were all independent predictors of postoperative AF.

Conclusions

An older age, transfusion, and aortic surgery are strong independent predictors of postoperative AF. These findings help to identify high-risk patients for AF after cardiovascular surgery. Careful perioperative management is required for older patients undergoing aortic surgery with cardiopulmonary bypass.     

Amiodarone reduces the incidence of atrial fibrillation after coronary artery bypass grafting

OBJECTIVE: The purpose of this study was to evaluate the safety and efficacy of postoperative administration of prophylactic amiodarone in the prevention of new-onset postoperative atrial fibrillation in patients undergoing coronary artery bypass grafting. METHODS: In this prospective study 157 patients were randomly divided into two groups: 77 patients (amiodarone group) received intravenous amiodarone in a dose of 10 mg/kg/d for postoperative 48 hours. On postoperative day 2 oral amiodarone was started with a dose of 600 mg/d for 5 days, 400 mg/d for the following 5 days, and 200 mg/d for 20 days, and 80 patients received placebo (control group). RESULTS: Preoperative patient characteristics and operative variables were similar in the two groups. Postoperative atrial fibrillation occurred in 8 patients (10.4%) receiving amiodarone and in 20 (25.0%) patients receiving placebo (P =.017). Duration of atrial fibrillation was 12.8 +/- 4.8 hours for the amiodarone group compared with 34.7 +/- 28.7 hours for the control group (P =.003). The maximum ventricular rate during atrial fibrillation was slower in the amiodarone group than in the control group (105.9 +/- 19.1 beats per minute and 126.0 +/- 18.5 beats per minute, respectively, P =.016). The two groups had a similar incidence of complication other than rhythm disturbances (20.8% vs 20.0%, P =.904). Amiodarone group patients had shorter hospital stays than that of control group patients (6.8 +/- 1.7 days vs 7.8 +/- 2.9 days, P =.014). The in-hospital mortality was not different between two groups (1.3% vs 3.8, P =.620). CONCLUSIONS: Postoperative intravenous amiodarone, followed by oral amiodarone, appears to be effective in the prevention of new-onset postoperative atrial fibrillation. It also reduces ventricular rate and duration of atrial fibrillation after coronary artery bypass grafting. It is well tolerated and decreases the length of hospital stay.     

Predictors of atrial fibrillation after off-pump coronary artery bypass graft surgery

OBJECTIVE: Atrial fibrillation is the most common complication after coronary artery bypass graft surgery. This arrhythmia may lead to hemodynamic compromise, prolonged hospitalization, and increased risk for cerebral thromboembolism. Older age is the only variable consistently associated with the development of postoperative atrial fibrillation; however, no strong predictive model exists. The purpose of this study was to identify perioperative characteristics associated with new-onset atrial fibrillation in patients undergoing off-pump coronary artery bypass grafting. DESIGN: Prospective, observational. SETTING: University tertiary care hospital. PARTICIPANTS: One hundred sixty consecutive patients undergoing off-pump coronary artery bypass grafting. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Incidence of postoperative atrial fibrillation was the major outcome. Atrial fibrillation occurred in 33 patients (20.6%). Multivariate analysis identified reintervention (odds ratio 26.8), revascularization of the ramus medianus (odds ratio 3.9), and age (odds ratio 1.069 per year) as the only independent predictors of postoperative atrial fibrillation. All patients were in sinus rhythm at hospital discharge. One hospital death was noted. CONCLUSIONS: Despite the less invasive approach, the incidence of postoperative atrial fibrillation is high after off-pump coronary artery bypass grafting. Older age, grafting of the ramus medianus, and a redo operation were predictors of new-onset postoperative atrial fibrillation. It is possible that left atrial stretching with heart dislocation during revascularization of the lateral wall could lead to postoperative atrial fibrillation.     

左房顶-房隔径路二尖瓣手术与心律失常

目的：验证左房顶－房隔径路二关瓣手术的安全性。方法：１９９３年１０月至１９９７年１２月,采用此径路行二尖瓣手术５１例,其中二尖瓣替换术（ＭＶＲ）１８例,二尖瓣成形术（ＭＶＰ）１例,二尖瓣及主动脉瓣替换术（ＤＶＲ）３２例。     

A perspective on postoperative atrial fibrillation.

Some patients develop atrial fibrillation after any type of surgery, some patients develop atrial fibrillation only after cardiac surgery, and still other patients never develop postoperative atrial fibrillation. Despite the inherent difficulty in identifying the causes of postoperative atrial fibrillation, several important observations have been made during the recent past that may play a role in treating or even preventing this common and serious postoperative problem. This communication provides a framework within which the problem of postoperative atrial fibrillation can be evaluated and treated.     

Efficacy of low-dose landiolol,an ultrashort-acting β-blocker,on postoperative atrial fibrillation in patients undergoing pulmonary resection for lung cancer

Purpose  

Postoperative atrial fibrillation is the most common complication encountered during the early postoperative period following a pulmonary resection procedure. Landiolol is a newly developed, ultrashortacting, β-adrenoceptor antagonist. The objective of the present study was to evaluate the efficacy and safety of low-dose landiolol for postoperative atrial fibrillation in patients undergoing pulmonary resection for lung cancer.     

The effects of steroids on the occurrence of postoperative atrial fibrillation after coronary artery bypass grafting surgery: a prospective randomized trial

OBJECTIVE: Atrial fibrillation remains one of the most common postoperative complications of coronary artery bypass grafting. Despite many clinical studies, there is still no consensus regarding the best prevention strategy for atrial arrhythmia. A randomized, double-blind, placebo-controlled trial was conducted to determine the effect of steroids on the occurrence of atrial fibrillation after elective coronary artery bypass grafting. METHODS: Eighty-eight consecutive patients were prospectively entered in this study. No patient had documented or suspected arrhythmias before surgery. Forty-three patients received 1 g of methylprednisolone before surgery and 4 mg of dexamethasone every 6 hours for 1 day after surgery, and 43 patients received only placebo. The primary end point was the overall occurrence of postoperative atrial fibrillation. RESULTS: Postoperative atrial fibrillation occurred in 9 (21%) of the 43 patients in the steroid group, as compared with 22 (51%) of the 43 patients in the placebo group ( P = .003). Minor postoperative complications occurred in 15 steroid patients (35%) and in 6 patients (14%) receiving placebo ( P = .01). Major complications occurred in 4 patients who received steroids (9%) and in 2 patients (5%) who received placebo ( P = .68; for all complications, P = .05). CONCLUSIONS: Prophylactic short-term steroid administration in patients undergoing coronary artery bypass grafting significantly reduced postoperative atrial fibrillation. In this study, there was no significant difference between the steroid group and the placebo group with regard to the length of hospital stay; however, the steroid group had more complications, which may contribute to prolonged hospitalization.