胸腔阻抗无创血流动力学监测在非心脏手术老年患者全麻术后的临床应用

目的 评价胸腔阻抗(TEB)无创血流动力学监测在非心脏手术老年患者全麻术后的应用价值.方法 选取收治于ICU的非心脏手术全麻术后老年患者56例,按照随机数字表法分为对照组和TEB组,每组28例,所有患者均给予常规监护并监测中心静脉压,TEB组在上述基础上行TEB无创血流动力学监测,根据监测结果给予利尿药、正性肌力药、血管扩张剂或补液治疗;比较两组患者心率、平均动脉压、中心静脉压、尿量以及机械通气时间、住ICU时间.结果 两组患者同一时间相应的心率、平均动脉压、中心静脉压、尿量比较差异均无统计学意义(P＞0.05).机械通气时间TEB组患者为(19.5±15.9)h,较对照组的(25.5±16.5)h缩短,但差异无统计学意义(P=0.173);住ICU时间TEB组患者为(2.8±1.0)d,较对照组的(3.6±1.6)d缩短,且差异有统计学意义(P=0.032).结论 TEB无创血流动力学监测对非心脏手术老年患者全麻术后的治疗具有指导作用,有利于患者的术后恢复.

Abstract：

Objective To evaluate the application value of non-invasive hemodynamic monitoring by thoracic electrical bioimpedance (TEB) in elderly non-cardiac surgery patients after general anaesthesia.Methods Fifty-six elderly non-cardiac surgery patients after general anaesthesia were divided into control group and TEB group with 28 patients in each group by random digits table. All patients received standardized care including central venous pressure (VAP). Besides these monitoring, hemodynamic monitoring by TEB was used to evaluate the hemodynamic state of patients in TEB group. Diuretics, inotropic agents, vasoactive drugs or intravenous fluid therapy were used according to monitoring guidance. The heart rate (HR), mean arterial pressure (MAP), VAP, urine output (UO) were recorded in different time. The length of mechanical ventilation and ICU stay were also recorded. The difference in HR, MAP, VAP, UO, the length of mechanical ventilation and ICU stay between two groups were analyzed. Results The differences between two groups had no significance in HR, MAP, VAP, UO at the same time (P ＞ 0.05 ). The length of mechanical ventilation of TEB group [ (19.5±15.9)h] was shorter as compared to that of control group [ (25.5 ± 16.5) h ], but the difference was not significant (P =0.173). The ICU stay of TEB group [(2.8 ± 1.0) d ] was shorter as compared to that of control group[(3.6±1.6)d] and the difference was significant (P=0.032). Conclusion Non-invasive hemodynamic monitoring by TEB can monitor the changes of hemodynamics and direct treatment in elderly non-cardiac surgery patients after general anaesthesia.     

快速康复外科在结直肠癌手术中的应用

目的 探讨快速康复外科在结直肠癌手术中的应用.方法 选取80例结直肠癌手术患者,按随机数字表法分为观察组和对照组,每组40例,分别采用快速康复外科治疗及传统方法 治疗,比较两组术后首次排气、排便时间及住院时间、术后并发症发生率、再住院率及住院费用.结果 观察组首次排气、排便时间及住院时间[分别为(2.7±0.9)、(2.9±0.1)、(5.8±1.0)d]明显短于对照组[分别为(3.9±0.5)、(4.2±0.3)、(8.3±1.2)d],术后并发症发生率[7.5%(3/40)]及住院费用[(1.83±0.22)万元]也明显低于对照组[分别为27.5%(11/40)、(2.35±0.36)万元],差异均有统计学意义(P＜0.05).结论 采用快速康复外科技术可以有效促进结直肠癌患者术后胃肠道功能的恢复,减少并发症的发生并节省住院费用.

Abstract：

Objective To investigate the feasibility of fast-track surgery in colorectal surgery.Methods Eighty consecutive patients with colorectal cancer admitted for colorectal surgery were divided into two groups by random digits table with 40 cases each. Group A was treated with the new concept of fasttrack surgery and group B was treated with the traditional methods of operation. The time of postoperative bowel venting and defecation,hospital stay time, the rate of complication, the rate of readmission and the total cost during hospitalization were compared. Results The time of postoperative bowel venting and defecation,hospital stay time were shorter in group A [(2.7 ± 0.9), (2.9 ± 0.1 ), (5.8 ± 1.0) d,respectively]than those in group B [( 3.9 ± 0.5 ), (4.2 ± 0.3 ), ( 8.3 ± 1.2) d, respectively] and the rate of complication and the total cost during hospitalization in group A [7.5%(3/40), ( 1.83 ± 0.22) ten thousand yuan] were lower than those in group B[27.5%(11/40), (2.35 ± 0.36) ten thousand yuan](P＜ 0.05). Conclusion The new concept of fast-track surgery can accelerate recovery after colorectal resection,reduce the rate of overall complications and total cost during hospitalization.     

快速康复方案在肛肠外科围手术期的临床研究

目的 研究快速康复方案在肛肠外科围手术期的安全性及有效性.方法 将169例结直肠、肛管恶性肿瘤围手术期患者按随机数字表法分为快速康复治疗方案组(观察组)86例与传统治疗方案组(对照组)83例,比较两组患者术后开始下床活动时间、首次肠道排气时间、停止静脉输液时间、住院时间、治疗费用及术后并发症的发生情况.结果 观察组术后首次肠道排气时间(33.6±12.9)h,停止静脉输液时间(4.5±1.3)d,住院时间(5.6±1.2)d,治疗费用(1.5±0.3)万元,对照组分别为(81.7±20.1)h、(7.4±1.6)d、(8.9±2.7)d、(1.6±0.4)万元,两组比较差异均有统计学意义(P＜0.01或＜0.05);观察组术后并发症的发生率[5.8%(5/86)]明显低于对照组[16.9%(14/83)](P＜0.05).结论 快速康复方案在肛肠外科围手术期的应用安全、有效、有益.

Abstract：

Objective To study the safety and efficacy of fast track program in anorectal surgery perioperative period. Methods One hundred and sixty-nine cases of rectal cancer were divided into the study group of 86 patients with fast track program, and the control group of 83 patients with traditional programs by random digits table. Both groups were compared from the time out of bed, the first intestinal discharge time,intravenous fluids stopping time,length of hospital stay,total cost of treatment and the incidence of postoperative complications. Results The study group compared with the control group: the first intestinal discharge time [(33.6 ± 12.9) h vs. (81.7 ± 20.1) h], intravenous fluids stopping time [(4.5 ±1.3) d vs.(7.4 ± 1.6) d],and length of hospital stay [(5.6 ± 1.2) d vs.(8.9 ±2.7) d],the total cost of treatment [(15 000 ± 3000) yuan vs. (16 000 ± 4000) yuan], the differences were statistically significant (P ＜ 0.01 or ＜ 0.05),and had less incidence of postoperative complications in study group than that in control group [5.8% (5/86) vs. 16.9% (14/83)], the difference was statistically significant (P ＜ 0.05).Conclusions Fast track program in anorectal surgery perioperative period is safe and effective, beneficial,conducive to rehabilitation of patients.     

含橄榄油脂肪乳剂在肝叶切除患者术后肠外营养中的应用

目的 研究含橄榄油脂肪乳剂在肝叶切除患者术后肠外营养中应用的安全性和有效性.方法 31例选择性肝叶切除术后患者按入院顺序用随机数字表法分为对照组(n=16)和研究组(n=15),两组患者在术后48～72 h后接受连续6 d的等氮、等热量的肠外营养支持.研究组使用含橄榄油脂肪乳,对照组使用标准的中/长链脂肪乳.分别于术前和术后第1天、第7天取患者清晨空腹外周静脉血,检测肝功能指标和血浆蛋白水平,并观察脂肪乳的安全性和术后患者恢复情况.结果 两组患者术前总胆红素、直接胆红素、谷草转氨酶、谷丙转氨酶、碱性磷酸酶、总蛋白、白蛋白和前白蛋白具有可比性(P均>0.05).两组患者术后的安全性及肝功能指标差异均无统计学意义(P均>0.05),但研究组术后第7天血浆总蛋白、自蛋白和前白蛋白较对照组更快恢复到正常水平,与对照组相比差异具有统计学意义[(57.57±9.84)g/L比(47.76±6.53)g/L,P=0.000;(31.29±3.11)g/L比(26.34±4.87)g/L,P=0.000;(0.188±0.059)g/L比(0.103±0.037)g/L,P=0.000],住院时间也明显缩短[(13.1±1.2)d比(15.2±1.1)d,P=0.041].研究组与对照组的并发症发生率分别为26.7%和31.3%.结论 含橄榄油脂肪乳剂具有很好的耐受性,能够促进术后血浆蛋白的恢复;可能有益于缩短术后住院时间,但对术后并发症发生率无明显影响.

Abstract：

Objective To assess the safety and efficacy of an olive oil-based lipid emulsion for parenteral nutrition in patients after hepatectomy.Methods Thirty-one postoperative patients with elective hepateetomy were randomized to receive isonitrogenous,isocalorie parenteral nutrition over 6 days after liver lobectomy(48-72hours)with either olive oil-based lipid emulsion(study group,n=15)or standard soybean oil emulsion(control group,n=16).The liver function and plasma protoins were assessed using peripheral venous blood collected before surgery,one day after surgery,and 7 days after surgery.The safety profiles of emulsion supports and postoperative rehabilitation were also assessed.Results The preoperative serum levels of total bilirubin,direct bilirubin,alanine amiotransferase,aspartate aminotransferase,alkaline phosphatase,total protein,albumin,and prealbumin were comparable between the two groups(all P>0.05).Although the Postoperative safety profile and liver function were not significantly different between two groups(all P>0.05),plasma total proteins,albumin,and prealbumin returned to the normal levels significantly faster in the study group than in control group[(57.57±9.84)g/L vs.(47.76±6.53)g/L,P=0.000;(31.29±3.11)g/L vs.(26.34±4.87)g/L,P=0.000;(0.188±0.059)g/L vs.(0.103±0.037)g/L,P=0.000]on the 7th Postoperative day,and the Postoperative hospital stay was also significantly shorter in the study group[(13.1±1.2)d vs.(15.2±1.1)d,P=0.041].The incidence of postoperative complications in study group and control group was 26.7%and 31.3%.respectively.Conclusions Treatment with the new olive oil-based lipid emulsion is weU tolerated in hepatectomy patients.It can speed up plasma proteins recovery and may shorten postoperative hospital stay,although it does not remarkably decrease the incidence of postoperative complications.     

不同通气模式在慢性阻塞性肺疾病合并呼吸衰竭方面的效果比较

目的 探讨比较不同通气模式在慢性阻塞性肺疾病(COPD)合并呼吸衰竭中的效果.方法 选取50例COPD合并呼吸衰竭患者,按随机数字表法分为A组和B组,每组25例,均采用有创通气,出现肺部感染控制窗后分别采用同步间歇指令通气(SIMV)+压力支持通气(PSV)和PSV+呼气末正压(PEEP)模式进行治疗,比较两组患者的机械通气时间、住院时间、再插管、并发症及治疗前后的血清白细胞介素(IL)-8、超敏C反应蛋白(hs-CRP)、IL-4、干扰素(IFN)-γ水平.结果 B组的机械通气时间、住院时间短于A组[(11.8±2.3)、(16.8±3.2)d比(20.3±2.0)、(28.8±4.1)d],再插管率、并发症发生率均低于A组[8%(2/25)、8%(2/25)比24%(6/25)、24%(6/25)],而治疗后B组出现肺部感染控制窗后24、48 h的血清IL-8、hs-CRP、IL-4、IFN-γ水平均低于A组,差异有统计学意义(P＜0.05).结论 COPD合并呼吸衰竭行机械通气患者在出现肺部感染控制窗后及早行鼻面罩给氧效果更好,应引起重视.

Abstract：

Objective To study and compare the effect of different ventilation modes in chronic obstructive pulmonary diseases (COPD) combined with respiratory failure. Methods Fifty patients with COPD combined with respiratory failure were divided into group A and group B with 25 cases each by random digits table,and they were treated with invasive positive pressure ventilation. Then the two groups were respectively treated with synchronized intermittent mandutory ventilation (SIMV) + pressure suppert ventilation (PSV) and PSV + positive end-expiratory pressure (PEEP) after appearing the pulmonaryinfection-control- window. And the time of mechanical ventilation, length of hospital stay, reintubation rate, complication rate and serum interleukin (IL)-8,high Sensitiveity c-reactive protein (hs-CRP), IL-4 and interferon (IFN)- γ of the two groups before and after the treatment was analyzed and compared. Results The time of mechanical ventilation and length of hospital stay in group B was shorter than that in group A [(11.8 ± 2.3), (16.8 ± 3.2) d vs. (20.3 ± 2.0), (28.8 ± 4.1) d], and the reintubation rate and complication rate was lower than that in group A [8%(2/25), 8%(2/25) vs. 24%(6/25), 24%(6/25)]. The levels of serum IL-8, hs-CRP, IL-4 and IFN- 7 were lower in group B than those in group A (P ＜ 0.05). Conclusion The effect of nasal mask inhaled oxygen early given to COPD combined with respiratory failure is better, and it should be paid attention to.     

多通道微创经皮肾镜结合钬激光治疗复杂性肾结石的临床研究

目的 探讨多通道微创经皮肾镜结合钬激光治疗复杂性肾结石的临床疗效.方法 将86例复杂性肾结石患者分为两组,研究组(46例)采用多通道微创经皮肾镜结合钬激光碎石术,对照组(40例)行单通道微创经皮肾镜结合体外冲击波碎石术治疗.比较两组碎石取出时间、结石清除率、术后血红蛋白下降率、术中输血率、术后住院时间及并发症发生率.结果 研究组的碎石取出时间为(102±23)min,对照组为(121±28)min,两组比较差异无统计学意义(P＞0.05).研究组术后血红蛋白下降率为6.5%(3/46)、术中输血率为17.4%(8/46)、结石清除率为82.6%(38/46)、术后住院时间为(5.6±1.7)d,对照组分别为12.5%(5/40)、22.5%(9/40)、72.5%(29/40)、(7.4±1.8)d,两组比较差异均有统计学意义(P＜0.05).结论 多通道微创经皮肾镜结合钬激光治疗复杂性肾结石手术时间短、术中出血少、结石清除率高,且并发症相对较少,值得临床推广应用.

Abstract：

Objective To investigate the effect of multi-channel minimally invasive percutaneous nephrolithotomy in combination with Yag laser in complex renal calculi operation. Methods Eighty six complex renal calculi patients were divided into two groups, study group (46 cases) was treated with multi-channel minimally invasive percutaneous nephrolithotomy combined with Yag laser, control group was treated with single-channel minimally invasive percutaneous nephrolithotomy combinated with extracorporeal shock wave treatment. Comparison of gravel removed time, stone clearance rate,postoperative hemoglobin decreasing rate, blood transfusion rate of surgery,length of stay time and operative complications were done between the two groups, the results were analysed statistically. Result The gravel removed time was (102±23) min in study group, and ( 121 ± 28) min in control group, there was no significant difference between the two groups(P ＞ 0.05 ). In study group, postoperative hemoglobin decreasing rate was 6.5%(3/46), blood transfusion rate of surgery was 17.4% (8/46), stone clearance rate was 82.6%( 38/46 ), length of stay time was (5.6 ± 1.7) d,while those in control group was 12.5%(5/40),22.5%(9/40),72.5%(29/40), (7.4 ± 1.8) d,respectively. There was statistical significance between the two groups(P＜ 0.05 ). Conclusion Multi-channel minimally invasive percutaneous nephrolithotomy in combination with Yag laser in the treatment of complex renal calculi has the shorter operation time, less blood loss,less complications and higher stone clearance rate, and is worthy of promotion.     

含橄榄油脂肪乳剂在肝叶切除患者术后肠外营养中的应用

Objective To assess the safety and efficacy of an olive oil-based lipid emulsion for parenteral nutrition in patients after hepatectomy.Methods Thirty-one postoperative patients with elective hepateetomy were randomized to receive isonitrogenous,isocalorie parenteral nutrition over 6 days after liver lobectomy(48-72hours)with either olive oil-based lipid emulsion(study group,n=15)or standard soybean oil emulsion(control group,n=16).The liver function and plasma protoins were assessed using peripheral venous blood collected before surgery,one day after surgery,and 7 days after surgery.The safety profiles of emulsion supports and postoperative rehabilitation were also assessed.Results The preoperative serum levels of total bilirubin,direct bilirubin,alanine amiotransferase,aspartate aminotransferase,alkaline phosphatase,total protein,albumin,and prealbumin were comparable between the two groups(all P>0.05).Although the Postoperative safety profile and liver function were not significantly different between two groups(all P>0.05),plasma total proteins,albumin,and prealbumin returned to the normal levels significantly faster in the study group than in control group[(57.57±9.84)g/L vs.(47.76±6.53)g/L,P=0.000;(31.29±3.11)g/L vs.(26.34±4.87)g/L,P=0.000;(0.188±0.059)g/L vs.(0.103±0.037)g/L,P=0.000]on the 7th Postoperative day,and the Postoperative hospital stay was also significantly shorter in the study group[(13.1±1.2)d vs.(15.2±1.1)d,P=0.041].The incidence of postoperative complications in study group and control group was 26.7%and 31.3%.respectively.Conclusions Treatment with the new olive oil-based lipid emulsion is weU tolerated in hepatectomy patients.It can speed up plasma proteins recovery and may shorten postoperative hospital stay,although it does not remarkably decrease the incidence of postoperative complications.     

管状胃技术在26例食管、贲门癌根治术中的应用分析

目的 评价管状胃技术在食管、贲门癌根治术中的临床应用效果.方法 选取2007年1月至2010年6月收治的食管、贲门癌患者50例,按采取的手术方法不同分为管状胃组(26例)和胸腔胃组(24例).管状胃组中食管癌21例,贲门癌5例;术中左颈部吻合1例,主动脉弓上吻合11例,主动脉弓下吻合9例,贲门癌根治5例.胸腔胃组食管癌20例,贲门癌4例;术中左颈部吻合1例,主动脉弓上吻合11例,主动脉弓下吻合8例,贲门癌根治4例.观察两组患者手术后吻合口瘘发生率、手术时间、术后住院时间等临床指标.结果 两组患者均顺利完成手术,两组均无吻合口瘘发生.胸腔胃组术后发生肺部感染气管切开3例,死亡1例.管状胃组与胸腔胃组手术时间分别为(175±11)、(182±6)min,术后住院时间分别为(16.8±9.8)、(17.0±11.3)d,差异均无统计学意义(t=1.556,P=0.072;t=1.495,P=0.068).结论 管状胃在食管癌手术中并发症发生率较低,不增加手术时间和住院时间,可改善患者的生活质量,具有较好的临床应用价值.

Abstract：

Objective To evaluate the clinical application of gastric tube in radical operation for patients with esophageal or cardial carcinoma. Methods From January 2007 to June 2010,50 patients with esophageal or cardial carcinoma were enrolled. Based on surgical methods, they were divided into the gastric tube group (26 cases) and the traditional way group (24 cases). Among the gastric tube group, 21 patients had esophageal carcinoma,and the other 5 patients had cardial carcinoma,and 1 patient was treated with anastomosis in the left neck, 11 patients with anastomosis in upper aortic arch,9 patients with anastomosis in lower aortic arch and 5 cardial carcinoma patients underwent radical resection. Among the traditional way group, 20 patients had esophageal carcinoma,and the other 4 patients had cstdial carcinoma, 1 patient wastreated with anastomosis in the left neck, 11 patients with anastomosis in upper aortic arch, 8 patients with anastomosis in lower aortic arch and 4 cardial carcinoma patients underwent radical resection. The rate of anastomotic leakage, operation time, and length of stay in hospital of the two groups were observed. Results All surgeries were successfully performed. There was no anastomotic leakage case in the two groups, while there were 3 cases pulmonary infection and 1 case death in the traditional way group. There was no statistical difference in operation time [(175 ± 11) min vs. (182±6) min, t = 1.556, P = 0.072] and length of stay in hospital [(16.8 ±9.8) d vs.(17.0 ± 11.3) d,t = 1.495,P= 0.068] between the gastric tube group and the traditional way group. Conclusion Gastric tube has good value in clinical application with fewer complications and without prolonging operation and hospitalization time, which can surely ameliorate quality of life.     

学龄期儿童膳食钙与骨密度的关系

Objective To investigate the prevalence of overweight and obesity and the nutritional status of dietary calcium intake in school-age children in Shanghai and to analyze the relationship between dietary calcium and bone mineral density (BMD).Methods A cross-sectional study was conducted in the second and third grade students of 10 primary schools in Yangpu District and Baoshan District in Shanghai. Food frequency questionnaire was used tu estimate the relative intake of dietary calcium of students in 6 primary schools in Baoshnn District. Quantitative ultrasound bone density examination was used to estimate the calcaneal BMD.The relation-ship between calcium intake and BMD was analyzed.Results The average calcium intake was 647 mg/d among ested students.BMD was not significantly different among different age groups (F=1.595,P=0.173),while Z-score was significantly different among different age groups (F=16.02,P=0.000).The total calcium intake was not correlated with BMD or Z-score.The percentage of dairy calcium intake was positively correlated with BMD (r=0.097,P=0.015)and Z-score (r=O.117,P=0.003),the percentage of non-dairy calcium intake and the non-dairy calcium intake were negatively correlated with BMD (r=-0.097,P=0.015) and Z-score(r=-0.110,P=0.006).When the total dietary calcium intake was ≥600 mg/d,BMD and Z-score significantly higherin students with high dairy calcium intake than those with low dairy calcium intake (P<0.05).When the total dietary calcium intake was <600mg/d,BMD and Z-score were higher in students with high dairy calcium in-take than in those with low dairy calcium intake,although no statistical significance was noted (P>0.05).Conclusions BMD and Z-score increase along with the increase of dairy calcium intake.Such effect becomes even more obvious when the total dietary calcium intake is ≥600 mg/d.     

依托咪酯与普鲁泊福在困难气管纤维支气管镜引导插管时安全性比较

Objective To investigate the risk factors and anticoagulation parameters in patients of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) combined with deep venous thrombosis (DVT). Methods All of 110 AECOPD patients were divided into two groups according to Doppler examination of lower extremities: DVT group and non-DVT group. The risk factors and anticoagulation parameters were compared. Results Twelve cases (10.9%) were in DVT group,of whom 2 cases (1.8%)had pulmonary embolism. The rate of lying in bed > 3 d, smoke, mechanical ventilation, hospital stays and the levels of PaCO2 were significantly higher in DVT group than those in non-DVT group (P < 0.01 or <0.05 ). In DVT group, the activity of antithrombin Ⅲ and the level of protein S decreased (P < 0.05 ), and the level of D-Dimer increased (P < 0.05). Conclusions Long-term bed, smoke and mechanical ventilation requirement are the main risk factors of DVT in patients with AECOPD. Respiratory failure (type Ⅱ ) is easier to combine with DVT. Abnormality of coagulation and fibrinolytic system exists in AECOPD with DVT.     

阵发性心房颤动和心房扑动患者血清脑钠肽水平变化及临床意义

目的 观察阵发性心房颤动和心房扑动患者血清脑钠肽(BNP)水平,并探讨其临床意义.方法 选择非瓣膜性心脏病阵发性心房扑动患者126例(心房扑动组)、阵发性心房颤动患者96例(心房颤动组)及对照组72例作为研究对象.其中心房扑动组中,24 h内转复42例(A组),24～48h转复51例(B组),48h内未转复33例(C组).采用酶联免疫吸附法测定各组血清BNP水平,应用超声心动图测定各组左房内径(LAD)和左室射血分数(LVEF)并进行比较.结果 A、B、c组和心房颤动组BNP水平分别为(764.9±123.3)、(857.8±106.2)、(975.3±99.5)、(1137.2±113.2)ng/L,明显高于对照组的(251.3±42.5)ng/L,差异有统计学意义(P<0.05),而A、B、C组中BNP水平依次升高,两两比较差异有统计学意义(P<0.05);心房颤动组BNP水平明显高于A、B、C组(P<0.05).A、B、C组和心房颤动组LAD分别为(4.11±0.49)、(3.97±0.50)、(4.19±0.76)、(4.08±0.51)cm,明显高于对照组的(3.22±0.87)cm,差异有统计学意义(P<0.05),而A、B、C组与心房颤动组LAD比较差异无统计学意义(P>0.05).各组间LVEF比较差异无统计学意义(P>0.05).结论 阵发性心房颤动与心房扑动都是促进BNP分泌的重要因素,BNP对预测阵发性心房扑动的转复效果具有重要的临床意义.     

快速康复外科在胃癌患者围手术期应用的临床效果

目的 评价围手术期快速康复外科方案在胃癌患者中应用的临床效果。方法根据入选标准,82例胃癌患者进入本研究并随机分为两组,每组41例,一组为应用快速康复外科方案的研究组,另一组为应用传统方法的对照组。比较两组术后首次排便时间、术后住院时间、住院总费用和术后并发症的发生率。结果研究组术后首次排便时间为（45．58±26．91）h,显著早于对照组的（58．01±23．5）h（P=0．0287）,术后住院时间为（9．4±3．3）d,显著短于对照组的（12．4±3．6）d（P=0．0002）,住院总费用为（2．96±0．44）万元,显著少于对照组的（3．46±0．34）万元（P〈0．0001）。研究组和对照组并发症发生率分别为7．3％和17．1％,差异无统计学意义（P=0．232）。结论围手术期应用快速康复外科方案可以明显加快胃癌患者术后康复,缩短术后住院时间,降低医疗费用。     

心脏瓣膜手术同期冠状动脉旁路手术治疗冠心病合并瓣膜病的临床观察

目的探讨心脏瓣膜手术同期冠状动脉旁路手术(CABG)治疗冠心病合并瓣膜病的可行性。方法回顾性分析2005年1月-2011年8月海南农垦总医院行瓣膜手术和CABG的60例患者的临床资料,60例患者按是否同期行心脏瓣膜手术与CABG分为同期组和非同期组,比较两组术后临床指标和随访预后结果。结果同期组术后呼吸机辅助通气时间、ICU室停留时间、术后出院时间均显著低于非同期组,相比较差异有统计学意义(t=12.25、14.89、13.20,P<0.01);同期组术后房颤、围手术期心梗、恶性心律失常的发生率均显著低于非同期组,相比较差异有统计学意义(χ2=6.84、11.40、8.86,P<0.05);随访期内,同期组死亡率、瓣周漏发生率和永久性起搏器植入率均显著低于非同期组,相比较差异有统计学意义(χ2=20.89、7.60、5.07,P<0.05)。结论冠心病合并瓣膜病老年患者同期行CABG与心脏瓣膜手术是可行的。术前和术后要做好对症处理,术中做好心肌保护,可以大大降低手术的死亡率和并发症的发生率。     

曲美他嗪对非体外循环冠状动脉旁路移植术患者B型钠尿肽和心肌肌钙蛋白Ⅰ的影响

目的 观察非体外循环冠状动脉旁路移植术(OPCAB)患者外周血中B型钠尿肽(BNP)和心肌肌钙蛋白Ⅰ(cTnI)在围手术期的变化情况及其在心脏外科的临床应用价值,并探讨曲美他嗪预处理对心肌的保护效果.方法 将103例择期行OPCAB的冠心病患者按随机数字表法分为曲美他嗪组(52例)和对照组(51例).分别于术前及术后24h、72 h、7 d时检测外周血BNP和cTnI水平.结果 曲美他嗪组术后24 h、72 h、7dBNP水平[分别为(224.5±12.0)、(331.2±22.6)、(82.4±3.3)ng/L]均低于对照组[分别为(294.7±11.8)、(383.9±28.3)、(112.4±12.5)ng/L](P＜0.05);曲美他嗪组术后24 h、72 h、7 d cTnI水平[分别为(0.21±0.04)、(1.32±0.49)、(0.26±0.04)μg/L]均低于对照组[分别为(1.20±0.13)、(2.35±0.54)、(0.75±0.21)μgL](P＜0.05);BNP水平术后24 h即有上升,72 h达峰值,并维持至术后7d.BNP与cTnI呈显著正相关(r=0.635,P＜0.05),与左室射血分数(LVEF)呈显著负相关(r=-0.674,P＜0.01).结论 通过OPCAB术后外周血BNP和cTnI水平升高可以了解患者心功能状况,曲美他嗪可降低OPCAB患者术后BNP和cTnI的释放.     

心脏瓣膜替换伴与不伴心房颤动射频消融术后早期心功能比较

目的 比较心脏瓣膜替换伴与不伴心房颤动射频消融(RFA)术后早期心功能.方法 2007年3月至2009年8月对38例风湿性心脏病(RHD)患者行心脏瓣膜替换术+Cox-MazeⅣ心房颤动RFA(射频组),选取按一般情况予以配对同期仅行心脏瓣膜替换术的RHD心房颤动患者38例作为对照组.比较两组术后恢复时间、肌钙蛋白T(cTnT)水平及超声心动图情况.结果 尽管射频组的体外循环时间和主动脉阻断时间较对照组延长[(152.8±46.1)min比(104.7±40.8)min、(91.0±26.1)min比(68.0±30.3)min,P＜0.01],但两组术后恢复时间相似.射频组术后cTnT[(1.8±0.6)μg/L]较对照组[(0.8±0.4)μg/L]明显升高(P＜0.01),术后左房内径较术前普遍缩小(P＜0.05),其中主动脉瓣、二尖瓣联合替换术后左室后壁厚度增大和左室短缩分数减小.结论 和单纯行心脏瓣膜替换术相比,心脏瓣膜替换术+心房颤动RFA术后早期的心功能恢复在总体上良好,但存在潜在威胁可能性更大,更需注意围手术期的心肌营养和心功能维护.     

不同程度脓毒血症患者血浆BNP水平的变化及其临床意义

目的 观察不同程度脓毒血症患者血浆B型钠尿肽（BNP）浓度的改变及其与左心室射血分数（LVEF）的相关性,并探讨其临床意义.方法 选择台州医院重症监护室（ICU）脓毒血症患者100例作为研究对象,按病情程度分为：脓毒血症性休克组30例,严重脓毒血症组40例,脓毒血症组30例,对照组为自愿健康体检者20例.采用双抗夹心免疫荧光法测定血浆BNP浓度,并进行超声心动图检查,评价心功能.比较各组BNP浓度的差异以及各组BNP浓度与LVEF的相关性,并比较28 d死亡组和存活组患者的临床特征及差异,用受试者工作特征曲线（ROC曲线）评价BNP水平对死亡的预测作用.结果 脓毒血症性休克组血浆BNP水平[（976.3±160.7）pg/ml]明显高于严重脓毒血症组[（648.4±267.3）pg/ml]、脓毒血症组[（217.2±89.7）pg/ml]及对照组[（50.3±25.4）pg/ml]（P＜0.01）,脓毒症性休克组LVEF[（48.2±9.6）%]明显低于严重脓毒血症组[（52.8±9.4）%]、脓毒血症组[（61.3±8.9）%]及对照组[（66.4±9.3）%]（P＜0.05或P＜0.01）,脓毒血症性休克和严重脓毒血症二组LVEF与血浆BNP水平呈负相关（r=-0.876,-0.724,P＜0.01）.死亡组患者BNP水平明显高于存活组[（1367.6±506.4）pg/ml vs（420.3±82.6）pg/ml,P＜0.01].BNP水平与28 d死亡率的ROC曲线分析显示BNP水平的曲线面积为0.918（P＜0.01）.结论 不同程度脓毒血症患者血浆BNP浓度存在差异,血浆BNP浓度与LVEF呈负相关,血浆BNP水平对脓毒血症患者预后具有预测价值.     

集束化治疗对心脏直视术后呼吸机相关性肺炎的临床效果

目的 分析集束化治疗对心脏直视术后呼吸机相关性肺炎(VAP)的疗效.方法 对医院心脏外科重症监护病房(CSICU)2008年1月-2010年12月收治的心脏直视术后机械通气患者作为集束化治疗组进行前瞻性研究,对所有患者均采取医护人员采取严格洗手、床头抬高35～40度、加强口咽部护理、定期更换呼吸机管道等集束化治疗措施;以2005年1月-2007年12月心脏直视术后的患者作为对照组,比较两组患者VAP发病率,VAP患者的机械通气时间、CSICU入住时间和死亡率.结果 集束化治疗组VAP总发病率为17.0例/1000机械通气日,低于对照组的28.2例/1000机械通气日,差异有统计学意义(P＜0.01);引入集束化治疗后,VAP季度发病率呈下降趋势;集束化组VAP患者的机械通气时间、CSICU入住时间为(84.8士39.4)h、(7.5±3.1)d,明显低于对照组的(107.9±52.1)h、(9.6±4.7)d,差异均有统计学意义(P＜0.05);集束化组死亡率为6.5％,对照组为16.4％,差异无统计学意义.结论 集束化治疗可降低心脏直视术后VAP的发生率,改善VAP患者的预后.     

早期肠内营养对高血压性脑出血患者医院获得性肺炎的影响

目的 探讨早期肠内营养(EN)对重症高血压性脑出血患者医院获得性肺炎(HAP)的临床价值.方法 将140例重症高血压性脑出血患者按随机数字表法分成治疗组和对照组,治疗组(70例)术后48 h开始EN支持.对照组(70例)术后第2天开始全胃肠外营养(TPN)支持.观察两组HAP发生率、HAP持续时间、肺部二重感染发生率、呼吸机使用率、呼吸机使用时间以及HAP病死率.结果 治疗组HAP发生率、肺部二重感染发生率、呼吸机使用率分别为30.0%(21/70)、12.9%(9/70)、35.7%(25/70),显著低于对照组的47.1%(33/70)、27.1%(19/70)、47.1%(33/70)(P＜0.05);治疗组HAP持续时间、呼吸机使用时间分别为(6.4±2.3)、(6.4±0.5)d,显著短于对照组的(15.6±2.1)、(11.4±0.3)d(P＜0.01或＜0.05).治疗组HAP病死率(8.6%,6/70)显著低于对照组(18.6%,13/70)(P＜0.05).结论 早期EN不仅能有效降低重症高血压性脑出血患者HAP和肺部二重感染的发生率,还可以降低呼吸机使用率,缩短呼吸机使用时间,最终缩短了HAP的治疗时间,降低了HAP的病死率.

Abstract：

Objective To investigate the clinical value of early enteral nutrition (EN) on hospital acquired pneumonia (HAP) in postoperative patients with severe hypertensive cerebral hemorrhage.Methods One hundred and forty postoperative patients with severe hypertensive cerebral hemorrhage were divided into treatment group (70 cases) and controll group (70 cases) by random digits table. The treatment group was given EN from the second day after operation, while the control group was given total parenteral nutrition (TPN). The incidence and duration of HAP,the incidence of superinfection,the percent and duration of mechanical ventilation and the mortality rate of HAP was observed. Results The incidence of HAP, superinfection and using mechanical ventilation in treatment group [30.0% (21/70), 12.9% (9/70),35.7%(25/70)] were significantly lower than those in control group [47.1%(33/70) ,27.1%(19/70) ,47.1%( 33/70 )] (P ＜ 0.05 ). The duration of HAP and using mechanical ventilation in treatment group[(6.4 ± 2.3 ),(6.4 ± 0.5 ) d] were significantly lower than those in control group [( 15.6 ± 2.1 ), ( 11.4 ± 0.3 ) d] (P ＜ 0.01or ＜ 0.05 ). The mortality rate of HAP in treatment group was significantly lower than that in control group [8.6% (6/70) vs. 18.6% (13/70),P ＜0.05]. Conclusion Early EN not only effectively decreases the incidence of HAP and superinfection,but also decreases the incidence of mechanical ventilation, shortens the duration of mechanical ventilation and decreases the mortality rate of HAP.