To assess the impact of topical vancomycin (TV) application in decreasing sternal wound infections (SWIs) post cardiac surgery (CS), we lead a meta-analysis. Twenty-three thousand seven hundred and forty five participants had CS at the outset of the investigations, according to a thorough evaluation of the literature done up to November 2022; 8730 of them used TV, while 15 015 were controls. To assess the effectiveness of TV application in lowering SWIs following CS, odds ratios (OR) with 95% confidence intervals (CIs) were computed with dichotomous technique with a fixed- or random-effect model. The TV had significantly lower SWIs post CS (OR, 0.34; 95% CI, 0.20-0.57; P < .001), and deep SWIs post CS (OR, 0.26; 95% CI, 0.11-0.65; P = .004) compared with control as shown in Figures 2 and 3. Yet, there was no significant difference found amongst TV and control in superficial SWIs post CS (OR, 0.30; 95% CI, 0.07-1.30; P = .011). The TV had significantly lower SWIs, and deep SWIs post CS, and no significant difference was found in superficial SWIs post CS compared with control. The low number of included studies in this meta-analysis for superficial SWIs calls for precaution when analysing the outcomes.

OBJECTIVE:This study aimed to explore and analyze the factors affecting the incidence of pneumonia after coronary artery bypass grafting (CABG) to provide reference for the prevention of such situation.METHODS:A total of 500 patients who underwent CABG in a hospital were selected. From March 2019 to March 2022, 410 patients without pneumonia and 90 patients with pneumonia were divided into groups A and B. The influencing factors and pathogen composition of postoperative pneumonia were discussed and analyzed.RESULTS:Univariable analysis results showed that age, cardiac function grade, occurrence of smoking, operation time, tracheal intubation time, suspended red-blood-cell transfusion and hospital stay in group B were higher than those in group A. Multivariable logistic analysis results showed that operation time, smoking history, and tracheal intubation time were risk factors for pneumonia after CABG. Among the 90 patients with postoperative pneumonia, 90 had pathogens, 81 had Gram-negative bacteria, 4 had Gram-positive bacteria, and 5 had fungi.CONCLUSIONS:Patients after CABG were more likely to develop pneumonia. Operation time, smoking history, and tracheal intubation time were the risk factors of pneumonia after CABG. Most of these patients had Gram-negative bacteria. Patient intervention based on the influencing factors can effectively prevent the occurrence of postoperative pneumonia.

目的 探讨血栓弹力图(TEG)相关参数与非体外循环冠状动脉旁路移植术(OPCAB)中置入主动脉内球囊反搏患者围术期输血及引流量的相关性.方法 选择2016年1月～2021年10月承德医学院附属医院心脏外科收治的行择期OPCAB患者317例,其中术中置入主动脉内球囊反搏患者100例,使用随机数字表法分为传统常规凝血指标指导组(CCT组)及TEG指标指导组(TEG组),每组50例.比较2组患者术后血制品输注种类和使用量以及术后24 h纵隔和胸腔液体总引流量的差异.结果 TEG组血小板、新鲜冰冻血浆、冷沉淀使用量较CCT组明显减少[(1.62±0.37)U vs(1.88±0.54)U,P<0.05;290.0(227.5,300.0)ml vs 500.0(300.0,600.0)ml,P<0.01;(13.89±4.29)U vs(26.74±2.79)U,P<0.01].TEG组术后24 h纵隔和胸腔液体总引流量较CCT组明显减少[(302.50±31.35)ml vs(552.50±28.30)ml,P<0.01].结论 TEG相关指标用于指导OPCAB中置入主动脉内球囊反搏患者成分输血可显著提高治疗的有效性.同时可减少术后出血,提高临床治疗的安全性.

目的:研究AMI患者PCI术前后血清心型脂肪酸结合蛋白(H-FABP)、BNP、hsCRP、高敏肌钙蛋白(hscTnT)水平变化及其与预后的关系.方法:选择我院85例AMI患者为AMI组,同期90例体检健康者为健康对照组.观察比较两组血清H-FABP、BNP、hsCRP、hscTnT水平,AMI组PCI术前及术后1周上述血清标志物水平.依据随访6个月内是否发生主要心血管不良事件(MACE),AMI组被分为MACE组(35例)和非MACE组(50例),观察比较两组上述血清标志物水平.结果:与健康对照组比较,AMI组血清H-FABP、BNP、hsCRP、hscTnT水平均显著升高,P均=0.001.与术前比较,术后1周AMI组血清H-FABP[(97.4±37.1)μg/L比(18.8±8.6)μg/L]、BNP[(369.7±191.5)pg/ml比(84.6±61.1)pg/ml]、hsCRP[(13.2±7.0)mg/L比(2.7±2.1)mg/L]、hscTnT[(1577.8±537.4)ng/ml比(503.0±204.9)ng/ml]水平均显著降低,且术后3d即已显著下降,但显著高于术后1周,P均=0.001.与非MACE组比较,MACE组血清H-FABP[(81.4±30.6)μg/L比(120.4±34.2)μg/L]、BNP[(301.6±134.9)pg/ml比(467.0±221.1)pg/ml]、hsCRP[(10.3±5.7)mg/L比(17.3±6.9)mg/L]、hscTnT[(1353.2±462.1)ng/ml比(1898.8±483.7)ng/ml]水平均显著升高,P均=0.001.结论:AMI患者血清H-FABP、BNP、hsCRP、hscTnT水平显著升高,并对预后具有预测价值.

目的 分析年龄≥60岁女性左主干病变血运重建患者5年生存情况.方法 收集解放军总医院第六医学中心2013年1月～2015年12月收治的年龄≥60岁连续女性左主干病变患者46例,根据血运重建方法分为PCI组14例和冠状动脉旁路移植术(CABG)组32例,收集入选者一般临床资料,观察主要不良心血管事件(MACE)发生情况.结果 PCI组2例死亡,1例因脑梗死卧床,3例偶有心悸、胸闷,口服药物好转,不影响日常生活.CABG组2例失访,3例随访到2018年,3例术后院内死亡,1例随访期间乳腺癌死亡,1例术后5年行PCI.PCI组与CABG组MACE发生率及生存时间比较,无统计学差异[21.4％ vs 20.0％,P=0.955;(75.3±3.1)个月vs (81.2±5.5)个月,P=0.974].结论 对于左主干病变患者,CABG仍是首选的血运重建方式,对于经过选择的老年女性左主干病变患者,PCI是一种可接受的血运重建方式.

目的 探讨心外科首次非体外循环冠状动脉搭桥术病人血清脑钠肽(BNP)、生长分化因子-15(GDF-15)水平及与预后的相关性.方法 选取2015年1月—2018年12月我院收治的108例心外科首次非体外循环冠状动脉搭桥术病人,根据术后是否发生心力衰竭分为心力衰竭组(n=19)和非心力衰竭组(n=89),比较两组临床资料、术后BNP、GDF-15水平.比较不同美国纽约心脏病协会(NYHA)心功能分级病人术后BNP、GDF-15水平,采用Spearman分析BNP、GDF-15水平与NYHA分级的关系,绘制受试者工作特征曲线(ROC),分析BNP、GDF-15预测心力衰竭的临床价值.结果 心力衰竭组术后BNP、GDF-15水平高于非心力衰竭组(P<0.01).心功能Ⅱ～Ⅳ级病人术后BNP、GDF-15水平比较,差异有统计学意义(P<0.01);Ⅳ级病人术后BNP、GDF-15水平高于Ⅱ级和Ⅲ级病人,Ⅲ级病人术后BNP、GDF-15水平高于Ⅱ级(P<0.05).BNP、GDF-15与NYHA分级均呈正相关(P<0.01).BNP预测心力衰竭AUC为0.968,BNP为100 pg/mL时诊断心力衰竭灵敏度为90.00％,特异度为94.70％;GDF-15预测心力衰竭AUC为0.896,GDF-15为824 ng/mL时诊断心力衰竭灵敏度为93.30％,特异度为78.90％,BNP预测价值优于GDF-15.结论 血清BNP、GDF-15与心外科首次非体外循环冠状动脉搭桥术病人NYHA分级呈正相关,BNP和GDF-15均可诊断心力衰竭.

目的探讨体外膜肺氧合（ECMO）联合主动脉内球囊反搏（IABP）预防性应用于高危经皮冠状动脉介入治疗（HR-PCI）患者的短期临床疗效。方法选择2018年5–8月10例HRPCI患者,术中应用ECMO联合IABP循环支持。结果 10例患者中男性8例,女性2例,年龄51～84（70.3±11.1）岁,平均左心室射血分数（35.7±10.2）%。10例患者均为严重三支病变,左主干病变7例,其中合并右冠状动脉（RCA）慢性完全闭塞（CTO）病变5例,前降支CTO病变2例;剩余3例中2例为RCA和左前降支（LAD）近/中段CTO病变,1例为RCA CTO病变合并LAD/左回旋支（LCX）严重狭窄。在ECMO联合IABP支持下7例左主干病变中先处理左主干病变6例,1例处理了RAC CTO病变和LAD重度狭窄;剩余3例中2例RCA和LAD近/中段CTO病变均先处理了LAD CTO病变,另1例RCA CTO病变合并LAD/LCX严重病变患者先处理了RCA CTO病变。术中ECMO平均灌注流量（1.80±0.30）L/min,总运转时间（3.4±0.7）h。PCI平均手术时间（2.2±0.5）h。1例PCI术中发生血流动力学崩溃,ECMO灌注流量提高到3.0 L/min维持血流动力学,直到循环正常。术后所有患者ECMO均成功撤机。2例患者IABP穿刺部位血肿,其中1例术后发现假性动脉瘤;1例术后于ICU发生室性心动过速和心室颤动;无ECMO管道机械性问题、下肢缺血和感染并发症发生。结论对不适合行外科血管重建术的HR-PCI术患者,ECMO联合IABP循环支持下行PCI术是可行的。

目的 比较英夫利西单抗与静脉注射免疫球蛋白(intravenous immunoglobulin,IVIG)治疗IVIG初治无效川崎病的效果.方法 选取2013年1月至2017年10月本院儿科诊断的88例IVIG初治无效川崎病患儿为研究对象,其中22例患儿接受英夫利西单抗治疗(英夫利西单抗组),66例患儿追加IVIG治疗(IVIG复治组).比较两组患儿持续发热时间、不同时间点的退热率、冠状动脉病变(coronary artery lesions,CALs)发生率及不良反应发生情况.结果 英夫利西单抗组患儿平均持续发热时间[(16.8±2.9)小时]显著短于IVIG复治组[(56.3±8.6)小时](P＜0.001),不同时间点退热率均显著高于IVIG复治组(P＜0.05).治疗后第10天,英夫利西单抗组1例患儿出现CALs,治疗后第56天恢复正常;IVIG复治组9例患儿出现CALs,治疗后第56天病变仍存在.IVIG复治组1例患儿出现严重不良反应(治疗后3周川崎病复发);英夫利昔单抗组患儿便秘发生率显著低于IVIG复治组(P＜0.05),治疗期间无一例患儿发生支气管炎;1VIG复治组8例患儿发生支气管炎.两组患儿其他不良反应发生率比较均无显著差异(P＞0.05).结论 英夫利西单抗能加速川崎病患儿退热,缩短患儿持续发热时间,且安全性良好,可有效治疗IVIG初治无效川崎病.

To explore the function and importance of Extracorporeal membrane oxygenation (ECMO) combined with Intra-aortic balloon pump (IABP) support for high-risk percutaneous coronary intervention (PCI). We analyzed 7 cases undergoing high-risk PCI assisted by ECMO combined with IABP from May 2012 to

OBJECTIVE Deep sternal wound infection (DSWI) is one of the most serious complications after the open heart cardiac surgery. To explore the risk factors and appropriate treatment methods,we performed this study retrospectively. METHODS Between Jan 2001 and Jan 2006,1123 patients underwent various cardiac surgical procedures via a median sternotomy in the Cardiovascular Center of Beijing Tongren Hospital. These patients were divided into two groups by whether suffered from DSWI. Univariate analyses were performed for possible risk factors,and Logistic regression was used in multivariate analysis. RESULTS Eight among 1123 (0.71%) patients suffered from DSWI. No one died from wound infection. Results from both single variate analysis and multivariate analysis showed that only age significantly associated with DSWI. No other independent risk factors significantly associated with DSWI. Blood culture in acute DSWI group tended to be positive,while in chronic group it tended to be negative. All patients with DSWI were effectively cured. CONCLUSIONS Age is an independent risk factor for DSWI. Early debridement with closed chest catheter irrigation and antibiotics using are strongly recommended as an easy and effective way to treat DWSI. Large-scale multicenter studies are still needed to determine reliable risk factors for DSWI.

Objective To summarize the cerebral protection effects of selective anterograde cerebral perfusion with different flow control methods for patients suffering from aortic dissection of Stanford type A who received total arch replacement.Methods From October 2010 to August 2015,there were 70 patients suffering from Stanford type A aortic dissection.According to different flow control methods,patients were divided into three groups.T1: 22 cases,simple flow control with cerebral perfusion flow of 5-10 ml/min/kg,T2: 24 cases,the cerebral perfusion flow was based on the left radial artery pressure ranged from 40 to 70 mmHg,T3: 24 cases,pump pressure control,the average pump pressure was maintained at 70 mmHg during cerebral perfusion.Time of consciousness after operation,mechanical ventilation time,transient neurological dysfunction rate (TND),permanent neurological dysfunction rate(PND) were compared among different groups.Results Time of consciousness after operation and mechanical ventilation time in patients received the pump pressure control anterograde cerebral perfusion were shorter,with fewer suffered from TND and PND.Conclusion In patients suffering from Stanford type A aortic dissection who received intraoperative anterograde cerebral perfusion,usage of pump pressure flow control method showed fewer interference factors and better cerebral protection effects,which was simple to deal with and worth promoting.

Objective: To investigate the early application of peritoneal dialysis in radical surgery of tetralogy of Fallot in children after.Methods:From January 2014 to December 2015 in our hospital underwent radical surgery, surgery of tetralogy of Fallot after application of peritoneal dialysis treatment discharge syndrome in 10 cases clinical data were retrospectively analyzed and reviewed the low heart, change of lactic acid, urine volume, central venous pressure and renal function were compared before and after peritoneal dialysis.Results: All the 10 patients survived, and no peritoneal dialysis related complications occurred. After dialysis, the urine volume was significantly improved, the low cardiac output symptoms gradually improved, plasma lactic acid concentration was significantly decreased third days after dialysis.Conclusion: Early application of peritoneal dialysis is safe and effective, can low cardiac cycle syndrome in children with tetralogy of Fallot improved after operation, can effectively reduce the serum lactic acid concentration, improve the survival rate of children.

Objective To examine the change of N-terminal pro-brain natriuretic peptide (Nt-proBNP) and high sensitive C reactive protein (hs-CRP) in patients underwent coronary artery bypass grafting and to evaluate their value as risk predictors for postoperative complications and atrial fibrillation. Methods Seventy-five patients underwent coronary artery bypass grafting under on-pump (CCABG) and 44 patients underwent off-pump bypass grafting (OPCAB). The levels of Nt-proBNP and hs-CRP were monitored before and 24 h after operation in all patients. Results The serum levels of hs-CRP and Nt-proBNP were significantly higher in 24 h after operation (P<0.001). The level of Nt-proBNP before oper-ation was negatively correlated with left ventricular ejection fraction (r = -0.43,P < 0.001). By univariate and multivariate logistic regression analysis, multivariable predictors including Nt-proBNP 24 h after operation and left ventricular ejection fraction were significantly associated with a more frequent postoperative congestive heart failure and low cardiac output. Conclusion Nt-proBNP and hs-CRP after CABG is increased significantly. Nt-proBNP after op-eration and left ventricular ejection fraction are postoperative complication risk predictors, but has no predictive value for postoperative atrial fibrillation in patients undergoing CABG.

Objective To explore the application value of transesophageal echoeardiography ( TEE) standardized measure-ment used in the modified morrow procedure .Methods From March, 2008 to December, 2013, the modified Morrow procedure was performed in 21 cases of hypertrophic cardiomyopathy (HCM) confirmed with transthoracic echocardiography (TTE).Before establish-ment of extracorporeal circulation , TEE assessments of the left ventricular outflow tract ( LVOT) pressure gradient and interventricular septum thickness ( IVST) were used to correct the transthoracic echocardiography ( TTE) measurements and the distance between ante-rior mitral valve leaflet columnae papillae and the aortic valve ring to detect the excision range .Mitral valve ring diameter , leaflet echo intensity and the extent of leaflets regurgitation were applied to determine whether valve replacement was required .TEE was repeated upon completion of myocardial resection to compare postoperative measurements with preoperative ones to assess the curative effect .Half ayearlater,allthepatientshadTTEfollow-up.Results (1)PreoperativeTEEmeasurementsofLVOTpressuregradientandIVST were (87.6 ±3.1) mmHg and (22.1 ±0.5) mm respectively.TEE measurements of LVOT and IVST pressure gradient the instant af-ter operation were (18.4 ±2.5) mmHg and (11.5 ±0.4) mm respectively.There was significant reduction of them , as compared with those before operation(P<0.05).(2) TEE detection predicted that mitral valve replacement was required in 5 cases, of which 4 cases underwent mitral valve replacement .TEE detection also showed that there was no significant mitral valve regurgitation after surgery . (3) All the patients had medical follow-ups, and results indicated that 19 patients had no LVOT obstruction recurrence .Conclusion TEE standardized measurement could precisely determine the scope of excision , predict whether or not valve replacement was required ,and help to evaluate the surgical effect the moment after surgery , which was of importance value clinically .

心血管系统功能在人体中很容易受精神因素影响，大量研究表明，行为模式、应激、情绪等因素与冠心病的发生和发展有很大关系［1］。本研究对冠心病患者的心理状况进行了初步的研究和探讨。

【Objective】To investigate the application of cardiopulmonary bypass (CPB) in the treatment of locally advanced pulmonary malignant tumors invaded heart or great vessels.【Methods】We received a case of advanced left lower peripheral lung cancer with intracardial carcinomous embolism. Through the 5th left intercostal space, we treated the left lower arteria pulmonalis, and CPB was established through the left arteria cruralis and vein, and with arrest of the heart, we resected the intracardial carcinomous embolism, then withdrew CPB, we carried out the left lower pneumonectomy.【Results】CPB was smooth, and heart automatically rebeated. Maintained mechanical ventilation for 12 h, 72 h later exelcymosis the thoracic drainage tube. The patients has survived over 10 months. 【Conclusions】To locally advanced pulmonary malignant tumors invaded heart or great vessels,CPB could guarantee the safety of anesthesia and surgery,and be helpful for completely removal.

Objective To investigate the extracardiac conduit total cavopulmonary anastomosis in the treatment of complex congenital heart diseases and the operation outcomes.Methods Of the 31 patients who underwent extracardiac conduit total cavopulmonary anatomosis between May 2004 to October 2012,including 17 males and 14 females,their average age was(11.7±6.3)years,and the average body weight was(32.5±15.0)kg.Diseases including single ventricle in 10 patients,Complete endocardial cushion defect and transposition of great arteries in 10 patients,tricuspid atresia in 3 patients,double outlet right ventricle and complete endocardial cushion defect in 2 patients.Result Early postoperative death happened in 2 cases.The average follow-up period in the rest patients was 2 months-9 years,and no death occurred and their cyanosis disappeared.All patients could perform daily activities.Postoperative patients with venous pressure was significantly increased in 2 cases,1 case had pulmonary hypertension,1 case had heart pipeline calcification atresia.Conclusion Extracardiac conduit total cavopulmonary anastomosis is relatively simple,and the result of this study has shown that the early postoperative effect is good,however,the long-term effect needs further study.

Objective To summarize the clinical effect and experience of extracorporeal membrane oxygenation( ECMO) support for critical percutaneous coronary intervention( PCI) treatment. Methods From January 2012 to March 2013,6 patients with critical coronary heart disease for perioperative PCI treatment received ECMO support,Retrospective summary and analysis of the clinical data of these patients were done in demographics,mechanical circulatory assist duration,complications and in-hospital mortality. Results Six patients were successfully finished the operation and weaned off from ECMO after operation. One patient died. Conclusions ECMO can supply effective support treatment for patients with PCI treatment,but detailed assessment of condition and intime appropriate use are required.

<正>冠状动脉旁路移植术是目前外科治疗冠状动脉粥样硬化性心脏病最有效的方法之一,左心功能低下的患者,在行非体外循环、心脏跳动下冠状动脉旁路移植术时,往往不能耐受心脏搬动,出现低血压、心律失常,甚至室颤,有时需紧急改为体外循环辅助下完成手术。我院2010年10月至2013年4月,对

Objective To Summarize the extracorporeal circulation management of ventricular septal defect with pulmonary hypertension.Methods From October 2005 to December 2012,65 patients with ventricular septal defect with pulmonary hypertension were admitted in the hospital.Fifty-four cases of ventricular prothesis were performed under extracorporeal circulation conventionality.Results The duration of extracorporeal circulation was from 26 minutes to 68 minutes,aorta crass clamping time ranged from 15 to 38 minutes.One patient died.Conclusion For patients with ventricular septal defect with pulmonary hypertension,appropriate time for operation,myocardial preservation,pulmonary protection,correction of acid-base imbalance,prompt application for ultrafiltration and vasodilatoin are important factors for successful extracorporeal circulation.