目的 评价单侧无名动脉灌注在主动脉全弓置换术中对大脑的保护效果.方法 选取2018年1月—2019年1月在上海长海医院行主动脉全弓置换术时采用无名动脉插管进行大脑灌注的患者120例,所有患者均采用中度低温停循环的体外循环方法.采用上、下腔静脉,或右心房、股动脉插管建立体外循环.大脑保护方法为单侧选择性顺行性脑灌注,即单纯右侧无名动脉灌注.使用近红外光谱脑氧饱和度监测仪行双侧经皮脑组织氧饱和度持续监测.结果 120例患者停循环前左侧脑氧饱和度为(54.9±6.8)％,右侧脑氧饱和度为(58.2±6.1)％;大脑灌注开始后10 min时左侧脑氧饱和度为(52.3±7.3)％,右侧脑氧饱和度为(57.8±7.5)％;大脑灌注开始后20 min时左侧脑氧饱和度为(51.4±7.5)％,右侧脑氧饱和度为(57.5±7.0)％;循环恢复时左侧脑氧饱和度为(63.5±5.6)％,右侧脑氧饱和度为(60.4±6.2)％.左、右侧脑氧饱和度在各时间点的差异均无统计学意义(P值均＞0.05).7例患者发生术后短暂性神经系统功能不全,均于术后2?5 d恢复正常,无1例发生永久性脑损伤.结论 在主动脉全弓置换术中采用单纯右侧无名动脉灌注安全、可靠,能够满足停循环期间大脑的供血、供氧需求,值得在临床推广.

目的 分析体外循环手术后急性肾损伤病患实施个性化护理的作用.方法 选择本院收治的100例实施体外循环手术治疗后出现急性肾损伤的病患为研究样本,其研究时间均在2017年3月至2020年3月之间.采取随机数字排列表法将其分成常规组(50例)以及实验组(50例),予以常规组病患基础护理,予以实验组病患基础护理以及个性化护理.对比每组病患干预前以及干预后5天、10天时血肌酐水平;监护室停留时间以及使用静脉利尿剂时间;中转血液透析治疗人数.结果 干预后5天以及干预后10天时实验组病患血肌酐水平均低于常规组(P＜0.05).实验组病患监护室停留时间以及使用静脉利尿剂时间均短于常规组(P＜0.05).实验组与常规组病患中转血液透析治疗人数占比依次是2.00％、14.00％ (P＜0.05).结论 对体外循环手术后发生急性肾损伤病患实施个性化护理,可显著改善其血肌酐水平,缩短在监护室停留时间以及使用静脉利尿剂时间,减少中转血液透析治疗人数,进而改善疾病转归.

本文综述主动脉夹层的发病原因、临床分型、临床表现,启示医护人员采取积极有效的护理措施,重点做好病情观察及评估、应急处置、一般护理、疼痛护理、控制心率和血压、严格限制活动量和心理护理等,稳定入院早期病情,为患者争取手术和治疗机会,挽救患者生命.为相关护理人员的临床实践和科研作一参考.

目的 探讨在体外循环心脏手术后预防患者ICU综合征发生中采用综合护理干预的临床应用价值.方法 选取我院收治的120例行体外循环心脏手术患者作为本次研究对象,按照护理干预方法 的差别分为常规护理组与综合护理组,患者选取时间为2017年1月至2019年12月,两组各有患者60例.为常规护理组患者选择常规护理方法 ,为综合护理组采用综合护理方法 ,护理结束后对比两组ICU综合征发生率与患者情况.结果 护理结束后,综合护理组的ICU综合征发生率与住院时间明显优于常规护理组,组间差异明显(P<0.05).结论 在体外循环心脏手术后预防患者ICU综合征发生中采用综合护理干预相对于常规护理而言,能够有效的减少患者的住院时间与ICU综合征发生情况,效果确切.

Objective To analyze the recent clinical results and experience of extracorporeal membrane oxygenation (ECMO) in treating critical patients, so as to summarize the methods, timing and indications of ECMO treatment. Methods We retrospectively analyzed the clinical data (primary disease, supportive mode, adjuvant time and so on) of 18 critical patients treated with ECMO from Jan. 2014 to Nov. 2016 in our hospital, compared the offline rate and success rate of different kinds of critical patients, and analyzed the survival factors and causes of death of the patients. Results Among the 18 critical patients, 12 cases were treated with vein-artery ECMO, four with vein-vein ECMO and two with vein-artery-artery ECMO. Totally seven (38.9%) cases were successfully offline and five (27.8%) cases survived. The offline rate and success rate of the patients with circulatory failure were 62.5% (5/8) and 37.5% (3/8), respectively, while those of the patients with respiratory failure were both 20% (2/10). None of the six patients with adult respiratory distress syndrome (ARDS) secondary to severe burn, trauma or operation survived. The survival rates of patients with ARDS secondary to pulmonary disease (HR=12.3, 95%CI: 2.2-69.9; P<0.01) and patients with circulatory failure (HR=4.6, 95% CI: 1.1-19.5; P<0.05) were significantly higher than that of patients with ARDS secondary to non-pulmonary causes, while there was no significant difference in survival rate between the patients with circulatory failure and ARDS secondary to pulmonary disease. Conclusion Prompt selection of ECMO treatment time, improvement of the treatment procedure, active treatment of primary disease, and prevention of complications are the keys of ECMO treatment. The establishment of hospital emergency channel and the formation of ECMO treatment team with multidisciplinary and multisectoral cooperation should be carried out to insure the success of ECMO treatment.

<正>体外循环(CPB)手术患者常规使用鱼精蛋白中和肝素,常规使用量均按肝素与鱼精蛋白的比例为1:1.5进行中和,以使活化凝血时间(activated coagulation time,ACT)值恢复正常。但鱼精蛋白使用过量也可影响凝血机制,使ACT值延长,鱼精蛋白使用的量为多少适宜,其使用后的体内具体浓度是多少,目前还