Objective:To investigate the change of D-Dimer (D-D), cardiac troponin I (cTnI) and vasoactive-inotropic score (VIS) after Stanford type A aortic dissection (TAAD) and thier predictive effect on death outcome.Methods:120 patients with TAAD who were treated in the Affiliated Hospital of Jining Medical College from January 2019 to January 2022 were retrospectively selected and divided into death group ( n=17) and survival group ( n=103) according to the 28-day survival after operation. The difference of clinical data between the two groups was compared, and the influencing factors of postoperative death in TAAD patients were analyzed by logistic regression method. Results:The age, deep hypothermic circulatory arrest time, D-D and cTnI of the patients in the death group were (60.50±5.42)years old, (30.40±9.92)min, (15.65±5.52)g/L and (3.32±0.82)mg/L, respectively, which were significantly higher than those in the survival group (all P<0.05). The VIS score and change of VIS score in the death group at 24 hours after operation were (9.66±1.10)points and (4.50±0.91)points respectively, which were significantly higher than those in the survival group (all P<0.05). Logistic regression analysis showed that age, D-D, cTnI and change of VIS score were the influencing factors of death after TAAD (all P<0.05). The area under the receiver operating characteristic (ROC) curve predicted by the D-D, cTnI and change of VIS score for death in TAAD patients was 0.718, 0.691 and 0.789 respectively (all P<0.05). Conclusions:Postoperative death of TAAD patients is affected by their age, D-D, cTnI and change of VIS score. The D-D, cTnI and change of VIS score have certain application value in predicting postoperative death of patients.

The degree of hemodynamic support by vasoactive drugs in critically ill patients is often considered one of the markers of disease severity. The sequential organ failure assessment (SOFA), European system for cardiac operative risk evaluation II (EuroScore II), and other scores only roughly quantify the drug support of cardiovascular system. When patients need large doses of vasoactive drugs, the mortality increases accordingly. The vasoactive-inotropic score (VIS) objectively quantifies the degree of cardiovascular support using a simple formula that standardizes the dose of different agents, and it is recommended as a simple, effective, and accurate prognostic indicator. In recent years, there are more and more clinical applications and related studies at home and abroad. This paper reviews the application and progress of VIS score in critically ill patients, providing help for doctors to judge the condition and prognosis of patients and guiding the decision-making of diagnosis and treatment.

Objective:To analyze the status and influencing factors of early out of bed activity in patients after coronary artery bypass grafting.Methods:Using the convenient sampling method, patients who underwent coronary artery bypass grafting in Affiliated Hospital of Jining Medical University from January 2018 to December 2020 were selected as the research objects. The general situation questionnaire, the Chinese version of Brief Disease Cognition Questionnaire, Muscle Strength Rating Scale and Visual Analog Scale were used to investigate them. Binomial Logistic regression was used to analyze the influencing factors of early out of bed activity after coronary artery bypass grafting.Results:A total of 100 questionnaires were distributed in this study and 100 were recovered. The effective recovery rate of the questionnaire was 100%. 38% (38/100) of patients with coronary artery bypass grafting performed early out of bed activity within 72 hours after surgery. Binomial Logistic regression analysis showed that vascular bridge selection, postoperative pain, lower limb incision blister, lower limb muscle strength rating and disease awareness were the influencing factors of early out of bed activity after coronary artery bypass grafting ( P<0.05) . Conclusions:Vascular bridge selection, postoperative pain, lower limb incision blister, lower limb muscle strength rating and disease awareness were the influencing factors of early out of bed activity after coronary artery bypass grafting

目的:探讨行主动脉弓部置换术的主动脉夹层(AD)患者围术期大量输注红细胞(RBC)的危险因素.方法:回顾性分析2013年1月至2021年8月,行主动脉弓部置换的AD患者232例,术中和术后24h内输注RBC总量≥8U为大量输血组(131例),＜8U为常规输血组(101例),比较两组临床资料,采用多因素Logistic回归分析围术期大量输注RBC的危险因素.结果:大量输血组患者年龄大,女性占比高,合并冠心病、中等量心包积液、术前冠状动脉受累、行冠状动脉旁路移植比例高,体外循环(CPB)和主动脉阻断时间长,术中及术后24h内出血量多,与常规输血组比较,差异均有统计学意义(P＜0.05),多因素回归分析女性(OR=3.653,95％CI:1.511～8.833,P=0.004)、术前 Hb＜130g/L(OR=3.616,95％CI:1.732～7.549,P=0.001)、CPB 时间＞200min(OR=3.374,95％CI:1.552～7.335,P=0.002)、术中出血≥1 500mL(OR=5.079,95％CI:2.442～10.567,P=0.001)是行主动脉弓部置换术AD患者围术期大量输注RBC的危险因素.结论:行主动脉弓部置换术AD患者围术期RBC输注量大,大量输注RBC的危险因素包括女性、术前 Hb＜130g/L、CPB 时间＞200min、术中出血≥1 500mL.

报道1例成人型左冠状动脉异常起源于肺动脉患者的术后护理.左冠状动脉起源异常发病率极低加之术后延迟关胸,对患者术后的护理要求较高,需要护理人员密切观察病情,同时加强患者的心理护理,促进其角色的转变,帮助患者树立战胜疾病的信心.本例患者入住ICU11d,未出现严重并发症,取得了良好的护理效果.

目的 分析品管圈(quality control circle,QCC)对冠状动脉旁路移植术(coronary artery bypass grafting,CABG)后患者卧床时间的影响.方法 成立"QCC"活动小组,选定缩短CABG后患者卧床时间为主题,对CABG后患者卧床时间现况进行调查,分析术后患者卧床时间长的原因,制定相应措施并实施,比较实施前后患者卧床时间及术后肺部感染发生情况.结果 实施QCC后患者术后卧床时间较实施前大大缩短,卧床时间由(75.41±7.48)h缩短至(36.32±7.76)h,差异有统计学意义(P<0.01).术后肺部感染发生率,由4.28%降至1.45%,差异有统计学意义(P<0.05).结论 通过QCC活动,可显著缩短患者术后卧床时间,减少术后肺部感染并发症.

目的 探讨通过品管圈(QCC)对提高冠状动脉搭桥术(Coronary Artery Bypass Grafting,CABG)后患者康复运动执行率的效果.方法 应用QCC对CABG后患者早期康复运动执行情况进行管理,通过现状调查,确定改善重点,分析CABG后患者早期康复运动执行率低的原因,制定对策并组织实施.结果 实施QCC后,CABG后患者康复运动执行率由64%提高至93%(目标值设定为85%),患者首次康复运动时间由改善前75小时缩短至36小时,本次QCC活动目标达成率为138%.活动后,小组成员在QCC手法运用、个人综合能力、解决问题能力等方面均有显著提高.结论 QCC活动能够提高CABG后患者康复运动执行率,缩短患者术后卧床时间,促进个人综合能力及团队的凝聚力提高,促进质量持续改进.

Objective To explore the clinical effect of preoperative visit combined with postoperative re-strictive visiting for elderly patients with anxiety and depression in perioperative period of coronary artery by-pass graft( CABG).Methods 115 patients elderly underwent CABG were prospectively investigated using Hospital Anxiety and Depression Scale.Patients with anxiety and /or depression after CABG were defined as the study group (n=55),and the other patients were included in the control group(n=60).Patients of con-trol group were just given routine nursing care.And patients were given preoperative visit combined with postoperative restrictive visiting in study group.The incidence of anxiety and depression in two groups was compared.Results On third postoperative day, the scores of HAD in two groups were significantly lower than that in the first day of cardiac surgery.Compared with control group,HAD score and the incidence of anxiety and depression on third postoperative day were significantly declined in the study group.Conclusion Preoperative visit combined with postoperative restrictive visiting can reduce the incidence of anxiety and de-pression in perioperative period of elderly patients underwent CABG.

目的：探讨冠状动脉旁路移植术（ CABG）患者焦虑、抑郁状态的发生情况及其影响因素。方法采用综合性医院焦虑抑郁量表对200例拟行CABG 的患者术前行一般情况问卷调查及综合性医院焦虑抑郁量表（ HAD）评分，根据评分将其分为焦虑或（和）抑郁状态者134例（观察组）与无明显焦虑、抑郁者66例（对照组），对焦虑抑郁的影响因素行单因素及多因素Logistic回归分析。结果焦虑、抑郁发生率为52．5％，年龄≥60岁、文化程度低、无固定工作、负性家庭生活事件、患者为家中主要经济来源、医疗费用报销比例低为术前出现焦虑、抑郁的原因；文化程度、负性家庭生活事件为独立影响因素。结论 CABG术患者术前焦虑、抑郁状态发病率较高，应进行早期干预。

目的：研究老年与中青年患者冠状动脉旁路移植术（CABG）后焦虑抑郁状态发生率及危险因素。方法：将150例 CABG患者按年龄分组，术后应用综合性医院焦虑抑郁量表行心理评估，比较老年组与中青年组术后焦虑抑郁发生率及危险因素。结果：老年患者 CABG 术后焦虑和抑郁状态发生率分别为31.0%、45.9%，二者均有的占26.4%，中青年患者发生率分别为47.6%、22.2%，二者均有的占12.7%（P ＜0.05）。老年组术后焦虑抑郁危险因素主要为患者文化程度低、负性家庭生活事件、合并脑卒中、ICU 住院时间。中青年组危险因素主要为家庭经济状况、胸痛发作方式及时间、术后切口疼痛程度。结论：CABG 术后老年患者焦虑并抑郁状态发生率高于中青年，老年患者以抑郁状态为主，中青年焦虑状态为主，且危险因素亦不尽相同。

目的:探讨三级医院冠状动脉旁路移植术(CABG)患者,术后焦虑抑郁状态及其相关危险因素.方法:应用前瞻性研究方法,采用综合性医院焦虑抑郁量表,对本院180例CABG患者围术期行心理测评,评价术后焦虑抑郁状态的发生率,根据术后是否存在焦虑状态或(和)抑郁状态将患者分为焦虑抑郁状态组(n=103例)和对照组(n=77),对可能影响因素进行多因素Logistic回归分析.结果:①CABG患者术后焦虑、抑郁状态的发生率分别为42.2％、39％,二者均有的占23.9％;②单因素分析:文化程度低、无固定工作、负性家庭生活事件、患者为家中主要经济来源、术前合并焦虑抑郁、术前脑卒中史、初发心绞痛或心肌梗死、术后刀口疼痛评分＞6分及ICU停留时间长为术后出现焦虑抑郁的危险因素(P＜0.05);③Logistie回归分析:文化程度(P=0.018)、负性家庭生活事件(P =0.046)、术前合并焦虑抑郁(P =0.023)、初发心绞痛或心肌梗死(P =0.038)是术后出现焦虑抑郁的独立危险因素.结论:在基层三级医院,CABG患者术后焦虑抑郁状态发病率比较高,应该重视围手术期焦虑抑郁状态的筛查,采取有针对性的干预,从而改善预后,提高手术质量.

目的:探讨全胸腔镜辅助修补房间隔缺损对患者细胞因子及心肌肌钙蛋白Ⅰ水平的影响及其临床意义.方法:选取2011年12月至2013年12月,我院46例先天性房间隔缺损患者作为观察对象.根据术式不同分为观察组(全胸腔镜辅助修补)和对照组(常规手术),对比分析两组术前、主动脉开放时、开放后2、6、12及24小时白细胞介素-6(IL-6)、血清细胞黏附分子(ICAM-Ⅰ)、肿瘤坏死因子(TNF-α)和心肌肌钙蛋白Ⅰ(cTnⅠ)含量变化.结果:观察组监护时间、住院时间和术后引流量均低于对照组(P＜0.05).两组患者的TNF-α、IL-6、ICAM-Ⅰ及cTn-Ⅰ在主动脉开放后均较治疗前上升,24小时后均下降趋于正常.观察组在主动脉开放时和开放2小时TNF-α、IL-6含量均显著高于对照组(P＜0.05),在开放后6小时IL-6低于对照组,ICAM-Ⅰ高于对照组(P＜0.05),12小时IL-6含量低于对照组,24小时TNF-α低于对照组(P＜0.05);cTn-Ⅰ在开放后6小时和12小时时显著低于对照组(P＜0.05),而开放后24小时两组均发生回落,且两组差异无统计学意义(P＞0.05).结论:全胸腔镜辅助修补早期炎性应激反应快,后期炎性因子下降迅速.提示全胸腔镜辅助修补较常规手术对心肌及全身组织损伤轻,是一种对组织创伤轻、心肌损伤小、恢复快、安全有效的术式.

目的：探讨综合护理干预对冠状动脉搭桥手术（ CABG）患者焦虑、抑郁状况的影响。方法：将100例行CABG治疗患者随机分为研究组和对照组各50例，对照组给予围术期常规护理，研究组在此基础上给予综合护理干预，比较两组护理效果。结果：两组患者术后第3天综合性医院焦虑抑郁量表（HAD）评分低于入科后第1天（P﹤0.05），研究组术后第3天HAD评分低于对照组（P﹤0.05）；研究组术后第3天焦虑、抑郁发生率低于对照组（P﹤0.05）。结论：综合护理干预可明显改善CABG患者的焦虑、抑郁情绪。

目的:评价动静脉二氧化碳分压差(Pcv-aCO2)对组织氧供需平衡作用.方法:对本院2012年8月至2013年1月,行冠状动脉旁路移植术(CABG) 82例患者,分别于术后入监护室即刻,12小时和24小时检测动静脉血气分析.分析Pcv-aCO2与中心静脉血氧饱和度(ScvO2)、动脉氧分压(PaO2)相关性;比较术后并有呼吸、循环并发症患者对Pcv-aCO2、ScvO2、PaO2、SaO2及乳酸(Lac)值的影响.结果:Pcv-aCO2与ScvO2呈负相关(P＜0.01),与PaO2无相关性(P＞0.05);并发症组较无并发症组Pcv-aCO2明显增高(P＜0.01),ScvO2降低(P＜0.05).Pcv-aCO2平均值＜8组并发症发生率明显减低(P＜0.01),ScvO2平均值＞70并发症发生率无明显减低(P＞0.05).结论:Pcv-aCO2和ScvO2较PaO2,SaO2和Lac能准确反映患者组织氧供需状态和组织损害程度,Pcv-aCO2较ScvO2敏感性更强,对判断组织缺氧损害程度具有较大临床指导价值.

目的 研究犬在体外膜肺氧合(ECMO)辅助期间动静脉二氧化碳分压差(Pcv-aCO2)与心输出量(CO)的关系.方法 5只犬经股静脉放置中心静脉管,股动脉放置动脉测压管连接有创心输出量监测仪及心电监护仪,采用股静脉·颈静脉ECMO模式进行辅助,于ECMO建立前(T0)、转机后即可(T1)、辅助1 h(T2)和辅助2 h(T3)四个时点监测CO,并同时采集动静脉血进行血气分析计算Pcv-aCO2值,分析Pcv-aCO2、中心静脉血氧饱和度(ScvO2)、乳酸(Lac)与CO相关性.结果 Pcv-aCO2与CO呈负相关(r=-0.457,P＜0.05)；ScvO2、Lac与CO之间无明显相关.结论 犬ECMO辅助期间Pcv-aCO2与CO具有相关性,Pcv-aCO2可间接反映CO的变化趋势.

目的 观察法洛四联征根治术联合介入栓堵术治疗重症法洛四联征(TOF)合并主动脉-肺动脉侧支(体肺侧支)形成的效果.方法 TOF合并体肺侧支形成患者6例,术前行CTA及主动脉造影检查,均行法洛四联征根治术,介入栓堵体肺侧支.结果 本组根治术前栓堵体肺侧支2例,术后未发生灌注肺,顺利恢复出院.术后栓堵4例,3例栓堵后血痰消失,撤离呼吸机顺利,其中2例治愈出院,1例因畸形矫正不满意导致充血性心力衰竭,放弃治疗;另1例栓堵术后低氧血症加重,死亡.结论 根治手术联合介入栓堵术治疗TOF合并体肺侧支形成可有效减少术中肺静脉回流和术后灌注肺的发生,疗效较好.

目的探讨实施心理行为干预对急性闭角型青光眼患者心理状态的影响。方法将80例急性闭角型青光眼住院患者随机分为干预组40例和对照组40例。对照组进行常规护理,干预组在常规护理的同时给予心理行为干预。观察2组心理状态、眼压降至正常时间及住院时间。结果干预组心理行为干预前后焦虑自评量表(SAS)评分比较有显著性差异(P<0.01)。对照组护理前后SAS评分比较无显著性差异。干预组眼压下降时间比对照组提前,住院时间比对照组明显缩短。结论对急性闭角型青光眼患者进行心理行为干预可消除或减轻患者焦虑、恐惧情绪,促进眼压下降术后的康复。

Objective: To observe and understand the status of hand washing compliance of the personnel in supply room,and to analyze the influencing factors so as to formulate the corresponding measures to improve the hand washing compliance.Methods: Retrospective analytical method was adopted to observe the implementation of hand washing of the personnel in supply room from Apr.to Oct.2010.Results: The compliance rate of the personnel in charge of the loading and unloading the items was 60.45%.The compliance rate of the nurses was 63.79% and the implementation rate of nursing workers was 45.44%.The hand washing was generally low,the implementation rate of the nurses was higher than that of nursing workers.Conclusion: The hand washing compliance of the personnel in supply room is low,so the effective intervention measures should be adopted to improve the hand hygiene compliance.

球后注射是眼科常用的一种局部给药方法,是将药物注射到眼球后部或视神经处达到治疗浓度,多用于眼球后部炎症、眼底血管病变及内眼手术的麻醉等[1].球后注射技术性强,危险性大,加之眼球是敏感器官,病人常因精神高度紧张,较难配合注射,易导致多种并发症,如下眼睑及结膜下出血肿胀、球后出血、眼球穿通伤等.为此,对球后注射方法进行了改进,明显减少了并发症的发生,临床效果满意.现报告如下.

目的:分析原发性闭角型青光眼发病因素。方法:通过病史采集及问卷调查方式对368例患者发病相关因素进行调查并分类统计记录,用统计学方法进行处理。结果:情志因素在其发病中占98%为其主要因素。结论:做好原发性闭角型青光眼患者的情志调理是非常重要的。