For patients with severe heart disease whose circulatory system is unstable or tends to be stable, it is controversial whether early enteral nutrition support therapy has a positive effect. retrospectively review the data of 108 patients who received intra-aortic balloon pump in our hospital, and explore the role of early enteral nutrition support therapy in such patients.

Objective To observe and analyze the morbidity and risk factors of postoperative delirium in the patients un-dergoing cardiac surgery.Methods From March 2017 to March 2018, 478 patients who need cardiac surgery were selected from our hospital.According to the postoperative results evaluated with Confusion Assessment Method(CAM), they were divid-ed into delirium group(54 patients)and control group(424 patients).Morbidity and risk factors of postoperative delirium were analyzed.Results Delirium occurred in 54 patients of 478 patients and morbidity of postoperative delirium was 11.3％.Psy-chomotor excitement is the most common clinical presentations , followed by attention impairment and a reduced level of con-sciousnes.Single factor analysis result showed that delirium was associated with advanced age (≥65 years) , hypertension, pre-vious cerebral vascular event(previous cerebral infarction, previous brain heamorhage), intraoperative blood loss, mechanical ventilation time, intensive care unit duration time.The multiple-logistic regression analysis indicated that the perioperative risk factors of delirium included advanced age, cerebrovascular accident history and ICU duration time.Conclusion The patients with advanced age, hypertension, previous cerebral vascular event(previous cerebral infarction, previous brain heamorhage) are the high risk groups for delirium after cardiac surgery.Advanced age, hypertension, previous cerebral vascular event(previ-ous cerebral infarction, previous brain heamorhage) are risk factors for delirium in patients undergoing cardiac surgery.

Radiofrequency ablation concomitant with open-heart procedures is one of the most common surgical methods to treat organic heart disease complicated with atrial fibrillation .However, the recurrence of atrial fibrillation still bothers both doctors and patients.There are different views on the main factors influencing the long-term effects of sinus rhythm maintenance after ablation.We reviewed past related clinical observations and researches to summarize the factors influencing recurrence of long-term atrial fibrillation after radiofrequency ablation concomitant with open-heart procedures.

Objective To investigate the risk factors of new-onset postoperative atrial fibrillation in the elderly patients undergoing off-pump coronary artery bypass grafting. Methods A total of 156 patients who need selective off-pump coronary artery bypass grafting in the First Affiliated Hospital of Zhengzhou University from June 2017 to June 2018 were selected. According to the occurrence of new-onset postoperative atrial fibrillation, the patients were divided into the AF group (37 cases) and the non-AF group (119 cases). The perioperative clinical data of the two groups were statistically analyzed to study the risk factors of postoperative atrial fibrillation. Results In the whole group, 37 cases ( 23. 7％) had postoperative atrial fibrillation. Univariate analysis showed that history of diabetes mellitus(OR=1. 726, P=0. 037), preoperative left atrial diameter (LAD)≥38mm(OR= 2. 632, P=0. 001) and mechanical ventilation time(OR=1. 692, P<0. 018) were correlated with new-onset postoperative atrial fibrillation in elderly patients after off-pump coronary artery bypass grafting. Logistic multivariate regression analysis showed that it is an independent risk factor for new-onset postoperative atrial fibrillation that elderly patients with history of diabetes mellitus, preoperative left atrial diameter (LAD)≥38mm and mechanical ventilation time after off-pump coronary artery bypass grafting. Conclusions Preoperative left atrial diameter (LAD)≥38mm, history of diabetes and prolonged mechanical ventilation are risk factors for new-onset postoperative atrial fibrillation in elderly patients undergoing off-pump coronary artery bypass grafting.

目的 探讨急性心肌梗死(AMI)患者血清高敏心肌肌钙蛋白T(hs-cTnT)水平变化及其诊断意义.方法 选取72例AMI患者,同时选取不稳定型心绞痛(UA)患者42例,稳定型心绞痛(SA)患者39例,检测各患者血清hs-cTnT、肌钙蛋白I(cTnI)和肌酸激酶同工酶(CK-MB)的水平.结果 AMI组患者血清hs-cTnT、cTnI和CK-MB明显高于UA组和SA组(P<0.05);UA组和SA组血清hs-cTnT、cTnI和CK-MB比较差异无统计学意义(P>0.05);hs-cTnT、cTnI和CK-MB诊断AMI的ROC曲线下面积分别为0.882(95%CI为0.826~0.937)、0.816(95%CI为0.737~0.896)和0.680(95%CI为0.589~0.771),P均<0.05;hs-cTnT截断值为15.42pg/mL时,灵敏度和特异度分别为86.50%和86.10%.结论 AMI患者hs-cTnT水平明显升高,在鉴别诊断AMI中有较好的诊断效能,值得临床推广.

患者男,33岁。咽喉肿痛3个月,进行性活动后乏力、胸闷半个月。心电图示:窦性心动过速104次/min,左心室肥大。超声心动图示:主动脉瓣上异常回声,考虑赘生物可能;主动脉关闭不全(重度),考虑无冠瓣穿孔可能;全心增大,肺动脉高压(轻度);有效心搏量减低;心包积液少量。2015年4月在全麻、体外循环下行"主动脉瓣置换术"。

患者女，42岁。胸闷、气促20余天，活动后加重10余天。无其他特殊不适。查体：血压128／86 mmHg（1 mmHg＝0.133 kPa），脉搏80次／min。心律整齐，三尖瓣听诊区可闻及4／Ⅳ级收缩期杂音。超声心动图示右心室内20 mm ×14 mm实质高回声光团，蒂似附着于侧壁，随心脏收缩运动呈摆动状（图1）。冠状动脉造影阴性，既往无高血压、糖尿病。3年前于当地医院行子宫瘤剥除术；1年前在我院行腹腔镜下子宫全切术＋肠粘连松解术＋右侧附件切除术＋阑尾切除术＋输尿管支架置入术。8个月前在我院行右肾及右输尿管切除术。

Objective To explore the effect of pleural cavity integrity on respiratory system after off-pump coronary artery bypass grafting (OPCABG),through comparing the respiratory complication after OPCABG.Methods One hundred and two patients were accepted OPCABG,among whom 49 patients' pleural cavities were opened (open group) and 53 patients' pleural cavities were closed (close group).The ventilation time,intensive care unit time,pleural effusion,the rate of atelectasis and respiratory failure after operation were compared between two groups.Results The ventilation time and intensive care unit time in open group were (40.3 ± 4.8) h and (78.3 ± 10.8) h,in open group were (28.6 ± 6.8) h and (54.8 ± 6.1) h.The ventilation time and intensive care time in open group were significantly longer than those in close group(P ＜ 0.01 or ＜ 0.05).The pleural effusion in open group was (800.0 ± 60.5) ml,in close group was (350.0 ± 28.6) ml.The pleural effusion in open group was significantly higher than that in close group (P ＜ 0.01).The rate of postoperative atelectasis and respiratory failure in open group were 36.7％(18/49) and 38.8％(19/49),in close group were 15.1％(8/53) and 18.9％(10/53).The rate of postoperative atelectasis and respiratory failure in open group were significantly higher than those in close group (P ＜ 0.01).Conclusions OPCABG is the operation in mediastinum.To avoid pleural cavity opened in OPCABG can reduce the incidence of postoperative respiratory complication.

Objective To assess the feasibility of anticoagulation therapy after mechanical valve replacement in grass-root health institutions.Methods One hundred and sixty one patients with mechanical valve replacement received anticoagulation therapy with warfarin,including 79 cases receiving the therapy in grass-root health institutions (test group) and 82 cases in the tertiary hospitals (control group).The patients were followed up for 12 months after operation;the rate of anticoagulation efficacy,the anticoagulationrelated complications,and the anticoagulation-related cost were documented and compared between two groups.Results The international normalized ratio (INR) tests were performed for 1 021 times in test group and 717 times were up to anticoagulation standard (70.2 ％,717/1 021),while INR tests in control group were performed for 965 times and 688 times were up to standard (71.3％,688/965);there were no significantly differences in efficacy rate between two groups (P ＞ 0.05).There were no significant differences in rate of bleeding events and thrombosis between two groups [16.5％ (13/79) vs.12.2％ (10/82),6.3％(5/79) vs.4.9％(4/82),respectively,x2 =0.596,P=0.44,x2 =0.161,P=0.69].The anticoagulation-related cost per month and per patient in test group was significantly lower than those in control group [(63.1 ±.12.8) vs.(176.6 ± 16.4) yuan,t =48.716,P ＜0.05].Conclusion Compared with the tertiary hospital,the anticoagulation therapy in grass-root institutions can accomplish the similar clinical outcomes and significantly reduce the medical cost in patients with mechanical valve replacement.

Objective To investigate the role of titanium plate fixation for sternum closure after off-pump coronary artery bypass grafting (OPCABG) in elderly patients.Methods A total of 120 elderly patients who accepted OPCABG were randomly divided into two groups.The control group (n =60) received wire to fix the sternum,and the experimental group (n=60) received titanium plate combined with wire to fix the sternum.The chest closure time,the rate of postoperative incision pain,the rate of sternal dehiscence and sternal re-fixation between two groups were observed and recorded.Results The rates of postoperative incision pain,sternal dehiscence,sternal re-fixation was lower in experimental group than in control group [11.7％(7/60) vs.38.3％(23/60),3.3％(7/60) vs.13.3％(8/60),1.7％(1/60) vs.11.7％(7/60),x2 =11.378,3.927,4.821 respectively all P＜0.05].The chest closure time was longer in experimental group than in control group [(39±5)min vs.(30±2) min,x2 =13.386,P＜0.05].Conclusions Titanium fixation plate combined with wire for sternum closure can increase the stability of sternum fixation,reduce the postoperative pain and sternal dehiscence,and then decrease the risk of sternal re-fixation,but delay sternal closure of OPCABG in the elderly.

OBJECTIVE:To evaluate the clinical efficacy of tricuspid valve (TV) annuloplasty with MC3 valve ring for management of functional tricuspid regurgitation (FTR). METHODS:A total of 85 patients who accepted TV annuloplasty with MC3 valve ring for management of FTR were retrospectively analyzed, of which included moderate tricuspid regurgitation (TR) (45 cases) and severe TR (40 cases). The ratio of regurgitant area to RA area, right atrium and ventricular transverse diameter, annulus diameter were measured by echocardiography at three different stages: before, early stage and 1 year after operation. RESULTS:At early stage after operation, there were 81 cases of mild TR, 4 cases of moderate TR. At 1 year after operation, there were 82 cases of mild TR , 3 cases of moderate TR. Compared with the results of pre-operation, the ratio of regurgitant area to RA area, right atrium transverse diameter, annulus diamete and right ventricular transverse diameter at early stage and 1 year after operation were significantly reduced ((14.9±4.6)% and (13.1±4.3)% vs (37.7±8.2)%, (37.2±4.9) and (29.6±5.6) vs (42.5±6.1) mm , (27.3±1.0) and (27.2±1.0) vs (32.2±2.4) mm, (35.5±3.7) and (28.1±4.0) vs (36.9±3.4) mm, all P<0.05).The ratio of regurgitant area to RA area, right atrium and ventricular transverse diameter at early stage after operation were significantly reduced than at 1 year after operation (all P<0.05), but there was no significant difference in the annulus diameter between early stage and 1 year after operation (P>0.05). No complications occurred during follow-up. CONCLUSION:TV annuloplasty with MC3 valve ring is effective for the management of FTR.

目的探讨动脉导管未闭合并慢性肺动脉血栓栓塞的外科治疗疗效。方法回顾性总结2010年1月至2013年6月间9例动脉导管未闭合并慢性肺动脉血栓栓塞患者的诊治过程和临床经验。患者均在深低温低流量或停循环下行动脉导管缝闭或动脉导管结扎术,肺动脉切开取栓术或内膜剥脱术,术中持续泵入前列地尔。结果术后1例因急性灌注肺死亡,其余8例均存活顺利康复出院,肺动脉压下降31 4 5 mm Hg(1 mm Hg=0.133 kPa);术后随访2个月 3 年,临床症状均有减轻、无明显并发症,活动能力均有明显提高,未见复发病例。结论动脉导管未闭合并慢性肺动脉血栓栓塞的外科治疗能有效的降低肺动脉高压,缓解临床症状;围术期处理好肺再灌注损伤、肺水肿等并发症是确保疗效的关键。

Objective To investigate the effect of alprostadil on the cardio-pulmonary function of the patients after coronary artery bypass graft (CABG) by using Liposome prostaglandin.Methods Sixty cases of CAD were evenly divided into two groups:observation group and control group.Both groups were given the basic treatments such as anti-inflammation,mechanical ventilation,etc.Liposome prostaglandin was intravenously injected after surgery in control group,10 μg,thrice every day for 2 days.The changes of PaO2,and PaO2/FiO2 were examined at 0.5,6.0,and 12.0 h after surgery.The changes in RVEF and PVRI at 48.0 h after surgery were measured by using the right cardiac catheterization techniques.Results Before alprostadil administration and at 0.5 h after surgery,the PaO2 value was (82.3 ± 8.4) mmHg (1 mmHg=0.133 kPa) in observation group and (83.1 ±8.5) mmHg in control group,and the PaO2/FiO2 value was (212.8 ± 10.4) mmHg in observation group and (214.3 ± 10.7) mmHg in control group (P ＞0.05).After alprostadil administration and at 6.0 and 12.0 h after surgery,the PaO2 value was (96.0±9.8) and (108.0 ± 10.6) mmHg in observation group and (84.3 ±6.1) and (86.7 ±7.3) mmHgin control group,and the PaO2/FiO2 value was (248.6 ± 18.9) and (280.9 ±34.8) mmHg in observation group and (220.5 ± 16.1) and (245.9 ±28.2) mmHg in control group,respectively (P ＜0.01).At 48.0 h after surgery,RVEF in observation and control groups was (0.53 ±0.05) and (0.46 ± 0.04),and PVRI was (203 ±28) and (235 ± 33) mL,respectively (P ＜0.05).Conclusion Patients after CABG that were given liposome prostaglandin can get improvement in PaO2,PaO2/FiO2,RVEF and PVRI.Liposome prostaglandin administration also contributes to the recovery of postoperative cardiopulmonary function.

患者男,60岁.因间断胸闷、乏力伴左半身麻木5年,加重1个月入院.高血压史5年,长期服用抗高血压药物,血压控制良好.X线胸片示两上肺纹理增粗,轻度肺淤血改变,心影大,心胸比0.64.心电图示窦性心动过缓,左心室肥大伴劳损,左前分支传导阻滞。

心房颤动(房颤)患者左心瓣膜置换术后常见的并发症有晚期三尖瓣关闭不全(TR)或原有TR加重[1-2].引起TR的原因很多:继发性三尖瓣环扩张、右心室功能障碍、三尖瓣面积和右心室扩张的比例失衡等[3].研究表明房颤也是左心瓣膜置换术后引发TR的危险因素[4].1994年1月至2008年12月,我们为163例房颤患者实施了左心瓣膜置换手术,现总结报道如下.

目的探讨胸部CT平扫在心脏手术后胸骨裂开的诊断与治疗中的作用。方法我院2011年12月—2012年1月心脏手术后胸骨裂开病例9例,通过行胸部CT平扫诊断胸骨裂开程度。结果胸部CT平扫显示钢丝松动3例;钢丝切割胸骨致钢丝脱落4例;钢丝断裂2例。根据胸骨裂开分型分别进行胸带外固定、局部钢丝再固定及二次开胸胸骨再固定。9例病人均痊愈出院,无死亡病例。结论胸部CT平扫可以诊断心脏手术后胸骨裂开的原因及程度,可以为胸骨裂开后胸骨再固定提供重要指导作用。

Objective To observe the effect of transcatheter closureofcongenital heart disease using occlude device.Meathods From November,2004 to March,2008,186 patientswhich suffered from congenital heart disease were occluded with occluder.The kind of congenital heart disease included ventricular septal defect(VSD) 60 cases,atrial septal defect(ASD)40 cases,patent ductus arteriosus(PDA)86 cases.The mean age was 10.5～7.2(3～32 years old).All patients underwent examination of heart coloure echo and ECG,chest x-ray before catheter closure,and the closure was monitored under the transthoracic echo cardiography and fluoroscopy guidance.The left ventriculaography and aortagraphy were repeated to assess the size of PDA or VSD,and assess the efficacy immediately after the closure.The TTE and chest film were performed 3 months,6 months and 12 months after the closure to evaluate its therapeutic effect.Result Two patients which suffered from VSD were failure to closure and change to operation treatment,another patients all were successed closured.LVED from 56.4～6.5 mm before closureing decreased to 40.5～3.0 mm(P<0.01)after closureing.Culsions Transcatheter closure of congenital heart disease using VSD,ASD and PDA occluder is an efficient method.The procedure is simple method with a high success rate.

Objective To summarize the surgical treatment results of valve replacement in 87 patients with pulmonary arterial hypertension. Methods Eighty-seven patients undergoing valve replacement within 6 years were studied.All cases of mitral replacement adopted the preservation methods(involved 12 cases of mitral along with aortic valve replacement).Results In this group,5 patients had postoperative low cardiac output syndrome and 9 patients had serious arrhythmias.Two patients died in hospital(2.3%).Conclusion The perioperative management,myocardial protection,surgical methods and intensive care should be paid much attention to improve the outcome of operation.

对49例先天性心脏病合并重度肺动脉高压患者,行房间隔缺损修补术9例,室间隔缺损修补术26例,动脉导管心内直视修补术3例,部分性心内膜垫修补术9例,全肺静脉异位引流纠治术2例,同时行严格的围手术期麻醉管理.结果麻醉过程平稳,术后治愈出院47例,死亡2例.认为对先天性心脏病合并重度肺动脉高压患者围手术期的麻醉处理,只有遵循保持患者血流动力学稳定,降低肺动脉压、肺循环阻力,维护心功能,避免肺动脉压危象发生的原则,才能提高手术成功率、降低手术死亡率.

目的总结37例二尖瓣闭式扩张术后的瓣膜置换术的经验。方法37例患者均在全麻低温体外循环下行二尖瓣置换术,采用右心房-房间隔入路,其中单纯二尖瓣置换30例;二尖瓣加主动脉瓣双瓣置换7例;21例合并三尖瓣关闭不全同时行三尖瓣DeVega成形。结果围术期死亡2例,主要死亡原因为出血和低心排症。32例患者随访6个月～6年,无远期死亡,疗效满意。结论二尖瓣闭式扩张术后再狭窄,而接受瓣膜置换术的患者应尽早手术,注意术中操作,良好的心肌保护及正确的围术期处理是提高手术效果的关键。二尖瓣闭式扩张术后瓣膜置换术是安全的,死亡率较低。