目的:探究快速康复理念下预警性干预对经皮冠状动脉介入术(PCI)术后1年内肺癌术围术期血栓事件的影响.方法:选取因非小细胞肺癌于医院行肺叶切除术且术前12个月内接受过PCI治疗的60例患者,采用随机数表法将其分为对照组和观察组,每组30例,对照组采用常规护理,观察组在快速康复理念下预警性护理,应用Caprini深静脉血栓风险评估表动态掌握患者病情,从基础预防、物理预防和药物预防进行全方位管理,比较两组患者的凝血功能指标、血栓事件、生活质量简表-36(SF-36)评分和患者对护理的满意度.结果:干预后两组的血红蛋白(Hb)、纤维蛋白原(FIB)、血小板计数(BPC)、凝血酶原时间(PT)、D-二聚体(D-D)和纤维蛋白(原)降解产物(FDP)水平数据均显著优于干预前,且观察组的Hb、FIB、BPC、PT、D-D和FDP水平数据优于对照组,其差异有统计学意义(t=2.417,t=9.342,t=8.322,t=8.191,t=8.194,t=5.343.观察组术后肢体瘀斑面积为(1.88±0.21)cm2,显著低于对照组,组间差异有统计学有意义(t=7.097,P＜0.05);血栓事件发生率及其他并发症发生率分别为3.3%(1/30)和6.6%(2/30),均显著低于对照组,组间差异有统计学意义(x2=6.405,x2=4.320;P＜0.05).干预后观察组的SF-36评分为(92.32±3.14)分,显著高于对照组,组间差异统计学有意义(t=15.672,P＜0.05).观察组患者总满意率为90.0%(27/30),显著高于对照组,组间差异有统计学意义(x2=4.812,P＜0.05).结论:快速康复理念下预警性护理能够改善PCI术后1年内肺癌手术患者的凝血功能,减少围术期血栓事件及并发症的发生,以及患者术后肢体瘀斑面积,提高患者生活质量和患者满意度.

目的 探究加速康复外科护理应用于肺癌合并冠心病(冠状动脉粥样硬化性心脏病)患者围手术期的临床价值.方法 选择2020年6月至2021年6月首都医科大学附属北京安贞医院收治的90例拟行手术的肺癌合并冠心病患者作为研究对象.根据随机数字表法分为观察组和对照组,各45例.对照组应用围手术期常规护理,观察组在对照组基础上进行加速康复外科干预.比较2组围手术期指标,术前及术后1、3d的疼痛情况,术前、术后1个月心理状况,围手术期并发症发生情况.结果 观察组术后首次排便时间、拔除胸腔引流管时间、住院时间均明显低于对照组[(39±3)h比(48±5)h、(85±14)h比(114±17)h、(9.4±1.0)d比(13.8±1.2)d](均P<0.05).观察组术后1、3 d的疼痛视觉模拟量表评分均明显低于对照组[(5.0±0.6)分比(6.5±0.6)分、(3.1±0.3)分比(4.0±0.4)分](均P<0.05).2组术后1个月焦虑自评量表与抑郁自评量表评分均明显低于术前,且观察组明显低于对照组(均P<0.05).观察组围手术期并发症发生率低于对照组[6.7％(3/45)比22.2％(10/45)](P=0.036).结论 加速康复外科应用于肺癌合并冠心病患者围手术期护理可以有效减轻疼痛,缓解不良情绪,减少并发症,加快患者康复.

目的 观察心脏移植等待患者间断重复输注左西孟旦治疗心力衰竭的临床疗效.方法 选取2019年6月至2021年1月间首都医科大学附属北京安贞医院37例心脏移植等待患者,接受每月一次输注左西孟旦策略,每次剂量为12.5 mg,输注速度为0.1 ml·kg-1·min-1,时限6个月.研究终点为心衰发作需机械辅助、需紧急心脏移植及死亡.收集基线与终点数据资料,血红蛋白、B型利钠肽(BNP)、N末端B型利钠肽前体(NT-proBNP)、肝功能、肾功能检验,行心电图、心脏超声心动图检查和6分钟步行试验,完成明尼苏达心力衰竭生活质量评分和堪萨斯心肌病评分.结果 1例患者于研究起始3月后在院外猝死;3例患者分别于研究起始1、2、4月后在院内因心力衰竭死亡;7例患者在研究观察期间接受了队列计划的心脏移植.研究前后,患者的血红蛋白、肝功能、肾功能指标数据没有显著性差异;超声心动图测得的左心室舒张末内径分别为(73.3±8.0)mm和(71.7±8.7)mm,差异无显著性;射血分数分别为(21.3±3.7)％和(23.3±5.5)％,差异无显著性;BNP水平显著下降,分别为(2857.0±1003.5)pg/ml和(2205.3±1120.5)pg/ml;但NT-proBNP无显著差异,分别为(3605.3±1254.7)pg/ml和(3325.3±1537.0)pg/ml;6分钟步行试验结果增加,分别为(255±95)m和(294±86)m,差异具有显著性;研究前后,明尼苏达心力衰竭评分与堪萨斯心肌病评分分别为(37±18)、(45±20),(45±23)、(49±22),差异无显著性.结论 间断重复输注左西孟旦治疗终末期心力衰竭心脏移植等待患者,改善了BNP水平和6分钟步行试验结果;在治疗过程中其安全性可接受.

Objective:To evaluate the mid-term outcomes of patients with rheumatic heart disease who underwent aortic valve repair surgery in a prospective cohort.Methods:From January 2016 to December 2020, a total of 54 patients with rheumatic heart disease underwent aortic valve repair surgery in Beijing Anzhen Hospital, with an average age of (50.61±13.29) years, including 29 females (53.7%). There were 31 patients (57.4%) had pure aortic insufficiency, 2 patients (3.7%) had pure aortic stenosis and 21 patients (38.9%) had mixed lesion. During the same period, 43 patients (80.0%) underwent mitral valve surgery, 36 patients (66.7%) underwent tricuspid valve surgery, and 20 patients (37.0%) underwent atrial fibrillation radiofrequency ablation.The follow-up period was from 1 month to 61 months (median follow-up was 25 months). Paired rank-sum test was used to compare the differences in continuous variables among subjects, and Kaplan- Meier method was used to analyze the clinical outcomes during the follow-up period. Results:Proportion of moderate and severe aortic regurgitation Preoperatively was higher than that of discharge data, aortic valve orifice maximum velocity and left ventricular end-diastolic diameter were significantly lower than discharge data (all P<0.05). The 5-year survival rate was (96.1±2.7)% (2 patients died). The 5-year freedom from reoperation after aortic valve repair was (89.5±4.5)%(5 patients underwent redo surgery). The 5-year freedom from valvular-related complications was (91.3±4.2)%(3 patients suffered from complications). Conclusion:Aortic valve repair surgery for rheumatic aortic valve disease is feasible and has excellent early and mid-term results, it can be a reliable treatment option.

2014年1月至2018年8月北京心脏移植及瓣膜外科诊疗中心采用脑死亡捐献供体进行同种异体原位心脏移植77例，其中男51例(66.2%)，女26例(33.8%)，年龄(47.19±15.89)岁，体质量(63.28±15.36) kg。诊断为扩张性心肌病51例(66.2%)，缺血性心肌病16例(20.8%)，终末期瓣膜病4例(5.2%)，限制性心肌病3例(3.9%)，心脏恶性肿瘤2例(2.6%)，矫正型大动脉转位1例(1.3%)。供体器官应用HTK液进行心肌保护。冷缺血时间(247.92±100.13)min。采用双腔静脉法进行供体移植吻合。术后采用他克莫司(FK506)/环孢素A(CsA)＋吗替麦考酚酯(MMF)＋激素三联免疫抑制方案抗排异治疗。围手术期死亡6例，余71例康复出院，围手术期生存比例92.2%。术后进行ECMO辅助3例，IABP辅助2例，CRRT辅助3例，ECMO＋CRRT辅助6例，ECMO＋IABP辅助1例，ECMO＋CRRT＋IABP辅助1例。术后早期发生脑出血2例，但无明显神经系统症状。随访(17.82±15.45)个月，期间7例死亡，其中4例因肺感染死亡。心脏移植是治疗终末期心脏病的最有效的方法。对脑死亡患者进行充分的评估，匹配合适的受体，提高移植手术的成功率；远期按时随诊，坚持抗排异治疗，合理抗感染，提高受者生存。

目的 利用大鼠异位心脏移植模型,研究在心脏移植物排斥反应时心肌细胞动作电位(AP)的变化,探索心脏移植排斥反应的心电生理学变化机制.方法 建立对照组(Brown Norway-Brown Norway)和实验组(Brown Norway-Lewis)大鼠腹部心脏移植模型,每组建立模型20只,将20只模型随机分为4组,于术后第2天、第4天随机选取各组移植大鼠,获取心脏移植物分别进行病理检查,并应用快速酶解法分离单个心室肌细胞,应用全细胞膜片钳技术记录心肌细胞AP.结果 两组模型中供心复跳率100％,设定实验时间前对照组术中大鼠死亡2例,实验组死亡1例.组织学见对照组心脏移植物在移植后第2(n=4)、4(n=5)天均无明显排斥反应;实验组在移植后第2(n=4)、4(n=5)天有轻度到中重度排斥反应.在移植后第2、4天,实验组较对照组心肌细胞AP时程(APD)均显著延长[第2天APD90:实验组(n=15)vs 对照组(n=12),(88.1±6.5)mV vs (49.3±5.6)mV,P=0.0016;第4天APD90:实验组(n=21)vs 对照组(n=15),(104.0±9.5) mV vs (59.3±5.2)mV,P=0.0064];心肌细胞AP最大去极化速率(dv/dt)均显著增加;动作电位幅度(APA)无显著差异.结论 在大鼠心脏移植物排斥反应发生时,心肌细胞APD明显延长,AP dv/dt显著增加,APA无显著变化.

Objective:To characterize the variations of transient outward potassium current (Ito) and action potential(AP) in cardiomyocytes during acute cardiac rejection in abdominal heart transplantation model in rats.Methods:Heterotopic heart transplantation was performed in allogeneic (Brown Norway-to-Lewis) and isogeneic(Brown Norway-to-Brown Norway) rats.Recipients were sacrificed at the 2nd day and the 4th day after operation.Histopathological examinations of grafted hearts were performed in half rats of each group randomly.The other half of grafted hearts were excised rapidly and enzymatically dissociated to obtain single cardiomyocytes.Ito,inward rectifier potassium curren(Ik1) and AP were recorded using whole cell patch-clamp technique.Results:Histologic examination showed mild rejection at the 2nd day and moderate rejection at the 4th day in allogeneic group after cardiac transplantation,while no evidence of histologic lesions of rejection in isogeneic group.Under-40-60mV test potential,there is no significant difference between two groups about the current density of Ito,however,it was significantly decreased at the 4th day after cardiac transplantation.Under150--90mV test potential the current density of Ik1 was significantly decreased also.Compared with isogeneic group,action potential duration (APD) of cardiomyocytes in allogeneic group was significantly prolonged (APD90 was (49.28 ± 5.621) mV in isogeneic group,(88.08 ± 6.445) mV in allogeneic group at the 2nd day,P =0.0016;APD90 was (59.34 ± 5.183) mV in isogeneic group,(104.0 ± 9.523) mV in allogeneic group at the 4th day (P =0.0064).Conclusion:APD of cardiomyocytes was significantly prolonged during acute cardiac rejection in rats.Under-40-60mV test potential the current density of Ito was significantly decreased at the 4th day after cardiac transplantation.Under-150 to-90mV test potential the current density of Ik1 was significantly decreased also.

Objective:To explore the clinical diagnostic criteria of infective endocarditis in order to provide clinical reference for treatment of IE.Method:Collecting the clinical data (General condition,blood routine test,liver and kidney function,blood culture,electrocardiogram,echocardiography,operation)of patients with infective endocarditis who were admitted to ward 9 in Beijing Anzhen Hospital during 10 years (January 2007 to December 2016).The modified Duke criteria were used as diagnostic criteria.Results:According to the modified Duke criteria,126/161 cases have history of repeated fever,accounting 78.3％.Preoperative blood culture 149 cases,the positive rate was 20.1％;preoperative ultrasound found valve vegetation in 130 cases,the positive rate was 80.7％.In the total of 114 cases,8 cases can be confirmed preoperatively and 106 cases can be suspected to IE.Conclusion:Echocardiography is an important diagnostic method of infective endocarditis,repeated several tests will help to improve the sensitivity of diagnosis.To enhance the understanding of infective endocarditis,full and detailed medical history collection,physical examination,and laboratory data will help improve the clinical diagnosis.

Objective To evaluate the application value of case-based learning (CBL) combined with evidence-based medicine (EBM) teaching method in cardiac surgery education.Methods A total of 142 undergraduates majoring in clinical medicine(grade 2010-2013) in Capital Medical University were randomly divided into observation group(76 cases) and control group(66 cases).The observation group participated in CBL + EBM cardiac surgery education;the control group received traditional teaching lessons.The Critical Thinking Disposition Inventory(CTDI-CV) questionnaire was conducted and a classroom test was performed in both groups after classes.Results The total score of CTDI-CV and scores of analyzing ability,systematic ability,self-confidence and thirst for knowledge in observation group were significantly higher than those in control group[(312 ±30)points vs (256 ± 30) points,(48 ± 6) points vs (39 ± 7) points,(48 ± 7) points vs (37 ± 7) points,(52 ± 6) points vs (35 ± 7)points,(47 ± 5)points vs (38 ± 7)points] (P ＜ 0.05).The total test score and case analysis score in observation group were significantly higher than those in control group[85.5 (82.0,88.5) points vs 78.0 (68.5,82.0)points,45.5(40.0,50.0)points vs 35.0(31.5,38.0)points] (P＜0.05).Conclusions Combined education based on CBL and EBM can improve learning initiative,mastery of knowledge,critical thinking and practical analyzing abilities in students,which may enhance the quality of cardiac surgery education.

Objective To summarize the nursing experience for patients who received lung resection synchronous with off-pump coronary artery bypass grafting(OPCABG).Methods Clinical data of ten patients who received lung resection synchronous OPCABG from Mar 2000 to Nov 2009 were retrospectively analyzed.The nursing experiences were summarized.Results All cases recovered successfully.Among them 8 patients with lung cancer received lobe and lymph nodes resection.The other 2 patients with benign disease only had local lung excision.The operation time was 4.2 ～ 7.9 h.The average hospital day after operation was(20.0±9.2) days.Postoperative complications included atrial fibrillation(3 cases) and heart failure(1 case).No patients died.Cardiorespiratory function was recovered well in all patients.Conclusions Pre-operative psychological nursing,function exercise and airway preparation were very important.Carefully nursing and preventing the complication were one of key points for successful lung resection synchronous with OPCABG.

OBJECTIVE To analyze the performances of the on-pump beating heart(OPBH) coronary artery bypass graft(CABG) in 28 patients with severe left ventricular dysfunction.METHODS From 2003 to 2006,28 cases having left ventricular dysfunction undertook selective CABG with OPBH.There were 6 cases of emergent switching to extracorporeal circulation(ECC) due to unstable hemodynamic,which was 0.85% in the same period of OPCAB cases(6/702),and 22 selected cases undertook routine OPBH CABG.The procedure and the experience of the OPBH were analyzed.RESULTS In the 22 routine OPBH CABG cases, the number of grafts was(3.4±0.8),the time of ECC was(97.2±32.8) min,and no severe complications happened.The number of the grafts was(2.8±0.4),and the time of ECC was(186.0±94.9) min in the group of emergent switch,meanwhile, intra-aortic balloon pump was used in 3 cases during opertion and 3 cases died of heart failure,multi-organ failure and acute pulmonary thromboembolism after operation.CONCLUSION The reasonable application of OPBH CABG is safe and credible for patients with severe left ventricular dysfunction.

OBJECTIVE To sum up the experience of Cardiopulmonary Bypass(CPB) Process in emergency coronary artery bypass grafting(ECABG),for reducing the complications of CPB and increasing the rate of success of ECABG..METHODS Thirty-eight patients underwent ECABG from Jan,1999 to Mar,2002. 30 cases with CPB including 2 cases on-pump beating heart. The process of CPB,the measures for myocardial protection and the stand by for off-pump ECABG are analyged.RESULTS 30 cases are on-pump ECABG. 8 are off-pump. The average time of CPB 119.0±32.5min,the ischemia time 66.2±24.3,supplementary time 45.8±13.6,the rate of heart rebeating 92.8%,8 cases undertook off-pump ECABG. 3 cases died,one died of respiratory dysfunction,one pulmonary thromboemlism and one heart failure,there was no serious complications,angina and myocardial ischemia in 35 suruioals.CONCLUSION The adequate managements of CPB is the key factor for increasing the rate of success of ECABG.

目的:了解我院1994-7-1～2002-6-10日1000例行冠状动脉搭桥术的发展曲线,总结有关临床经验及体会.方法:对我院1994-7-1～2002-6-10日完成冠状动脉搭桥术1000例患者的部分资料建立数据库,并对其进行分析统计.结果:973例治愈出院,心绞痛症状消失,心功能明显改善,死亡27例,死亡率2.7%.结论:通过1000例分析,我们认为:(1)CABG术是治疗冠心病的有效可靠的方法之一;(2)中国少数医院水平已向国际水平接轨,整体水平及规模还有很大的发展空间;(3)有条件单位宜逐步开展CABG、OPCAB及E-CABG工作;(4)应加强术后的随访工作.

冠状动脉搭桥术２６例分析肖锋颜钧刘岩韩薇张希涛李鸣胡大一１９９４年９月至１９９５年９月，我们为２６例冠状动脉硬化性心脏病（冠心病）病人施行冠状动脉搭桥手术。现报告如下：一、对象和方法１．对象：本组男性２３例，女性３例。年龄４６～７４岁（平均５９．８岁...