55岁女性患者，因发作性胸痛入院。X线胸片检查示镜面右位心，胸腹腔脏器全反位；头颈部CTA检查示右侧颈内动脉起始处重度狭窄近闭塞；冠状动脉造影检查示三支血管严重病变。2022年2月在全麻下行非体外循环不停跳冠状动脉旁路移植术+右侧颈动脉内膜剥脱术。先患者先垫高右侧肩，行右侧颈动脉内膜剥脱术；然后取平卧位，更换经口气管插管，正中开胸，行非体外循环不停跳冠状动脉旁路移植术。联合手术共计用时5.5 h，术中血流动力学稳定，术毕返心外ICU，术后第2天转出ICU，术后9天痊愈出院。目前随访5个月，患者恢复正常工作和一般体力活动。

目的 分析二尖瓣关闭不全(MI)患者冠脉搭桥术(CABG)后低氧血症发生情况及其影响因素.方法 回顾性分析2018年10月至2020年10月在我院行CABG治疗的74例MI患者的临床资料,根据患者是否发生低氧血症将其分为发生组与未发生组,比较两组患者的基本情况,分析导致MI患者CABG术后发生低氧血症的相关影响因素.结果 74例MI患者中有20例(27.03％)CABG术后发生低氧血症.发生组吸烟史占比、合并慢性肺病占比、BMI均高于未发生组,LVEF低于未发生组(P<0.05);经Logistic回归分析结果显示,有吸烟史、BMI偏高、合并慢性肺病、LVEF偏低是MI患者CABG术后发生低氧血症的影响因素(OR>1,P<0.05).结论 MI患者CABG术后发生低氧血症与其吸烟史、BMI偏高、合并慢性肺病、LVEF偏低密切相关,术前应给予患者针对性干预,以有效减少术后低氧血症的发生.

目的 探讨皮下脂肪部分剔除预防心脏术后胸骨正中切口愈合不良的疗效.方法 选取2019年3月至2020年5月在我科行胸骨正中切口的心脏手术患者539例,按切口缝合方式分为两组:皮下脂肪部分剔除组(对照组)和常规组,比较其发生切口愈合不良的比率和术后总住院时间.结果 皮下脂肪部分剔除组心脏术后胸骨正中切口愈合不良率显著少于常规组(0比6.97％,P<0.05),术后总住院时间显著短于常规组[(11.7±4.9)d比(13.54±7.3)d,P<0.05].结论 皮下脂肪部分剔除可显著降低心脏术后胸骨正中切口愈合不良的发生率并缩短术后总住院时间,可广泛应用于临床.

Objective:To investigate the relationship between tumor necrosis factor-α (TNF-α) G308A single nucleotide polymorphism and complications after heart valve replacement.Methods:The clinical data of 173 patients with valve replacement in our hospital from January 2018 to January 2020 were collected, and they were divided into complication group and non-complication group according to whether there were complications. Genotyping technique was used to detect TNF-α (TNF-α) polymorphism 308 G/A was genotyped. The genotypes of TNF-α 308 were analyzed. The genotypes of TNF-α 308 in different complications were analyzed; Multivariate logistic regression analysis was used to screen the independent risk factors of postoperative complications.Results:The frequency of GG genotype in patients without complications (80.54%, 120/149) was significantly higher than that in patients with complications (54.17%, 13/24, χ2=7.109, P<0.05). The frequency of GA genotype in patients without complications (13.42%, 20/149) was significantly lower than that in patients with complications (29.17%, 7/24, χ2=6.001, P<0.05). The frequency of AA genotype in patients without complications (6.06%, 9/149) was significantly lower than that in patients with complications (16.67%, 4/24, χ2=4.917, P<0.05). The frequency of G allele in patients without complications (87.25%, 130/149) was significantly higher than that in patients with complications (68.75%, 17/24, χ2=6.987, P<0.05). The frequency of G allele in patients without complications (12.75%) was significantly lower than that of a genotype in patients with complications (31.25%, χ2=6.153, P<0.05). The level of TNF-α in peripheral blood of the patients without complications [(1.23±0.27) ng/ml] was significantly lower than that of patients with complications [(1.85±0.35) ng/ml, t=4.991, P<0.05]. The level of TNF-α in peripheral blood of patients with GG genotype [(1.03±0.23) ng/ml] was significantly lower than that of patients with GA genotype patients [(1.45±0.28) ng/ml, t=3.019, P<0.05]. The level of TNF-α in peripheral blood of patients with GA genotype [(1.98±0.31) ng/ml] was significantly higher than that of AA genotype patients [(1.45±0.28) ng/ml, t=4.018, P<0.05]. Multivariate logistic regression analysis showed that TNF-α and G308A were independent factors of postoperative complications. Conclusion:TNF-α and G308A are independent factors of complications after valve replacement.