患儿男,1岁4个月,12 kg。体检发现心脏杂音1年。超声心动图诊断"先天性心脏病,法洛四联症,房间隔缺损"。64排CT示"主动脉骑跨、室间隔缺损、房间隔缺损、右心室肥厚、右心室流出道及肺动脉狭窄"。2014年8月在全麻体外循环下行"法洛四联症纠治、房间隔缺损修补术"。术中跨瓣自体心包补片扩大右心室流出道至左肺动脉。术后第3天顺利撤除呼吸机。当日患儿血氧饱和度(SpO 2 )进行性下降,双肺闻及大量湿罗音,再次插管。二次

Objective:To investigate the therapeutic effect of pulmonary rehabilitation on acute lung injury and acute respiratory distress syndrome(ALI-ARDS) after cardiopulmonary bypass surgery.Method:A total of 36 cases of patients with mechanical ventilation after cardiopulmonary bypass were treated with pulmonary rehabilitation,they were in line with ALI-ARDS diagnostic criteria,the oxygenation index,blood gas analysis and hemodynamics changes before and after pulmonary rehabilitation were compared.Result:In 36 cases,PaO2 and oxygenation index after pulmonary rehabilitation were (110.2±28.3)mm Hg,(164.0±52.2),significantly higher than (62.1±12.2)mm Hg,(102.8±38.2)before the pulmonary rehabilitation,and the differences were statistically significant(P<0.05).There were no significant differences in hemodynamics before and after pulmonary rehabilitation(P>0.05).In the process of recruitment maneuvers,CVP increased went up temporarily as the PEEP increased.But when the PEEP decreased,CVP would get normal.There were no adverse reactions in all of patients.Conclusion:Recruitment maneuvers is helpful to improve oxygenation for the patients suffering from ALI-ARDS after cardiac surgery with cardiopulmonary bypass,and impact little on the hemodynamics.

Objective:To study the application of bedside continuous renal replacement therapy(CRRT)in acute renal failure after cardiac surgery.Method:The clinical data of 30 patients who occurred acute renal failure after cardiac surgery in our hospital from November 2012 to November 2014 were retrospectively analyzed.All patients were given bedside CRRT on the basis of routine treatment.The treatment results,the cardiac function and the renal function before and after the treatment were observed.Result:Among the 30 patients,26 cases survived and 4 cases died.In the 26 survival patients,23 patients were recovery and 3 patients were effective.The total effective rate was 86.67%.CRRT was applied in 2 to 24 hours after the operation,it was continuously applied for more than 24 hours,the mean time was (68.7±6.2)hours.The cardiac index(CI),heart rate(HR),mean arterial pressure(MAP),pulmonary capillary wedge pressure(PCWP),central venous pressure(CVP),oxygen saturation(SpO2),left ventricular ejection fraction (LVEF),oxygenation index(PaO2/FiO2),blood urea nitrogen(BUN),creatinine(Cr),HCO3-in blood,serum potassium and urine volume after treatment were better than before treatment,the differences were statistically significant (P<0.05).Conclusion:Bedside CRRT in patients with acute renal failure after cardiac surgery can effectively reduce the mortality rate and improve heart function and renal function.The curative effect of the treatment is remarkable and it has positive clinical significance.

Objective Evaluate the clinical efficacy of central venous catheter negative pressure drainage in treat‐ment of pneumothorax in Intensive Care Unit . Methods From October 2012 through September 2014 ,59 cases with pneumothorax were randomly divided into central venous catheter negative pressure drainage group or conven‐tional chest tube drainage group to compare the effective and safety indicators . Results There were no signifi‐cant difference in the rate of lung reexpansion ,time of lung reexpansion ,operating costs between groups ( P>0.05) .Moreover ,similar results were observed in the rate of pleural reaction ,hemothorax ,subcutaneous emphyse‐ma ,rate of tube blocked ,reexpansion pulmonary edema and wound infection(P>0.05) .However ,the venous cath‐eter negative pressure drainage group showed significantly lower degree of pain(P<0.05) . Conclusion Central venous catheter negative pressure drainage in treatment of spontaneous pneumothorax resultes in significant thera‐peutic effect ,as evidenced by less invasive ,low pain ,fewer complications and thus can be clinically valuable to pop‐ularize .