west china medical publishers
Keyword
  • Title
  • Author
  • Keyword
  • Abstract
Advance search
Advance search

Search

find Keyword "围术期" 89 results
  • 冠状动脉旁路移植术后围术期心肌缺血

    目的 探讨冠状动脉旁路移植术(CABG)术后出现围术期心肌缺血(PMI)的相关危险因素及其处理措施. 方法 回顾性总结2 680例CABG患者的临床资料,并根据术后是否发生PMI将其分为PMI组(30例)和非PMI组(2 650例),分析CABG后出现PMI的危险因素. 结果 PMI组中11例进行急诊再血管化,其余行主动脉内球囊反搏(IABP)或药物治疗;院内死亡7例,死亡率为23.3%.心绞痛症状缓解22例,心电图完全或部分复原9例,残留心肌梗死改变14例.非PMI组院内死亡58例,死亡率为2.2%.两组死亡率之间比较差别具有显著性意义(χ2=56.04,P=0.001).多因素分析表明,术前无心肌梗死史、冠状动脉弥漫性病变和术中内膜剥脱为相关危险因素.结论 PMI是CABG术后一种比较危险的并发症,严重者可危及生命,及早诊断和适当的治疗尤为重要,对于因旁路血管堵塞造成的PMI,急诊再次血管移植是挽救患者生命的必要措施.

    Release date:2016-08-30 06:32 Export PDF Favorites Scan
  • Extended thymectomy for myasthenia gravis via subxiphoid versus intercostal approaches: A retrospective cohort study in a single center

    ObjectiveTo analyze the clinical outcomes of extended thymectomy for myasthenia gravis (MG) patients under different surgical approaches, and to determine the factors affecting the prognosis of MG. MethodsThe MG patients who underwent extended thymectomy from January 2014 to March 2021 in our hospital were retrospectively collected. According to the surgical approach, they were divided into a subxiphoid group and an intercostal group, and the perioperative results and prognosis were compared between the two groups. A “good outcome” was defined as complete stable remission (CSR), pharmacological remission (PR) or minimal manifestations state (MMS); a “poor outcome” was defined as outcomes worse than MMS. Univariate and multivariate logistic regression analyses were performed to assess the factors associated with the good outcomes. ResultsA total of 187 MG patients were included in the study, including 82 males and 105 females, with a median age of 50 (36, 60) years. There were 134 patients in the intercostal group and 53 patients in the subxiphoid group. Compared with the intercostal group, although the operation time of the subxiphoid group was longer [200.0 (172.0, 232.0) min vs. 141.0 (118.0, 169.0) min, P<0.001], the intraoperative blood loss was less [10.0 (10.0, 20.0) mL vs. 20.0 (10.0, 50.0) mL, P<0.001], the postoperative hospital stay was shorter [3.0 (2.5, 4.0) d vs. 5.0 (3.0, 7.0) d, P<0.001], and the incidence of complications was lower [1 (1.9%) vs. 26 (19.4%), P=0.001]. A total of 159 (85.0%) patients were followed up for a median period of 46 (13, 99) months, with a good outcome rate of 90.6% and CSR rate of 33.3%. There were no statistical differences in PR, MMS or overall good outcome rates between the two groups (P>0.05). Multivariate logistic analysis showed that age≤50 years was an independent predictor for "good outcome" of MG patients. ConclusionExtended thymectomy via subxiphoid for MG is a safe, feasible and effective surgical approach.

    Release date:2024-08-02 10:43 Export PDF Favorites Scan
  • Expert recommendations for standardized perioperative management after transapical transcatheter aortic valve implantation

    The technique of transcatheter aortic valve implantation has become increasingly mature. Although the transapical approach has a certain degree of minimally invasive trauma, it still has the characteristics such as heart beating without cardiopulmonary bypass, and the low technical requirements of catheter guide wire. In particular, the valve path is short and coaxial, which is easy to manipulate, and pure regurgitation and stenosis can be easily operated and are not subject to the limit of peripheral artery stenosis. It is still one of China's main approaches for transcatheter aortic valve replacement. Its perioperative management still has specific features and differs from the femoral artery approach. In addition, there is little relevant literature abroad. Therefore, domestic experts in this field were organized to discuss the development of perioperative management specifications to provide reference and techniques support for developing this field in China and further improve the quality of clinical operation and perioperative management. It will provide more safe and more effective medical services to these patients.

    Release date:2023-07-10 04:06 Export PDF Favorites Scan
  • Perioperative Nursing of Spinal Cord Arteriovenous Malformation

    摘要:目的: 探讨脊髓动静脉畸形患者科学的围手术期护理方法。 方法 :对31例脊髓动静脉畸形围术期患者进行了科学的护理,即心理,术前、术后以及特殊症状护理,并分析护理效果。 结果 :31例患者中治愈27例,好转4例。 结论 :脊髓动静脉畸形手术难度大,危险性高,科学的围手术期护理是促进治疗效果的重要保证。Abstract: Objective: To discuss the effectiveness of scientific perioperative nursing for the patients with spinal arteriovenous malformations. Methods : 31 patients with spinal arteriovenous malformations had got nursing, such as psychology nursing and special perioperative symptoms. The nursing effective is analysed. Results : 27 cases are cured and the other 4 cases improved. Conclusion : Spinal arteriovenous malformations is difficult and dangerous for operation.The scientific perioperative nursing is important guarantee for advancing the cure effective.

    Release date:2016-09-08 10:12 Export PDF Favorites Scan
  • Coronary artery bypass grafting for patients older than 70

    Objective To introduce the results and strategy of perioperative management undergo coronary artery bypass grafting (CABG) for patients older than 70. Methods One hundred and twenty one patients, 93.4%(113/121) of whom was complicated with other diseases, were retrospectively studied. Off-pump CABG (OPCAB) was used in 80 cases (66.1%). For the rest patients with severely compromised heart function or small target vessel with diffuse lesion, conventional CABG (CCABG) was selected. Left internal mammary artery (LIMA) was harvested leaving pleural cavity intact and grafted to left anterior descending artery (LAD). Saphenous vein(SV) was utilized for other anastomoses. Transit-time flowmeter (TTFM) was utilized to make sure that grafts were patent with satisfactory blood flow. Procedure of sternotomy and chest closure was carefully performed to decrease the complication of mediastinitis. Adequate nutrition and gradually increased physical activity were encouraged for "fast-track". Results Grafts were 3.08±0.75 for CCABG and 2.24±0.82 for OPCAB . LIMA was used in 90.9%(110/121) patients. One patient receiving emergency operation died of multiple organ failure syndrome resulting in mortality of 0.8%. The incidence of complication was 3.3%(4/121). The others recovered smoothly without any complication. Intubation time of OPCAB(10.04±5.68 h) was significantly shorter than that of CCABG(21.46±14.54 h). Patients were discharged within 12.22±5.56 days after operation. Conclusion Good short term result, namely low incidence of mortality and complication, could be obtained in patients older than 70 who underwent CABG through meticulous perioperative management.

    Release date:2016-08-30 06:28 Export PDF Favorites Scan
  • Influence of enhanced recovery after surgery on intestinal flora of patients with colorectal cancer based on high-throughput sequencing technology

    ObjectiveTo explore the influence of enhanced recovery after surgery (ERAS) on intestinal flora in patients with colorectal cancer.MethodsBy convenient sampling method, 60 patients with colorectal cancer were selected from August 2018 to December 2019 in the Department of Gastrointestinal Surgery of West China Hospital of Sichuan University and randomly divided into ERAS group and traditional treatment group (traditional group). Among them, the perioperative clinical management was carried out according to the ERAS management and traditional treatment process in the the ERAS group and in the traditional group, respectively. The fresh fecal samples were collected within 24 h after admission and the first natural defecation after operation. The bacterial 16 Sr DNA V3–V4 region was sequenced by Illumina MiSeq sequencer, and the results were analyzed by bioinformatics.ResultsA total of 60 patients with colorectal cancer were included, 30 cases in the traditional group and 27 cases in the ERAS group (3 people temporarily withdrew from the study). There were no significant differences in the basic informations between the two groups (P>0.05). ① Before or after operation, there were no significant differences in Shannon index and Simpson index between the two groups. The difference between preoperative and postoperative comparison in the same group was also not statistically significant (P>0.05). ② Beta diversity analysis showed that there was no significant difference in community composition between the traditional group and the ERAS group before operation, and there was a clear boundary between the traditional group and the ERAS group after operation. ③ At the phylum level, compared with the preoperative abundance, the postoperative abundance Firmicutes decreased by 26.5% and 5.5% in the traditional and ERAS group, respectively; Bacteroidetes increased by 21.6% and 4.7% in the traditional and ERAS group, respectively; Proteobacteria increased by 7.2% and 2.2% in the traditional and ERAS group, respectively. At the genus level, compared with the preoperative abundance, the postoperative abundance of Bacteroides in the traditional group increased by 17.6% and in the ERAS group decreased by 1.6%; Bifidobacterium decreased by 1.8% and 1.3% in the traditional group and in the ERAS group, respectively.ConclusionsERAS does not affect species diversity of intestinal flora. Although ERAS has some damage to structure of intestinal flora, it is weaker than traditional process, so it is more conducive to reconstruction and restoration of intestinal microecological environment.

    Release date:2020-12-30 02:01 Export PDF Favorites Scan
  • Perioperative protection for right heart in patients with apical displacement of tricuspid valve leaflets

    The apical displacement of tricuspid valve leaflets complicated with significantly enlarged, thin and fibrotic wall of the right ventricle is prone to dysfunction of right heart. Therefore, the myocardial protection for the right ventricle is important. Based on the pathological changes, an algorithm of perioperative myocardial protection strategy is summarized. Firstly, we should clearly know that the right ventricular myocardium with severe lesions is much different from the unimpaired myocardium, because it is now on the margin of failure; secondly, right heart protection should be regarded as a systematic project, which runs through preoperative, intraoperative and postoperative periods, and requires close collaboration among surgeons, perfusionists, anesthesiologists and ICU physicians. In this article, we try to introduce the systematic project of the right heart protection, in order to improve the outcome of this population.

    Release date:2020-12-31 03:27 Export PDF Favorites Scan
  • Research progress of anxiety and depression in adult patients undergoing cardiac surgery

    Anxiety is a strong behavioral and psychological reaction with fear components, while depression is a mental disorder dominated by high or low mood, both of which are accompanied by cognitive and behavioral changes, and are common comorbidities in patients with heart disease. Cardiac surgery is one of the important factors which trigger specific emotional and physiological reactions of patients. Persistent or initial depression and anxiety after surgery will not only increase surgical complications, short- or long-term mortality and medical costs, but also seriously affect patients' social function and quality of life. With the transformation of bio-psycho-social medical model, it is necessary to evaluate the perioperative psychological state and biological risk of patients undergoing cardiac surgery. This article reviews the characteristics, related mechanisms and therapeutic interventions of anxiety and depression in patients undergoing cardiac surgery.

    Release date:2020-05-28 10:21 Export PDF Favorites Scan
  • 重症法洛四联症根治术的围术期处理

    目的探讨重症法洛四联症(TOF)围术期处理的方法与经验. 方法 1998年6月~2000年6月共纠治重症TOF 56例,行根治术43例,包括肺动脉闭锁7例,左右肺动脉发育较差26例,肺动脉瓣缺如2例,二期根治术8例. 结果残余室间隔缺损分流3例,残余肺动脉远端梗阻(压力阶差gt;30mmHg)11例;死亡2例(4.6%). 结论重症TOF因心脏畸形复杂、手术时间长、难度大和术后低心排血量发生率高,搞好围术期处理对提高重症TOF患者的术后生存率有重要意义.

    Release date:2016-08-30 06:32 Export PDF Favorites Scan
  • 内镜下黏膜剥离术的围术期护理

    目的探讨内镜黏膜下剥离术(ESD)的治疗与护理配合方法,以降低术中及术后并发症的发生率。 方法对2012年1月-8月收治的32例胃肠道病变患者行ESD治疗及护理方法进行回顾性分析。 结果32例患者均安全、成功完成手术。术中出现创面少量出血4例,予电凝、氩气刀或止血夹成功止血;术后24 h内出现出血1例,予急诊内镜下止血夹成功止血。无穿孔发生。平均随访3~6个月,均未出现复发或食管狭窄等其他远期并发症。 结论在ESD术中正确运用护理程序,做好术前准备、术中配合、术后观察及并发症的护理是顺利进行手术,减少其并发症,促进患者早日康复的重要保证。

    Release date: Export PDF Favorites Scan
9 pages Previous 1 2 3 ... 9 Next

Format

Content