简介：BackgroundDeepsternawoundinfection(DSWI)aftermediansternotomyforcardiacsurgeryisoneofthemostcomplexandpotentiallylife-threateningcomplications.ItsverydifficulttotreatDSWI,andthereislackofagreementregardingthebesttherapystrategy.Thus,weaimedtosummarizeourexperiencesofsurgicaltreatmentforDSWI,inwhichsatisfactoryclinicalresultswereobtained.MethodsWeretrospectivelyanalyzed17caseswhosufferedfromDSWIaftercardiacsurgeryinourdepartmentfromJanuary2010toJune2015.Therewere8maleand9femalepatientswiththeiraverageageof62.7±9.5years(range42~75years).Allpatientsreceivedreservationofpartofsternumcombinedwithvacuum-assistedsuctiondrainageandbilateralpectoralismajormyocutaneousadvancementflaps.ResultsTheaverageintervalbetweencardiacsurgeryanddiagnosedDSWIwas10.9±6.5days(range5~21days).Timeofvacuum-assistedsuctiondrainagewas11.6±4.8days(range5~15days)andwoundhealingtimewas27.3±7.2days(range23~35days).Allpatientshadanuneventfulpostoperativerecoveryandgoodwoundhealing.Follow-uptimewas33.7±13.3months(range8~74months).Norecurrentinfectionwasobserved.ConclusionsReservationofpartofsternumcombinedwithvacuum-assistedsuctiondrainageandbilateralpectoralismajormyocutaneousadvancementflapsisasimpleandeffectivesurgicalstrategyforthetreatmentofDSWIaftercardiacsurgery.

简介：BackgroundAmongpatientsundergoingmitral-valvesurgery,30to50%presentwithatrialfibrillation,whichisassociatedwithreducedsurvivalandincreasedriskofstroke.Surgicalablationofatrialfibrillationhasbeenwidelyadopted,butevidenceregardingitssafetyandeffectivenessislimited.MethodsWerandomlyassigned260patientswithpersistentorlong-standingpersistentatrialfibrillationwhorequiredmitral-valvesurgerytoundergoeithersurgicalablation(ablationgroup)ornoablation(controlgroup)duringthemitral-valveoperation.Patientsintheablationgroupunderwentfurtherrandomizationtopulmonary-veinisolationorabiatrialmazeprocedure.Allpatientsunderwentclosureoftheleftatrialappendage.Theprimaryendpointwasfreedomfromatrialfibrillationatboth6monthsand12months(asassessedbymeansof3-dayHoltermonitoring).ResultsMorepatientsintheablationgroupthaninthecontrolgroupwerefreefromatrialfibrillationatboth6and12months(63.2%vs.29.4%,P<0.001).Therewasnosignificantdifferenceintherateoffreedomfromatrialfibrillationbetweenpatientswhounderwentpulmonary-veinisolationandthosewhounderwentthebiatrialmazeprocedure(61.0%and66.0%,respectively;P=0.60).One-yearmortalitywas6.8%intheablationgroupand8.7%inthecontrolgroup(hazardratiowithablation,0.76;95%confidenceinterval,0.32to1.84;P=0.55).Ablationwasassociatedwithmoreimplantationsofapermanentpacemakerthanwasnoablation(21.5vs.8.1per100patient-years,P=0.01).Therewerenosignificantbetween-groupdifferencesinmajorcardiacorcerebrovascularadverseevents,overallseriousadverseevents,orhospitalreadmissions.ConclusionsTheadditionofatrialfibrillationablationtomitral-valvesurgerysignificantlyincreasedtherateoffreedomfromatrialfibrillationat1yearamongpatientswithpersistentorlong-standingpersistentatrialfibrillation,buttheriskofimplantationofapermanentpacemakerwasalsoincreased

简介：BackgroundComparedwiththeopensaphenousveinharvesting(OVH),thereisalargerdecreaseinincisioncomplicationsofendoscopicveinharvesting(EVH).Fewerstudieswereconductedtoevaluatethequalityofgreatsaphenousvein(SVG)harvestingbythesetwomethods.Toapplytransittimeflowmeasurement(TTFM)toSVGgraftsincoronaryarterybypassgrafting(CABG),weproperlyevaluatethequalityofSVGandsurgicaleffect.MethodsFromJanuary2012toAugust2012,38casesunderwentEVHand16casesunderwentOVH.Werecordedpulsatilityindex(PI),meangraftflow(MGF)anddiastolicflow(DF)ofSVGgraftsforstatisticalanalysis.ThedysfunctionalgraftsdiagnosticcriteriaisPI>5,MGF<10mL/minorDF<50%.ResultIntermsofSVGgrafts,nosignificantdifferenceexistedinthelengthoftwogroups(P=0.2395).EVHgroupharvestingtimewaslongerthanOVHgroup(P=0.0113),buttheincisionlengthofEVHgroupwasshorter(P=0.0000)anditneededlesssuturetime.EVHgrouppresentednosignificantdifferencesinincisioncomplicationratefromOVHgroup(P=0.7055)within1monthaftersurgery.TTFMdataofwellfunctioninggraftshadnosignificantdifferenceinthetwogroups(PI3.2±1.0vs.2.9±0.9,MGF34.7±20.4vs.36.3±19.2mL/min,DF66.3%±10.6%vs.68.5%±10.3%).Therewasnosignificantdifferenceintherateofdysfunctionalgraftsintwogroups(P=0.7954)aswell.Thecausefordysfunctionalgraftsisanastomoticstricture.Were-anastomosedthegraftswithsatisfactoryeffect.ConclusionEVHisasafeandrecommendableoptionalSVGharvestingmethods.ThesurgicaleffectandthequalityofSVGgraftscanbereasonablyevaluatedbyTTFM.

简介：BackgroundVocalcordmovementdisorder(VCMD)isalaryngealdisordercharacterizedbyparadoxicaladductionofthevocalcordsduringininspiration,expirationorboth.ThenursingexperienceofpatientswithVCMDafteraorticdissectionsurgeryislimited.MethodsWeretrospectivelyanalyzedtheclinicaldataandnursingrecordsof269patientsafteraorticdissectionsurgeryinGuangdongGeneralHospitalbetweenMay2010andMay2012.Weobservedthepatients’pronunciation,andjudgediftherewasdysphagiaundergoingwaterdrinkingtesttwohoursafterextubation,toconfirmwhetherpatientshadVCMD.ResultsSeventeenpatientshadVCMDafteraorticdissectionsurgery,ofwhom2sufferedhoarseness,3haddysphasiaand12hadbothhoarsenessanddysphasia.Aftertimelytreatmentandcarefullynursing,allthepatientsrecoveredwell.ConclusionsWiththeenhancedcareofpatientswithaorticdissection,observinghoarsenessappearanceanddrinkingexperimentimmediatelyafterextubationcandetectVCMDassoonaspossible.Furtherrehabilitationtrainingandpsychologycarecanpreventbuckingandaspirationeffectively,andpromotingrecoveryandimprovingpatient’slifequality.

简介：BackgroundThoracoscopicminimallyinvasivepectusexcavatumrepair(Nussoperation)featuresitslittletrauma,simple,shortoperationtime,andgoodoutcomecomparedwithtraditionaltreatmentofpectusexcavatumsurgery-sternalelevation(Ravitchoperation)andsternalturnover.Theeffectoftheoperationonpatients’heartandheartfunctionremainsunclear.ThisstudyaimedtounderstandthechangesofelectrocardiogramandcardiacfunctionafterNussprocedure.MethodsFrom2008Januaryto2013July,thoracoscopicNussoperationwasperformedin217patientswithpectusexcavatum.Allthepatientsunderwentthepreoperative,postoperativedetectionofECGandcardiacfunctionin3monthsto1yearafteroperation.ResultsAfter3monthsto1yearfollow-up,arrhythmiaspersistedin46outof135patientswithpreoperativesymptoms(P<0.05);Strokevolumeandcardiacoutputsignificantlyincreased(P<0.05);Andcardiacparametersgreatlyimproved(P<0.05).ConclusionsMinimallyinvasiverepairofpectusexcavatumdeformitycancorrectthechestmalformation,alleviatearrhythmia,andimprovecardiacfunction.

简介：ObjectivesTotestthefeasibilityoftheuseofhighthoracicepiduralanesthesiaasasoleanestheticinpatientsundergoingoffpumpcoronaryarterybypasssurgery,avoidinggeneralanesthesia.MethodsBetweenOctober2002toApril2003,twentyfivecasesunderwentbeatingheartcoronaryarteryrevascularizationwithoutendotrachealgeneralanesthesia,usinghighthoracicepiduralanesthesiaandanalgesia.Allthepatientsunderwentepiduralcatheterizationontheeveningbeforethesurgery.ResuitsThepatientsinallreceived71grafts(singlen=11,doublen=5,triplen=6,quadruplen=3).Sixpatientsunderwentrepeatcoronaryarterybypass.Exceptonewasconvertedtogeneralanesthesiaandcardiopulmonarybypass,theotherpatientsunderwentoff-pumpcoronaryarterybypassgraftsurgery,2patientsunderwentgraftingvialeftthoracotomy(MIDCAB)andtherestthroughmidsternotomy.Therewasnomortality.Meanlengthofstayintheintensivecareunitwas16.2(4.2hoursandhospitalwas3.0(1.2days.ConclusionsOurexperienceconfirmsthefeasibilityofperformingmuhiplecoronaryarterybypassesinconsciouspatientswithoutendotrachealgeneralanesthesia.

简介：ObjectivesToanalyzetheriskfactorsforrecurrenthemorrhageaftercraniotomyforhypertensivecerebralhemorrhage(HCH).MethodsClinicaldatafrom162HCHpatientswhounderwentsurgerywereretrospectivelyanalyzedforthecorrelationbetweenrecurrenthemorrhageandgender,age,durationofhypertension,historyofdiabetesmellitusandhypercholesterolemia,siteandvolumeofhemorrhageandpost-surgicalsystolicanddiastolicpressure.ResultsPost-surgicalrecurrenthemorrhagewasfoundin24patients.Withmulti-variateregressionanalysis,historyofdiabetes,long-termhypertensionandhigherpost-surgicalsystolicpressurewereprovedpositivelycorrelatedtotheincidenceofrecurrenthemorrhageaftercraniotomyforhypertensivecerebralhemorrhage(P<0.05).ConclusionsRiskfactorsforrecurrenthemorrhageaftercraniotomyforhypertensivecerebralhemorrhagearehistoryofdiabetes,long-termhypertensionandhigherpost-surgicalsystolicpressure.Patientswithdiabetesandhypertensionareathigherriskforcerebralhemorrhageorpost-surgicalrecurrenthemorrhage.Effectivecontrolonbloodpressureaftersurgerycanreducetheincidenceofrecurrenthemorrhageaftersurgeryforhypertensivecerebralhemorrhage.

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简介：ObjectivesToevaluateretrospectivelythepotentialbenefitsofcombinedutilizationofvariousassistedcirculationdevicesincardiacarrestpatientswhodidnotrespondtoconventionalcardiopulmonarycerebralresuscitation(CPCR).MethodsAssistedcirculationdevices,includingemergencycardiopulmonarybypass(ECPB),intra-aorticballoonpump(IABP),andleftventricularassistdevice(LVAD),wereappliedto16adultpatientswhohadcardiacarrest82min-56hafteropenheartsurgeryanddidnotrespondto20minorlongerconventionalCPCR.ECPBwasappliedto2patients,ECPBplusIABPto8patients,ECPBplusIABPandLVADto6patients.ResultsOnepatientrecoveredfullyandonepatientdied.Oftheother14patients,13resumedspontaneouscardiacrhythmandonedidnot;noneofthemcouldbeweanedfromECPB.Furthertreatmentofthe14patientswithcombinationsofassistedcirculationdevicesenabled6patientstorecover.Oneofthe7recoveredpatientsdiedofreoccurringcardiacarrestafter11days;theother6weredischargedingoodconditionandwerefollowedupfor3-49months(mean=22months).Ofthe6dischargedpatientsonesufferedcerebralembolismduringLVADtreatment,resultinginmildlimitationofmobilityoftherightlimbs;theother5nevermanifestedanycentralnervoussystemcomplications.Therewasnolatedeathsgivinga37.5%(6/16)long-termsurvivalrate.ConclusionsECPBcouldeffectivelyreestablishbloodcirculationandoxygensupply,rectifyacidosis,andimproveinternalmilieu.ThecombinedutilizationofECPB,IABP,andLVADreducesthedurationofECPB,improvestheincidenceofrecovery,andoffersbeneficialalternativestorefractorycardiacarrestpatients.

简介：BackgroundHospital-acquiredpneumonia(HAP)isthemostcommonandmostseriousnosocomialinfectionforcardiacsurgerypatients,withhighincidenceandfatalityrate1.ItisimportantforcardiacsurgeonstocorrectlyidentifyHAP,assesstheseverity,andthenadjustanti-infectionmethod,whichcanreducethemortalityrate,shortenhospitalizationtime,andreducethewasteofmedicalresources.ThepurposeofthisresearchistoevaluatetheapplicationvalueoflungCTindiagnosisandtreatmentofHAPaftercardiacsurgery.MethodsAretrospectiveanalysiswasconductedforclinicaldataabout76cardiacsurgerypatientswhowerediagnosedwithHAPduringJanuarytoDecember2013.Theclinicaldatamainlyincludedsymptoms,physicalsigns,laboratoryexaminations(suchasroutinebloodtestsandserumprocalcitonin),andlungCTandX-raydata.OurfocusisonthecomparisonbetweenlungCTandX-raydata.ResultsThepositivediagnosticrate,falsenegativerate,andfalsepositiverateoflungCTwere71/76(93.4%),5/76(6.6%),and1/76(1.3%)respectively.ThecoincidencerateofX-rayandCTwas45/76(59.2%),andthefalsenegativerateofX-raywas23/76(30.3%).ConclusionLungCTisbetterthanX-rayindiagnosisofHAPaftercardiacsurgeryandassessmentofseverity,andhasgreatersignificanceforguidingtherationaluseofantibiotics.Therefore,lungCTisworthyofapplicationandpopularization.

简介：BackgroundPoorwoundhealingorpostoperativeinfectionafteropen-heartsurgeryismostcommonlyseen.Ifnottreatedintimeortheinfectionprogresses,itcanleadtosternalinfection,evenmediastinalandpericardialinfection,causingahighermortalityrate.Vacuumsealingdrainage(VSD)isanewtechnologytopromotewoundhealing.WestudiedtheuseofVSDtechniqueinpoorwoundhealingafterheartvalvesurgerytoseeifitcouldachievegoodtherapeuticefficacy.MethodsFrom2013Octoberto2014OctoberinGuangdongGeneralHospital,86casesoftheapplicationofvacuumsealingdrainagetechniqueinthetreatmentofcardiacnonunionaftervalvereplacementinpatientswithnursingobservation.Thetreatmenttime,deathrateandinfectionrate,etcwerecompared.ResultsWoundhealingtimeof86patientsreceivingvacuumsealingdrainagewas14.6±3.6days,andnopatientdied.Twopatientscamebacktohospitalforrepairduetodehiscenceoftheincisionafterdischarge.ConclusionNursingobservationanddrainagemanagementwerethekeyofVSD.VSDtechniqueisworthytobepopularizedclinically.

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