The Application Effect of Predictive Nursing on Cardiopulmonary Rehabilitation of Patients Undergoing Heart Valve Surgery with Extracorporeal Circulation

Objective:To evaluate the application effect of predictive nursing on patients undergoing heart valve surgery with extracorporeal circulation(ECC).Methods:92 ECC patients admitted to the hospital between July 2021 and July 2023 were selected and grouped by random number table method;the observation group practiced predictive nursing,while the reference group practiced conventional nursing.The cardiopulmonary rehabilitation and other indexes were compared between the groups.Results:The postoperative rehabilitation time of the observation group was shorter than that of the reference group,the treatment compliance was higher than that of the reference group,the cardiopulmonary function indexes were all better than that of the reference group,and the complication rate was lower than that of the reference group(P<0.05).Conclusion:The implementation of predictive nursing for ECC patients can promote postoperative rehabilitation,improve patients’treatment compliance,and enhance the cardiopulmonary rehabilitation effect,and nursing safety is high.

Univariate Risk Factors for Prolonged Mechanical Ventilation in Patients Undergoing Prosthetic Heart Valves Replacement Surgery

Data from 736 patients undergoing prosthetic heart valve replacement surgery and concomitant surgery （combined surgery） from January 1998 to January 2004 at Union Hospital were retrospectively reviewed. Univariate logistic regression analyses were conducted to identity risk factors for prolonged mechanical ventilation. The results showed that prolonged cardiopulmonary bypass duration, prolonged aortic cross clamp time and low ejection fraction less than 50 percent （50 %） were found to be independent predictors for prolonged mechanical ventilation. Meanwhile age, weight, and preoperative hospital stay （days） were not found to be associated with prolonged mechanical ventilation. It was concluded that. for age and weight, this might be due to the lower number of old age patients （70 years and above） included in our study and genetic body structure of majority Chinese population that favor them to be in normal weight, respectively.

Is the European System for Cardiac Operative Risk Evaluation useful in Chinese patients undergoing heart valve surgery？

Background The European System for Cardiac Operative Risk Evaluation （EuroSCORE） is one of the most widely used risk models for the predicting mortality after cardiac surgery. The aim of this study was to validate the EuroSCORE model for predicting operative mortality in heart valve surgery on a Chinese multicenter database and comparing the performance of EuroSCORE with our new risk stratification system, the Sino System for Coronary Operative Risk Evaluation （SinoSCORE）. Methods Data from patients undergoing heart valve surgery between January 2007 and December 2008 were retrospectively collected, from 43 hospitals in China. The EuroSCORE and the SinoSCORE were calculated for each patient. Mortality was defined as any in-hospital death. Area under the receiver operating characteristics curve （AUC） was used to study the discriminatory abilities of the models. The Hosmer-Lemeshow （H-L） goodness-of-fit test was used to study the calibration of the predictive models. Results A total of 15 367 patients were analyzed. For the entire cohort, the observed mortality was 2.34%, the predicted mortality was 3.71% （additive）, 3.19% （logistic） and 3.66% （SinoSCORE）. AUC was 0.747 for SinoSCORE, 0.699 additive and 0.696 for logistic EuroSCORE. Calibration of SinoSCORE and additive EuroSCORE was good （H-L： P=-0.250 and P=0.051, respectively）, but the logistic EuroSCORE model had a poor calibration （H-L： P〈0.05）. The discriminatory ability and calibration of the SinoSCORE were good in low- and high-risk patients, However, the discriminatory ability of the EuroSCORE model was poor in all risk deciles. Conclusions The EuroSCORE does not accurately predict mortality in Chinese patients with heart valve surgery, and the SinoSCORE is superior to the EuroSCORE at predicting in-hospital mortality in Chinese heart valve surgery patients.

Clinical risk score for postoperative pneumonia following heart valve surgery

Background:Postoperative pneumonia(POP)is one of the most common infections following heart valve surgery(HVS)and is associated with a significant increase in morbidity,mortality,and health care costs.This study aimed to identify the major risk factors associated with the occurrence of POP following HVS and to derive and validate a clinical risk score.Methods:Adults undergoing open HVS between January 2016 and December 2019 at a single institution were enrolled in this study.Patients were randomly assigned to the derivation and validation sets at 1:1 ratio.A prediction model was developed with multivariable logistic regression analysis in the derivation set.Points were assigned to independent risk factors based on their regression coefficients.Results:POP occurred in 316 of the 3853 patients(8.2%).Multivariable analysis identified ten significant predictors for POP in the derivation set,including older age,smoking history,chronic obstructive pulmonary disease,diabetes mellitus,renal insufficiency,poor cardiac function,heart surgery history,longer cardiopulmonary bypass,blood transfusion,and concomitant coronary and/or aortic surgery.A 22-point risk score based on the multivariable model was then generated,demonstrating good discrimination(C-statistic:0.81),and calibration(Hosmer-Lemeshowχ^(2)=8.234,P=0.312).The prediction rule also showed adequate discriminative power(C-statistic:0.83)and calibration(Hosmer-Lemeshowχ^(2)=5.606,P=0.691)in the validation set.Three risk intervals were defined as low-,medium-,and high-risk groups.Conclusion:We derived and validated a 22-point risk score for POP following HVS,which may be useful in preventive interventions and risk management.Trial Registration:Chictr.org,ChiCTR1900028127;http://www.chictr.org.cn/showproj.aspx?proj=46932.

Vacuum sealing drainage technique in the treatment of poor healing wounds after heart valve surgery:experience in cardiac nursing

Background Poor wound healing or postoperative infection after open-heart surgery is most commonly seen. If not treated in time or the infection progresses, it can lead to sternal infection, even mediastinal and pericardial infection, causing a higher mortality rate. Vacuum sealing drainage （VSD） is a new technology to promote wound healing. We studied the use of VSD technique in poor wound healing after heart valve surgery to see if it could achieve good therapeutic efficacy. Methods From 2013 October to 2014 October in Guang- dong General Hospital, 86 cases of the application of vacuum sealing drainage technique in the treatment of cardiac nonunion after valve replacement in patients with nursing observation. The treatment time, death rate and infection rate, etc were compared. Results Wound healing time of 86 patients receiving vacuum sealing drainage was 14.6 ± 3.6 days, and no patient died. Two patients came back to hospital for repair due to dehis- cence of the incision after discharge. Conclusion Nursing observation and drainage management were the key of VSD. VSD technique is worthy to be popularized clinically.

Validation of four different risk stratification models in patients undergoing heart valve surgery in a single center in China

Background Several risk stratification models have been developed for cardiac surgery. This study aimed to evaluate the accuracy of four existing risk stratification models, the Fuwai System for Cardiac Operative Risk Evaluation （FuwaiSCORE）, the Society of Thoracic Surgeons 2008 cardiac surgery risk model for isolated valve surgery （the STS model）, the European System for Cardiac Operative Risk Evaluation （EuroSCORE） and the initial Parsonnet＇s score （the Parsonnet model） in predicting prolonged intensive care unit （ICU） stay in Chinese patients undergoing heart valve surgery. Methods Data were collected retrospectively from records of 1333 consecutive patients who received heart valve surgery in a single center between November 2006 and December 2007. Prolonged ICU stay was defined as not less than 124 hours. Calibration was assessed using the Hosmer-Lemeshow （H-L） goodness of fit test. Discrimination was assessed using the receiver-operating-characteristic （ROC） curve area. Results The FuwaiSCORE showed good calibration and discrimination compared with other risk models. According to the H-L statistics, the value of the FuwaiSCORE was 12.82, P 〉0.1. The area under ROC curve of the FuwaiSCORE was 0.81 （95%C/0.78-0.84）. Conclusions Our study suggests that the FuwaiSCORE is superior to the other three risk models in predicting prolonged length of ICU stay in Chinese patients with heart valve surgery. Having fewer variables, the system is much easier for bedside use than other systems.

Prevalence of Preoperative Anemia in Elective Rheumatic Valve Surgery at a Tertiary Care Center in Nepal

Background: Rheumatic Valvular Heart disease (RVHD) is common in developing countries often associated with anemia;however its burden is often overlooked. Anemic patients undergoing surgery are likely to receive blood transfusion, increasing morbidity and mortality. Prevalence of anemia in cardiac surgical patients are studied extensively, however its burden in RVHD is lacking. This study attempted to investigate the prevalence of preoperative anemia in RVHD and its effect on blood transfusion, morbidity and mortality in patients undergoing valve surgery. Methods: This is a retrospective observational study conducted at a tertiary care hospital in Nepal. We considered 340 patients who underwent Rheumatic valve replacement surgery from 2014 January to December 2016 and data on their socio-demographic and clinical characteristics were extracted from the patient’s records. The analyses meeting the study objectives were conducted using IBM SPSS v25 for Windows (IBM Statistical Package for Social Sciences, 2015IBM Corporation, New York, United States). Results: The prevalence of no anemia, mild, moderate, and severe anemia was 34.1%, 57.7%, 39.6%, 2.5%, respectively. The units of Red Blood Cell used for transfusion were 1.2 units, 2.0 units, 2.3 units, and 1.6 units in patients without anemia, and those with mild, moderate and severe anemia respectively. The incidence of reexploration was higher in patients with severe anemia as compared to the non anemic with an incidence of 66.6%. A proportion of the patients with no anemia, mild, moderate and severe anemia with less than 7 days stay in the intensive care unit were 89%, 82%, 84.7% and 100% respectively. The length of hospital stay more than 10 days was seen in 58.9%, 71.6%, 63% and 100% in patients with no anemia, mild, moderate and severe anemia. An overall incidence of mortality in anemic patients was 11% while in non anemic patients was 5.3%. Conclusions: The prevalence of anemia was high in the Nepalese patients with Rheumatic valvular heart disease planned for elective surgery. There was an increased incidence of blood transfusion, longer hospital stay, and increased mortality in anemic patients compared to their non anemic counterparts.

Isolated Tricuspid Valve Repair and Right Atrial Plication Performed Using a Beating-Heart Technique for Atrial Functional Tricuspid Valve Regurgitation

Background: Isolated tricuspid valve disease remains a controversial indication for surgical intervention. Many patients referred for surgery already have a poor clinical condition and an advanced New York Heart Association functional class. There is no consensus on the optimal surgical technique for this condition, including on whether to perform the procedure on a beating or an arrested heart and whether to perform valve repair or replacement. Methods: We analyzed four case series between 2015 and 2022 in which patients with secondary tricuspid regurgitation (TR) underwent valve repair on a beating heart and right atrial plication for a dilated right atrium. The TRI-SCORE was calculated for each patient. Results: All patients experienced a favorable postoperative course with significant improvements in heart failure symptoms. TR was markedly reduced;however, in one patient with concomitant mitral regurgitation (MR) and a high TRI-SCORE, MR worsened postoperatively. This patient later died from unknown causes due to multiple comorbidities in the late phase. Conclusions: Tricuspid valve repair on a beating heart was effective for improving the cardiac function, and the TRI-SCORE proved useful as a preoperative risk assessment tool. The underlying mechanism by which TR exacerbates MR requires further investigation.

Quality of life and functional capacity in patients after cardiac surgery intensive care unit

Coronary heart disease and aortic stenosis are prevalent cardiovascular diseases worldwide,leading to morbidity and mortality.Coronary artery bypass grafting(CABG)and surgical aortic valve replacement(SAVR)have therapeutic benefits,including improved postoperative quality of life(QoL)and enhanced patient functional capacity which are key indicators of cardiac surgery outcome.In this article,we review the latest studies of QoL outcomes and functional capacity in patients who underwent cardiac surgery.Many standardized instruments are used to evaluate QoL and functional conditions.Preoperative health status,age,length of intensive care unit stay,operative risk,type of procedure,and other pre-,intra-,and postoperative factors affect postoperative QoL.Elderly patients experience impaired physical status soon after cardiac surgery,but it improves in the following period.CABG and SAVR are associated with increases of physical and mental health and functional capacity in the immediate postoperative and the long long-term.Cardiac rehabilitation improves patient functional capacity,QoL,and frailty following cardiac surgery.

Safety and effectiveness of neuromuscular electrical stimulation in cardiac surgery:A systematic review

BACKGROUND Lack of mobilization and prolonged stay in the intensive care unit(ICU)are major factors resulting in the development of ICU-acquired muscle weakness(ICUAW).ICUAW is a type of skeletal muscle dysfunction and a common complication of patients after cardiac surgery,and may be a risk factor for prolonged duration of mechanical ventilation,associated with a higher risk of readmission and higher mortality.Early mobilization in the ICU after cardiac surgery has been found to be low with a significant trend to increase over ICU stay and is also associated with a reduced duration of mechanical ventilation and ICU length of stay.Neuromuscular electrical stimulation(NMES)is an alternative modality of exercise in patients with muscle weakness.A major advantage of NMES is that it can be applied even in sedated patients in the ICU,a fact that might enhance early mobilization in these patients.AIM To evaluate safety,feasibility and effectiveness of NMES on functional capacity and muscle strength in patients before and after cardiac surgery.METHODS We performed a search on Pubmed,Physiotherapy Evidence Database(PEDro),Embase and CINAHL databases,selecting papers published between December 2012 and April 2023 and identified published randomized controlled trials(RCTs)that included implementation of NMES in patients before after cardiac surgery.RCTs were assessed for methodological rigor and risk of bias via the PEDro.The primary outcomes were safety and functional capacity and the secondary outcomes were muscle strength and function.RESULTS Ten studies were included in our systematic review,resulting in 703 participants.Almost half of them performed NMES and the other half were included in the control group,treated with usual care.Nine studies investigated patients after cardiac surgery and 1 study before cardiac surgery.Functional capacity was assessed in 8 studies via 6MWT or other indices,and improved only in 1 study before and in 1 after cardiac surgery.Nine studies explored the effects of NMES on muscle strength and function and,most of them,found increase of muscle strength and improvement in muscle function after NMES.NMES was safe in all studies without any significant complication.CONCLUSION NMES is safe,feasible and has beneficial effects on muscle strength and function in patients after cardiac surgery,but has no significant effect on functional capacity.

A Rare Case of Infective Mediastinitis after Melody Valve Implantation

Pulmonary valve implant is frequently necessary in children and adults with congenital heart disease.Infective endocarditis represents a rare but life-threatening complication after transcatheter pulmonary valve implantation.There are various treatments for native or prosthetic valve endocarditis.Surgical intervention,combined with intravenous antibiotic treatment,is of paramount importance,in case of concomitant mediastinal infection,in order to ensure the radical debridement of all infected tissue,avoiding any recurrent endocarditis.In this report,we describe a rare case of mediastinitis,associated with an infected endocarditis,occurring 8 months after Melody(Medtronic
,Minneapolis,USA)valve implant,successfully treated with the implantation of a homograft to reconstruct the right ventricular outflow tract.

Heart Surgery Practice in Sub Saharan Africa: Single Nigerian Institutional Midterm Results and Challenges

Background: The majority of prospective cardiac surgical patients in sub Saharan Africa lack access to open heart surgery. We reviewed our midterm results to identify the obstacles to growth and challenges with sustainability. Methods: Records of patients undergoing heart surgery at LASUTH from December 2004 to March 2006 were retrospectively reviewed for clinical and outcome data. Results: Twenty four patients age 10-50, mean 28.0 +/? 10.49 years and 13 (54.2%) males underwent surgery. 12 (50.0%) patients had mechanical valve replacements, 11 (45.8%) closure of septal defects and 1 (4.2%) left atrial myxoma resection. Logistic euroscore for valve patients was 5.81 +/? 4.74 while observed mortality was 8.3% (1/12). Overall 30 days operative mortality was 8.3% (2/24) and major morbidity 4.2% (1/24). Patients with septal defects closure stopped clinic visits within a year. Valve patients follow up was complete in 90.1% with mean duration of 55.2 +/? 15.3 months. Late events occurred only in females with mitral valve replacements. The 5-year freedom from thromboembolism and bleeding was 74.0% and survival 82.0% in valve patients. Conclusion: Despite limited resources heart surgery can safely be performed with good outcomes by trained local personnel under supervision of visiting foreign teams until they are proficient to operate independently. Patients with less complex congenital defects have excellent postsurgical outcomes, while patients with rheumatic valve replacement are subject to ongoing valve related morbidity and mortality therefore require lifetime follow up. Choice of prosthetic valve for the mostly indigent and poorly educated population remains a challenge. We now prefer stented tissue valve despite its known limitations, in child bearing age females desirous of childbirth and others unlikely to comply with anticoagulation regimen. Barriers to sustainability include poor infrastructures, few skilled manpower, inadequate funding and restricted patient access due to inability to pay without third party insurance or government Medicaid.

Anesthetic management of a child with Cornelia de Lange Syndrome undergoing open heart surgery:A case report

BACKGROUND Cornelia de Lange syndrome(CdLS)is a congenital multisystemic genetic disorder.The expected lifespan of children with this disorder has been prolonged in parallel with the advances in medicine in recent years.However,they still more frequently undergo cardiac surgery.There are some challenges for clinicians when faced with CdLS patients.We present the perioperative management of a child with CdLS undergoing open-heart surgery.CASE SUMMARY Severe pulmonic and subpulmonic valvular stenosis,enlargement of the right side of the heart,mild tricuspid regurgitation,atrial septal defect,and patent ductus arteriosus were diagnosed in a 14-month-old boy with manifested cyanosis,developmental delay,and malnutrition.Attempted balloon valvuloplasty was unsuccessful due to a severe stenotic pulmonary valve,therefore it was decided to perform an open surgical repair.Following a successful and uncomplicated intraoperative course,the patient was extubated on postoperative day 5,and adrenalin and dopamine infusions were gradually decreased and stopped on postoperative days 6 and 10,respectively.Moderate laryngomalacia and suboptimal vocal cord movements were diagnosed,and tracheotomy and percutaneous endoscopic gastrostomy were performed under general anesthesia in the same session at postoperative day 32.The patient was discharged on postoperative day 85 after a challenging postoperative period with additional airway and nutritional problems.CONCLUSION This is the first report of the perioperative anesthetic and clinical management of a CdLS patient undergoing open-heart surgery.

复脉益心方辅助治疗风湿性心脏瓣膜病患者的临床疗效及对其心功能、基质金属蛋白酶-9、N末端前体脑利钠肽水平的影响

目的 探讨复脉益心方辅助治疗风湿性心脏瓣膜病患者的疗效及对其心功能、血清基质金属蛋白酶-9(Matrix metalloprotein-9,MMP-9)水平、N末端前体脑利钠肽(N-terminal precursor brain natriuretic peptide,NT-pro BNP)水平的影响。方法 选取2021年2月—2022年2月期间湖南中医药大学第一附属医院收治的风湿性心脏瓣膜病患者88例作为研究对象。采用随机数字表法将患者分为对照组和观察组,每组各44例。两组患者均接受二尖瓣置换术治疗,术后根据病情给予西医常规治疗,观察组术后在常规西医治疗基础上联合复脉益心方治疗。治疗4周后,观察比较两组患者临床疗效、安全性,治疗前后中医证候积分,MMP-9、NT-pro BNP水平、心功能指标(每分钟心输出量、每搏输出量、心脏指数、左心室射血分数)、生活质量评分(社会限制、体力限制、症状、情绪)变化情况。结果 治疗后两组患者心悸、疲乏、气短、盗汗或自汗、心烦、失眠多梦评分均较治疗前降低,差异有统计学意义(P<0.05);且观察组心悸、疲乏、气短、盗汗或自汗、心烦、失眠多梦评分均明显低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者血清MMP-9和NT-pro BNP水平均较治疗前明显降低,差异有统计学意义(P<0.05);且观察组血清MMP-9和NT-pro BNP水平均明显低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者每分钟心输出量、每搏输出量、心脏指数及左心室射血分数指标均较治疗前明显升高,差异有统计学意义(P<0.05);且观察组每分钟心输出量、每搏输出量、心脏指数及左心室射血分数指标均高于对照组,差异有统计学意义(P<0.05)。治疗后两组患者社会限制、体力限制、症状及情绪评分均较治疗前明显降低,差异有统计学意义(P<0.05);且观察组社会限制、体力限制、症状及情绪评分均低于对照组,差异有统计学意义(P<0.05)。治疗后观察组总有效率95.45%(42/44)明显高于对照组79.55%(35/44),差异有统计学意义(P<0.05)。治疗期间,两组患者肝肾功能、血常规均未发生异常,术后也未出现明显用药不良反应。结论 复脉益心方辅助二尖瓣置换术治疗风湿性心脏瓣膜病,能够降低MMP-9、NT-proBNP水平,有助于改善患者心功能,保护心肌,快速缓解患者临床症状,提高生活质量。

房颤射频消融术对心脏搭桥合并心脏瓣膜手术患者心功能、心肌损伤及预后的影响

目的探究房颤射频消融术(RA)对心脏搭桥合并心脏瓣膜手术患者心功能、心肌损伤及预后的影响。方法选取我院2022年2月至2023年3月接受心脏搭桥合并心脏瓣膜手术患者50例,随机数字表法将其分为观察组25例(房颤RA治疗)与对照组25例(保守药物治疗)。对比两组手术相关指标、不同时间点心肌损伤[肌酸激酶同工酶(CK-MB)、肌钙蛋白I(cTnI)、N末端脑钠肽前体(NT-proBNP)]及心功能[左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)]指标,术后随访3个月,统计患者窦性心律转复及心脑血管不良事件(MACCE)发生率。结果观察组体外循环时间比对照组长,总住院时间比对照组短,差异均有统计学意义(P<0.05)。两组术后血清CK-MB、cTnI、NT-proBNP水平均呈现先上升、后下降趋势(P<0.05);观察组术后2 h血清CK-MB、cTnI、NT-proBNP水平均显著高于对照组(P<0.05),但两组间术后48 h上述指标差异均无统计学意义(P>0.05)。术后3个月,观察组比对照组LVEF[(49.78±2.35)%vs.(45.03±2.17)%]显著上升,LVEDD[(54.93±4.30)mm vs.(57.38±4.16)mm]、LVESD[(39.62±4.37)mm vs.(46.15±5.23)mm]显著下降(P<0.05)。观察组术后第1天、出院时及术后3个月窦性心律转复率均显著高于对照组(P<0.05),术后3个月内MACCE两组对比差异无统计学意义(P>0.05)。结论房颤RA能有效改善心脏搭桥合并心脏瓣膜手术患者心功能,提高窦性心律转复率,短期预后好,但可能引发一过性心肌酶上升。

风湿性心脏病瓣膜置换术患者应用双心护理联合放松训练的效果分析

目的:分析风湿性心脏病瓣膜置换术患者应用双心护理联合放松训练后睡眠质量、自我管理能力的改善情况。方法:选取2021年6月至2023年4月厦门大学附属第一医院收治的风湿性心脏病患者99例作为研究对象,按照随机数字表法分为对照组(n=49)和观察组(n=50)。对照组给予常规护理干预,观察组给予双心护理联合放松训练干预,2组患者均护理2周。采用生命质量综合评定问卷(GQOLI)对患者护理前后生命质量进行评估,采用睡眠状况自评量表(SRSS)对护理前后睡眠质量进行评估,比较2组患者的护理依从性,采用8项Morisky服药依从性量表(MMAS-8)评估患者服药依从性,采用自制问卷评估患者护理依从性及自我管理能力,采用焦虑自评量表(SAS)、抑郁自评量表(SDS)比较2组患者焦虑、抑郁症状改善情况,比较2组患者各项临床指标。结果:护理后,2组患者GQOLI各项评分、护理依从性、服药依从性及自我管理能力得分均升高,且观察组显著高于对照组,SRSS各项评分、SDS、SAS得分均降低,且观察组显著低于对照组,差异均有统计学意义(均P<0.05)。结论:风湿性心脏病瓣膜置换术患者应用双心护理联合放松训练可有效改善生活、睡眠质量,提高护理依从性、服药依从性及自我管理能力,并减轻负面情绪,值得临床推广应用。

改良Del Nido与国产HTK停搏液在成人心脏瓣膜置换术中的应用效果

目的:分析改良Del Nido与国产HTK停搏液在成人心脏瓣膜置换术中的应用效果。方法:回顾性分析2022年1月—2023年7月钦州市第一人民医院收治的60例心脏瓣膜置换术患者资料。根据停搏液使用情况将其分为DN组(30例)和HTK组(30例)。HTK组使用国产HTK停搏液,DN组使用改良Del Nido停搏液。比较两组围手术期指标,术后24 h、48 h相关指标及肾功能。结果:DN组灌注次数多于HTK组,术后机械通气时间长于HTK组,主动脉阻断时间短于HTK组,自动复跳率高于HTK组,差异有统计意义(P<0.05)。两组术后24 h、48 h心肌肌钙蛋白(cTnI)、肌酸激酶同工酶(CK-MB)水平比较,差异无统计意义(P>0.05)。两组术后24 h、48 h血尿素氮(BUN)、血肌酐(Scr)水平比较,差异无统计意义(P>0.05)。结论:与国产HTK停搏液对比,改良Del Nido停搏液应用于成人心脏瓣膜置换术中能缩短主动脉阻断时间,提高自动复跳率,灌注次数较多,术后机械通气时间较长,但两者均具有良好的心肌保护作用。

亚临床甲减对成人心脏瓣膜手术患者围术期输血情况及预后的影响

目的:探讨成人心脏瓣膜手术患者术前合并亚临床甲状腺功能减退症(SCH)对围术期输血情况及预后的影响。方法:选取929例择期行心脏手术的患者为研究对象,根据血清促甲状腺激素(TSH)水平将患者分为亚临床甲减组(SCH组,n=208)与甲状腺功能正常组(N组,n=721)。应用多因素回归模型分析患者术前合并亚临床甲减对住院期间输血情况、ICU停留时间、住院时间及住院期间死亡率的影响。结果:未校正前,SCH组与N组围术期输血率、输血量、住院时间、住院期间死亡率比较,差异均无统计学意义(P>0.05);ICU停留时间两组患者有统计学差异(P<0.05)。多因素回归分析显示,术前合并SCH与围术期输血率、住院时间无相关性(P>0.05),但其是围术期输血量增加及ICU停留时间延长的独立危险因素(P<0.05)。结论:在择期成人体外循环心脏瓣膜手术中,患者术前合并SCH不增加围术期的输血风险,但与发生输血的患者中红细胞用量增加有关,也与ICU停留时间延长有关。

叙事医学模式下患者参与式决策干预在心脏瓣膜置换术中的应用研究

目的 探讨叙事医学模式下患者参与式决策干预在心脏瓣膜置换术中的应用效果。方法 选取2020年9月至2022年2月于福建省泉州市第一医院接受心脏瓣膜置换手术的84例心脏瓣膜患者为研究对象,按照随机数字表法分为对照组与研究组,每组各42例。对照组采取心脏瓣膜置换术常规护理模式,研究组在对照组的护理模式基础上实施叙事医学模式下患者参与式决策方案的干预,观察两组患者的术后恢复情况(首次排气时间、首次排便时间)及住院时间和不良事件发生率(低心排出量综合征发生率、肾功能衰竭发生率、感染发生率、心律失常发生率、脑栓塞发生率)差异,术前1 d和术后7 d各评估1次两组患者的生存质量[世界卫生组织生存质量测定量表(WHOQOL-100)]和心理状况[自我效能感量表(GSES)、心理弹性量表(Rs-14)]。结果 研究组的住院时间和不良事件总发生率低于对照组,差异有统计学意义(P <0.05)。两组的首次排气、排便时间和各项不良事件发生率差异无统计学差异(P> 0.05)。术前1 d,两组的WHOQOL-100评分、GSES评分和Rs-14评分差异无统计学意义(P> 0.05),术后7 d,研究组的WHOQOL-100评分、GSES评分和Rs-14评分均高于对照组,差异有统计学意义(P <0.05)。结论 在心脏瓣膜置换手术常规护理中,实施叙事医学模式下患者参与式决策干预,有助于改善患者心理状态,减少术后不良事件发生风险,从而促进患者术后恢复,对改善术后生存质量有积极意义。

预后营养指数在心脏瓣膜病术后肺部感染预测价值研究

目的探讨预后营养指数(OPNI)对心脏瓣膜病(HVD)术后肺部感染的预测价值。方法回顾性分析2019年3月至2023年3月我院391例择期HVD手术患者。根据患者术后肺部感染情况,分为感染组(n=142)和非感染组(n=249)。收集患者临床资料,以NRS2002量表为标准,获取OPNI的截止值。采用Lasso回归分析筛选混杂因素,通过多因素二元Logistic回归分析HVD术后肺部感染的影响因素。绘制受试者工作特征(ROC)曲线分析OPNI预测HVD患者术后肺部感染的价值。结果142例(36.3%)心脏瓣膜置换手术的患者发生术后肺部感染;两组年龄、OPNI、吸烟史、血清白蛋白、淋巴细胞计数、纽约心功能分级、射血分数、肺动脉高压、术中输血、手术时间、体外循环时间、主动脉阻断时间、瓣膜置换或成形合并其他手术方式组间比较,差异有统计学意义(P<0.05);多因素Logistic回归分析显示,OPNI、射血分数、术中输血、吸烟史、淋巴细胞计数是HVD患者术后肺部感染的独立危险因素(P<0.05);OPNI取值45.925,区分营养不良的约登(Youden)指数最大值为0.731,曲线下面积(AUC)为0.914,敏感度和特异度分别为84.0%和89.1%;OPNI预测肺部感染的AUC为0.706,Youden指数最大0.412,敏感度和特异度分别为64.1%和77.1%。结论术前OPNI是简单有效的预测HVD术后肺部感染的临床指标,以45.925为界值有良好的预测价值。