Global trend of review articles focused on cardiopulmonary bypass:Perspectives from bibliometrics

BACKGROUND Cardiopulmonary bypass(CPB)is a life-support technology widely used in surgery.Review articles reflect research advances in a certain topic or field within a certain period of time.AIM To perform a bibliometric analysis of the review articles that focused on CPB for cardiovascular surgery.METHODS This study was based on a bibliometric analysis.Data were acquired from the Web of Science and basic bibliometric parameters were analyzed and visualized using VOSviewer and Excel.RESULTS We identified 141 review articles on CPB.Generally,the number of publications increased,and most of them were published in the 2010s(n=57,40.4%)and the 2020s(n=45,31.9%).There were 113(80.1%)narrative review articles,21(14.9%)meta-analysis studies and 7(5.0%)systematic review papers.The United States(n=25,17.7%)and China(n=21,14.9%)were the leading countries in terms of publication number.The articles were published in 98 different journals.The Journal of Cardiothoracic and Vascular Anesthesia(n=14,10.0%)and Perfusion-United Kingdom(n=11,7.8%)were preferred by the authors.The high-frequency keywords included inflammatory response,children,acute kidney injury,meta-analysis and off-pump,except for CPB and cardiac surgery.Inflammatory response had the closest relationship with CPB during cardiac surgery.The complications of CPB,including inflammatory response,kidney injury and ischemia,caught lots of concern.CONCLUSION The rapid increase of review papers shows that the research on CPB in cardiac surgery is increasingly being emphasized by scholars and clinical staff worldwide.Meta-analysis has been widely conducted to analyze clinical controversies and further guide clinical practice.Strategies to improving the outcomes of patients undergoing cardiac surgery with CPB are the hot spots in this field.

Thrombolysis and extracorporeal cardiopulmonary resuscitation for cardiac arrest due to pulmonary embolism:A case report

BACKGROUND Cardiac arrest caused by acute pulmonary embolism(PE)is the most serious clinical circumstance,necessitating rapid identification,immediate cardiopulmonary resuscitation(CPR),and systemic thrombolytic therapy.Extracorporeal CPR(ECPR)is typically employed as a rescue therapy for selected patients when conventional CPR is failing in settings where it can be implemented.CASE SUMMARY We present a case of a 69-year-old male who experienced a prolonged cardiac arrest in an ambulance with pulseless electrical activity.Upon arrival at the emergency department with ongoing manual chest compressions,bedside pointof-care ultrasound revealed an enlarged right ventricle without contractility.Acute PE was suspected as the cause of cardiac arrest,and intravenous thrombolytic therapy with 50 mg tissue plasminogen activator was administered during mechanical chest compressions.Despite 31 minutes of CPR,return of spontaneous circulation was not achieved until 8 minutes after initiation of Veno-arterial extracorporeal membrane oxygenation(ECMO)support.Under ECMO support,the hemodynamic status and myocardial contractility significantly improved.However,the patient ultimately did not survive due to intracerebral hemorrhagic complications,leading to death a few days later in the hospital.CONCLUSION This case illustrates the potential of combining systemic thrombolysis with ECPR for refractory cardiac arrest caused by acute PE,but it also highlights the increased risk of significant bleeding complications,including fatal intracranial hemorrhage.

Co-treatment with surfactant and sonication signifi cantly improves Agrobacterium-mediated resistant bud formation and transient expression efficiency in soybean

Soybean is a widely planted genetically modified crop around the world. However, it is still one of the most recalcitrant crops for genetic transformation due to the difficulty of regeneration via organogenesis and some factors that affect the transformation efficiency. The percentages of resistant bud formation and transient expression efficiency are important indexes reflecting the regeneration and transformation efficiency of soybean. In this study, the percentages of resistant bud formation and transient expression of 13-glucuronidase （GUS） were compared after treatment with sonication or surfactant and co-treatment with both. The results showed that treatment with either sonication or surfactant increased the percentage of resistant bud formation and transient expression efficiency. The highest percentages were acquired and significantly improved when cotyledon node explants were co-treated with sonication for 2 s and surfactant at 0.02% （v：v） using two different soybean genotypes, Jack and Zhonghuang 10. The improved transformation efficiency of this combination was also evaluated by development of herbicide-tolerant soybeans with transformation efficiency at 2.5-5.7% for different geno- types, which was significantly higher than traditional cotyledonary node method in this study. These results suggested that co-treatment with surfactant and sonication significantly improved the percentages of resistance bud formation, transient expression efficiency and stable transformation efficiency in soybean.

Cardiac arrest, stony heart, and cardiopulmonary resuscitation: An updated revisit

The post-resuscitation period is recognized as the main predictor of cardiopul-monary resuscitation(CPR)outcomes.The first description of post-resuscitation syndrome and stony heart was published over 50 years ago.Major manifestations may include but are not limited to,persistent precipitating pathology,systemic ischemia/reperfusion response,post-cardiac arrest brain injury,and finally,post-cardiac arrest myocardial dysfunction(PAMD)after successful resuscitation.Why do some patients initially survive successful resuscitation,and others do not?Also,why does the myocardium response vary after resuscitation?These ques-tions have kept scientists busy for several decades since the first successful resuscitation was described.By modifying the conventional modalities of resu-scitation together with new promising agents,rescuers will be able to salvage the jeopardized post-resuscitation myocardium and prevent its progression to a dismal,stony heart.Community awareness and staff education are crucial for shortening the resuscitation time and improving short-and long-term outcomes.Awareness of these components before and early after the restoration of circulation will enhance the resuscitation outcomes.This review extensively addresses the underlying pathophysiology,management,and outcomes of post-resuscitation syndrome.The pattern,management,and outcome of PAMD and post-cardiac arrest shock are different based on many factors,including in-hospital cardiac arrest vs out-of-hospital cardiac arrest(OHCA),witnessed vs unwitnessed cardiac arrest,the underlying cause of arrest,the duration,and protocol used for CPR.Although restoring spontaneous circulation is a vital sign,it should not be the end of the game or lone primary outcome;it calls for better understanding and aggressive multi-disciplinary interventions and care.The development of stony heart post-CPR and OHCA remain the main challenges in emergency and critical care medicine.

Effect of early stepwise cardiopulmonary rehabilitation on function and quality of life in sepsis patients

BACKGROUND Sepsis,as a non-limiting host infection disease,can be accompanied by serious complications such as organ failure,which seriously threatens patient quality of life.AIM To investigate the effect of early stepwise cardiopulmonary rehabilitation on cardiopulmonary function and quality of life in patients evacuated from mechanical ventilation with sepsis.METHODS A total of 80 patients with sepsis who were hospitalized in our hospital from January 2021 to January 2022 were selected and divided into the observation group(n=40)and the control group(n=40)according to the random number table method.The observation group was treated with early stepwise cardiopulmonary rehabilitation,and the control group was treated with a conventional treatment regimen.Cardiac function indexes(central venous pressure,cardiac troponin I,B-type brain natriuretic peptide),lung function indicators(diaphragmatic mobility,changes in central venous oxygen saturation,oxygenation index),and quality of life(Quality of Life Evaluation Scale)were compared between the two groups after treatment.RESULTS After treatment,the central venous pressure,diaphragm mobility,central venous oxygen saturation,oxygenation index,and Quality of Life Evaluation Scale scores in the observation group were higher than those in the control group,and the differences were statistically significant(P<0.05).The observation group was less than that of the control group for other parameters,and the differences were statistically significant(P<0.05).CONCLUSION Early stepwise cardiopulmonary rehabilitation can effectively enhance cardiac and pulmonary function and improve the quality of life in patients evacuated from mechanical ventilation with sepsis.

Research and Practice of Cardiopulmonary Rehabilitation Training Programs

In today’s society, the incidence of cardiopulmonary diseases is increasing annually, seriously affecting patients’ quality of life. Therefore, developing a scientific and effective rehabilitation training program is of great significance. This study first analyzes the theoretical basis of cardiopulmonary rehabilitation training, including the effects of aerobic exercise, interval training, and strength training on cardiopulmonary function. Based on this, a comprehensive rehabilitation training program is designed, which includes personalized training plans, comprehensive interventions, multidisciplinary collaboration, patient education, and regular follow-up visits. The cardiopulmonary rehabilitation training plan developed in this study has certain scientific practicability, which provides a theoretical basis for cardiopulmonary rehabilitation training, and also provides a reference for medical institutions, rehabilitation centers and communities, which is helpful for promotion and application to a wider range of patients with cardiopulmonary diseases.

Successful rescue of disseminated Nocardia infection with multiple abscesses in a patient with membranous nephropathy after cardiopulmonary resuscitation:A three-year follow-up

Nocardiosis manifests as an opportunistic infection,primarily affecting individuals who are immunocompromised and susceptible to the infection.We present a case study of one patient with nephrotic syndrome and membranous nephropathy,who underwent treatment with prednisone and cyclosporine in 2016.In early 2017,the patient was diagnosed with a"fungal infection"and discontinued the use of cyclosporine.After one month of anti-infection therapy,a cranial magnetic resonance imaging scan showed multiple abscesses in the right temporal region.The diagnosis of nocardiosis was confirmed based on the presence of metastatic abscess masses,multiple lung and brain lesions,and a positive culture of Nocardia in the drainage.We changed the anti-infection therapy to a combination of trimethoprim-sulfamethoxazole(TMP-SMX),minocycline,and voriconazole.However,the patient experienced a sudden cardiac arrest and subsequently recovered after cardiopulmonary resuscitation.During the five-month follow-up period following the discharge,the patient displayed an enhanced nutritional status and stable renal function.The focal infection ultimately resolved during the subsequent three years.Neuro-infection caused by Nocardia should be considered in immunocompromised patients,and TMP-SMX is the preferred initial therapy;however,because of the high mortality rate,a long-term combination therapy with imipenem,cefotaxime,amikacin,and TMP-SMX is suggested.

Abnormal ACT in a Patient with Prekallikrein Deficiency Undergoing Cardiopulmonary Bypass

Prekallikrein deficiency is a disorder that often remains undiagnosed. Prekallikrein activates factor XII, which initiates the intrinsic coagulation pathway. Prekallikrein deficiency results in prolonged Partial Thromboplastin Time and Activated Clotting Time in absence of anticoagulants or active bleeding. This case report describes the anesthesia management of a patient with Prekallikrein deficiency who underwent cardiac surgery with Cardiopulmonary Bypass for correction of a congenital cardiac malformation. We highlight the importance of understanding the different tests available for the diagnosis of coagulation factors deficiency during administration of heparin in the setting of cardiovascular procedures under general anesthesia.

Effect of cuproptosis on acute kidney injury after cardiopulmonary bypass in diabetic patients

BACKGROUND Cardiopulmonary bypass(CPB)is a common procedure in cardiac surgery.CPB is a high-risk factor for acute kidney injury(AKI),and diabetes is also such a factor.Diabetes can lead to copper overload.It is currently unclear whether AKI after CPB in diabetic patients is related to copper overload.AIM To explore whether the occurrence of CPB-AKI in diabetic patients is associated with cuproptosis.METHODS Blood and urine were collected from clinical diabetic and non-diabetic patients before and after CPB.Levels of copper ion,lactate,glucose,heat shock protein-70(HSP-70),and dihydrolipoamide dehydrogenase(DLAT)were determined.A diabetic rat model was established and CPB was performed.The rats were assessed for the development of CPB-AKI,and for the association of AKI with cuproptosis by detecting copper levels,iron-sulfur cluster proteins and observation of mitochondrial structure by electron microscopy.RESULTS CPB resulted in elevations of copper,lactate,HSP-70 and DLAT in blood and urine in both diabetic and nondiabetic patients.CPB was associated with pathologic and mitochondrial damage in the kidneys of diabetic rats.Cuproptosis-related proteins also appeared to be significantly reduced.CONCLUSION CPB-AKI is associated with cuproptosis.Diabetes mellitus is an important factor aggravating CPB-AKI and cuproptosis.

Advances in the Use of Prone Cardiopulmonary Resuscitation During Spinal Surgery in the Prone Position

Spinal surgery is usually performed in the prone position, which is a longer and more difficult procedure and is prone to complications such as circulatory dysfunction and stress injuries. Among them, stress injury is the main complication of prone spine surgery, but the reasons for stress injury in prone spine surgery are not clear, and whether prone cardiopulmonary resuscitation (CPR) can be used needs to be further verified. Supine cardiopulmonary resuscitation is commonly used in posterior spinal surgery, retroperitoneal surgery, and so on, which can effectively improve the patient’s hypoxemia. Such surgeries require a high level of anesthetic management, and cardiopulmonary resuscitation is necessary if a patient in a prone position experiences cardiac arrest. In the process of cardiopulmonary resuscitation, supine cardiopulmonary resuscitation is often used, especially for some obese patients, if they are immediately changed to the supine position, it takes up more time, there may be wound infection, and there is a possibility of missing the optimal rescue and resuscitation time. Based on this, this paper reviews the use of prone-position cardiopulmonary resuscitation for spinal surgery in the prone position.

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.

Analysis of the Application Value of Virtual Reality Combined with Flipped Classroom Teaching Mode in Cardiopulmonary Resuscitation Teaching

Objective:To analyze the value of using virtual reality combined with the flipped classroom teaching model in teaching cardiopulmonary resuscitation(CPR).Methods:Two classes of our nursing program were randomly selected for the study from September 2022 to September 2023,Class A(52 students,conventional teaching method)and Class B(52 students,virtual reality combined with flipped classroom teaching mode).The assessment scores and independent learning ability scores of the students in the two classes were compared.Results:CPR theory and operation scores,passing rate,and independent learning ability scores of Class B were higher than those of Class A(P<0.05).Conclusion:the use of virtual reality combined with the flipped classroom teaching mode in CPR teaching is conducive to the improvement of students’assessment scores and independent learning ability.

HeartCode BLS混合式教学模式在心肺复苏实训课程中的应用研究

目的 探究AHA HeartCode BLS混合式教学模式在心肺复苏实训课程中的应用与影响。方法 研究对象为广西中医药大学医学生,随机分为对照组和观察组,观察组给予AHA HeartCode BLS混合式教学模式,对照组给予常规带教方式,观察两组教学后的心肺复苏技能和理论评分,最后采用在线问卷调查进行满意度评分并进行对比。结果 观察组的理论评分、技能评分、满意度评分高于对照组(P<0.05)。结论 AHA HeartCode BLS混合式教学模式有助于提高医学生的心肺复苏能力,适合在教学中开展应用。

八段锦对急性心肌梗死1年后射血分数保留型心力衰竭病人心肺功能的影响

目的:探讨急性心肌梗死1年后射血分数保留型心力衰竭病人坚持6个月的八段锦训练能否延缓心脏重构,减慢心功能恶化,并提升病人的运动耐力。方法:选取冠心病急性心肌梗死后1年,心脏彩超测量左室射血分数(LVEF)≥50%,年龄35~75岁的心力衰竭病人。按随机对照原则分为对照组和锻炼组,各27例。对照组采用西医标准药物治疗,锻炼组采用八段锦联合标准药物治疗。两组入院第1周,完成心肺功能、心脏彩超、6min步行距离等指标检测。干预6个月后,再次检测病人心肺功能、心脏彩超、6min步行距离等指标。观察左心房容积指数、LVEF;心肺功能检测公斤峰值摄氧量(peakVO2/kgmax)、无氧阈下代谢当量(AT-METs)和最大代谢当量(METs)及6 min步行距离变化。结果:干预6个月后,对照组peakVO2/kgmax、AT-METs、最大METs较治疗前降低,锻炼组LVEF、peakVO2/kgmax、AT-METs、最大METs较治疗前增高,且锻炼组LVEF、peakVO2/kgmax、AT-METs、最大METs高于对照组,差异均有统计学意义(P<0.01)。干预6个月后,锻炼组6 min步行距离较干预前延长,且锻炼组长于对照组,差异均有统计学意义(P<0.001)。结论:短期八段锦锻炼未显著改善病人左心房心脏重构,可提高心肺功能及运动耐量,有助于提高生活质量。

最大脂肪氧化强度运动改善超重或肥胖人群身体成分、心肺耐力和脂质代谢的Meta分析

背景 研究证实,超重或肥胖人群体质(体成分、心肺耐力、脂质代谢)与肥胖密切相关,并可能存在双向关联。最大脂肪氧化强度(FATmax)运动作为一种新型运动干预手段,可有效促进体质改善,但改善效果的量化关系需要进一步探讨。目的 系统评价FATmax运动对超重或肥胖人群体质相关指标的干预效果。方法 检索Pubm Med、Web of Science、EBSCO、中国知网、维普网、万方数据知识服务平台,检索FATmax运动对超重或肥胖患者身体成分、心肺耐力、脂质代谢相关指标干预效果的随机对照试验,检索时间为2001年1月—2024年1月。基于Cochrane风险偏倚评估工具评估纳入文献的质量,Meta分析由Rev Man 5.4软件完成。结果 共纳入16项随机对照试验,包含568例超重或肥胖患者。Meta分析结果显示,与对照组相比,FATmax运动干预组身体成分[BMI:WMD=-1.82,P<0.01;体脂百分比(BFR):WMD=-2.86,P<0.01;腰臀比(WHR):WMD=-0.04,P<0.01]、心肺耐力[最大摄氧量(VO2_(max)):WMD=3.34,P<0.01],除总胆固醇(TC)外脂质代谢状况[三酰甘油(TG):WMD=-0.24,P<0.05;高密度脂蛋白胆固醇(HDL-C):WMD=0.14,P<0.05;低密度脂蛋白胆固醇(LDL-C):WMD=-0.27,P<0.05]显著改善。经亚组分析得出最佳干预方案为:干预周期≥12周,3~5次/周的训练,60 min/次的跑步,以优化身体成分;而提升VO2_(max)的最佳方案为5次/周、<60 min/次的组合运动。在脂质代谢方面,对TG的改善最佳方案为3次/周、60 min/次的跑步;对HDL-C的最佳改善方案为4次/周、60 min/次的组合运动;对LDL-C则是4次/周、>60 min/次的组合运动。结论 FATmax运动可显著改善超重或肥胖患者BMI、BFR、WHR、VO2_(max)、TG、HDL-C、LDL-C结局指标,但对TC并无改善作用。

The Topical Use of Aprotinin in Cardiac Surgery with Cardiopulmonary Bypass

Objective To investigate the effects of the topical use of aprotinin on thebasis of comprehensive blood conservations in cardiopulmonary bypass (CPB). Methods In a prospectiveclinical trial, 20 patients were randomly divided into 2 groups. Control group: placebo was usedtopically. Aprotinin group: aprotinin was poured into the pericardial cavity before closure of thesternotomy. Before and 24h after surgery, hemoglobin (Hb), hematocrit (Hct), bleeding time (BT),clotting time (CT) and prothrombin time (PT) were measured. Meanwhile, amounts of the mediastinaldrainage and the hemoglobin loss were observed at 0, 2, 6 and 24h after operation. The samples fromthe mediastinal drainage were also collected to measure D-Dimer (D-D), tissue type plasminogenactivator (t-PA) activity, plasminogen activator inhibitor (PAI) activity and protein C (PC).Results In Aprotinin group, D-D, t-PA activity and PC were significantly reduced, compared withthose in Control group (P<0.05, P<0.05, P<0.01). On the contrary, PAI activity was significantlyincreased, compared with that in Control group. Amounts of the mediastinal drainage and thehemoglobin loss were decreased by 43% and 52%, compared with those in Control group. Conclusion Ourresults suggest that the topical use of aprotinin can have better effects on the basis ofcomprehensive moderate blood conservation.

心脏骤停存活者心肺复苏并发症的影响因素

目的基于临床资料及胸外按压相关参数构建心肺复苏并发症风险LASSO-logistic回归模型,为预防心肺复苏并发症提供参考。方法选取2020年4月至2023年5月石家庄循环化工园区医院收治的100例心脏骤停存活患者,根据并发症情况分为并发症组和无并发症组,比较2组临床资料、胸外按压相关参数,用LASSO回归初筛心肺复苏并发症的影响因素,用logistic回归分析心肺复苏并发症的影响因素,绘制Nomogram预测心肺复苏并发症的风险。结果LASSO回归初筛显示,体重指数、胸廓前后径、施救者文化程度、施救者性别的系数被压缩,当λ=1.786时,影响因素最少,模型性能优良,此时筛选出施救者身份、施救者心肺复苏培训、应用气垫床、应用减压垫、按压深度、按压时长、严格控制液体量7个预测变量,达到最佳影响因素的选择;logistic回归分析显示,施救者为护士、施救者接受过心肺复苏培训、应用气垫床、应用减压垫、严格控制液体量是心肺复苏并发症的相关保护因素,按压深度、按压时长是心肺复苏并发症的相关危险因素(P<0.05);绘制心肺复苏并发症风险logistic预测模型的列线图显示,其C指数为0.932,具有良好的区分度,且校正曲线与理想曲线拟合良好,所构建预测模型与实际观测结果有较好的一致性。结论胸骨骨折、肺挫伤、肋骨骨折等心肺复苏并发症的发生风险与施救者身份、施救者心肺复苏培训、应用气垫床、应用减压垫、按压深度、按压时长、严格控制液体量情况密切相关。

不同运动处方对同型半胱氨酸影响的研究进展

同型半胱氨酸(Hcy)是蛋氨酸代谢的重要中间产物,其表达升高不仅是高血压的独立危险因素,而且在导致心脑血管事件上具有显著的协同作用,使发病概率大幅增加。影响Hcy浓度的因素包括年龄、性别、遗传、饮食和体力活动。尽管体育锻炼被证明能降低心血管风险,但其对Hcy浓度的影响尚不明确,研究结果存在矛盾。前期研究表明,多数情况下剧烈运动会导致健康人群Hcy浓度升高,但轻度或中等强度运动通常会降低心血管疾病或神经系统疾病患者的Hcy水平。该研究旨在探讨不同运动对心脑血管人群等H型高血压患者Hcy浓度的影响,以期为制订个体化运动防治H型高血压提供新思路。

卒中恢复期患者心肺适能评估及中高强度有氧训练的可行性、安全性及有效性研究

目的探讨卒中后恢复期患者进行心肺适能评估及中高强度有氧训练的可行性、安全性及有效性。方法连续纳入2022年12月—2023年9月在复旦大学附属华山医院静安分院康复医学科住院的卒中恢复期(1个月≤病程≤12个月)患者进行心肺运动试验,并将完成心肺运动试验的患者随机分为对照组与干预组。两组患者均接受常规康复治疗(3 h/d、5日/周、持续4周)。同时干预组根据心肺适能结果增加按照运动处方制订的中高强度有氧训练(每周5次,40分钟/次),对照组增加同样时长的康复指导(康复宣教、柔韧性训练等)。比较两组患者在试验前及试验4周后日常生活能力指标[改良Barthel指数(modifiedBarthelindex,mBI)],运动功能指标[Fugl-Meyer运动功能评定量表(Fugl-Meyer assessment scale,FMA)],以及平衡功能指标[Berg平衡量表(Berg balance scale,BBS)],并通过心肺运动试验分别评估两组患者的峰值摄氧量(peakoxygenuptake,VO_(2peak))、峰值功率等,同时比较两组患者的不良反应发生率、依从性。结果本试验纳入68例卒中恢复期患者,其中13例(19.12%)没有完成心肺运动试验,5例(7.35%)患者在评估过程中出现下肢痛、心肌缺血、血压过高、心律失常等不良反应,6例(8.82%)患者拒绝后续试验。最终44例(64.71%)完成心肺运动试验的患者随机分为干预组和对照组,每组各22例,其中干预组3例(13.64%)患者、对照组2例(9.09%)患者在治疗过程中出现下肢痛、心慌、头晕等不良反应退出训练。两组患者均未发生与本研究相关的再发心脑血管事件、猝死等严重不良事件。所有患者的出勤率为86.25%(759/880),其中干预组为88.41%(389/440),对照组为84.09%(370次/440次)。康复治疗前,两组患者的FMA(上肢/下肢)、BBS、mBI、VO_(2peak)、峰值功率差异无统计学意义。康复治疗后,干预组的ΔFMA下肢[3.86(2.00~5.25)分vs.2.27(1.00~3.25)分,P=0.016]、ΔmBI[15.23(5.00~25.00)分vs.9.36(5.00~11.25)分,P=0.025]、ΔVO_(2peak)[(3.78±3.49)mL/(kg·min)vs.(1.15±2.10)mL/(kg·min),P=0.004]、Δ峰值功率[(15.68±10.50)W vs.(7.05±10.20)W,P=0.008]较对照组改善明显。且两组患者的FMA上肢(P<0.001)、FMA下肢(P<0.001)、BBS(P<0.001)、mBI(P<0.001)、VO_(2peak)(P<0.001)、峰值功率(P=0.006)等指标均较本组治疗前明显改善。结论对卒中恢复期患者进行心肺运动试验评估及有氧训练安全可行,且相比常规康复治疗,进行中高强度有氧训练在患者运动功能、心肺功能等方面,可以得到更大获益。

瑞芬太尼应用于体外循环心脏手术的效果

目的 探讨瑞芬太尼对体外循环心脏手术患者血清白细胞介素-6β(interleukin-6β,IL-6β)、细胞间黏附分子-1(intercellular adhesion molecule-1,ICAM-1)、中枢神经特异蛋白(central nerve specific protein-β,S100β)水平的影响。方法 以河北省邯郸市第一医院收治的84例体外循环心脏手术患者作为研究对象,用随机数字表法分为注射用盐酸瑞芬太尼组和枸橼酸舒芬太尼注射液组,每组42例。注射用盐酸瑞芬太尼组给予注射用盐酸瑞芬太尼靶控输注,枸橼酸舒芬太尼注射液组给予枸橼酸舒芬太尼注射液静脉滴注,2组术后均观察至出院。比较2组患者的手术信息,术前、术后1、3 d的疼痛程度和认知功能,麻醉前(t_(0))、麻醉诱导后2 min(t_(1))、气管插管后2 min(t_(2))、体外循环开始时(t_(3))、手术结束时(t_(4))的血流动力学、血清细胞因子水平及术后情况。结果 注射用盐酸瑞芬太尼组枸橼酸舒芬太尼注射液用量少于枸橼酸舒芬太尼注射液组(P<0.05)。与术前比较,术后1、3 d,2组的疼痛数字分级评分法(numerical rating scale,NRS)评分逐渐降低,注射用盐酸瑞芬太尼组术后1、3 d的NRS评分低于枸橼酸舒芬太尼注射液组(P<0.05)。与术前比较,术后1 d 2组的简易智力状态检查量表(mini mental state examination scale,MMSE)评分均降低,且注射用盐酸瑞芬太尼组高于枸橼酸舒芬太尼注射液组(P<0.05);与术后1 d比较,术后3 d 2组的MMSE评分均升高,且注射用盐酸瑞芬太尼组高于枸橼酸舒芬太尼注射液组(P<0.05)。与t_(0)、t_(1)、t_(2)时比较,t_(3)、t_(4)时2组的平均动脉压(mean arterial pressure,MAP)均降低,且注射用盐酸瑞芬太尼组高于枸橼酸舒芬太尼注射液组(P<0.05);2组的血清IL-6β、ICAM-1、S100β水平均降低,且注射用盐酸瑞芬太尼组低于枸橼酸舒芬太尼注射液组(P<0.05);2组的血清血糖(glucose,Glu)、乳酸(lactate,Lac)水平均升高,且注射用盐酸瑞芬太尼组低于枸橼酸舒芬太尼注射液组(P<0.05)。注射用盐酸瑞芬太尼组拔管时间短于枸橼酸舒芬太尼注射液组(P<0.05)。结论 瑞芬太尼能够调节体外循环心脏手术患者的血清IL-6β、ICAM-1、S100β、Glu、Lac水平,减轻应激反应,并可维持患者血流动力学稳定,同时能够减轻患者的疼痛程度,减少舒芬太尼的用量,缩短拔管时间,且对患者认知功能的影响较小。