Objective: To explore the patterns of Syndrome Differentiation (SD) of coronary heart disease (CHD) patients in peri-operative stage of coronary artery bypass graft (CABG). Methods: One week after operation, thirty-seven CHD patients, who received CABG of internal mammary artery or great saphena vein under conventional general anesthesia with low or middle temperature extracorporeal circulation were differentiated as various syndromes, with the pre- or post-operational EKG, color Doppler echocardiography were done during and after operation. The hemodynamic parameters were monitored. Results: In the CHD patients, 64.9% were differentiated as Qi-Yin deficiency, 67.6% were complicated with phlegm syndrome and 62.2% with blood stasis, suggesting that Qi-deficiency, phlegm and stasis are the basic pathogenetic factors in patients with CABG. Moreover, the peri-operative syndrome was correlated with the condition of coronary artery lesion, heart and lung functions before operation, and the extracorporeal circulation time during the operation. Conclusion: TCM SD conducting in peri-operative stage might be useful in exploring the patterns of syndrome alteration which provided a basis for preventing peri-operative complications and elevating success rate of operation.

The conventional bypass design is to implant a graft on the stenosed host artery allowing blood to flow bypass the stenotic artery. However, restenosis is a challenging problem which finally results in reoperation. The purpose of this paper is to propose a new bypass graft design of coronary artery with an assistant graft for the treatment of coronary artery stenosis. An additional assistant graft was employed in the new design compared with the conventional ETS anastomosis. Numerical simulations were performed by means of finite volume method using computational fluid dynamics (CFD) solver. Results demonstrated that the new anastomoses model provided a more smooth flow at the distal ETS anastomosis without any stagnation point on anastomotic bed and vortex formation in the heel region. Oscillatory shear index (OSI) and time-averaged wall shear stress gradient (TAWSSG) at the artery bed of the distal ETS anastomosis were reduced. The coronary artery bypass graft with an assistant graft is feasible to improve the local hemodynamics and diminish the probability of restenosis in the treatment of coronary artery stenosis.

冠脉搭桥术后内皮细胞损伤引起再狭窄机制

冠状动脉搭桥手术(coronary aaery bypass graft,CABG)损伤冠状动脉和桥血管,同时冠状动脉病变不断进展,移植血管桥发生加速粥样硬化病变等,影响术后近、远期血管通畅率和生存率.术后动脉桥10年内发生再狭窄率为5%～10%;静脉桥再狭窄率第1年接近15%～30%,10年内发生阻塞率高达50%[1].再狭窄是一个复杂的生物学过程,血管内皮细胞(vascular endothelial cell,VEC)损伤诱发血管痉挛、炎症和血栓形成、血管平滑肌细胞(vessel smooth muscle cell,VSMC)迁移和过度增殖、脂质和细胞外基质过度沉积、粥样硬化等病理过程,是导致术后再狭窄的关键因素.

医学职称英语考试模拟试题(6)

I.阅读理解:阅读下列短文,然后回答文章后面的问题,从四个供选择的答案中挑出正确的一个.Heart Patient Awake During SurgeryA 61-year-old man stayed awake for the entire 4-hour, 10-minute open heart surgery operation performed on him by a team of three doctors. Dr. Mark Anderson of the Miami Veterans' Affairs Medical Center performed a single coronary artery bypass graft Thursday using only an epidural,an anesthetic shot injected into the spinal cord. The operation began at 8:10 am and was over at 12:20 pm. The patient,whose name was not made public, was reported to be in stable condition at the hospital Thursday evening.

同期行心脏瓣膜置换和冠状动脉旁路移植术后并发症的观察及护理

心脏瓣膜手术和冠状动脉旁路移植术(CABG)均已成为心脏外科的常规手术,但对部分心脏瓣膜疾病合并冠状动脉病变或冠心病合并心脏瓣膜功能不全的病人,需同期行心脏瓣膜手术和冠状动脉血运重建.由于此类病人多数病情重、病史长、年龄大、血管条件差、合并脏器功能不全者较多、手术操作复杂、手术时间长、体外循环及主动脉阻断时间长,致使病死率明显增加[1].2006年2月-2007年6月对18例行同期心脏瓣膜置换和冠状动脉旁路移植术,现对病人的临床资料进行回顾性总结,探讨其并发症的发生及护理.

1例冠状动脉旁路移植术术后呼吸衰竭使用体外膜肺氧合病人的护理

体外膜肺氧合(extracorporeal membrane oxygennation,ECMO)是将血液引流至体外,经膜肺氧合后再灌注体内,通过长时间的转流,对呼吸或循环系统衰竭的病人进行有效的支持,维持机体适当的氧供和去除体内的二氧化碳以保证机体代谢[1].

冠状动脉旁路移植术后并发低氧血症病人的观察及护理

冠状动脉旁路移植术(CABG)是治疗冠心病心肌缺血有效的方法,术后可改善病人的生活质量.通过术后严密的监护及高质量的护理,可预防和减少并发症,降低病死率,提高手术效果[1].但冠心病多见于老年人,而老年人肺部储备功能有不同程度的减退,如有长期吸烟史、慢性支气管炎、呼吸道潜在感染等因素,术前动脉氧分压多处于正常临界水平,加之麻醉和体外循环对肺部的影响,此类病人术后多发生低氧血症,严重影响机体恢复,甚至导致病人死亡.现将我科12例CABG后并发低氧血症的病人进行观察和护理介绍如下.

小剂量胺碘酮预防冠状动脉旁路移植术后心房颤动的临床观察及护理

心房颤动(AF)是冠状动脉旁路移植术(CABG)后常见的心律失常,可导致低血压、心肌缺血、心力衰竭、肺部感染、心源性休克、栓塞等严重并发症,不仅加重病人痛苦,而且延长住院时间,增加治疗费用.胺碘酮为Ⅲ类抗心律失常药物,其广谱抗心律失常反应已经在多中心大规模临床研究中得到证明.但长期口服大剂量胺碘酮的毒副作用发生率高、损害严重.因此,小剂量胺碘酮的临床研究引起重视,其预防AF的作用和安全性急需进一步研究和评价.现将临床观察与护理报告如下.

护患情境会话

冠脉搭桥术后病人便秘的护理指导Post-Operative Nursing Instructions on Constipation for a Coronary Artery Bypass Graft Patient
　　交流
　　病人：这样我就放心了，但我已经好几天没上厕所了，估计还是不能很顺利地解出。
　　护士：别担心，让我来帮你，我先来给你按摩按摩腹部好吗？它可以刺激肠蠕动，促进排便。
　　病人：好的，谢谢你。