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复方丹参注射液对非体外循环冠状动脉旁路移植术胃粘膜的保护作用
有文献报道证实,心脏手术后胃粘膜内pH低下者术后合并症增多,非体外循环下冠状动脉旁路移植术(off-pump coronary artery bypass, OPCAB)中由于对心脏的刺激比较强烈,故加强胃肠道的保护尤其重要.有报道认为丹参对胃肠道有一定的保护作用.1999年1月-2003年1月,我们以胃粘膜内pH(gastric mucosa intramembrane pH, pHi)为指标,观察了复方丹参注射液对OPCAB中胃粘膜的保护作用,现报道如下.
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非体外循环冠状动脉搭桥术患者的临床护理分析
非体外循环冠状动脉搭桥术(off-pump coronary artery bypass,OPCAB)是20世纪90年代兴起的微创心脏外科手术.该手术不使用体外循环,在心脏搏动下进行冠状动脉移植,避免了常规体外循环冠脉搭桥术(CABG)所引起的心肌缺血再灌注损伤和体外循环造成的创伤,具有出血少、术后输血少、用药少、拔管早、进食早、并发症少等优点[1-3].OPCAB成功的关键是心肌完全血管化、良好的心肌保护和术后监护[4].
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联合冠状动脉血运重建术国内首例报告(摘要)
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80岁以上老年患者非体外循环冠状动脉旁路移植术13例分析
年龄是影响手术死亡率和近远期疗效的重要因素之一.Benetti成功开展的非体外循环冠状动脉旁路移植术(off-pump coronary artery bypass, OPCAB),避免或减少了心脏缺血再灌注损伤和体外循环损伤,成为现代微创冠状动脉外科的代表术式,使得老年患者获益更大.2000年3月至2003年12月,我们共对13例80岁以上患者行冠状动脉旁路移植术,现报道如下.
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杂交(Hybrid)技术治疗冠状动脉多支病变:进展和争议
杂交技术冠状动脉再血管化是指将微创冠状动脉旁路移植术(minimally invasive direct coronary artery bypass,MIDCAB)与经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)相结合治疗冠状动脉多支病变的技术.
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冠状动脉旁路移植术41例临床分析
冠状动脉旁路移植术(CABG)是治疗冠状动脉粥样硬化性心脏病(冠心病)和缓解心绞痛的有效方法.从2001年6月至2005年6月我们共完成CABG 41例,取得了满意的疗效.现报道如下.
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Objective To evaluate radial artery (RA) and internal mammary artery (IMA) grafts in coronary artery bypass and the use of color Doppler ultrasound in the peri-operative evaluation of IMA and radial-ulnar collateral circulation.Methods From June 1998 to June 2000, sixty cases of coronary bypass revascularization with RA and IMA were performed. Preoperatively, the radial-ulnar collateral circulation was evaluated with the modified Allen's test, color Doppler ultrasound and noninvasive oxygen saturation measurement. The IMA lumen and blood flow were measured at the first intercostal space with color Doppler ultrasound preoperatively and postoperatively.Results One patient (1.7%) died of serious cardiac arrhythmia on the fourth postoperative day. There were no arterial graft harvest related complications. Before harvesting, the ulnar artery blood flow was 30.78±9.71?ml/min, and it increased to 43.36±13.98?ml/min (40.87% increase, P<0.01) after the operation. Compared with the baseline, there was no obvious change of IMA blood flow postoperatively (P>0.05), but the systolic/diastolic flow ratio markedly decreased from 8.57±3.98?ml/min to 3.41±4.87?ml/min (P<0.01).Conclusions Arterial grafts can be safely used for coronary bypass revascularization with good results. The ulnar artery blood flow can increase compensatively after RA harvesting. The diastolic blood flow of grafted IMA markedly increased postoperatively. Color Doppler ultrasound was very helpful both in evaluating the radial-ulnar collateral circulation before RA harvesting and in assessing the patency of the grafted IMA after coronary artery bypass grafting (CABG).
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合并升主动脉钙化的多支血管病变的冠脉搭桥手术治疗策略
虽然不停跳冠状动脉搭桥术(off-pump coronary artery bypass,OPCABG)术后神经系统并发症的发生率在逐年下降,但神经系统并发症一旦发生,其具有较高的致残致死率并严重影响患者的预后.当合并升主动脉钙化时,使用主动脉侧壁钳行桥血管近端吻合,可能会导致病变升主动脉内钙化斑块脱落增加术后神经系统并发症的发生率.现总结浙江医院心外科2005年9月-2011年9月63例合并升主动脉钙化的不停跳冠脉搭桥手术患者的临床资料,通过积极改进手术治疗策略和使用主动脉近端吻合装置,得到满意手术效果,报道如下.
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非体外循环冠状动脉旁路移植术患者FloTrac-Vigileo系统与肺动脉导管技术监测心指数的一致性
Objective To determine if the cardiac index (Cl) measured with FloTrac-Vigileo system agrees with that measured with pulmonary artery catheter (PAC).Methods Forty-three ASA Ⅱ or Ⅲ patients aged 53-75 yr weighing 46-100 kg undergoing off-pump coronary artery bypass grafting were included in this study.Anesthesia was induced with midazolam,sufentanil,propofol and rocuronium and maintained with propofol,remifentanil and atracurium.One MAC sevoflurane was inhaled at breast bone splitting and closing.Cl was measured with FloTrac-Vigileo system and PAC before,and at 5,15 min of sevoflurane inhalation and recorded.All data were compared by Bland-Altman analysis and with kappa coefficient for agreement and percentage error was calculated.Results Bland-Altman comparison of FloTrac-Vigileo system and PAC:matching data of 258 measurements:Cl (2.8 ± 0.6) L·min-1 ·m-2,bias was 0.23 L·min-1 ·m-2 and limit of agreement was (-0.57,1.02) L·min-1 ·m-2,resulting in κ =0.546 and an overall percentage error of 28.6%.Conclusion Cl values obtained by FloTrac-Vigileo system agrees well with that obtained by thermodilution technique using PAC in patients undergoing off-pump coronary artery bypass grafting.
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骨科微创技术的应用现状与前景
骨科微创技术早在20世纪70年代就已经应用于临床,如经皮穿刺椎间盘切除术,但微创外科技术(minimally invasive surgery,MIS)作为一种新的手术概念而兴起,早源自20世纪90年代初期的微创冠脉搭桥(minimally invasive direct coronary artery bypass,MIDCAB),它强调的不仅仅是一个手术小切口,而且非常强调在保证获得常规外科手术疗效的前提下,通过精确的定位技术,减少手术对周围组织造成的创伤和对病人生理功能的干扰,降低围手术期并发症,促使病人的早日康复.
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艾司洛尔用于OPCAB手术cTnI水平变化的临床研究
有文献提示,非体外循环下冠状动脉旁路移植术(off pump coronary artery bypass, OPCAB)中静脉输注艾司洛尔有助于手术成功[1],本文目的是通过检测患者心肌肌钙蛋白I(cTnI)、肌红蛋白(myoglobin)、心肌型肌酸激酶同功酶(CK-MB)水平,监测艾司洛尔用于OPCAB手术心肌损伤程度,以便更好使用艾司洛尔用于OPCAB.
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非体外循环冠状动脉旁路移植术的病理生理与麻醉处理
冠状动脉旁路移植术(coronary artery bypass grafting,CABG)是常见的心脏手术.非体外循环冠状动脉旁路移植术(off-pump coronary artery bypass,OPCABG)早于1964年在圣彼得堡完成,但很快随着体外循环(cardiopulmonary bypass,CPB)技术及心脏停跳液的发展而被弃之不用.
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非体外循环下冠状动脉搭桥术的麻醉处理
非体外循环下冠状动脉搭桥术( off- pump coronary artery bypass ,OPCAB)与常规体外循环下冠状动脉搭桥术( conventional coronary artery bypass grafting,cCABG)相比,从理论上避免了体外循环损伤和心肌缺血再灌注损伤,手术创伤小、术后并发症发生率低、住院时间短,已成为当代微创心脏外科手术的热点术式之一.我院自 2001年至今共施行 OPCAB手术 10例,现将麻醉作一总结.
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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 Graf t (CABG) Patient
点评
这位护士针对冠脉搭桥术后病人的心理特点,运用了有效的护理措施。首先,她肯定了这位病人已积累的自我保健和应对疾病的经验和方式。再对病人的顾虑采取了协商、提醒、暗示等进行交流,并辅以护理技能的支持,取得良好的效果。 -
非体外循环下冠状动脉搭桥术麻醉期间的处理
非体外循环下冠状动脉搭桥术(minimaily Invaisve off-pump Coronary Artery Bypass MI-OPCAB)是近年来心脏外科开展的新技术.