Extracorporeal membrane oxygenation support in acute cardiorespiratory function failure patients after cardiac surgery / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the treatment experience of extracorporeal membrane oxygenation (ECMO) support after cardiac surgery.</p><p><b>METHODS</b>Retrospectively analyze the clinical data of 117 postoperative patients supported with ECMO in cardiac intensive care unit from March 2005 to June 2008. There were 32 female and 85 male patients, with a mean age of (48.7 +/- 16.5) years old. The cardiac operations included coronary artery bypass grafting (n = 20), coronary artery bypass grafting and remodeling of left ventricle (n = 9), coronary artery bypass grafting and valvular operation (n = 5), repair of ventricular septal perforation following acute myocardial infarction (n = 2), valvular operation (n = 46), heart transplantation (n = 20), lung heart transplantation and repair of ventricular septal defect (n = 1), correction of congenital heart defects (n = 10), aortic operations (n = 4). Venoarterial bypass was instituted in 115 for hemodynamic failure and venovenous in 2 patient for hypoxemia following cardiac surgery. ECMO was established in 110 patients by cannulation of the right atrium and femoral artery, and 5 of the right atrium and ascending aorta. And 2 case added left atrial drainage to ECMO. Heparin was infused to maintain the whole blood activated coagulation time (ACT) of 160 to 200 s in centrifugal pump (14 cases), and 200 to 250 s in roller pump (3 cases) to avoid thrombotic events. This was administered until decannulation. Intra-aortic balloon pump was used in 15 patients and continuous renal replacement therapy in 29 cases.</p><p><b>RESULTS</b>Mean ECMO duration was 61 h (ranged 3 to 225 h) and the mean duration of ICU stay was 5 d. 87 patients (74.4%) were successfully weaned from ECMO. 69 patients (59.0%) survived to discharge. The most common complications were re-exploration for bleeding (n = 24) and alimentary tract hemorrhage (n = 14), renal failure required renal replacement therapy (n = 29), infection(n = 32), limb ischemia (n = 5), plasma leak of oxygenators (n = 29), hemolysis (n = 7), neurological complication (n = 4).</p><p><b>CONCLUSIONS</b>ECMO is an effective mechanical assistance method for short-term treatment of postoperative cardiorespiratory failure. Indication should be controlled strictly. Earlier institution of ECMO and prevent complication may improve outcome.</p>

Primary investigation of central auditory function in patients with temporal lobe epilepsy / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the function of central auditory, Speech-perception-in-noise test (SPIN test) was used to assess that whether temporal lobe epilepsy patients have central auditory processing disorders.</p><p><b>METHODS</b>Four audiological test were performed in 9 patients with temporal lobe epilepsy and 19 age-matched normal hearing persons as controls, which include pure tone audiometry, acoustic immittance measurement, ABR (auditory brainstem response) and SPIN test. All the temporal lobe epilepsy patients were performed by CT or MRI and diagnosed by the neurologists prior to the test. The testing materials of speech and noise in SPIN test was recorded in independent tracks and the S/N was identified by -25 dB by pre-experiment. In the test, every words were read twice and both the results were recorded.</p><p><b>RESULTS</b>In the ABR test, only wave V latency showed longer values in the left ear, other waves like I, III and inter-peak intervals had'nt shown significant statistical differences in both ears of temporal lobe epilepsy patients. However, in the SPIN test, there's no significant statistical differences in both left and right ears of the controls by the first-time hearing (P = 0.107), and the differences showed by the second-time hearing (P = 0.048); but in the comparison of both ears in temporal lobe epilepsy patients, both time of hearing showed no significant statistical differences with P = 0.174 and P = 0.163. In additional, the SPIN recognition score of the temporal lobe epilepsy patients, whether in the fist or second time hearing, whether in the monaural or binaural models, presented significant statistical differences compared to the controls (P = 0.000).</p><p><b>CONCLUSIONS</b>There was no statistically significant difference in pure tone audiometry and ABR test for all the groups. But the speech recognition score obtained from SPIN test of tempol lobe epilepsy patients is lower than the normal persons, which has statistically significant difference. (P < 0.001) Then we can come to the conclusion that Temporal lobe epilepsy patients had central auditory dysfunctions and SPIN test is a sensitive way to assess this abnormal.</p>

Acute hemodynamic effects of intravenous diltiazem in patients with congenital heart defects and pulmonary hypertension post cardiac surgery / 中华心血管病杂志

<p><b>OBJECTIVE</b>To observe the acute hemodynamic effects of intravenous diltiazem in patients with congenital heart defect (CHD) and severe pulmonary hypertension (HP) post cardiac surgery.</p><p><b>METHODS</b>From November 2003 to September 2005, 12 patients with CHD and severe HP (4 male, mean age 17.8 +/- 9.8 years) after cardiac surgery received intravenous diltiazem (3 - 5 microg x kg(-1) x min(-1)) in the Intensive Care Unit. Mean pulmonary artery pressure (mPAP), mean arterial pressure (MAP), heart rate (HR), stroke volume (SV), systemic vascular resistance (SVR), pulmonary vascular resistance (PVR) were monitored with Swan-Ganz catheter before (T1) and 6 hours (T2) after diltiazem injection, before weaning patients off of ventilator (T3), 1 hour (T4) and 24 hour (T5) after extubation.</p><p><b>RESULTS</b>All patients survived during the observation period and no patient developed pulmonary hypertension crisis. The average ventilation time was (88.7 +/- 50.1) hours. Mean ICU stay time was (5.8 +/- 3.1) days. Compared to T1, mPAP was significantly decreased at T3 and T5, MAP significantly increased at T4 and T5, HR significantly reduced at T2 and thereafter, SV significantly increased at T3, T4 and T5 and PVR significantly increased at T3 and T5 while SVR remained unchanged after diltiazem therapy.</p><p><b>CONCLUSION</b>Intravenous use of diltiazem is safe and effective for patients with CHD with severe HP post cardiac surgery.</p>