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Objective:To evaluate the efficacy of left heart attracting pressure monitoring technology applied in cardiopulmonary bypass (CPB) in cardiac surgery.Methods:Eighty patients of both sexes, aged 40-64 yr, weighing 50-80 kg, of American Society of Anesthesiologists physical status Ⅱ-Ⅳ, with New York Heart Association grade Ⅱ or Ⅲ, with left ventricular ejection fraction≥40%, undergoing elective cardiac valve replacement, were divided into 2 groups using a random number table method: traditional left heart aspiration group (T group) and modified left heart aspiration group (M group), with 40 patients in each group.The rotation speed of left ventricular suction pump was adjusted according to left ventricular suction volume and surgical field clarity in group T and by monitoring the pressure in the left suction tube in real time in group M. After aspiration returned to normal aspiration, blood of the left heart returned after aspiration was collected to determine the concentration of free hemoglobin.The number of adjustments after left ventricular aspiration, intraoperative hemoglobinuria, and occurrence of tissue sediment in the aspiration tube after operation were recorded.Results:Compared with T group, the concentration of free hemoglobin, incidence of intraoperative hemoglobinuria and incidence of tissue sediment in the aspiration tube after operation were significantly decreased, and the number of adjustments after left ventricular aspiration was decreased in M group ( P<0.05). Conclusion:Left heart attracting pressure monitoring technology can be safely and effectively applied in CPB in cardiac surgery.
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Objective:To summarize the clinical experience of changing the membranous pulmonary system during extracorporeal membrane oxygenation(ECMO) in infants after congenital heart disease opration with cardiopulmonary bypass.Methods:From January to September in 2019, 6 cases of congenital heart disease with cardio-pulmonary bypass in our hospital were analyzed retrospectively, whose membrane obstruction occurred during ECMO treatment and replaced successfully.The hemodynamics and blood gas before and after replacement of ECMO system were observed, and the experience was summarized.Results:Six patients(3 males and 3 females), aging from 1 to 3 months and weighing from 3.0 to 4.9 kg, were received VA-ECMO adjuvant therapy.The ECMO system replacement process was smooth and took 175-209 s. The hemodynamic of the children was stable.The ECMO support time was 134-249 h. After the improvement of cardiac systolic function, all children were successfully withdrawn and survived.Conclusion:The improved method of liquid replacement in ECMO system can make full use of the blood components in the original system and avoid the loss of blood tangible components.According to the plan of rapid replacement, the risk of replacement will not be increased.
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Objective:To compare the curative effects of different venous cannulas and drainage to improve patient's whole body oxygenation during the auxiliary process of venous-arterial extracorporeal membrane oxygenation (VA-ECMO) in lung transplantation.Methods:From December 2016 to December 2019, 12 patients who were assisted by VA-ECMO in one lung transplantation in People's Hospital of Henan Province were selected as the research objects. According to the number of side holes of venous cannulas, they were divided into two groups: one group with few side holes and other group with multiple side holes. The differences in blood gas indexes among the right radial artery, left radial artery, and right internal jugular vein before and after assistance were compared, and the assistance effect was evaluated.Results:The arterial partial pressure of oxygen (PaO 2) of blood gas indexes of the right and left radial arteries in both groups were significantly higher than that before assistance [mmHg (1 mmHg = 0.133 kPa): right and left radial artery in few side holes group: 79.5±4.2 vs. 48.3±3.8 and 88.1±3.5 vs. 48.3±3.8; right and left radial artery in multiple side holes group: 67.7±5.9 vs. 48.7±3.2 and 84.0±3.8 vs. 48.7±3.2, all P < 0.05]. The arterial partial pressure of carbon dioxide (PaCO 2) of blood gas index was significantly lower than that before assistance (mmHg: 44.2±2.6 vs. 71.7±4.4 for the right radial artery and 44.7±1.4 vs. 71.7±4.4 for the left radial artery in the group with few side holes; 46.2±2.1 vs. 71.2±3.5 for the right radial artery and 44.1±1.9 vs. 71.2±3.5 for the left radial artery in the group with multiple side holes, all P < 0.05). The partial pressure of oxygen in venous blood (PvO 2) of blood gas index of ECMO system in the group with few side holes was significantly lower than that of the multiport side holes group (mmHg: 56.4±3.2 vs. 88.7±1.5, P < 0.01), and the partial pressure of carbon dioxide in venous blood (PvCO 2) was significantly higher than that of multiport side holes group (mmHg: 63.6±3.7 vs. 44.2±1.7, P < 0.01). Conclusions:When VA-ECMO is used in lung transplantation, the superior vena cava blood flow can be fully drained by using intravenous cannula with few side holes. It can effectively improve the oxygenation of the upper body of lung transplant patients, avoid the dilemma of hypoxemia in the upper body and hyperxemia in the lower body, provide more effective assistance to patients undergoing single lung transplantation, and is more meaningful for improving the oxygenation status of the whole body in patients undergoing single lung transplantation.
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Objective To summarize the application experiences and curative efficacies of single lung transplantation assisted by extracorporeal circulation with coated lung ,centrifugal pump and coated pipe .Methods Retrospective analysis was conducted for clinical data of 6 adult patients with respiratory insufficiency undergoing single lung transplantation .The changes of hemodynamics and oxygenation before and after adjuvant treatment were observed ,the effects of adjuvant evaluated and the experiences of application summarized .Results The hemodynamic parameters post-assistance significantly improved as compared with that pre-assistance and pulmonary arterial pressure dropped from (56 ± 15 ) to (45 ± 13 ) mmHg with statistically significant differences . Arterial blood gas parameters significantly improved .PO2 spiked from (47 ± 12) to (68 ± 9) mmHg and PCO2 declined from (65 ± 14) to (55 ± 12)mmHg .And there were statistically significant differences .All patients were discharged successfully .Conclusions The simple extracorporeal membrane oxygenation system of coated lung , centrifugal pump and coated pipe during routine extracorporeal circulation may guarantee the operative safety of single lung transplantation and provide a new therapeutic option .
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Objective To evaluate the effects of processing banked suspended red blood cells (RBCs) with cell saver before priming on perioperative systemic inflammatory responses of infants undergoing cardiac surgery under cardiopulmonary bypass (CPB).Methods Forty pediatric patients of both sexes,aged 3 months-2 yr,weighing 5-13 kg,of American Society of Anesthesiologists physical status Ⅱ-Ⅳ,undergoing repair of atrial or ventricular septal defect under CPB,were divided into control group (group C,n =20) and processing group (group P,n =20) using a random number table.Banked suspended RBCs were primed directly after being added to CPB circuit in group C.Banked suspended RBCs were washed with cell saver and then primed after being added to CPB circuit in group P.At 5 min before skin incision,at 30 min after the start of CPB,at 10 min after aortic unclamping,immediately after the end of CPB and at 6,12 and 24 h after the end of CPB (T1.7),blood samples were collected from the radial artery for determination of the concentrations of tumor necrosis factor,interleukin-1β (IL-1β),IL-6,IL-8,IL-10 and neutrophil elastase in plasma by enzyme-linked immunosorbent assay.Blood samples were taken from the radial artery at T1 and T4.7 for measurement of blood routine and plasma acute phase reactive protein concentrations.Results Compared with group C,the concentrations of tumor necrosis factor,IL-1β,IL-6,IL-8 and neutrophil elastase in plasma were significantly decreased at T6,7,the total number of white blood cells,neutrophil count and concentration of plasma acute phase reactive protein were decreased at T7,and duration of stay in intensive care unit was shortened in group P (P＜0.05).Conclusion Processing banked suspended RBCs with cell saver before priming can reduce perioperative systcmic inflammatory responses of infants undergoing cardiac surgery under CPB.
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Objective:To provide some thoughts for pharmaceutical treatment and care for the patients with pulmonary infection af-ter renal transplantation. Methods:Clinical pharmacists participated the whole treatment process of one case of pulmonary infection af-ter renal transplantation. According to the literatures combined with medical history, clinical symptoms and lab results, the drug treat-ment process of the patient was analyzed, and the key points of the optimized pharmaceutical care were summarized. Results: The pharmaceutical care included the dose adjustment of immunosuppressants at the early phase of the disease and after the improvement of clinical symptoms, attention paid to the interactions between multiple anti-infective drugs and immunosuppressive agents, dosage ad-justment based on the renal function of the patient, monitoring adverse drug reactions and drawing up personalized regimen. Conclu-sion:Through comprehensive medication monitoring, clinical pharmacists can help physicians develop timely and effective treatment programs and provide professional and effective pharmaceutical care for patients.
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Objective:To analyze the drug resistance of Pseudomonas aeruginosa( PA) isolated from clinical specimen to provide the guidance for the clinical treatment. Methods:The infection status of PA from January 2012 to December 2012 was reviewed retro-spectively, and the results of susceptibility test for 448 PA strains were analyzed. Results:The antibiotic susceptibility of the PA strains to cefoperazone sodium and sulbac, ampicillin aodium and aulbacta,aiprofloxacin,cefepime,piperacillin/ sulbactam,amikacin, ceftazi-dime,meropenem, imipenem, minocycline, selectrin and aefuroxime was 100%, 76%, 72. 8%, 69. 4%, 66. 3%, 65. 6%, 64. 8%, 59. 9%,28. 9%,2. 4% and 0%,respectively. Conclusion:PA is one of the main pathogenic bacteria for nosocomial infection. It is necessary to strengthen the drug resistance test and standardize the application of antibiotics in order to provide the reference for clinical rational use of antibacterial drugs.