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With the population ageing,increasing health needs and demands,changing family structure and the transformation of general hospital service model,home care as an important part of primary care,has been brought more and more attention.Home healthcare would relieve the pressure caused by increasing needs of elderly care and transformation of hospital functions,so it should have greater development in the future.This article reviews the present situation and the future development direction of home healthcare in China.
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Objective To summarize the clinical experiences in setting up cardiopulmonary bypass(CPB)using extracorporeal membrane oxygenation(ECMO)circuit and turning CPB to ECMO after open heart operations in 16 cases.Methods In the group of 16 cases,the annulations were via femoral vessels:by Medtronic ECMO machine and membrane oxygenator was used in all patients.All patients accepted A-V bypass.Results CPB was running smoothly during the operations,and converted to ECMO after the surgeries without complications,and the rate of ECMO withdraw was 93.75%.Mortality was 18.5%,and 81.25%of patients were discharged.Conclusion ECMO is an effective device for cardio and pulmonary support.Many patients with severe cardiac diseases and marginal cardiac function will need mechanical support after surgery.For these patients,setting up CPB using ECMO circuit during the operation and converting it to ECMO after surgery can prevent patients from additional exposure to a standard CPB circuitry.It helps decrease the inflammatory response,avoid dilution of patient's volume of cells and factors,and reduce expenses.
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Objective To investigate the perioperative hemodynamic features of mitral replacement of patients with small left ventricle.Methods Patients with left ventricle end-diastolic dimension (LVEDD) less than 40mm received mitral replacement sur- gery were divided into big size M-2 group and small size M-1 group.The perioperative echo results were analyzed with SPSS software. Results The big size M-2 group has lower trans mitral gradient [ (5.9?1.6) mm Hg vs.(10.7?3.2) mm Hg],larger in vivo va- lular acre[ (2.9?0.2) cm~2 vs.(2.6?0.2) cm~2],and high mitral match index [(1.92?0.23) cm~2/m~2 vs.(1.73?0.18) cm~2/m~2 ].Conclusion With the meticulous perioperative treatment and myocardial protection,the patients with small left ventricle should also receive a mitral replacement as big as possible to achieve the ideal hemodynamics results.
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Objective To summarize and analyze the experiences on clinical application of extracorporeal membrane oxygenation (ECMO), and on the prevention of complications. Methods Seven patients, suffered from heart and respiratory failure after heart surgeries with no obvious curative effect by conventional therapy, were treated with ECMO adjunctively. Centrifugal pump assistant device was adopted for five cases, while the other two cases were treated with pulsated pump assistant device, and vasoactive agents were used in all the seven cases. Results After using of ECMO, two cases died of pulmonary infection, one died of thrombosis, one died of disseminated intravascular coagulation (DIC) induced by hemolysis, and the other three cases were successfully recovered and discharged after treatment. Other complications included hemorrhage, right heart failure, arrhythmia and hypotension, etc., and were recovered after treatment. Conclusions Clinical symptoms must be monitored after cardiac surgical operations, and ECMO should be used adjunctively once heart and/or respiratory failure appear. During the ECMO treatment, it is also import to prevent from the complications, once they occur, active therapies must be carried out to save the patients' lives.