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地苍
4 years ago
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1 Intern 林家瑋

2 Name: 吳 x Gender: female Age:68 y/o Past history: no DM, HTN, smoking Chieft complcint: Suudden onset tearing pain and back pain with radiation to anterior chest at since 2PM Diagnosis: 1. Dissection of aorta, type A intrmular hematoma. 2. Moderate to severe Aortic regurgitation

3 Treatment: 1.Aortic valve replacement with 23mm Edward- Carpentier SAV porcine valve 2.Ascending aortic grafting with 30mm Hemashield graft Complication 1. Post-OP day 1: focal seizure 2. Post-OP day 2: left hemiparesis, brain CT: multiple bilateral basal ganglia infarcts

4 During cardiac surgery: Inadequate hypothermia during cardiopulmonary bypass Cold CPB Cool the patient after aortic cannulation and at the onset of bypass Rewarm the patient before bypass is terminated, usually before the aortic cross-clamp is removed.

5 Population: Old patients who need cardiopulmonary bypass during cardiac surgery Intervention: Hypothermia during cardiopulmonary bypass Comparison: Normothermia during cardiopulmonary bypass Outcome: Post-operative neruologic symptoms

9 Compare this two papers: A. Martin TD, Craver JM, Gott JP, et al. Prospective randomised trial of retrograde warm blood cardioplegia: myocardial protection and neurological threat. Annals of Thoracic Surgery 1994; 57: 298?04 B. Warm Heart Investigators. Randomised trial of normothermic versus hypothermic coronary bypass surgery. Lancet 1994; 343: 559?3.

10 Patients included: March 1991 ~ July 1992, 1,001 patients having elective coronary artery bypass grafting Study design: Randomized to receive (1) continuous warm (> or = 35 degrees C) blood cardioplegia with systemic normothermia (> or = 35 degrees C) (2) intermittent cold (< or = 8 degrees C) oxygenated crystalloid cardioplegia and moderate systemic hypothermia (< or = 28 degrees C).

11 Preoperative variables: (1) Similar: age, sex, prior coronary bypass grafting, hypertension, prior myocardial infarction, diabetes, angina class, and preoperative heart failure class, intraoperative variables of number of coronary grafts, mammary artery use, and cardiopulmonary bypass time. (2) Different: Aortic cross-clamp time was significantly longer in the warm group (46 +/- 23 minutes versus 40 +/- 21 minutes).

12 Result: 1. Total neurologic events (warm, 4.5%, and cold, 1.4%; p < 0.005) 2. Perioperative strokes (warm, 3.1%, and cold, 1.0%; p < or = 0.02)

13 Patient included: 1732 patients undergoing isolated coronary bypass surgery in three adult cardiac surgery centres at the University of Toronto, Canada. Study design: Randomised trial Allocation to Warm CPB (860 patients) or Cold CPB (872) was stratified by urgent versus elective operations and by surgeon. Crossovers to Cold CPB occurred in 7.7% of cases either due to difficulty in sustaining cardiac arrest or due to coronary flooding.

14 Preoperative variables: Similar: demographics, angiographic findings and operative procedures. Result: Perioperative strokes (warm, 1.6%, and cold, 1.5%; No significance)

15 Neurologic outcomes- - stroke A. Warm CPB vs Cold CPB 3.1% VS 1% P< 0.02 B. Warm CPB vs Cold CPB 1.6% vs 1.5% No significance CPB technique Warm CPB >35 ^C, Warm CPB: ranged from 33 to 37 ^C. In-patient populations 1. The duration of CPB was longer in warm CPB patients 2. High-risk patients, such as diabetics and those undergoing redo surgery, were included There is no consistent advantage to cold CPB over warm or normothermic CPB.

16 1. All of the cases underwent CABG, but our patient didn't receive CABG 2. The methods of CPB differ, especially in temperature range and duration

17 To the end

405 急性心肌梗死是临床较为常见的心血管疾病, 病情危急, 病死率高 [1] 随着经皮冠状动脉介入治疗 (percutaneous coronary intervention,pci) 技术在急性心肌梗死急诊

405 急性心肌梗死是临床较为常见的心血管疾病, 病情危急, 病死率高 [1] 随着经皮冠状动脉介入治疗 (percutaneous coronary intervention,pci) 技术在急性心肌梗死急诊 404 冠心舒通胶囊预防急性心肌梗死 PCI 术后再狭窄的临床研究李静, 王建榜, 王西辉西安医学院第二附属医院心内科, 陕西西安 710038 摘要 : 目的研究冠心舒通胶囊预防急性心肌梗死经皮冠状动脉介入治疗 (PCI) 术后再狭窄的临床