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The Study in Etiology of Atrial Fibrillation

Atrial fibrillation （AF） as a most frequent arrhythmia has a high incidence of 79% in patients with mitral valve disease. Thrombosis, embolization and serious arrhythmia can be caused by AF. There is the recrudescent tendency in using drugs to recover the sinus rhythm, surgery and radio frequency ablation can only cure a part of patients. By now the pathogenesis of AF is not known clearly. The pathogenesis of AF from virulence gene, cardiac electrophysiology, connecxins, cell ultramicrostructure and cell signaling system are reviewed in this article.

面罩无创通气在胸心血管外科的临床应用

目的探讨面罩无创通气在胸心血管外科的临床应用效果。方法20例心血管、肺、食管疾病患者行手术治疗，术后拔除气管内插管后发生呼吸衰竭，于拔除气管内插管1～39h实施了面罩无创通气，观察通气前、通气中以及撤离面罩后的呼吸相关生理参数变化。结果患者经面罩无创通气后的呼吸相关生理参数与通气前比较有明显好转（P〈0．01）。结论面罩无创通气能有效改善患者的呼吸状态，促进呼吸、循环系统功能的恢复。

双瓣膜置换术后长Q—T间期综合征并发尖端扭转型室性心动过速一例

Analysis of Risk Factors for Death in Patients Undergoing Continuous Renal Replacement Therapy after On-pump Cardiovascular Surgery

ObjectiveTo retrospectively evaluate the risk factors of mortality in postoperative acute kidney injury (AKI) patients undergoing continuous renal replacement therapy (CRRT) after cardiopulmonary bypass (CPB). MethodsWe retrospectively analyzed the clinical data of 66 patients (38 males and 28 females with mean age of 59.11±12.62 years) underwent CRRT after cardiovascular surgery in our hospital between May 2009 and June 2014. The patients were divided into a survival group (18 patients) and a death group (48 patients) according to treatment outcome at discharge. Univariate analysis for risk factors of death was carried out for preoperative characteristics and lab results among study population. Significant univariate factors were then further analyzed by multivariable logistic regression models. ResultsSignificant predictors of death included blood transfusion volume during operation, peak level of blood sugar and lactate during operation, the total bilirubin level and platelet count on the first day after operation, hypotension on the first day after operation, pulmonary infection, multiple organ dysfunction syndrome (MODS) and the interval time of oliguria and CRRT (P<0.05). Logistic regression showed that there were statistical differencs in hypotension on the first day after operation, postoperative platelet count, and interval time of oliguria and CRRT respectively (P<0.05). ConclusionImproving intraoperative management, reducing bleeding and blood transfusion, controlling blood sugar level, dealing with complications such as hypotension, pulmonary infection and MODS more aggressively, starting CRRT when needed may be helpful to reduce mortality. Monitoring of the blood pressure and platelet count on the first day after operation is useful for prognosis estimation.

腰大池引流脑脊液治疗主动脉夹层术后截瘫六例

床旁肺部超声评估对心脏术后早期肺实变和肺不张的诊断准确性研究Accuracy of bedside lung ultrasonography in diagnosis of pulmonary consolidation and atelectasis in postoperative cardiac surgery patients

目的 探讨床旁肺部超声对心脏术后早期肺实变和肺不张的诊断准确性。 方法 选取 2014 年 9 月至 2015 年 8 月四川大学华西医院心脏大血管外科行心脏大血管手术（包括冠状动脉旁路移植术、瓣膜置换术等）后 1 周之内出现呼吸衰竭的 49 例患者，其中男 24 例、女 25 例，年龄（54.4±13.2）岁。收集患者术后床旁肺部超声及胸部 CT 检查结果，进行对照、分析、总结。 结果 在肺实变和肺不张的诊断中，胸部 CT 诊断 47 例（95.9%）患者为阳性，肺部超声评估方案（BLUE方案）诊断 45 例（91.8%）患者为阳性，床旁肺部超声与胸部 CT 诊断一致率为 95.9%。 结论 床旁肺部超声可作为筛查肺实变和肺不张的方法。