Medical history summary: Male, 47 years old, was admitted to the hospital due to “dizziness accompanied by chest tightness and pain for more than 8 days”. One week ago, the patient experienced chest tightness, chest...Medical history summary: Male, 47 years old, was admitted to the hospital due to “dizziness accompanied by chest tightness and pain for more than 8 days”. One week ago, the patient experienced chest tightness, chest pain accompanied by profuse sweating for 3 hours and underwent emergency percutaneous coronary intervention (PCI) at a local hospital. The procedure revealed left main stem occlusion with subsequent left main stem to left anterior descending artery percutaneous transluminal coronary angioplasty (PTCA). After the procedure, the patient experienced hemodynamic instability, recurrent ventricular fibrillation, and critical condition, thus transferred to our hospital for further treatment. Symptoms and signs: The patient is in a comatose state, unresponsive to stimuli, with bilateral dilated pupils measuring 2.0 mm, exhibiting reduced sensitivity to light reflex, and recurrent fever. Coarse breath sounds can be heard in both lungs, with audible moist rales. Irregular breathing pattern is observed, and heart sounds vary in intensity. No pathological murmurs are auscultated in any valve auscultation area. Diagnostic methods: Coronary angiography results at the local hospital showed complete occlusion of the left main stem, and left main stem to left anterior descending artery percutaneous transluminal coronary angioplasty (PTCA) was performed. However, the distal guidewire did not pass through. After admission, blood tests showed a Troponin T level of 1.44 ng/ml and a Myoglobin level of 312 ng/ml. The platelet count was 1390 × 10<sup>9</sup>/L. Von Willebrand factor (vWF) activity was measured at 201.9%. Bone marrow aspiration biopsy showed active bone marrow proliferation and platelet clustering. The peripheral blood smear also showed platelet clustering. JAK-2 gene testing was positive, confirming the diagnosis of primary thrombocytosis. Treatment methods: The patient is assisted with mechanical ventilation and intra-aortic balloon counterpulsation to improve coronary blood flow. Electrolyte levels are closely monitored, especially maintaining plasma potassium levels between 4.0 and 4.5 mmol/l. Hydroxyurea 500 mg is administered for platelet reduction. Anticoagulants and antiplatelet agents are used rationally to prevent further infarction or bleeding. Antiarrhythmic, lipid-lowering, gastroprotective, hepatoprotective, and heart failure treatment are also provided. Clinical outcome: The family members chose to withdraw treatment and signed for discharge due to a combination of reasons, including economic constraints and uncertainty about the prognosis due to the long disease course. Acute myocardial infarction has gradually become one of the leading causes of death in our country. As a “green channel” disease, corresponding diagnostic and treatment protocols have been established in China, and significant progress has been made in emergency care. There are strict regulations for the time taken from the catheterization lab to the cardiac intensive care unit, and standardized treatments are provided to patients once they enter the intensive care unit. Research results show that the incidence of acute myocardial infarction in patients with primary thrombocythemia within 10 years is 9.4%. This type of disease is rare and difficult to cure, posing significant challenges to medical and nursing professionals. In order to benefit future patients, we have documented individual cases of treatment and nursing care for these patients. The research results show that these patients exhibit resistance to traditional oral anticoagulant drugs and require alternative anticoagulants. Additionally, there are significant differences in serum and plasma potassium levels among patients. Therefore, when making clinical diagnoses, it is necessary to carefully distinguish between the two. Particularly, nursing personnel should possess dialectical thinking when supplementing potassium levels in patients in order to reduce the incidence of malignant arrhythmias and mortality rates.展开更多
Background:With the decline of birth population and the development of medical technology in China,studies assessing how these changes have affected the adoption of congenital heart disease surgery at the national or ...Background:With the decline of birth population and the development of medical technology in China,studies assessing how these changes have affected the adoption of congenital heart disease surgery at the national or regional scale are lacking.Methods:We investigated the status of congenital heart surgery in China in the period from 2017-2022,through investigation of the total rates of cardiac surgeries,cardiopulmonary bypass(CPB),adult congenital heart surgeries(CHS),and pediatric CHS(<18 years old),as recorded by the Extracorporeal Cir-culation Branch of the Chinese Society of Biomedical Engineering.Subsequently,we evaluated correlations between these factors with economic,demographic,and other factors.Results:From 2017 to 2022,the total num-ber of cardiac operations increased from 230,772 to 263,292,representing an increase of 14.09%over 6 years;the CHS dropped from 76,365 to 68,940(10.19%decrease),and the proportion of CHS in the total cardiac surgeries dropped from 33.26%to 26.18%(7.08%decrease).Finally,cases of pediatric CHS decreased from 61,825 to 38,174(38.25%decrease).The annual percentage change(APC)of the total amount of pediatric CHS cases was-10.03(-15.95 to-3.69,p=0.013).Adult CHS increased from 14,940 to 30,766(105.93%increase).The proportion of adult CHS cases of the total number of cardiac surgeries increased from 6.47%to 11.68%(5.21%increase).From a regional perspective,the APC for the proportion of pediatric CHS in the local population was generally lower in western China.The proportion of CHS in the local population generally decreases from the north to the south,although the lowest incidence is found in the northeast region.Conclusions:Due to demographic changes,med-ical technology and economic factors,the number of surgical operations for congenital heart disease(CHD)in children decreased significantly from 2017 to 2022,and may decline further in the future.Nevertheless,in the same period,a significant increase in the number of operations for CHD in adults was observed,which brings new opportunities and challenges to the development of congenital cardiac surgery and cardiac critical care.展开更多
To the Editor:During the coronavirus disease 2019(COVID-19)pandemic,patients with severe respiratory failure required ventilators or even higher levels of life support,bringing extracorporeal membrane oxygenation(ECMO...To the Editor:During the coronavirus disease 2019(COVID-19)pandemic,patients with severe respiratory failure required ventilators or even higher levels of life support,bringing extracorporeal membrane oxygenation(ECMO)into the spotlight.[1]ECMO is commonly used for the rescue and treatment of patients with severe cardiopulmonary failure;its core components are the membrane lung(oxygenator)and blood pump with two fundamental support modes:venovenous(V-V)and venoarterial(V-A)ECMO.COVID-19 patients may require V-V ECMO for acute respiratory distress syndrome and when combined cardio-circulatory support is needed;the support mode could be V-A ECMO.展开更多
Background： Recent advances in extracorporeal membrane oxygenation （ECMO） have led to increasing interest in its use during cardiopuhnonary resuscitation （CPR）. However, decisions regarding extracorporeal CPR （E...Background： Recent advances in extracorporeal membrane oxygenation （ECMO） have led to increasing interest in its use during cardiopuhnonary resuscitation （CPR）. However, decisions regarding extracorporeal CPR （ECPR） in children are difficult as a result of limited studies, especially in Asia Pacific. The objective of this study was to investigate trends in survival and demographic details for children with ECPR in Asia Pacific recorded in the Extracorporeal Life Support Organization （ELSO） registry from 1999 to 2016 and identify the risk factors associated with in-hospital mortality. Methods： The data of children younger than 18 years of age who received ECPR over the past 18 years in Asia Pacific were retrospectively analyzed. The data were extracted from the ELSO registry and divided into two 9-year groups （Group 1 1999-2007 and Group 2： 2008-2016） to assess temporal changes using univariate analysis. Then, univariate and multiple logistic regression analyses were performed between survivors and nonsurvivors to identify factors independently associated with in-hospital mortality. Results： A total of 321 children were included in final analysis, with an overall survival rate of 50.8%. Although survival rates were similar between Group 1 and Group 2 （43.1% vs. 52.5%,χ^2= 1.67, P - 0.196）, the median age （1.7 [0.3, 19.2] months for Group 1 vs. 5.6 [0.8, 64.9] months for Group 2, t = 2.93, P = 0.003） and weight （3.7 [3.0, 11.5] kg for Group 1 vs. 6.0 [3.4, 20.3] kg for Group 2, t = -3.14, P 0.002） of children increased over time, while the proportion of congenital heart disease （75.9% for Group 1 vs. 57.8% for Group 2, χ^2=6.52, P 0.011 ） and cardiogenic shock （36.2% for Group 1 vs. 7.2% for Group 2, χ^2=36.59, P 〈 0.001 ） decreased. Patient conditions before ECMO were worse, while ECMO complications decreased across time periods, especially renal complications. Multiple logistic regress!on analysis of ECMO complications showed that disseminated intravascular coagulation （DIC）, myocardial stunning, and neurological complications were independently associated with increased odds of hospital mortality. Conclusions： The broader indications and decreased complication rates make EPCR to be applicated more and more extensive in children in Asia Pacific region. ECMO complications such as myocardial stunning are independently associated with decreased survival.展开更多
Objective To investigate the application of the retroperitoneal approach in aortic surgery. Methods We collected and analyzed data of 7 patients in Macao who presented with aortic diseases from 2007 to 2008 and were t...Objective To investigate the application of the retroperitoneal approach in aortic surgery. Methods We collected and analyzed data of 7 patients in Macao who presented with aortic diseases from 2007 to 2008 and were treated with aorta repair through retroperitoneal approach. Demographic features as well as intraoperative and postoperative data were analyzed. One case of thoracoabdominal aneurysm and 4 cases of abdominal aneurysm received artificial graft, among which hybrid iliac artery reconstruction with Zenith stent covering the ostium of the left subclavian artery was performed in 2 cases of infrarenal abdominal aneurysm. Aortic-iliac artery bypass was performed in 2 cases of aortoiliac occlusion. Results No operative or early postoperative death was observed. No perioperative intestinal adhesion or ureteral obstruction was found. One case reported delayed paraplegia and graft infection as postoperative complications. The complications were partially removed 3 months later after rehabilitation. Conclusion Retroperitoneal approach is a safe and feasible technique, which associated with a low incidence of postoperative pulmonary complications.展开更多
文摘Medical history summary: Male, 47 years old, was admitted to the hospital due to “dizziness accompanied by chest tightness and pain for more than 8 days”. One week ago, the patient experienced chest tightness, chest pain accompanied by profuse sweating for 3 hours and underwent emergency percutaneous coronary intervention (PCI) at a local hospital. The procedure revealed left main stem occlusion with subsequent left main stem to left anterior descending artery percutaneous transluminal coronary angioplasty (PTCA). After the procedure, the patient experienced hemodynamic instability, recurrent ventricular fibrillation, and critical condition, thus transferred to our hospital for further treatment. Symptoms and signs: The patient is in a comatose state, unresponsive to stimuli, with bilateral dilated pupils measuring 2.0 mm, exhibiting reduced sensitivity to light reflex, and recurrent fever. Coarse breath sounds can be heard in both lungs, with audible moist rales. Irregular breathing pattern is observed, and heart sounds vary in intensity. No pathological murmurs are auscultated in any valve auscultation area. Diagnostic methods: Coronary angiography results at the local hospital showed complete occlusion of the left main stem, and left main stem to left anterior descending artery percutaneous transluminal coronary angioplasty (PTCA) was performed. However, the distal guidewire did not pass through. After admission, blood tests showed a Troponin T level of 1.44 ng/ml and a Myoglobin level of 312 ng/ml. The platelet count was 1390 × 10<sup>9</sup>/L. Von Willebrand factor (vWF) activity was measured at 201.9%. Bone marrow aspiration biopsy showed active bone marrow proliferation and platelet clustering. The peripheral blood smear also showed platelet clustering. JAK-2 gene testing was positive, confirming the diagnosis of primary thrombocytosis. Treatment methods: The patient is assisted with mechanical ventilation and intra-aortic balloon counterpulsation to improve coronary blood flow. Electrolyte levels are closely monitored, especially maintaining plasma potassium levels between 4.0 and 4.5 mmol/l. Hydroxyurea 500 mg is administered for platelet reduction. Anticoagulants and antiplatelet agents are used rationally to prevent further infarction or bleeding. Antiarrhythmic, lipid-lowering, gastroprotective, hepatoprotective, and heart failure treatment are also provided. Clinical outcome: The family members chose to withdraw treatment and signed for discharge due to a combination of reasons, including economic constraints and uncertainty about the prognosis due to the long disease course. Acute myocardial infarction has gradually become one of the leading causes of death in our country. As a “green channel” disease, corresponding diagnostic and treatment protocols have been established in China, and significant progress has been made in emergency care. There are strict regulations for the time taken from the catheterization lab to the cardiac intensive care unit, and standardized treatments are provided to patients once they enter the intensive care unit. Research results show that the incidence of acute myocardial infarction in patients with primary thrombocythemia within 10 years is 9.4%. This type of disease is rare and difficult to cure, posing significant challenges to medical and nursing professionals. In order to benefit future patients, we have documented individual cases of treatment and nursing care for these patients. The research results show that these patients exhibit resistance to traditional oral anticoagulant drugs and require alternative anticoagulants. Additionally, there are significant differences in serum and plasma potassium levels among patients. Therefore, when making clinical diagnoses, it is necessary to carefully distinguish between the two. Particularly, nursing personnel should possess dialectical thinking when supplementing potassium levels in patients in order to reduce the incidence of malignant arrhythmias and mortality rates.
文摘Background:With the decline of birth population and the development of medical technology in China,studies assessing how these changes have affected the adoption of congenital heart disease surgery at the national or regional scale are lacking.Methods:We investigated the status of congenital heart surgery in China in the period from 2017-2022,through investigation of the total rates of cardiac surgeries,cardiopulmonary bypass(CPB),adult congenital heart surgeries(CHS),and pediatric CHS(<18 years old),as recorded by the Extracorporeal Cir-culation Branch of the Chinese Society of Biomedical Engineering.Subsequently,we evaluated correlations between these factors with economic,demographic,and other factors.Results:From 2017 to 2022,the total num-ber of cardiac operations increased from 230,772 to 263,292,representing an increase of 14.09%over 6 years;the CHS dropped from 76,365 to 68,940(10.19%decrease),and the proportion of CHS in the total cardiac surgeries dropped from 33.26%to 26.18%(7.08%decrease).Finally,cases of pediatric CHS decreased from 61,825 to 38,174(38.25%decrease).The annual percentage change(APC)of the total amount of pediatric CHS cases was-10.03(-15.95 to-3.69,p=0.013).Adult CHS increased from 14,940 to 30,766(105.93%increase).The proportion of adult CHS cases of the total number of cardiac surgeries increased from 6.47%to 11.68%(5.21%increase).From a regional perspective,the APC for the proportion of pediatric CHS in the local population was generally lower in western China.The proportion of CHS in the local population generally decreases from the north to the south,although the lowest incidence is found in the northeast region.Conclusions:Due to demographic changes,med-ical technology and economic factors,the number of surgical operations for congenital heart disease(CHD)in children decreased significantly from 2017 to 2022,and may decline further in the future.Nevertheless,in the same period,a significant increase in the number of operations for CHD in adults was observed,which brings new opportunities and challenges to the development of congenital cardiac surgery and cardiac critical care.
基金supported by grants from Noncommunicable Chronic Diseases-National Science and Technology Major Project(No.2023YFC2507100)National Medical Products Administration Key Laboratory for Extracorporeal Circulation Devices:Open Project(No.2024YB01).
文摘To the Editor:During the coronavirus disease 2019(COVID-19)pandemic,patients with severe respiratory failure required ventilators or even higher levels of life support,bringing extracorporeal membrane oxygenation(ECMO)into the spotlight.[1]ECMO is commonly used for the rescue and treatment of patients with severe cardiopulmonary failure;its core components are the membrane lung(oxygenator)and blood pump with two fundamental support modes:venovenous(V-V)and venoarterial(V-A)ECMO.COVID-19 patients may require V-V ECMO for acute respiratory distress syndrome and when combined cardio-circulatory support is needed;the support mode could be V-A ECMO.
文摘Background： Recent advances in extracorporeal membrane oxygenation （ECMO） have led to increasing interest in its use during cardiopuhnonary resuscitation （CPR）. However, decisions regarding extracorporeal CPR （ECPR） in children are difficult as a result of limited studies, especially in Asia Pacific. The objective of this study was to investigate trends in survival and demographic details for children with ECPR in Asia Pacific recorded in the Extracorporeal Life Support Organization （ELSO） registry from 1999 to 2016 and identify the risk factors associated with in-hospital mortality. Methods： The data of children younger than 18 years of age who received ECPR over the past 18 years in Asia Pacific were retrospectively analyzed. The data were extracted from the ELSO registry and divided into two 9-year groups （Group 1 1999-2007 and Group 2： 2008-2016） to assess temporal changes using univariate analysis. Then, univariate and multiple logistic regression analyses were performed between survivors and nonsurvivors to identify factors independently associated with in-hospital mortality. Results： A total of 321 children were included in final analysis, with an overall survival rate of 50.8%. Although survival rates were similar between Group 1 and Group 2 （43.1% vs. 52.5%,χ^2= 1.67, P - 0.196）, the median age （1.7 [0.3, 19.2] months for Group 1 vs. 5.6 [0.8, 64.9] months for Group 2, t = 2.93, P = 0.003） and weight （3.7 [3.0, 11.5] kg for Group 1 vs. 6.0 [3.4, 20.3] kg for Group 2, t = -3.14, P 0.002） of children increased over time, while the proportion of congenital heart disease （75.9% for Group 1 vs. 57.8% for Group 2, χ^2=6.52, P 0.011 ） and cardiogenic shock （36.2% for Group 1 vs. 7.2% for Group 2, χ^2=36.59, P 〈 0.001 ） decreased. Patient conditions before ECMO were worse, while ECMO complications decreased across time periods, especially renal complications. Multiple logistic regress!on analysis of ECMO complications showed that disseminated intravascular coagulation （DIC）, myocardial stunning, and neurological complications were independently associated with increased odds of hospital mortality. Conclusions： The broader indications and decreased complication rates make EPCR to be applicated more and more extensive in children in Asia Pacific region. ECMO complications such as myocardial stunning are independently associated with decreased survival.
文摘Objective To investigate the application of the retroperitoneal approach in aortic surgery. Methods We collected and analyzed data of 7 patients in Macao who presented with aortic diseases from 2007 to 2008 and were treated with aorta repair through retroperitoneal approach. Demographic features as well as intraoperative and postoperative data were analyzed. One case of thoracoabdominal aneurysm and 4 cases of abdominal aneurysm received artificial graft, among which hybrid iliac artery reconstruction with Zenith stent covering the ostium of the left subclavian artery was performed in 2 cases of infrarenal abdominal aneurysm. Aortic-iliac artery bypass was performed in 2 cases of aortoiliac occlusion. Results No operative or early postoperative death was observed. No perioperative intestinal adhesion or ureteral obstruction was found. One case reported delayed paraplegia and graft infection as postoperative complications. The complications were partially removed 3 months later after rehabilitation. Conclusion Retroperitoneal approach is a safe and feasible technique, which associated with a low incidence of postoperative pulmonary complications.
