BACKGROUND:The treatment of pulmonary hypertension secondary to congenital heart disease has been a hot topic in the clinical research on cardiac surgery. Although traditional drugs for reducing pulmonary hypertension have excelent effects, there are some defaults, such as difficult monitoring and rebounding phenomenon after drug withdrawal. The traditional heart dacron graft is prone to cause complications, such as deformation, thrombosis, embolism, hemolysis and infection. OBJECTIVE:To investigate the effect of glutaraldehyde-fixed bovine pericardium patch and aerosolized iloprost in patients with pulmonary hypertension secondary to congenital heart disease. METHODS:Ninety patients with pulmonary hypertension due to congenital heart disease underwent a surgery. Glutaraldehyde-treated bovine pericardium patch were used to repair cardiac septal defect, and then aerosolized iloprost was applied after operation, administered for 3 days according to 30 ng/min/kg, every 4 hours in the first 12 hours of a day, and every 6 hours in the resting 12 hours. Mean arterial pressure, mean pulmonary arterial pressure, systemic vascular resistance index, pulmonary vascular resistance index were recorded before inhalation, immediately after inhalation, and 30 minutes after inhalation. The pericardium-associated complications, and cardiac function were also observed at folow-ups. RESULTS AND CONCLUSION: The involved 90 cases were detected by echocardiography. The results showed that, al the flaps were closed, there was no shunting or echo discontinuation of atrial septum. The heart contraction function was normal. No pericardium-associated complications were found. There was no significant difference in the mean arterial pressure and systemic vascular resistance index in al patients at different time points. The mean pulmonary arterial pressure and pulmonary vascular resistance index immediately after inhalation were significantly lower than that before inhalation (P < 0.01). The decrease was also significant 30 minutes after inhalation (P < 0.05). The intervention of glutaraldehyde-fixed bovine pericardium patch and aerosolized iloprost is safe and effective to treat patients with pulmonary hypertension secondary to congenital heart disease.

Objective To analyze the causes and treatment methods of early complications after central systemic-pulmonary shunt in complex cyanotic congenital heart diseases.Methods Two hundred and twelve cases of central systemic-pulmonary shunt in complex cyanotic congenital heart diseases were retro-spectively analyzed in order to explore the early postoperative complications and related treatment measures. Results There were 61 cases(28.77%)of the early postoperative complications,including severe low car-diac output syndrome in 27 cases,acute pulmonary edema in 14 cases,24 h shunt pipe blockage in 12 cases, and supraventricular tachycardia in 8 cases.All patients got followed up,average for(2.49 ±1.21 )years.Af-ter the systemic-to-pulmonary artery shunts,pulmonary vascular had significant growth,8 patients(3.77%) of them who pulmonary hypoplasia were promoted by transcatheter aortopulmonary collateral vessels.At the end of the follow-up,77 patients(36.32%)achieved the standard of radical surgery.Conclusion The factors affecting surgical survival rate include:enhancement of patients cardiac function and strictly handle operation indication before operation a clear operational view;rational surgical methods;treatment of complication with-out delay;strict,intensive care and synthesized treatment.

Objective To explore method of early diagnosis and treatment of adult patients with cerebral ischemic stroke after cardiovascular surgery.Methods The chnical data of 24 adult patients with cerebral ischemic stroke after cardiovascular surgery were retrospectively analyzed.Firstly,CT or MRI should be accomplished to determine the type of cerebral ischemic stroke as soon as patients' condition of circulation and respiration were stable.Secondly,the vital signs should be monitored closely,and the consciousness,pupil,respiratory and hmbs activity of the patients were observed.Thirdly,the patients' temperature of head should be reduced and be given dehydration,anticoagulation,cholesterol-lowering medication,brain nutrition drugs,beta receptor blockers and other drugs.Overall,the balance of fluid,electrolytes and acid-base were maintained in the course of treatment.Results Among the 24 patients,male was 66.7％ (16/24).Early cerebral ischemic stroke occurred in 6 cases,delayed cerebral ischemic stroke occurred in 18 cases.Cerebral ischemic stroke happened in 12 patients who underwent coronary artery bypass grafting surgery,8 patients after cardiac valve replacement surgery,2 cases after artery dissection surgery and 2 patients after other surgery.Two cases were death during hospital stay,the mortality was 8.3％ (2/24).Conclusion Adult patients with clinical manifestation of cerebral ischemic stroke after cardiovascular surgery should be diagnosed early as soon as possible,the treatment key of cerebral ischemic stroke is strict monitoring and comprehensive treatment.

Objective To observe the effects of Yukouning on immunologic function in recurrent aphthous ulcer (RAU) patients with brimming heat of heart and spleen (BHHS type).Methods The study was composed of 30 patients with RAU (BHHS type) and 30 healthy individuals.All patients with RAU (BHHS type) were divided into levomisole group and Yukouning group (n =15).Patients of levomisole group were give 50 mg of levomisole,bid,lasted two days.Patients of Yukouning group were give Yukouning decoction.The changes of the class of T-cells and the levels of immunoglobulins (IgA,IgG,IgM) and complement (C3,C4) in different groups were tested by flow cytometry (FCM) and single immunodiffusion method.Results The levels of CD8+,IgG,IgA,C3 and C4 in RAU (BHHS type) patients increased significantly as compared with those in healthy group (P ＜ 0.05).The level of CD4+ and the ratio of CD4+/CD8+ decreased significantly as compared with those in healthy group (P ＜0.05).Furthermore,the levels of CD8+,IgG,IgA,C3 and C4 in RAU (BHHS type) patients decreased significantly after different drug treatment,respectively (P ＜ 0.05).At the same time,the level of CD8+ and the ratio of CD4+ / CD8+ increased significantly after different drug treatment,respectively (P ＜ 0.05).But all the above-mentioned indexes had no significant differences between the two drug groups (P ＞ 0.05).After 1-year follow-up,the effective rate (both 93.3％) had no significant difference between the two groups (P ＞ 0.05).Conclusion Imbalance of immune function is correlated with RAU (BHHS type).Yukouning plays a therapeutic role by regulating cellular and humoral immunity in RAU (BHHS type) patients.

Objective:To explore the value of the concentration of adenosine triphosphate (ATP) in CD4 +T lymphocytes in predicting repeated respiratory tract infections (RRTI) in silicosis patients. Methods:In April 2020, 614 silicosis patients admitted from March 2016 to March 2018 were included in the study, and they were divided into the RRTI group ( n=105) and the non RRTI group ( n=509) according to whether the occurrence of RRTI, another 30 healthy cases taken from body check were served as control group, and the concentrations of ATP produced by CD4 +T lymphocytes was measured by ImmuKnow assay, and were compared between the three groups. And drawed the receiver operating characteristic (ROC) curve, and the Logistic regression analysis was used to explore the risk factors of RRTI. Results:The incidence of RRTI in silicosis patients was 17.10% (105/614) . The concentration of ATP produced by CD4 +T lymphocytes in the RRTI group [ (260.42±90.36) mg/L] was significantly lower than that in the non RRTI group [ (413.66±138.74) mg/L] ( t=-10.849, P<0.01) . The area under the ROC curve was 0.834, the cutoff value was 284 mg/L, the sensitivity was 0.88, and the specificity was 0.83. Logistic regression analysis showed that the concentration of ATP produced by CD4 +T lymphocytes≤284 mg/L, impaired pulmonary ventilation function, serum albumin<40 g/L and diabetes were the risk factors of RRTI in silicosis patients ( OR=2.126, 1.217, 1.164, 1.125, P<0.05) . Conclusion:Low CD4 +T lymphocyte ATP value was a risk factor of RRTI in silicosis patients, and can predict the risk of RRTI in patients with silicosis.

Objective:To explore the value of the concentration of adenosine triphosphate (ATP) in CD4 +T lymphocytes in predicting repeated respiratory tract infections (RRTI) in silicosis patients. Methods:In April 2020, 614 silicosis patients admitted from March 2016 to March 2018 were included in the study, and they were divided into the RRTI group ( n=105) and the non RRTI group ( n=509) according to whether the occurrence of RRTI, another 30 healthy cases taken from body check were served as control group, and the concentrations of ATP produced by CD4 +T lymphocytes was measured by ImmuKnow assay, and were compared between the three groups. And drawed the receiver operating characteristic (ROC) curve, and the Logistic regression analysis was used to explore the risk factors of RRTI. Results:The incidence of RRTI in silicosis patients was 17.10% (105/614) . The concentration of ATP produced by CD4 +T lymphocytes in the RRTI group [ (260.42±90.36) mg/L] was significantly lower than that in the non RRTI group [ (413.66±138.74) mg/L] ( t=-10.849, P<0.01) . The area under the ROC curve was 0.834, the cutoff value was 284 mg/L, the sensitivity was 0.88, and the specificity was 0.83. Logistic regression analysis showed that the concentration of ATP produced by CD4 +T lymphocytes≤284 mg/L, impaired pulmonary ventilation function, serum albumin<40 g/L and diabetes were the risk factors of RRTI in silicosis patients ( OR=2.126, 1.217, 1.164, 1.125, P<0.05) . Conclusion:Low CD4 +T lymphocyte ATP value was a risk factor of RRTI in silicosis patients, and can predict the risk of RRTI in patients with silicosis.

Objective To investigate the comfort of total video-assisted thoracoscopic intracardiac repair of atrial septal defect.Methods A total of 546 cases undergoing intracardiac repair of atrial septal defect form January 2015 to December 2020 in our hospital were selected into the study.According to the operation method,the patients were divided into thoracoscopic group and thoracotomy group,with 273 cases in each group.The pain degree,thoracic numbness,pressure feeling,thoracic deformation,anxiety,depression and phobia,and incision complications were recorded and compared between the two groups during ICU stay,at discharge,and at 1 and 3 months after discharge.Results According to the numeric rating scales(NRS),the degree of pain in the thoracoscopic group was higher than that in the thoracotomy group during ICU stay[(6.5±2.1)points vs.(5.3±2.2)points,t = 5.736,P =0.000],and lower than that in the thoracotomy group at other stages(all P =0.000).There was no significant difference in thoracic numbness and pressure feeling between the two groups during ICU stay(P>0.05),but the extant in the thoracoscopic group was significantly lower than that in thoracotomy group at discharge and 1 and 3 months after discharge(P<0.05).There was no thoracic deformation in the thoracoscopic group.The thoracic deformation rate in the thoracotomy group showed an upward trend at 1 and 3 months after discharge,and there was significant difference between the two groups(P<0.05).There was no significant difference in anxiety,depression and phobia between the two groups at discharge(P = 0.785).The psychological state of the thoracoscopic group was significantly better than that of the thoracotomy group at 1 and 3 months after discharge(P<0.05).There was no significant difference in incision complication rate between the two groups(P>0.05).Conclusion Total video-assisted thoracoscopic intracardiac repair of atrial septal defect is safe and effective,which improves the patient's medical comfort,being worthy of popularization and application.

Objective:To evaluate the effect of flipped classroom combined with problem-based learning (PBL) on the standardized training for perioperative beside echocardiography.Methods:A total of 64 second-year standardized training students from the Department of Anesthesiology at Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, were selected between January 2021 and June 2022 and assigned to control group ( n=32) and test group ( n=32) using a random number table method. Control group employed the traditional teaching model, and test group utilized the flipped classroom combined with PBL. After a 3-month period of teaching standard views and hemodynamic evaluation of bedside echocardiography, the comprehensive theoretical and clinical practice scores (a score of≥80 was considered excellent or good) were compared between the two groups. Additionally, a questionnaire was distributed to assess students′ self-directed learning ability and initiative, interest in learning, efficiency in mastering professional knowledge, satisfaction with teaching, communication and collaboration skills, and clinical thinking ability. Results:Compared with control group, the students in test group showed significant improvements in both comprehensive theoretical ([87 ± 8] vs [80 ± 8]) and clinical practical ([86 ± 8] vs [78 ± 8]) echocardiography scores( P<0.05 or 0.01).The excellent or good rate for comprehensive theoretical scores (88% vs 47%) and clinical practice scores (84% vs 50%) was significantly higher in test group than in control group( P<0.05 or 0.01).A total of 64 questionnaires were distributed, and all of them were returned, yielding a response rate of 100%. The students in test group demonstrated enhanced self-directed learning ability and initiative (94% vs 69%), increased interest in learning (91% vs 66%), improved efficiency in mastering professional knowledge (97% vs 75%), greater satisfaction with teaching (94% vs 62%), enhanced communication and collaboration skills (84% vs 62%), and improved clinical thinking ability (88% vs 59%) compared to control group ( P<0.05). Conclusions:The combination of a flipped classroom and PBL produces better effect than traditional teaching methods when used for standardized training for perioperative bedside echocardiography.