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Objective:To investigate the effect of the timing of intra-aortic balloon counterpulsation (IABP) treatment on the clinical efficacy of patients after severe cardiac surgery.Methods:A prospective study was conducted on 64 patients with IABP after cardiac surgery in Gaozhou People′s Hospital of Guangdong Province from March 2018 to March 2020.According to the time of IABP treatment, 33 patients were divided into early treatment group (severe cardiac surgery<6 h) and late 31 cases in treatment group (≥6 h after severe cardiac surgery): two groups of mean arterial pressure(MAP), left ventricular ejection fraction (LVEF), mechanical ventilation time, IABP indwelling time, ICU stay time, central venous oxygen saturation(ScvO2), N terminal pro B type natriuretic peptide(NT-proBNP), lactate clearance rate, complications and follow-up.Results:After 48 hours of IABP, MAP and LVEF in the early treatment group were (79.47±7.07) mmHg and (45.20±3.86)%, respectively, and those in the late treatment group were (71.38±6.26) mmHg and (41.66±4.49)%.There were significant differences between the two groups ( t value was 34.604, 29.375 respectively all P<0.01). The mechanical ventilation time (71.56±5.98) h, IABP indwelling time (68.31±10.10) h, ICU stay time (5.84±1.04) d in the early treatment group, and those in the late treatment group (82.79±4.96) h, (89.49±9.97) h, (6.82±1.07) d. There were significant differences between the two groups ( t value was 70.093, 72.855, 31.859 respectively, all P<0.01). The ScvO 2, NT-pro BNP and lactate clearance rate in the early treatment group were (71.66±5.45)%, (1 698.36±1 032.98) ng/L and (30.12±2.29)%, respectively at 48 hours after IABP, and those in the late treatment group (66.03±4.61)%, (2 898.43±1 383.29) ng/L and (20.47±1.92)%.There were significant differences between the two groups ( t value was 38.279, 34.379 respectively, all P<0.01). The incidence of complications were 18% (6/33) and 41.94%(13/31) in the early treatment group and the late treatment group.There was significant difference between the two groups( P=0.038). Conclusion:Early use of IABP treatment can improve the patients′ hemodynamic and serological indicators, reduce the patient′s mechanical ventilation time, IABP time, ICU monitoring time and complications.
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Objective To evaluate the feasibility and safety of supratotal resection of frontal or temporal lobe glioblastoma by the postoperative cognitive function and overall survival. Methods The clinical data of patients with frontal or temporal lobe glioblastoma and treated from January 2010 to January 2015 were analyzed retrospectively.The patients underwent supratotal resection of glioblastoma after March 2012(trial group, 33 cases). Before March 2012, the patients underwent total resection of glioblastoma(control group,28 cases).The Montreal cognitive assessment(MoCA)scores before operation and the 7th day after operation were used to evaluate the security, while overall survival was used to evaluate the feasibility. Variance analysis of repeated measurement quantitative data was used for the statistical analysis of the results. Multivariate Cox model was used as a method to estimate the independent association of a variable set with overall survival. Survival time observation was plotted by the Kaplan-Meier analysis,starting from the data of surgery.Results The MoCA scores in control group at the 7th day after operation were significantly lower than those before operation:(25.39 ± 3.04)scores vs.(26.67 ± 2.19)scores, t = 4.446,P < 0.05. The MoCA scores in trial group at the 7th day after operation were significantly lower than those before operation:(21.93 ± 4.46)scores vs.(25.39 ± 3.04) scores,t = 3.485,P < 0.05. The survival analysis of Kaplan-Meier method showed that age, surgical method and preoperative KPS scores were statistically significant (P < 0.05). Cox regression analysis showed that the choice of surgical method and preoperative KPS was 0.286 and 0.965,respectively.The risk of death in control group was 0.286 times of that in trial group.The survival time of trial group was better than that of control group.Conclusions The cognitive function of patients with frontal or temporal glioblastoma may have a certain degree of decline after tumor resection or supratotal resection.Supratotal resection could represent a promising strategy that can impact on outcome in glioblastoma patients. Supratotal resection could be a factor influencing survival.
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Objective@#To investigate the seroprevalence and epidemiological characteristics of hepatitis E virus (HEV) infection in pregnant women in Xiamen.@*Methods@#Sera samples of 910 pregnant women were collected from September 2014 to June 2015 in Xiamen Huli District Maternity and Child Care Hospital. Those who intended to give birth in target hospital were included in a subgroup which was asked to collect the second serum sample. All samples were tested for anti-HEV IgM and IgG antibody by enzyme linked immunosorbent assay (ELISA). HEV RNA was tested by reverse transcription-polymerase chain reaction (RT-PCR) for the positive samples of anti-HEV IgM antibody, meanwhile, the quantitative detections for anti-HEV IgG were conducted in specimens positive for anti-HEV IgG.@*Results@#Of the 910 pregnant women, 8 (0.88%, 95%CI 0.45%-1.73%) were anti-HEV IgM positive. HEV RNA was found in 3 cases through RT-PCR and viral load values were between 600 and 700 copies/ml; 140 (15.38%, 95%CI 13.19%-17.68%) were anti-HEV IgG positive and geometric mean concentration of the samples was 0.385 Wu/mL (95%CI 0.332-0.445 Wu/ml). The positive rate of anti-HEV IgG increased with age (P=0.004). In the subgroup, 150 pregnant women were included and followed up, 4 of those were defined as 'new HEV infection cases’ and the incidence was evaluated as 10.7/100 person-year (95%CI 3.39-25.7/100 person-year).@*Conclusions@#There were a low percentage of HEV carriers in pregnant women in Xiamen, but the risk of new primary infection in pregnant women during pregnancy was much higher than the general population, suggesting that it is necessary to expand sample size to clarify the burden of HEV infection during pregnancy.
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Objective To examine the clinical factors associated with postoperative outcome in dementia combined with cerebral amyloid angiopathy-related intracerebral hemorrhage (CAA-ICH). Methods The clinical data of 25 surgical patients of dementia combined with CAA-ICH were retrospectively analyzed. The postoperative short-term effects and long-term effects were evaluated at the 30 d and 6 months after operation according to the modified Rankin score (MRS), and the influencing factors were analyzed. Results Among the 25 patients, eusemia was in 6 cases. Age ≥ 75 years, Glasgow coma score (GCS) ≤ 8 scores on admission, hypertension, postoperative anemia, pulmonary diseases, midline shift were the influencing factors of postoperative short-term effects (P < 0.05 or <0.01). Twenty-two patients were followed up for 6 months, and ensemia was in 9 cases. Age≥75 years, GCS ≤ 8 scores on admission, hypertension, postoperative anemia, hypoproteinemia and pulmonary diseases were the influencing factors of postoperative long-term effects (P<0.01 or<0.05). Conclusions Preoperative assessment is important for the patients of dementia combined with CAA-ICH. Age ≥ 75 years, GCS ≤ 8 socres on admission, hypertension, postoperative anemia, pulmonary diseases, midline shift are associated with poor short-term effects; age ≥ 75 years, GCS ≤ 8 scores on admission,hypertension, postoperative anemia, hypoproteinemia and pulmonary diseases are associated with poor long-term effects.
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Objective To research the diagnostic value of troponin in the acute myocardial infarction after cardiac surgery.Methods The prospective study method was used.One hundred and thirtyfour patients of cardiac surgery were selected as observation group,36 patients of thoracic surgery were selected as control group.All the patients were given continuous electrocardiogram monitoring and measured troponin I,and the results were compared between the 2 groups.Results There was no statistical difference in the troponin I before anesthesia between the 2 groups (P ＞ 0.05).The troponin I 4 h after surgery was (13.010 ± 14.829) μg/L in observation group,(0.019 ± 0.007) μg/L in control group,there was statistical difference (P ＜ 0.05).One case of observation group happened the acute myocardial infarction after cardiac surgery,the troponin I was ＞ 40.000 μ g/L.Conclusions The troponin is obviously increased in the early stage in most patients of cardiac surgery,the false positive rate in diagnostic acute myocardial infarction is higher according to the troponin.For troponin,it will need the more evidence of evidence-based medicine to establish the diagnosis of acute myocardial infarction after cardiac surgery.
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Objective To investigate the efficacy of peritoneal dialysis(PD) in the children with complex congenital heart disease after surgery.Methods 65 children with complex congenital heart disease were divided into group A(33 cases) and group B(32 cases).Group A was given PD when diuretics or urine output was less than 0.5ml per hour,while group B was given PD when urine output was less than 0.5ml per hour after 6h.The survival effect and indicators of PD before and after treatment were observed.Results The effective rate of group A (84.85％ ) was significantly better than group B ( 53.12％ ) ( x2 =5.18,P ＜ 0.05 ).The fatality rate of group A (9.09％ ) was significantly lower than group B ( 18.75％ ) ( x2 =5.32,P ＜ 0.05 ).The renal function was significantly improved.Urine output increased to the normal level,serum potassium,blood urea nitrogen,serum creatinine concentration were effectively controlled,the changes of indicators had significant differences before and after PD (t =5.22,3.46,46,4.89,4.77,all P ＜ 0.05).Conclusion PD was an effective support method for heart,renal insufficiency after the surgery of complex congenital heart disease,and it had good clinical effect for early application.
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Objective To study the risk factors and pathogenesis of pulmonary infection in acute stroke patients. Methods A retrospective analysis was taken in 257 acute stroke cases to investigate the incidence of pulmonary infection and its relationship with the underlying disease, disturbance of consciousness, invasive operation,the type of pathogenic bacteria and drug susceptibility. Results The positive rate of pulmonary infection in acute stroke patients was high and related to many factors including severity of stroke, disturbance of consciousness,primary diseases, and invasive examination etc. The most popular infective bacteria were Gram-negative bacteria. The imipenem was most sensitive to Gram-negative and Gram-positive bacteria, followed by Amikacin and piperacillin too. Conclusions The pulmonary infection in cerebral stroke patients is caused by many factors, of which Gramnegative bacteria play the most important role. Identification of the risk factor and pathogenic bacteria is helpful in treating cerebral stroke infectious complications.
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Objective To investigate the effect of insulin combined with Edaravone therapy on delayed cerebral vasospasm (CVS) after experimental subarachnoid hemorrhage (SAH).Methods 40 New Zealand white rabbits were randomly separated into sham-operated group (n=8),SAH group (n=10),insulin group (n=10) and insulin+Edaravone group(n=12).SAH models were made by injecting blood twice into cisterna magna.30 min later of the first blood injected,the insulin 0.2 U/kg was subcutaneous injected in insulin group and insulin+Edaravone group,3 times daily for 7 d;while,the insulin+Edaravone group received Edaravone 0.5 mg/kg (intravenous injected in ear vein) twice a day for 7 d.7 d after the model made,the basilar artery cross sectional area was measured and the pathological changes were obseved to estimate the degree of CVS.The expression of insulin receptor(InRa) in vascular endothelial cell was detected by immunohistochemical staining.Results The basilar artery cross sectional area between insulin+Edaravone group[(0.46?0.3)mm2]and the sham-operated group[(0.48?0.4)mm2] was no significant difference;but they were obviously bigger than those in SAH group[(0.25?0.3) mm2] and the insulin group [(0.30?0.3)mm2](all P