ABSTRACT
Objective To explore the clinical significance of perioperative serum N-terminal pro-BNP(NT-proBNP)testing in patients with cardiac valve replacement.Methods The content of perioperative plasma NT-proBNP in 296 patients with cardiac valve replacement was detected,the relationship between preoperative plasma NT-proBNP content and heart function classification was analyzed,the postoperative changes were observed and the plasma NT-proBNP levels were compared among the death cases, the patients with complications and without complications.Results The left ventricular ejection fraction(LVEF)and plasma NT-proBNP content had statistical differences among different cardiac functional classifications(F =5.268,8.173,P <0.05),preopera-tive serum NT-proBNP level was positively proportional to the cardiac function classification(r =-0.776,P <0.01)and inversely proportional to LVEF(r=-0.472,P <0.05);on postoperative 1 d,plasma content of NT-proBNP reached the peak,there was sta-tistically significant difference compared with before treatment,(t=20.913,P <0.05),then which was gradually declined on post-operative 3,5,7 d.The preoperative plasma NT-proBNP content and postoperative plasma NT-proBNP peak levels in the death pa-tients and the patients with complications were higher than those in the patients without complications(P <0.05 ),the difference was statistically significant(P <0.05 ).Conclusion Preoperative plasma NT-proBNP concentration in the patients with cardiac valve replacement can reflect the cardiac function condition,the postoperative plasma NT-proBNP content is increased at the early stage,then gradually decreased,The increase of plasma NT-proBNP concentration before and after operation has a certain clinical value in predicting prognosis of the patients.
ABSTRACT
Objective To summarize our experience in the prevention and treatment of iatrogenic vascular(trauma).Methods The clinical data of 24 different types of iatrogenic vascular trauma committed from 2003 to 2006 were retrospectively analyzed.Results The 24 cases included 7 cases of superior mesenteric(arteriovenous) trauma,3 cases of portal venous trauma,4 cases of carotid arterial trauma,6 cases of iliac and femoral arterial trauma,and each one of trauma of popliteal artery,axillary artery,renal artery,left gastric artery,respectively.Treated method: Six cases underwent vascular repair,5 cases had vascular anastomosis,2 cases had vascular replacement,3 cases had vascular ligation,2 cases had covered stent implantation under intervention,and other methods included thrombectomy,thrombolysis and packing.Among the 24 cases,22 were cured completely,one patient died from massive hemorrhage 24 hours after operation,and the other died 5 days after operation.Conclusions Iatrogenic vascular trauma can be prevented and its incidence reduced by increased vigilance,clear identification of the anatomy,and accurate and careful operation.Once iatrogenic vascular trauma has occurred,its cause must be determined and then different treatment methods can be(chosen),based on the cicumstaces. When effective treatment technique is not at hand,one should promptly seek outside support or transfer the patient to an advanced hostipal.