Perioperative change in serum neutrophil gelatinase-associated lipocalin level among children with congenital heart disease and pulmonary hypertension / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the perioperative change in serum neutrophil gelatinase-associated lipocalin (NGAL) level among children with congenital heart disease (CHD) and pulmonary hypertension (PH) and its significance.</p><p><b>METHODS</b>Eighty children with CHD were divided into four groups according to pulmonary artery systolic pressure: non-PH, mild PH, moderate PH and severe PH groups. Serum NGAL levels were measured before operation, immediately after operation and 24 hours after operation. The relationship of serum NGAL level with PH and early prognosis was analyzed.</p><p><b>RESULTS</b>The mild, moderate and severe PH groups had significantly higher serum NGAL levels than the non-PH group, and the severer the PH, the higher the serum NGAL level (P<0.01). All groups showed significant decreases in serum NGAL levels after operation (P<0.01). Serum NGAL level was positively correlated with the degree of PH and length of stay in the intensive care unit (P<0.01).</p><p><b>CONCLUSIONS</b>Serum NGAL level increases in children with CHD and PH, and it gradually decreases after operation for closing the abnormal shunt. Serum NGAL level may be used as a serological indicator for evaluating the degree of PH and surgical outcome.</p>

Development and evaluation of individualized fluid therapy in the elderly patients with coronary heart disease undergoing gastrointestinal surgery: a randomized, controlled trial / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To develop and evaluate an individualized fluid therapy in the elderly patients with coronary heart disease undergoing gastrointestinal surgery.</p><p><b>METHODS</b>In this prospective study, 60 coronary heart disease patients undergoing gastrointestinal surgery were included in the First Affiliated Hospital of Xinjiang Medical University from March 2009 to March 2012. Patients were randomized into the intervention group and the control group with 30 patients in each group. Individualized fluid therapy was used during surgery and postoperative period in the ICU, which was determined based on target controlled fluid therapy according to cardiac index, stroke volume, and stroke volume variation. Traditional fluid therapy was used in the control group in the intraoperative and postoperative period. The two groups were compared in terms of postoperative hemodynamic parameters, total fluid volume, incidence of adverse cardiac events, and recovery of bowel function.</p><p><b>RESULTS</b>Compared with the control group, mean arterial pressure was significantly increased at the commencement of the surgery. The cardiac index was significantly elevated during surgery and at the end of the surgery. Stroke volume was significantly increased after induction of anesthesia, during the surgery, and at the early stay of ICU period(all P<0.05). Serum lactic acid in the intervention group was significantly lower at the end of surgery and during ICU stay than that in the control group (all P<0.05). During surgery and 24-hour stay in ICU, the total fluid volume, crystal usage, and urine were significantly less, while colloidal fluid use was significantly more in the intervention group as compared to the control group(all P<0.05). The perioperative adverse cardiac event rate was 36.7%(11/30) in the intervention group, lower than 56.7%(17/30) in the control group, but the difference was no statistically significance(P>0.05). In the intervention group, defecation time, time to first flatus, resumption of liquid intake, length of ICU stay and hospital stay were significantly less compared with the control group(P<0.05).</p><p><b>CONCLUSION</b>In the elderly patients with coronary arterial disease undergoing gastrointestinal surgery, individualized fluid therapy can effectively decrease adverse cardiac events, improve postoperative gastrointestinal function, and reduce length of hospital stay.</p>

Goal-directed fluid management prevents gastrointestinal complications in abdominal surgery: a meta-analysis of randomized controlled trials / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To assess whether goal-directed fluid management can prevent gastrointestinal complications in major surgery.</p><p><b>METHODS</b>Electronic databases including Cochrane library(Issue 3,2010), Pubmed, EMbase, Highwire, CBM, and CNKI were searched. The date of search was between January 2000 and December 2010. Randomized controlled trials(RCTs) were indentified studying association of goal-directed therapy (GDT) with gastrointestinal complications. Study selection and meta-analysis were conducted according to the Cochrane Handbook for systematic reviews. Data were extracted from these trials by 3 reviewers independently and analyzed by RevMan 5.0 software.</p><p><b>RESULTS</b>Ten trials involving 775 patients were included. GDT significantly improved oxygen supply(WMD=82.95, 95% CI: 17.43-148.46). GDT reduced postoperative hospital stay(WMD=-2.06, 95% CI: -2.95 - -1.17) and decreased postoperative complication rate after major surgery(RR=0.39, 95% CI: 0.29-0.52).</p><p><b>CONCLUSION</b>Goal-directed fluid management can stabilize cardiac output, augment oxygen supply, and therefore reduce postoperative complications.</p>

Surgical treatment of abdominal aortic aneurysms in octogenarians / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the open surgery as well as the endovascular treatment of abdominal aortic aneurysms (AAA) in octogenarians.</p><p><b>METHODS</b>Twenty AAA cases aging from 80 to 90 in the past six years were reviewed. Open surgery on 12 patients and endovascular repair on the other 8 ones were performed.</p><p><b>RESULTS</b>During peri-operation, there were 2 mortality from the surgical group among all 20 cases. The endovascular group underwent significantly better operational procedure and complication situation than the surgical one. Eighteen cases were followed up for 3-69 months (average months) except for 2 patients of surgical group. Both group suffered 2 late mortality. The accumulated survival rate were 6/10 in the surgical group and 6/8 in the endovascular group, respectively.</p><p><b>CONCLUSION</b>Surgical treatment in applicable for octogenarians with AAA. The endovascular repair was preferable to suitable cases.</p>

Surgical treatment of acute embolism of the upper extremity / 中华外科杂志

<p><b>OBJECTIVE</b>To study the methods of surgical treatment and the prognosis of acute embolism of the upper extremity.</p><p><b>METHODS</b>Balloon catheter embolectomy through the brachial artery was performed in 18 patients with acute embolism of the upper extremity.</p><p><b>RESULTS</b>Both the pulse of the radial and ulnar artery could be palpated in 8 patients, either the pulse of the radial or ulner artery could be palpated in 9 patients. The temperature of the upper extremity was increased in the patient whose embolectomy was performed in the 6th day after onset of the illness. Three patients died postoperatively.</p><p><b>CONCLUSIONS</b>Embolectomy through the brachial artery is an effective method to treat acute embolism of the upper extremity. Elderly and heart and pulmonary diseases are the high risk factors for postoperative death.</p>