ABSTRACT
Cardiac arrest is the fourth stage of sudden cardiac death, which is characterized by the cessation of electrical activity in the heart, rapid circulatory and respiratory failure, and the prognosis is often poor. How to effectively predict cardiac arrest is the key and difficult point in the diagnosis and treatment process. In recent years, the research on the application of early warning scoring system in cardiac arrest has made continuous breakthroughs, from initially formulating a traditional scoring system containing only basic vital signs indicators according to a certain number of samples to continuously increasing and changing indicators, increasing the sample size, and formulating an improved scoring system with better sensitivity and specificity. Nowadays, with the continuous development of electronic information technology, machine learning technology is introduced into the formulation of scoring system, which breaks through the limitations of previous scoring system and has achieved good results in clinic. This article analyzes and compares the relevant research and cutting-edge progress of different early warning scoring systems at home and abroad, and summarizes the research results, gaps and shortcomings. Finally, combined with the relevant policies of graded diagnosis and treatment in China, this paper discusses the development and application direction of cardiac arrest early warning scoring system in the future.
ABSTRACT
Objective:To study the safety and short-term clinical effect of no-touch technique for harvesting great saphenous vein in off-pump coronary artery bypass grafting(OPCABG).Methods:The clinical data of 117 patients in the single medical group who underwent OPCABG from December 2018 to April 2020 were analyzed retrospectively, including 55 patients in the no touch group (NTSV group) and 62 patients in the traditional open access group (traditional SV group). To evaluate the feasibility, safety and short-term clinical effect of using no-touch technique to harvest great saphenous vein for OPCABG. The no-touch technique was mainly based on the invention of Dr. Souza’s team in Sweden. For the treatment of isolated great saphenous veins, some improvements were made according to the clinical experience of the application of sequential bridging and radial artery in our center.Results:There were no significant differences between the two groups in hypertension, diabetes, hyperlipidemia, history of myocardial infarction, ventricular aneurysm formation, left ventricular systolic function reduction, history of cerebral infarction, chronic obstructive pulmonary disease and other complications ( P>0.05). The NTSV group had higher male proportion (96.4% vs. 61.3%) and lower mean age (53.49 years old vs. 63.76 years old), and the difference were statistically significant ( P<0.01). The patients in the two groups successfully completed the operation without cardiopulmonary bypass, and the proximal anastomosis was the first. There were no statistical significances in the average number of bypass, time to acquire great saphenous vein, operation time, 24 h postoperative thoracic drainage, blood bank transfusion, secondary thoracotomy and hemostasis, perioperative myocardial infarction, hospital death, ICU stay time, postoperative hospital stay time, and poor healing of lower limb incision of the two groups. One year after the operation, 36 patients were followed up, including 15 patients in NTSV group, and 21 patients in traditional SV group. There was no recurrence of angina pectoris, no out of hospital death and other major adverse cardiovascular events. Among them, 26 patients completed CTA reexamination of coronary artery, including 12 patients in NTSV group and 14 patients in traditional SV group, the patency rate of vein bridge was 96.4% vs. 87.2%. There was no reduction of left ventricular ejection fraction and no revascularization. Conclusion:The method of using no-touch technique to harvest great saphenous vein is safe and feasible. It does not increase the operation time and the incidence of poor healing of lower limb incision. The short-term effect of applying no-touch technique for harvesting great saphenous vein to OPCABG is better than the traditional open way.
ABSTRACT
<p><b>BACKGROUND</b>The radial artery (RA) is becoming a popular conduit for coronary artery bypass grafting (CABG), yet data reporting the long-term results are rare. We reported our clinical, angiographic and intravascular ultrasound findings on 93 patients who had the RA used as part of the conduit for the CABG procedures during a 12-year period from June 2001 to June 2013.</p><p><b>METHODS</b>A total of 118 radial artery conduits were harvested in 87 males and 6 females, age from 28 to 66 (mean 49.9) years. An "intra-operative Allen's test" was developed to safeguard blood supply to the arm and hand. A "double-clip & scissors-cut" technique was carried out to minimize the thermal injury to the radial artery from the diathermy. The left radial artery was used in 67 patients, the right in one, and bilateral radial arteries in 25 patients. One hundred and twenty-two out of 272 distal anastomoses (44.9%) were constructed with radial arteries, with an average of 2.9 grafts per patient (range 2-6).</p><p><b>RESULTS</b>Follow-up angiography and intravascular ultrasound study at 3-139 postoperative months (mean 59 months) revealed a 93.1% RA patency. String sign occurred in one patient in whom the RA was directed to a big right coronary artery with a stenosis of around 50%. The patency for the internal mammary artery was 96.4%.</p><p><b>CONCLUSIONS</b>The RA is an excellent conduit that broadens the options for total arterial CABG surgery. Good graft patency could be achieved through careful harvesting techniques and choice of proper target coronary vessels.</p>