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Objective:To evaluate the effect of perioperative application of hydroxychloroquine on the prognosis of patients undergoing cardiac surgery.Methods:All SLE patients in the Department of Cardiovascular Surgery of the First Affiliated Hospital of Zhengzhou University who took hydroxychloroquine and glucocorticoid for more than 7 days before operation were enrolled in the observation group(28 cases), including 3 males and 25 females, aged(38.3±8.2)years old. Patients who did not use hydroxychloroquine but only used glucocorticoid before operation were included in the control group(24 cases), including 2 males and 22 females, aged(37.9 ±9.8)years old. There was no significant difference in preoperative clinical data between the two groups in terms of sex, age, BMI, course of systemic lupus erythematosus, hemoglobin, albumin, C-reactive protein, ALT, serum creatinine, ejection fraction, diabetes, hypertension, hyperlipidemia, smoking, alcoholism, preoperative atrial arrhythmia, ventricular arrhythmia, atrioventricular block and so on. The constituent ratio of preoperative operation plan was basically the same between the two groups. The postoperative complications and survival of the two groups were compared.Results:There was no significant difference in early clinical indexes between the two groups, such as cardiopulmonary bypass time( t=0.12, P=0.19), chest drainage volume( t=0.30, P=0.77), second thoracotomy hemostasis( χ2=1.17, P=0.46). There was no significant difference in drug-related complications such as new retinopathy, myocardial concentric hypertrophy, atrial arrhythmia( χ2=1.27, P=0.26), ventricular arrhythmia( χ2=0.98, P=0.32), atrioventricular block( χ2=0.06, P=0.82) and other drug-related complications between the observation group and the control group. There was no significant difference between the two groups in postoperative acute heart failure( χ2=1.17, P=0.28), acute liver insufficiency( χ2=1.17, P=0.28), sternal infection and IABP use( χ2=0.47, P=0.50). Compared with the control group, the incidence of acute renal insufficiency after operation was lower in the observation group( χ2=4.51, P=0.04). The incidence of new postoperative pneumonia was lower( χ2=8.26, P=0.01). The length of postoperative antibiotic use, the length of postoperative ICU hospital stay, the postoperative hospital stay and the total cost of hospitalization in the observation group were significantly less than those in the control group( z=2.71, 2.09, 2.02, 2.02, P=0.01, 0.04, 0.04, 0.04). Compared with the control group, the in-hospital mortality rate of patients in the observation group was lower than that in the control group(3.6% vs. 12.5%, χ2=0.47, P=0.50), and the 6-month and 1-year survival rates of the observation group were higher than those of the control group(92.9% vs.83.3%, 92.9% vs.79.2%; χ2=0.41, 2.17; P=0.53, 0.34), but the difference was not statistically significant. Conclusion:Perioperative administration of hydroxychloroquine can significantly reduce the incidence of postoperative acute renal insufficiency and pneumonia, reduce the duration of postoperative antibiotic use, postoperative ICU hospital stay, postoperative hospital stay, and the cost of hospitalization. Hydroxychloroquine may reduce the in-hospital mortality and improve the long-term survival rate after cardiac surgery, but long-term large sample clinical studies are still needed.
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Objective To observe and analyze the morbidity and risk factors of postoperative delirium in the patients un-dergoing cardiac surgery.Methods From March 2017 to March 2018, 478 patients who need cardiac surgery were selected from our hospital.According to the postoperative results evaluated with Confusion Assessment Method(CAM), they were divid-ed into delirium group(54 patients)and control group(424 patients).Morbidity and risk factors of postoperative delirium were analyzed.Results Delirium occurred in 54 patients of 478 patients and morbidity of postoperative delirium was 11.3％.Psy-chomotor excitement is the most common clinical presentations , followed by attention impairment and a reduced level of con-sciousnes.Single factor analysis result showed that delirium was associated with advanced age (≥65 years) , hypertension, pre-vious cerebral vascular event(previous cerebral infarction, previous brain heamorhage), intraoperative blood loss, mechanical ventilation time, intensive care unit duration time.The multiple-logistic regression analysis indicated that the perioperative risk factors of delirium included advanced age, cerebrovascular accident history and ICU duration time.Conclusion The patients with advanced age, hypertension, previous cerebral vascular event(previous cerebral infarction, previous brain heamorhage) are the high risk groups for delirium after cardiac surgery.Advanced age, hypertension, previous cerebral vascular event(previ-ous cerebral infarction, previous brain heamorhage) are risk factors for delirium in patients undergoing cardiac surgery.
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Radiofrequency ablation concomitant with open-heart procedures is one of the most common surgical methods to treat organic heart disease complicated with atrial fibrillation .However, the recurrence of atrial fibrillation still bothers both doctors and patients.There are different views on the main factors influencing the long-term effects of sinus rhythm maintenance after ablation.We reviewed past related clinical observations and researches to summarize the factors influencing recurrence of long-term atrial fibrillation after radiofrequency ablation concomitant with open-heart procedures.
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Objective To assess the feasibility of anticoagulation therapy after mechanical valve replacement in grass-root health institutions.Methods One hundred and sixty one patients with mechanical valve replacement received anticoagulation therapy with warfarin,including 79 cases receiving the therapy in grass-root health institutions (test group) and 82 cases in the tertiary hospitals (control group).The patients were followed up for 12 months after operation;the rate of anticoagulation efficacy,the anticoagulationrelated complications,and the anticoagulation-related cost were documented and compared between two groups.Results The international normalized ratio (INR) tests were performed for 1 021 times in test group and 717 times were up to anticoagulation standard (70.2 ％,717/1 021),while INR tests in control group were performed for 965 times and 688 times were up to standard (71.3％,688/965);there were no significantly differences in efficacy rate between two groups (P ＞ 0.05).There were no significant differences in rate of bleeding events and thrombosis between two groups [16.5％ (13/79) vs.12.2％ (10/82),6.3％(5/79) vs.4.9％(4/82),respectively,x2 =0.596,P=0.44,x2 =0.161,P=0.69].The anticoagulation-related cost per month and per patient in test group was significantly lower than those in control group [(63.1 ±.12.8) vs.(176.6 ± 16.4) yuan,t =48.716,P ＜0.05].Conclusion Compared with the tertiary hospital,the anticoagulation therapy in grass-root institutions can accomplish the similar clinical outcomes and significantly reduce the medical cost in patients with mechanical valve replacement.
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Objective To explore the effect of pleural cavity integrity on respiratory system after off-pump coronary artery bypass grafting (OPCABG),through comparing the respiratory complication after OPCABG.Methods One hundred and two patients were accepted OPCABG,among whom 49 patients' pleural cavities were opened (open group) and 53 patients' pleural cavities were closed (close group).The ventilation time,intensive care unit time,pleural effusion,the rate of atelectasis and respiratory failure after operation were compared between two groups.Results The ventilation time and intensive care unit time in open group were (40.3 ± 4.8) h and (78.3 ± 10.8) h,in open group were (28.6 ± 6.8) h and (54.8 ± 6.1) h.The ventilation time and intensive care time in open group were significantly longer than those in close group(P ＜ 0.01 or ＜ 0.05).The pleural effusion in open group was (800.0 ± 60.5) ml,in close group was (350.0 ± 28.6) ml.The pleural effusion in open group was significantly higher than that in close group (P ＜ 0.01).The rate of postoperative atelectasis and respiratory failure in open group were 36.7％(18/49) and 38.8％(19/49),in close group were 15.1％(8/53) and 18.9％(10/53).The rate of postoperative atelectasis and respiratory failure in open group were significantly higher than those in close group (P ＜ 0.01).Conclusions OPCABG is the operation in mediastinum.To avoid pleural cavity opened in OPCABG can reduce the incidence of postoperative respiratory complication.
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Objective To investigate the role of titanium plate fixation for sternum closure after off-pump coronary artery bypass grafting (OPCABG) in elderly patients.Methods A total of 120 elderly patients who accepted OPCABG were randomly divided into two groups.The control group (n =60) received wire to fix the sternum,and the experimental group (n=60) received titanium plate combined with wire to fix the sternum.The chest closure time,the rate of postoperative incision pain,the rate of sternal dehiscence and sternal re-fixation between two groups were observed and recorded.Results The rates of postoperative incision pain,sternal dehiscence,sternal re-fixation was lower in experimental group than in control group [11.7％(7/60) vs.38.3％(23/60),3.3％(7/60) vs.13.3％(8/60),1.7％(1/60) vs.11.7％(7/60),x2 =11.378,3.927,4.821 respectively all P＜0.05].The chest closure time was longer in experimental group than in control group [(39±5)min vs.(30±2) min,x2 =13.386,P＜0.05].Conclusions Titanium fixation plate combined with wire for sternum closure can increase the stability of sternum fixation,reduce the postoperative pain and sternal dehiscence,and then decrease the risk of sternal re-fixation,but delay sternal closure of OPCABG in the elderly.
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ObjectiveAn out-thoracic paraaortic counterpulsation device(PACD) developed in the Reseach Center of our hospital was evaluated for its hemodynamic effects in an animal model with induced acute heart failure.MethodsEight healthy adult sheep with a weight of 38.5 to 54.5 kg were used as models for acute heart failure by snaring branches of coronary arteries.Thoracotomy was performed through the space under the left 4th rib.A Satinski clamp was used for partially clamping the descending aorta, and the Dacron vascular graft of out-thoracic PACD was sutured end-to-side to the descending aorta.The out-thoracic PACD used in this study had a blood chamber that was separated from the gas chamber by a movable polyurethane membrane .A stroke volume of 60 ml could be pumped when it was fully inflated.A 4F multipurpose catheter was inserted through the left ventricular apex for measuring and recording left ventricular pressures.A standard 40-ml intraaortic balloon was inserted into the descending aorta via the surgically exposed left femoral artery.Baseline hemodynamic data were collected after the model for acute heart failure was created without mechanical support.Mechanical support was randomly initiated either by the IABP or by the out-thoracic PACD in each experimental phase.Both devices were driven by the same console and synchronization with electrocardiogram was performed.Hemodynamic indexes and left carotid artery flow were calculated at baseline (device off) and during the period of 1 : 2 support for the 60-ml out-thoracic PACD and 40-ml IABP in the same animal.Baseline and support modes for devices were maintained for 15 minutes individually to ensure that a steady-state was achieved.ResultsBoth out-thoracic PACD and IABP resulted in a increase in the cardiac output (17.79％ with out-thoracic PACD vs.13.46％ with IABP, P =0.803) and the mean diastolic aortic pressure (29.48％ with out-thoracic PACD vs.15.01％ with IABP, P = 0.001).The use of out-thoracic PACD also led to a greater reduction in left ventricular end-diastolic pressure (35.09％ with out-thoracic PACD vs.15.79％ with IABP, P = 0.004).Meanwhile the out-thoracic PACD increased left carotid artery flow (14.52％ with out-thoracic PACD vs.6.70％ with IABP, P =0.006).No evidence of hemolysis, thrombus formation or major organ injury was identified during the experiment.ConclusionThe study indicated that a 60-ml out-thoracic PACD, which providing an improved mechanical circulatory support, was superior to a 40-ml IABP in the setting of experimental acute heart failure.This device may be used as a desirable alternative for the long-term mechanical support in patients with severe heart failure or those waiting for a heart transplantation, owing to its properties of low cost,easily to be implanted and removed, as well as a high biocompatibility.