ABSTRACT
Objective Fluid therapy strategy on cardiac surgical patients has always been disputing. The aim of the present study was to observe the effects of goal-directed hemodynamic management strategy on the prognosis of patients undergoing off-pump coronary artery bypass graft. Methods The study was a prospective quality improvement study. Patients who underwent elective off-pump coronary artery bypass grafting in our hospital from January to December 2016 were included in the study, and the implementation of improvement approach was started on June 20, 2016. A total number of 98 patients were included: 56 cases before the improvement (control group) and 42 cases after the improvement (experimental group). The approach of optimizing hemodynamic was standardized vasoactive usage based on the goal-directed fluid therapy taking SVV (Stroke Volume Variation) and CI (Cardiac Index) as the target. Intraoperative and postoperative data were collected through the medical record system. Comparison was done between two groups in the aspects of liquid intake and output, length of postoperative stay in hospital and complications, postoperative awaken time, volume of thoracic drainage in 24h, extubation rate in 6h, time of ICU stay, concentration of Troponin I on the first day after surgery, mortality rate within 30 days and 6 months. Results There was no statistically difference in total fluid intake after the improvement, while the volume of voluven(676.79± 380.90 mL vs 890.48 ±222.58mL,P < 0.05) and urine volume (516.07±224.87 mL vs 695.24± 311.53mL,P < 0.05) increased significantly, the volume of crystal decreased significantly (663.84 ±224.97mL vs 430.24 ±201.76mL,P < 0.001). The positive liquid balance of intake and output volume was significantly reduced (683.82 ±556.08ml vs 456.43 ±505.36ml, P < 0.05). There were no significant differences in proportion of autologous blood or erythrocyte transfusion and volume of blood loss between the two groups (P > 0.05). There were no significant differences between the two groups in postoperative awaken time, volume of thoracic drainage within 24h, extubation rate within 6, concentration of Troponin I on the first day after surgery and ICU stay(P > 0.05). After the improvement, the length of postoperative stay in hospital was reduced compared with the control group (11.81 vs 13.82, P < 0.05). Multiple linear regression analysis was performed after the logarithmic transformation, and the standardized coefficient B of the improvement was -0.296 (SE=0.061, P < 0.05), indicating that the goal-directed hemodynamic management would reduce the length of postoperative stay in hospital by 19.4 %( 95%CI 7.3%~31.5%) with other conditions being equal. Postoperative complications decreased from 41.07% to 16.67 %( P < 0.05). Conclusion The implementation of goal-directed hemodynamic management strategy can reduce postoperative complications, postoperative hospital stay and improve short-term prognosis of patients undergoing off-pump coronary artery bypass surgery.
ABSTRACT
Objective To observe the effect of vaginal delivery history on the dosage of propofol and the quality of postoperative recovery in painless hysteroscopy patients. Methods 120 patients from November 2018 to May 2019 who required painless hysteroscopy were enrolled in the First Affiliated Hospital of Anhui Medical University. According to their previous history, the patients were divided into two groups: the control group (no history of delivery, 60 cases) and the observation group (had a history of delivery, 60 cases). Basic vital signs (MAP, HR) of the two groups were compared at the following five time points: baseline, uterin edilation, immediately, 10 min and 30 min after surgery. The dosage of sufentanil, the total and induced dosage of propofol, the additional cases and dosage of propofol, the time of surgery and recovery, the satisfaction of doctor and patients were recorded. Results Compared with the control group, the observation group showed significant decrease in the total dosage of propofol [(133.3±25.4)mg vs (145.1±27.8)mg], the additional cases [(28,46.7%) vs (39,65%)] and dosage of propofol [(1.0, 2.0)mg vs (0.0,40.0)mg], and shorter recovery time [(32.7±10.2)s vs (42.8±11.5)s] (all P<0.05). The satisfaction of doctor and patients were significantly higher in the observation group than in the control group. There was no significant difference in adverse events between the two groups (P>0.05). Conclusion In painless outpatient hysteroscopy, in order to shorten the recovery time of patients, improve the quality of postoperative recovery, improve the efficiency and safety of painless hysteroscopic surgery, anesthesiologists should reduce the additional dosage of propofol for patients with previous vaginal delivery.