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Objective:To access the benefits and harms of remote ischemic preconditioning(RIPC) in patients undergoing cardiac surgery with cardiopulmonary bypass.Methods:An electronic and manual search of literature published before Mar 2020 was conducted using Pubmed, EMBASE, Cochrane Library for randomized controlled trials(RCTs), CNKI, CBM, WanFang and VIP. 23 studies involving in 5 025 participants were included. Patients were randomly assigned to either remote ischemic preconditioning group(n=2 524) or control group(n=2 521). Remote ischemic preconditioning consisted of 3-4 cycles of lower limbs or upper limbs ischemia and reperfusion with an automated cuff inflator. Clinical data and the levels of injury biomarkers were collected. The main outcomes were the incidence of adverse events, mortality in the hospital, and the post-operative troponin concentration. The effective values of dichotomous variables or continuous variables were estimated by Relative risk( RR) or by mean differences( MD), standardized mean differences( SMD) with 95% confidence intervals( CI) respectively. Results:In general risk of bias varied from low to moderate risk of bias across included studies, and insufficient detail was provided to inform judgement in several cases. There were no significant differences between the two groups with regard to all-cause mortality in hospital( RR=1.27, 95% CI: 0.84-1.91, P=0.26), no-fatal myocardial infarction( RR=0.92, 95% CI: 0.79-1.07, P=0.27) , new stroke( RR=0.96, 95% CI: 0.61-1.50, P=0.84), new atrial fibrillation( RR=0.98, 95% CI: 0.83-1.15, P=0.77) and acute renal failure( RR=1.01, 95% CI: 0.90-1.14, P=0.83). Conclusion:There is no evidence that RIPC has a treatment effect on clinical outcomes(measured as all-cause mortality in hospital, no-fatal myocardial infarction, new stroke, new atrial fibrillation, and acute renal failure). More research should be designed to confirm the effect of RIPC on myocardial protection with cardiopulmonary bypass.
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Objective: To analyze relative risk factors of hyperamylasemia after open-heart surgery, and provide basis for clinical prevention and treatment. Methods: A total of 521 adult patients, who received open-heart surgery under general anesthesia and low temperature in our hospital from Jan 1, 2013 to Jun 30, 2013, were selected. The 2ml peripheral venous blood was taken in each patient instant after ICU hospitalization, 24h, 48h and 72h after surgery, then serum was separated and measured for serum amylase level by Somogyi method. According to the measured results of serum amylase level, patients were divided into hyperamylasemia group (serum amylase≥500U/dl, n=76) and non- hyperamylasemia group (serum amylase<500 U/dl, n=445). Single factor and gradual Logistic regression analysis were used to analyze risk factors of hyperamylasemia in patients after open-heart surgery. Results: Gradual Logistic regression analysis indicated that cardiopulmonary bypass (CPB) time and hypotension during operation, renal dysfunction and infection after operation were independent risk factors for postoperative hyperamylasemia (OR=1.02~4.12, P<0.05 or <0.01). Conclusion: During perioperative treatment of open-heart surgery, shortening CPB time, avoiding hypotension during surgery, protecting renal function and preventing infection may reduce morbidity of postoperative hyperamylasemia and improve prognosis of patients.
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Objective To observe the clinical efficacy of the double C program consisting of glucose monitoring systems (CGMS) and insulin pump (CSⅡ) in perioperative period of patients undergoing coronary artery bypass patients with type2 diabetes mellitus (T2DM).Methods Divided participants who underwent coronary artery bypass surgery with T2DM into double C treatment group (double C group,n =20) and multiple subcutaneous insulin group (MSⅡ group,n =30).Before and after surgery,blood sugar control in blood glucose time,blood sugar fluctuations,the amount of insulin,the incidence of low blood sugar,incision infection,and total hospitalization days were observed.Results Comparing the double C treatment group with the MSⅡ group,blood sugar fluctuations ((5.76 ± 1.42) mmol/L vs.(7.91 ± 1.68) mmol/L,P ＜ 0.05),the amount of insulin ((38.82 ± 16.97) U/d vs.(49.00 ± 15.32) U/d,P =0.032),the blood sugar compliance time ((3.52 ± 1.13) d vs.(6.00 ± 4.27) d,P =0.002),hypoglycemia (4 cases vs.1 case,P =0.025),the incision infection rates in both the cases(P =0.948),the total admission days((23.68 ± 13.67) d vs.(30.12 ± 2.94) d,P =0.084).Conclusion The double C program is comprehensively effective.for the perioperative glycemic control of patients with T2DM undergoing coronary artery bypass.