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@#Objective To study the learning curve of minimal invasive coronary artery bypass grafting (MICS CABG) and the influence on the perioperative clinical effects by analyzing operation time. Methods From March 2012 to November 2020, 212 patients underwent MICS CABG by the same surgeon. Among them, 59 patients (52 males and average age of 62.89±8.27 years) with single vessel bypass grafting were as a single-vessel group and 153 patients (138 males, average age of 59.80±9.22 years) with multi-vessel bypass grafting were as a multi-vessel group. Two sets of operation time-operation sequence scatter plots were made and learning curve was analyzed by cumulative summation (CUSUM) and regression method of operation time. The surgical data of each group before and after the inflection point of the learning curve were compared with the main clinical outcome events within 30 days after surgery. Results There was no death, perioperative myocardial infarction and stroke in 212 MICS CABG patients and no transfer to cardiopulmonary bypass or redo thoracotomy. The learning curve conformed to the cubic fitting formula. In the single- vessel group, CUSUM (x operation number)=–1.93+93.45×x–2.33×x2+0.01×x3, P=0.000, R2=0.986, the tipping point was 27 patients. In the multi-vessel group, CUSUM (x)=y=2.87+1.15×x–1.29× x2+3.463×x3, P=0.000, R2=0.993, and the tipping point was 59 patients. The two sets of case data were compared before and after the learning curve and there was no statistical difference in main clinical outcomes within 30 days (mortality, acute myocardial infarction, stroke, perioperative blood transfusion rate), ventilator tube, and intensive care unit retention. Conclusion The learning curve of MICS CABG conforms to the cubic formula, and the process transitions from single to multiple vessels bypass. To enter the mature stage of the learning phase, a certain number of patients need to be done. Reasonable surgical procedures and quality control measures can ensure the safety during the learning phase.
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Objective To explore the clinical effect of Salvianolate for treatment of coagulant function abnormality in patients with septic shock.Methods One hundred and fifty-two septic shock patients admitted to Intensive Care Unit (ICU) of Department of Critical Care Medicine,Liuzhou Municipal Liutie Central Hospital from January 2007 to June 2016 were enrolled,and they were divided into a control group (67 cases) and a Salvianolate group (85 cases) by random number table.In the control group,conventional western medicine treatment was given,while in Salvianolate group,besides conventional treatment,additionally,Salvianolate 200 mg intravenous drip was applied daily for consecutive 10 days.The levels of D-dimer and platelet count (PLT) were examined on the 1st,3rd,7th,10th day after admission;disseminated intravascular coagulation (DIC) incidence and mortality were observed in 10 days after admission in the two groups.Results The levels of D-dimer were significantly lower in the Salvianolate group than those of the control group on 3,7,10 days after admission (mg/L:3 days was 9.14 ± 2.25 vs.18.42 ± 3.15,7 days was 6.71 ± 1.49 vs.14.57 ± 1.81,10 days was 1.01-± 0.20 vs.4.79-± 0.81,all P ＜ 0.01).In both groups,on the first day after admission the level of PLT began to decrease,on the 3th,7th day the levels were lowered significantly,and on the 10th day,the level of PLT was elevated;in the Salvianolate group,the levels of PLT were obviously higher on the 3rd,7th,10th day after admission than those of the control group [PLT (x 109/L) 3 days after admission:67.05-± 7.76 vs.40.97 ± 6.51,7 days:67.24 ± 6.35 vs.32.06 ± 5.13,10 days:90.18 ± 11.42 vs.59.04 ± 6.57,all P ＜0.01].The DIC incidence and mortality were significantly lower in the Salvianolate group than those of the control group [DIC incidence:12.94％ (11/85) vs.38.8％ (26/67),mortality:5.88％ (5/85) vs.29.85％ (20/67),both P ＜0.01].Conclusions Coagulant function abnormality was found in most patients with septic shock.The cause of PLT decreasing is mainly due to micro-vascular thrombosis that consumes a lot of PLT.Early intervention with Salvianolate in such patients can inhibit thrombosis,block the exhaustion of PLT and correct the coagulant function abnormality with certain efficacy in the patients.
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ObjectiveTo observe the influence of treating course on the lipid-regulating effect of Xuezhikang and Simvastati.MethodsTwo hundred and two patients with unstable angina pectoris(UAP) were randomly enrolled and divided into Simvastatin group(n = 98)and Xuezhikang group(n = 104).The TC, TG,LDL-C, HDL-Clevelsweremeasuredbeforethe treatment and atthe3rd, 6thmonthafter the treatment.According to the suitable threshold of blood lipids in normal Chinese people, the patients who had abnormal blood lipids were picked out from the two groups for the further observation.ResultsThe lipidregulating effects of Simvastatin and Xuezhikang were showed up at the 3rd month, and the effective rate were 40.6％ and 60.9％ for TC regulation,51.2％ and 84.5％ for LDL-C regulation,22.2％ and 61.5％ for HDL-C regulation.We found significantly better effects of Xuezhikang than that of Simvastatin(x2 = 6.38,17.05,4.04;P ＜ 0.05, P ＜ 0.01, P ＜ 0.05) .However, at the 6th month the effective rate of Simvastatin and Xuezhikang were 89.9％ and 95.4％ for TC regulation,89.1％ and 97.2％ for LDL-C regulation,83.3％ and 84.6％ for HDL-C regulation, which showed no significant differences (x2 = 1.81,3.57, 0.01 ; Ps ＞ 0.05).The effective percentages of reduced TG level of Simvastatin and Xuezhikang were 9.5％ and 24.5％ at the 3rd month,51.4％ and 68.4％ at the 6th month, which showed significant differences (x2 = 6.45,5.13 ; Ps ＜ 0.05) between the two groups at both time points.Conclusion The lipid-regulating effects of Xuezhikang and Simvastati were influenced by the treating period.Xuezhikang shows lipid-regulating effect more quickly ,and it is recommended in treating CHD patients,especially for the patients with hypertriglyceridemia.