The status of renal dysfunction after open cardiac surgery with cardiopulmonary bypass

Evaluation of renal dysfunction was performed in 103 patients (44 males, 59 females, between 9 and 65 years old), operated open cardiac surgery with cardiopulmonary bypass in Vietduc Hospital. Exclusive criteria included: chronic renal failure, renal calculus, urinary incontinence, taking drugs that affected to urinary elimination and creatinine quantitative analysis. The results: according to a diagnostic criterion of Morgan and Mikhail, renal dysfunction after open cardiac surgery was 47.57%. Only 6.12% was single renal dysfunction and 91.84% was multi-organs failure (in which, 71.43% was renal - cardiac failure, 16.33% was renal, cardiac and pulmonary failure). The more duration of staying in cardiac intensive care unit, the more serious renal dysfunction was, with slight and medium forms were 36.55 hours, serious form was (7.77%) was 140.12 hours. The patients died and progressed seriously caused by renal failure with forms of anuria or oliguresis, type B and C, decrease of creatinine clearance combined with increase of free water clearance.

To determine the risk factors of post operative renal dysfunction (RD) in open heart surgery under CPB

Material and methods: all patients with open heart surgery were enrolled in a case-control study. Renal dysfunction (RD) is defined as creatinine clearance 120 min, years ≤14 , EF 60 min, preoperative RD, per-CPB RD, infusion of catecholamine > 2 hours , mechanical ventilation >48 hours, hypotension >2 hours, hypovolemia, cardio-thoracic index >0.5, mean pulmonary artery pressure ≥ 25 mm/Hg, hemoglobinuria (+).

To determine the risk factors of renal dysfunction (RD) in open heart surgery under CPB

Material and methods: All patients with open heart surgery under CPB was enrolled in a case-control study. RD is defined as creatinine clearance 120 min (adjusted OR 6.35), aortic clamping >60 min (adjusted OR 4.16), pre-operative RD (adjusted OR 2.98), hemoglobinuria (adjusted OR 2.68). Conclusions: 5 independent risk factos of RD during CPB are long and low perfusion pressure, long duration of CPB and of aortic clamping, pre-operative RD and hemoglobinuria.

Role of PCO2 and pH measurements sampled from the right atrial cavity via the central venous catheter in open heart surgery

CO2 and W produced in tissus come into venous blood. Can PCO2 and pH sampled from the right atrial blood via a central venous catether approriately replace the arterial PCO2 and pH in open hear surgery? Objectives: To evaluate the correlation and the agreement of PCO2 and of pH between the arterial and venous right atrial blood. Methods: Cross-over study with matched comparision, calculation of paired t test, coefficient of correlation r (Pearson), agreement (Bland-Altman). Results: Arterial-venous right atrial PC02: gradient-5.68 (+/-2.44), r = 0.92 and narrow agreement. Arterial-venous right atrial pH: gradient 0.04 (+/-0.02), r = 0.94 and narrow agreement. Conclusion: PCO2 and pH of the right atrial blood can safely replace the arterial PCO2 and pH in cardiac anesthesia and intensive care.

Breaking of esophage, abdomen, swelling of cardia and breaking of the liver as combined trauma

Breaking in the site of connection of esophage and cardia is a rare condition in the close abdomen trauma with a high mortality. Its cause is usually a sudden rise of pressure in the abdomen cavity or an error in operation. Early diagnosis is most importance. Tomography is helpful to diagnose the emphysema in the chest in abdomen surgery is an approach od choise