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Objective To evaluate the clinical value of pulse indicator continuous cardiac output monitoring in treating acute kidney injury(AKI) due to sepsis.Methods Sixty-two patients with AKI due to sepsis in the Central Hospital of Zhumadian from August 2013 to August 2016 were rolled in and divided into control group (34 cases) and observation group (28 cases) according to whether adopted pulse indicator continuous cardiac output monitoring.Six hours and 24 hours after fluid resuscitatinn,resuscitation fluid volume,heart rate(HR),central venous pressure(CVP),mean arterial pressure(MAP),vasoactive drugs dose of the two groups were observed.Treatment times,daily filtration volume of continuous renal replacement therapy and independent urine volume,serum creatinine level,the survival rate after treating for seven days in the two groups were compared.Results There was no significant difference in the HR,central venous pressure,mean arterial pressure at six hours after fluid resuscitation between the two groups(P ＜ 0.05).At 24 hours after fluid resuscitation,there was no siguificant difference in the HR in the control group compared with that at six hours after fluid resuscitation (P ＜ 0.05),the CVP and MAP were higher than those at six hours after fluid resuscitation(P ＜ 0.05);the HR in the observation group was lower than that at six hours after fluid resuscitation (P ＜ 0.05),MAP was higher than that at six hours after fluid resuscitation (P ＜0.05),but there was no significant difference in the CVP in the control group compared with that at six hours after fluid resuscitation (P ＜ 0.05).The HR and CVP at 24 hours after fluid resuscitation in the observation group were lower than those in the control group(P ＜0.05),while there was no no significant difference in the MAP between the two groups(P ＜ 0.05).There was no significant difference in the fluid resuscitation volume,the dose of noradrenaline and dobutamine after treating for six hours between the two groups (P ＜ 0.05).Twenty four hours after fluid resuscitation resuscitation fluid volume and dobutamine dose in the observation group were significantly lower than those in the control group (P ＜ 0.05).The duration of renal replacement therapy,the daily filtration volume and the blood creatinine after treating for seven days in the observation group were significantly lower than those in the control group (P ＜ 0.05),but the independent urine volume after treating for seven days in the observation group was significantly higher than that in the control group (P ＜ 0.05).After treating for seven days,there were 28 cases survival,the survival rate was 82.4％ (28/34),while there were 25 cases survival,the survival rate was 89.3％ (25/28);the difference of survival rate between the two groups was not statistically significant (x2 =0.59,P ＜ 0.05).Conclusion In patients with AKI due to sepsis,pulse indicator continuous cardiac output monitoring can be used to optimize fluid management,and it can improved the renal function.
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<p><b>OBJECTIVE</b>To study the benefit of prophylactic antibiotics (PA) in totally percutaneous aortic endovascular repair (PEVAR) in the catheterization laboratory for reducing stent-graft infection and postimplantation syndrome (PIS).</p><p><b>METHODS</b>The clinical data were analyzed of patients undergoing thoracic endovascular aortic repairs. The patients were divided into non-PA group and PA group according to the use of prophylactic antibiotics before PEVAR. The diagnosis of infection was made by two senior physicians with reference to Hospital Acquired Infection Diagnostic Criteria Assessment released by the Ministry of Health of China.</p><p><b>RESULTS</b>The 95 enrolled patients included 35 with PA and 60 without PA group, who were comparable for baseline characteristics. Infection-related deaths occurred in 1 case in non-PA group and retrograde Stanford type A dissection and death occurred in 1 case in PA group (1.67% vs 2.85%, P=1.00). The PA and non-PA groups showed no significant difference in the incidence of postoperative infection (5% vs 2.86%, P=1.000), hospital stay (9.30±7.21 vs 10.06±5.69, P=0.094), infection-related mortality (1.67% vs 0%, P=1.00), or postoperative fever (70.90% vs 91.43%, P=0.20). The body temperature showed significant variations at different time points after procedure (F=19.831, P<0.001) irrelevant to the use of prophylactic antibiotics (F=0.978, P=0.326).</p><p><b>CONCLUSION</b>The current data do not support the benefit of PA in reducing postoperative infection and PIS in patients undergoing PEVAR, but the patients without PA may have worse clinical outcomes in the event of postoperative infections.</p>
Subject(s)
Humans , Anti-Bacterial Agents , Antibiotic Prophylaxis , Aorta, Thoracic , General Surgery , China , Endovascular Procedures , Length of Stay , Postoperative Complications , Stents , Vascular Surgical ProceduresABSTRACT
<p><b>BACKGROUND</b>The perioperative aortic dissection (AD) rupture is a severe event after endovascular stent graft placement for treatment of type B AD. However, this life-threatening complication has not undergone systematic investigation. The aim of the study is to discuss the reasons of AD rupture after the procedure.</p><p><b>METHODS</b>The medical record data of 563 Stanford type B AD patients who received thoracic endovascular repair from 2004 to December 2011 at our institution were collected and analyzed. Double entry and consistency checking were performed with Epidata software.</p><p><b>RESULTS</b>Twelve patients died during the perioperation after thoracic endovascular repair, with an incidence of 2.1%, 66.6% were caused by aortic rupture and half of the aortic rupture deaths were caused by retrograde type A AD. In our study, 74% of the non-rupture surviving patients had the free-flow bare spring proximal stent implanted, compared with 100% of the aortic rupture patients (74% vs. 100%, P = 0.213). The aortic rupture patients are more likely to have ascending aortic diameters = 4 cm (62.5% vs. 9.0%, P = 0.032), involvement the aortic arch concavity (62% vs. 27%, P = 0.041) and have had multiple stents placed (P = 0.039).</p><p><b>CONCLUSIONS</b>Thoracic AD endovascular repair is a safe and effective treatment option for AD with relative low in-hospital mortality. AD rupture may be more common in arch stent-graft patients with an ascending aortic diameter = 4 cm and with severe dissection that needs multi-stent placement. Attention should be paid to a proximal bare spring stent that has a higher probability of inducing an AD rupture. Post balloon dilation should be performed with serious caution, particularly for the migration during dilation.</p>
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Aortic Dissection , General Surgery , Aortic Aneurysm, Thoracic , General Surgery , Aortic Rupture , Blood Vessel Prosthesis Implantation , Retrospective Studies , StentsABSTRACT
<p><b>BACKGROUND</b>Decreasing the intracranial pressure has been advocated as one of the major protective strategies to prevent spinal cord ischemia after endovascular aortic repair. However, the actual changes of cerebrospinal fluid (CSF) pressure and its relation with spinal cord ischemia have been poorly understood. We performed CSF pressure measurements and provisional CSF withdrawal after thoracic endovascular aortic repair, and compared the changes of CSF pressure in high risk patients and in patients with new onset paraplegia and paraparesis.</p><p><b>METHODS</b>Four hundred and nineteen patients were evaluated for the risk of spinal cord ischemia after thoracic endovascular aortic repair. Patients with identified risk factors before the procedure constituted group H and received prophylactic sequential CSF pressure measurement and CSF withdrawal. Patients who actually developed spinal cord ischemia constituted group P and received rescue CSF pressure measurements and CSF withdrawal.</p><p><b>RESULTS</b>Among the 419 patients evaluated, 17 were graded as high risk. Four patients actually developed spinal cord ischemia after endovascular repair. The incidence of spinal cord ischemia in this investigation was 0.9%. The patients who actually developed spinal cord ischemia had no identified risk factors and had elevated CSF pressure, ranging from 15.4 to 30.0 mmHg. Six of the 17 patients graded as high risk had elevated CSF pressure: >20 mmHg in two patients and >15 mmHg in four patients. Sequential CSF pressure measurements and provisional withdrawal successfully decrease CSF pressure and prevented symptomatic spinal cord ischemia in high-risk patients. However, these measurements could only successfully reverse the neurologic deficit in two of the patients who actually developed spinal cord ischemia.</p><p><b>CONCLUSIONS</b>Cerebrospinal fluid pressure was elevated in patients with spinal cord ischemia after thoracic endovascular aortic repair. Sequential measurements of CSF pressure and provisional withdrawal of CSF decreased CSF pressure effectively in high risk patients and provided effective prevention of spinal cord ischemia. Risk factor identification and prophylactic measurements play the key role in prevention of spinal cord ischemia after thoracic endovascular aortic repair.</p>