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Objective To investigate the efficacy of dexmedetomidine on sedation in post-cardiac surgery patients with NIV intolerance.The changes of respiratory function and hemodynamics of the patients as well as non-invasive ventilation (NIV) failure rate were also under evaluation.Methods Thirty-five post-cardiac surgery patients with NIV intolerance and hypoxemia were enrolled in this prospective study.All patients were sedated with dexmedetomidine.NIV was standardized according to the uniform protocol.The main outcome was NIV success (avoiding endotracheal intubation) or NIV failure (requiring endotracheal intubation or die).The cardiorespiratory parameters (BP,HtR and RR) and artery blood gas analysis were prospectively recorded before and after sedation.The respiratory function and hemodynamics changes in both groups (NIV success group and NIV failure group) were then evaluated.Factors independently associated with NIV failure were identified using a logistic regression model.Results Twenty out of 35 patients (57.14％) survived while 15 (42.86％) patients failed NIV.After 1 h and 4 h of NIV with dexmedetomidine sedation,respiratory rate in both groups were decreased compared with baseline,especially in NIV success group.The PaO2/FiO2 was also improved after 1h and 4h of NIV treatment compared with baseline.The improvement was more significantly in NIV success group.The heart rate was decreased compared with baseline with no differences between two groups.There were no significant changes on PaCO2 and mean arterial pressure (MAP) during the treatment.The respiratory and hemodynamics variables identified as predictors of NIV failure were included in a multivariate logistic regression.RR ＞ 23 time/min (OR =3.2,95％ CI:2.043 ～ 4.301,P ＜ 0.01) 1 h after NIV,RR ＞ 20 time/min (OR =2.1,95％ CI:1.659～3.231,P=0.025) 4 h after NIV,PaO2/FiO2 ＜178 mmHg (OR=2.4,95％CI:1.892 ～ 3.287,P ＜0.01) 1 h after NIV and PaO2/FiO2 ＜ 185 mmHg (OR =1.7,95％ CI:1.243 ～ 2.365,P =0.041) 4 h after NIV independendy predicted NIV failure.Conclusions Dexmedetomidine might be considered as an effective and safe sedative for post-cardiac surgery patients with NIV intolerance.Early identification of predictors of NIV failure may facilitate early intervention.
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Objective Although heart transplantation surgery has become more common,little is known about the psychological status of patients waiting for a heart transplant.Method Ninety-three patients registered for heart transplantation from March 2013 to March 2014 in a large general hospital in Shanghai were assessed by a psychiatrist using the Hamilton Depression Scale (17 items) and the Hamilton Anxiety Scale.Out of them 36 were preoperatively admitted to the Cardiac Surgery Department.The scales were assessed repeatedly at the 1st day,3rd day,7th day,10th day and so on until the operation took place.Result The mean scores of HAMD and HAMA of 93 patients in the waiting list were separately 13.11 ±3.81 and 14.20±4.57.Among them 18(19.4％) were classified as moderately depressed,31(33.3％) had moderately anxious symptoms,and 14(14.1％) had severe anxious symptoms.Thirty-six patients were preoperatively admitted to hospital.Their mean scores of HAMD and HAMA were separately 13.19-± 3.82 and 16.17 ± 4.35.Among them 7(19.4％) were classified as moderate depression at the time of admission,16 (44.4％) had moderately anxious symptoms and 9 (25.0％) had severe anxious symptoms.The scores of HAMD had significant difference (t =3.383,P =0.002) before and after admission.Paired t test was separately conducted to analyze the first assessment and the 3rd-day assessment of HAMA and HAMD total scores after admission of all the inpatients.The results showed the scores were statistically different (for HAMA,t =2.786,P =0.009; for HAMD,t =14.024,P =0.000).Repeated ANOVA was used to analyze the recipients who had three assessments.The results had statistical difference (for HAMA,F =4.568,P=0.020; for HAMD,F=5.626,P =0.034) and the difference of HAMD score at different time points had a linear trend (F =8.273,P =0.013).Conclusion After hospital admission,the depression symptoms will be significantly alleviated.When waiting for the transplant in the hospital,the anxiety symptoms alleviate slightly in three days and then aggravate significantly.The depression symptoms alleviate slightly continuously.
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Objective Acute kidney injury(AKI) is a common and serious complication with high morbidity and mortality in patients undergoing surgery for Stanford type A aortic dissection.The purpose of this study is to investigate the mortality and risk factors for the prognosis of AKI requiring renal replacement therapy(RRT) in patients undergoing surgery for Stanford type A aortic dissection.Methods We retrospectively investigated 68 patients of AKI requiring RRT undergoing surgery for Stanford type A aortic dissection in Zhongshan Hospital from October 2005 to May 2013.The mean age was (55.31 ± 11.08) years.The patients were divided into two groups,survivors(n =40) and non-survivors(n =28).We observed the clinical data of the patients in both groups.Univariate and multivariate analyses were performed to investigate the risk factors for prognosis of AKI requiring RRT.Results Of the 68 patients,28 patients died.The in-hospital mortality was 41.18％.Univariate analysis showed the following as significant risk factors:APACHE Ⅱ score,hypotension,gastrointestinal bleeding,hepatic dysfunction,neurological deficits(P ＜ 0.05).Multivariable Cox regression analysis identified New York Heart Association (NYHA) functional class Ⅳ (HR 5.486,95 ％ CI 1.805-16.676),APACHE Ⅱ score (HR 1.123,95％ CI 1.055-1.196),hypotension (HR 3.328,95％ CI 1.180-9.382),hepatic dysfunction(HR 2.242,95％ CI 1.015-4.952) were independent predictors of in-hospital mortality (P ＜ 0.05).Conclusion AKI requiring RRT after Stanford type A aortic dissection surgery is associated with high mortality.Risk factors of death should be taken into consideration for perioperative care and may improve clinical outcome.
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Objective To investigate the incidence and risk factors for acute kidney injury (AKI) after adult cardiac surgery with cardiopulmonary bypass.Methods 6665 adult patients who underwent cardiac surgery with cardiopulmonary bypass in Zhongshan Hospital from September 2006 to July 2011 were analyzed retrospectively.The patients were divided into two groups according to whether AKI occurred after cardiac surgery.We observed the clinical data of the patients in both groups.The risk factors for AKI after operation were evaluated by Univariate analyses and multivariate logistic regression analysis.Results Of the 6665 patients,AKI developed in 1779 (26.69％) patients,whereas 102 (1.53％) had renal replacement therapy.Patients with AKI had significant higher mortality than patients without AKI (2.47％ vs.0.29％,P ＜0.0l).Multivariate logistic regression analysis revealed that male,increased age,hypertension,diabetes,preoperative serum creatinine (≥ 115 μmol/L),preoperative uric acid(≥420 μmol/L),low preoperative left ventricular ejection fraction(＜ 0.40),preoperative anemia,type of surgery(aortic aneurysm surgery),long cardiopulmonary bypass time(≥ 120 min),requirement of deep hypothermic circulatory arrest,postoperative hypotension,blood transfusion within 24 h after operation (≥ 1000 ml),prolonged mechanical ventilation time (≥ 72 h) were the independent risk factors for AKI in post cardiac surgical patients.Conclusion AKI is a common complication in adult undergoing cardiac surgery with cardiopulmonary bypass,and associated with an increased mortality.The development of AKI is closed related with variety perioperative risk factors,suggesting more attention should be paid to the assessment and prevention of these risk factors.
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Objective To evaluate the cardiopulmonary allograft function and to analyze key factors for long-term survival of heart-lung transplantation in a patient survived more than 5 years. Methods On December 17th, 2003 at Zhongshan Hospital of Fudan University, a homologous heart-lung transplantation was performed on a female who diagnosed with cardiopulmonary failure secondary to congenital atrial septal defect with severe pulmonary hypertension. Heart-lung allograft was preserved with 1 000 mL UW solution and 4 000 mL HTK solution.Postoperative immunosuppressive therapies were managed with Zenapax, cyclosporine A (or tacrolimus), mycophenolate mofetil and corticosteroids. Cyclosporine A maintained with serum trough levels of 100-200 μg/L and tacrolimus with serum trough levels of 8-20 μg/L. Cardiopulmonary allograft functions were evaluated by echocardiogram, pulmonary function test and thoracic CT periodically. Results The patient survived operation and experienced normal daily life with NYHA cardiac function of class Ⅰ-Ⅱ during the follow-up of 5 years and 6 months. Echocardiogram showed left ventricular ejection fraction of 65% to 86%. Pulmonary function test exhibited with nearly normal oxygen exchange, meanwhile, small airway obstruction was detected from one year after operation and keeping stable from then on. Two episodes of severe pneumonia were complicated and treated with antibiotics and fhconazob, no severe acute allograft rejection episode was experienced. Conclusions Heart-lung transplantation proves to be a reliable therapy modality for terminal cardiopulmonary failure. Excellent donor organ preservation, accurate balance of the risk between acute allograft rejection and infection, and strict preventive measures against infection are key factors for long-term survival of heart-lung transplantation.