ABSTRACT
Objective:To compare the effects of rosuvastatin and atorvastatin on coronary artery bypass grafting (CABG) on the incidence of acute kidney injury (AKI), and assess the independent risk factors of AKI.Methods:We retrospectively collected 550 patients aged 18 years or older who underwent CABG from May 2014 to May 2020. They were divided into the rosuvastatin group ( n=322), atorvastatin group ( n=125) and non statins group ( n=103) according to whether rosuvastatin or atorvastatin was routinely used before operation. Demographic data, clinical data before and after CABG and laboratory results were collected. Blood urea nitrogen (BUN), serum creatinine (Scr), creatinine clearance rate (Ccr) and incidence of postoperative AKI were compared among the three groups. Univariate analysis and binary logistic regression analysis were used to investigate the effect of statins on AKI in patients undergoing CABG. Results:Compared with preoperation, BUN showed no significant change ( P>0.05), while Scr was increased and Ccr was decreased significantly (both P<0.01); BUN in the rosuvastatin group was decreased significantly ( P<0.01), whereas Scr and Ccr had no significant change ( P>0.05); Scr in the atorvastatin group was increased significantly ( P<0.01), but there was no significant difference in BUN and Ccr ( P>0.05). BUN and Scr in the non statins group were increased significantly (both P<0.01), while Ccr was decreased significantly ( P<0.01). After operation, BUN and Scr in the rosuvastatin group and atorvastatin group were significantly lower than those in the non statins group (all P<0.01); Ccr was significantly higher than that in the non statins group ( P<0.01). BUN and Scr were not significantly different between the rosuvastatin and atorvastatin groups ( P>0.05), but Ccr was significantly higher than that in the atorvastatin group ( P< 0.05). There were significant differences in BUN, Scr and Ccr among the three groups ( χ2=48.925, 22.677 and 34.426, all P<0.01). The incidence of AKI among 550 patients was 15.1% (83/550), of which 9.6% (31/322) in the rosuvastatin group, 16.0% (20/125) in the atorvastatin group and 31.1% (32/103) in the non statins group. The incidence of AKI in the rosuvastatin and atorvastatin groups was significantly lower than that in the non statins group ( χ2=28.412, 7.282, P<0.01). Multivariate regression analysis showed that hypertension ( OR=3.555, 95% CI: 1.959-6.451, P<0.01), NHYAⅢ/Ⅳ ( OR=2.438, 95% CI: 1.187-5.008, P=0.015), and increased serum creatinine level ( OR=1.018, 95% CI: 1.003-1.032, P=0.016), and intraoperative cardiopulmonary bypass ( OR=2.936, 95% CI: 1.454-5.927, P=0.003) were independent risk factors for AKI after CABG, while preoperative conventional statin therapy ( OR=0.490, 95% CI: 0.247-0.974, P=0.042) and increased serum albumin level ( OR=0.920, 95% CI: 0.856-0.990, P=0.026) were protective factors for AKI after CABG. Conclusions:The incidence of AKI after CABG is common. Rosuvastatin or atorvastatin and increased preoperative serum albumin level can protect renal function and reduce the incidence of AKI, which are the protective factors of AKI after CABG. The hypertension, NHYAⅢ/Ⅳ, increased preoperative serum creatinine level and cardiopulmonary bypass are the independent risk factors of AKI after CABG.
ABSTRACT
Objective To evaluate the effectiveness of anticoagulation management by physician-clinical pharmacist team for patients with valvular atrial fibrillation. Methods One hundred and seventy two patients with valvular atrial fibrillation received warfarin therapy for anticoagulation during hospitalization in Linyi People′s Hospital from January 2014 to December 2016, the patients continued to receive warfarin therapy for>6 months after discharge. The patients were randomly assigned in two groups:the anticoagulation management was given by physician-clinical pharmacist team in 87 cases (trial group), while the dosage of wargarin was adjusted in outpatient department by physicians alone in 85 cases (control group). The goal attainment rate of international normalized ratio (INR), the proportion of patients with a stable warfarin dose, knowledge of anticoagulants, belief of medication, medication compliance were compared between two groups. Results There were no significant differences in age, sex, body weight, smoking and drinking habits, valvular disease type, comorbidities; and the initial INR, knowledge of anticoagulants, belief of medication and medication compliance at admission between two groups (all P>0.05). The goal attainment rate of INR (52.17％vs. 41.02％,χ2=8.178, P=0.004), the proportion of patients with a stable dose of warfarin (74.71％ vs. 56.47％,χ2=6.349, P=0.012), the knowledge of anticoagulants (11.03 ± 2.25 vs. 10.08 ± 1.86, t=3.018, P=0.003), the belief of medication[(12.23 ± 2.07) vs. (11.67 ± 1.48), t=2.042, P=0.043], and the medication compliance[(7.36 ± 0.89) vs. (7.04 ± 1.10), t=2.1128, P=0.036] in the trial group were significantly higher than those in control group. Conclusion Anticoagulation management by physician - clinical pharmacist team can improve the management level of anticoagulation and the knowledge of anticoagulans, enhance the medication belief, improve the goal attainment rate of INR and the compliance rate of medication in patients with valvular atrial fibrillation.
ABSTRACT
Objective To investigate the prevention of acute kidney injury (AKI) by earlier application of rosuvastatin in patients after coronary artery bypass grafting (CABG).Methods A total of 200 patients with CABG were enrolled from May 2013 to April 2017.According to whether rosuvastatin were used routinely before operation or not,all patients were divided into the trial group (n =136) and the control group (n =64).Demographics,and clinical data were collected before and after CABG.The renal function markers including blood urea nitrogen (BUN),serum creatinine (sCr),endogenous creatinine clearance rate (GFR),emergence of AKI of two groups were documented and compared.Enumeration data were analyzed with x2 test,measurement data were analyzed with t test,and P ＜ 0.05 was considered to be significant.Results There were no differences in sCr (t =-1.156,P ＞ 0.05) but differences in BUN and eGFR (t =-2.915,3.690,respectively,P ＜ 0.05) before operation between two groups.After operation,the BUN was decreased (t =2.486,P ＜ 0.05) compared with that of pre-operation in the trial group,but there were no significant difference in sCr and eGFR (t =-1.877,-0.752,respectively,P ＞0.05).The BUN and sCr were increased (t =-3.792,-5.027,respectively,P ＜ 0.05) after operation compared with that of pre-operation in the control group,while the eGFR was decreased (t =5.540,P ＜0.05).Compared with the control group,BUN,sCr and the incidence of AKI were significantly decreased in the trial group (t/x2 =5.759,4.196,15.506,respectively,P ＜0.05),while the eGFR was increased (t =-6.215,P ＜ 0.05).Conclusions Earlier application of rosuvastatin before CABG can effectively protect renal function and reduce the incidence of AKI.
ABSTRACT
OBJECTIVE:To evaluate the effects of clinical pharmacists participating in clinical pathway management for chron-ic heart failure(CHF). METHODS:A total of 107 CHF adult inpatients in Linyi People's Hospital during Jan. 2014-Oct. 2015 were divided into control group(56 cases,3 withdrawal,53 in total)and trial group(58 cases,4 withdrawal,54 in total)accord-ing to random number table. Control group received routine clinical pathway management method of CHF;trial group received clin-ical pathway management with the participation of clinical pharmacists. Clinical efficacy,the utilization of heart failure drugs,eco-nomic indexes,medication compliance after discharge,re-hospitalization rate due to heart failure were compared between 2 groups. RESULTS:Total response rate of trial group was significantly higher than control group,with statistical significance(P0.05). Hospitalization time,drug cost,total hospitalization cost and drug ratio of trial group were short-er or lower than control group,without statistical significance(P>0.05). One month after discharge,the proportion of medication compliance in trial group was significantly higher than control group,with statistical significance(P0.05). Three months after discharge,the proportion of medica-tion compliance in trial group was higher than control group,while re-hospitalization rate was lower than control group,with statis-tical significance(P<0.05). CONCIUSIONS:The participation of clinical pharmacists in clinical pathway management of CHF can significantly improve the utilization rate of recommended drugs by guideline,clinical efficacy and medication compliance,and reduce re-hospitalization rate.
ABSTRACT
Objective To investigate the prevention of acute kidney injury (AKI) by earlier application of rosuvastatin in patients after coronary artery bypass grafting (CABG).Methods A total of 200 patients with CABG were enrolled from May 2013 to April 2017.According to whether rosuvastatin were used routinely before operation or not,all patients were divided into the trial group (n =136) and the control group (n =64).Demographics,and clinical data were collected before and after CABG.The renal function markers including blood urea nitrogen (BUN),serum creatinine (sCr),endogenous creatinine clearance rate (GFR),emergence of AKI of two groups were documented and compared.Enumeration data were analyzed with x2 test,measurement data were analyzed with t test,and P ＜ 0.05 was considered to be significant.Results There were no differences in sCr (t =-1.156,P ＞ 0.05) but differences in BUN and eGFR (t =-2.915,3.690,respectively,P ＜ 0.05) before operation between two groups.After operation,the BUN was decreased (t =2.486,P ＜ 0.05) compared with that of pre-operation in the trial group,but there were no significant difference in sCr and eGFR (t =-1.877,-0.752,respectively,P ＞0.05).The BUN and sCr were increased (t =-3.792,-5.027,respectively,P ＜ 0.05) after operation compared with that of pre-operation in the control group,while the eGFR was decreased (t =5.540,P ＜0.05).Compared with the control group,BUN,sCr and the incidence of AKI were significantly decreased in the trial group (t/x2 =5.759,4.196,15.506,respectively,P ＜0.05),while the eGFR was increased (t =-6.215,P ＜ 0.05).Conclusions Earlier application of rosuvastatin before CABG can effectively protect renal function and reduce the incidence of AKI.
ABSTRACT
Objective To evaluate the relationship between pressure derived fractional collateral flow (Q C/Q N) and left ventricular remodeling after acute myocardial infarction(AMI) Methods The Q C/Q N was measured in 21 patients with first AMI treated with percutaneous transluminal coronary angioplasty (PTCA), being determined by simultaneous measurement of mean aorta pressure (P a), distal coronary pressure (P w) during the balloon occlusion 21 patients were divided into two groups according to the value of Q C/Q N (group A, Q C/Q N≥0 25, group B, Q C/Q N0 05) At one month follow up, the difference in EF ( P 0 05) Both ESVI and EDVI were considerably increased in two groups Conclusion Angiographic Rentrop′s classification has its limitation in assessing the collateral circulation Q C/Q N is a major determinant of left ventricular remodeling and prognosis in patients with AMI