Analysis of clinical effects, inflammatory stress and immune cell levels in patients with acute aortic dissection after TEVAR / 中国医师杂志

Objective:To investigate the clinical effects, inflammatory stress and immune cell levels of patients with acute aortic dissection (AD) after thoracic aortic endovascular repair (TEVAR).Methods:A retrospective analysis of 60 patients with acute aortic dissection admitted to our hospital from April 2014 to January 2016 were divided into conservative group ( n=30) and TEVAR group ( n=30) according to different treatment methods. The conservative group was given drug therapy, and the TEVAR group was given a thoracic aortic endovascular repair therapy. The inflammatory cytokines and immune cell levels of the two groups were measured before and after treatment. The therapeutic effects and the long-term effects of the two groups were analyzed. Results:Before treatment, there was no significant difference in serum interleukin (IL)-6, IL-8 and tumor necrosis factor-α (TNF-α) levels between the two groups ( P>0.05). After treatment, the levels of inflammatory cytokines in the two groups were significantly lower than those before treatment ( P<0.05); The levels of IL-6, IL-8 and TNF-α in the TEVAR group were significantly lower than those in the conservative group ( P<0.05). Before treatment, there was no significant difference in white blood cell count, neutrophil count, lymphocyte count and monocyte count between the two groups ( P>0.05). After treatment, the number of white blood cells and neutrophils decreased significantly in the two groups; and the number of lymphocytes in the two groups was significantly increased ( P<0.05). The number of white blood cells and neutrophils in the TEVAR group was significantly lower than that in the control group, and the number of lymphocytes was significantly higher than that in the conservative group ( P<0.05). The effective rate of the TEVAR group was significantly higher than that of the conservative group ( P<0.05). There was no significant difference in hospital mortality, hospitalization time and hospitalization complication between the two groups ( P>0.05). The 2-year survival rate of the TEVAR group was significantly higher than that of the conservative group. The postoperative complication rate was significantly lower than the conservative group ( P<0.05). There was no significant difference in the 1-year survival rate and secondary intervention rate between the two groups ( P>0.05). Conclusions:TEVAR has a better therapeutic effect, and improve survival rate to some extent.

Changes of coagulation / fibrinolysis factors in patients with type A aortic dissection after operation / 中国医师杂志

Objective:To investigate the changes of coagulation/fibrinolysis factors in patients with type A aortic dissection (AD) at early and middle stages after ascending aorta replacement+ total arch replacement+ elephant nose stenting.Methods:According to the inclusion and exclusion criteria, patients with type A AD who underwent cardiac surgery in Xinjiang Uygur Autonomous Region People′s Hospital from August 2017 to August 2018 were selected as the study group. According to the duration of onset, patients were divided into acute AD group (course <2 weeks) and chronic AD group (course ≥2 weeks). Both groups were treated with ascending aorta replacement + total arch replacement + elephant nose stenting. Fasting venous blood was drawn from the two groups, and the blood indexes [prothrombin time (PT), activated partial thrombo plastin time (APTT), fibrinogen (Fib), bone morphogenetic proteins (BMP)] and fibrinolysis indexes [D-dimer, tissue-type plasminogen activator (t-PA), plasminogen activator inhibitor (PAI)] were detected by enzyme-linked immunosorbent assay (ELISA).Results:The ELISA result showed that changes of PT, APTT, Fib, BMP, D-dimer, and PAI in patients with acute and chronic AD at 12 months after operation were significantly lower than those before operation ( P<0.05). The changes of t-PA in patients with acute and chronic AD at 12 months after operation were significantly higher than those before operation ( P<0.05). There was no significant difference in postoperative effective rate, in-hospital mortality, length of stay, incidence of complications and early and mid-term survival rate between the two groups ( P>0.05). Conclusions:Ascending aorta replacement+ total arch replacement+ elephant nose stent is effective in the treatment type A AD, and can significantly improve the expression of coagulation/ fibrinolysis markers in early and middle period after operation.

Teaching experience of cardiac surgery rotation for standardized training residents not majoring in cardiac surgery / 中华医学教育探索杂志

Cardiac surgery is the latest and fastest growing subject in surgery, which is character-ized by complex diseases and strong specialization.The standardized training of non cardiac surgery is short of time for the residents in cardiac surgery, and the teaching has certain complexity and particularity. The department of cardiac surgery of the Xinjiang Uygur Autonomous Region people's Hospital has analyzed the subject characteristics of the major, and explored the reform of cardiac surgery teaching. We adopted a variety of teaching forms to enhance clinical thinking ability and clinical practice ability as the focus of training, and strengthen clinical operation skills according to individual differences among residents. We improved the enthusiasm and initiative of the non-cardiac surgery residents to learn, training residents standardized,standardized diagnosis and treatment behavior,improve the quality of training.

Multiple factor analysis of preoperative myocardial enzymes in stanford type B aortic dissection / 国际外科学杂志

Objective To investigate preoperative myocardial enzymes and realative influencing factors in Stanford B type aortic dissection.Methods From Jan.2004 to Sep.2013,151 consecutive patients with Stanford type B aortic dissection were admitted to hospital,aged from 31 to 76 average:(51.51 ± 10.90)year sold.Ninty-five healthy people with similar age and sex were taken as the control group.Fasting venous blood collected more than 12h was collected,myocardial enzymes indexes such as CK,CKMB,LDH,HBDH were measured by Roche modular automatic biochemical analysis system.Primary entry tear and extent of aortic dissection was measured by Toshiba Aquilion ONE 320 slice CT.Degree of aortic valve insufficiency was measured by Philips Sonos 5500 Color Doppler ultrasonic diagnostic apparatus.Results Compared with control group,the level of myocardial enzymes (LDH,HBDH) of aortic dissection group increased significantly(P ＜ 0.01).part myocardial enzymes indexes(CK,LDH,HBDH) of acute stage group existed difference(P ＜ 0.05).Myocardial enzymes indexes only CK existed difference between acute stage group and subacute stage group and chronic stage group(F =18.72,P =0.000),no difference between subacute stage group and chronic stage group.LDH,HBDH of each sub group of aortic dissection group were higher than that of control group,P ＜ 0.01.Trough correlation analysis,CK negatively correlated with disease course of aortic dissection and patients sex [(r =-0.446 ; P =0.000) ; (r =-0.303 ; P =0.000)],CKMB negatively correlated patients sex [(r=-0.203;P=0.020)],LDH negatively correlated with patients sex [(r =-0.171 ;P =0.049)],positively with left ventricular end-diastolic diameter and left ventricular end-systolic diameter [(r =0.202 ; P =0.022) ; (r =0.271 ; P =0.002)].HBDH positively correlated with left ventricular enddiastolic diameter and left ventricular end-systolic diameter [(r =0.385 ;P =0.002) ; (r =0.515 ; P =0.000)],negatively with degree of aortic insufficiency [(r =-0.528 ;P =0.006)].Conclusions Myocardial enzymes rise in preoperative Stanford B aortic dissection,more representing skeletal muscle injury.Be affected by stage of aortic dissection,lower limb skeletal muscle injury aggravates more seriously in acute stage group persists entering the sub acute stage.

Outcome of patients using intra-aortic balloon pump undergoing coronary artery bypass grafting / 国际外科学杂志

Objective To evaluate the outcome of patients using intra-aortic balloon pump IABP undergoing coronary artery bypass grafting and to assess the results.Methods From December 2001 to December 2011,eighty-two consecutive patients,who used IABP undergoing coronary artery bypass grafting were studied.The out-come of early complication,mortality,LVEF were analyzed.Results Fourteen patients died.Forty-three patients,who used IABP,no serious complications (malignant arrhythmia,renal insufficience),preoperative LVEF was (46.0 ± 1.8) ％,LVEDD was (66.0 ± 4.1) mm,early postoperative LVEF was (50.0 ± 2.7) ％,LVEDD was (53.0 ± 2.8) mm (P ＜ 0.05).Conclusion Use of IABP decreased early mortality,and postopertive respiratory tract infections,renal insufficiency were the main complication.Positive use of IABP postoperatively can decrease early mortality.

Outcome of patients with low ejection fraction undergoing coronary artery bypass grafting / 国际外科学杂志

Objective To evaluate the outcome of patients with low ejection fraction undergoing coronary artery bypass grafting.Methods One hundred and twenty-eight consecutive patients with left ventricular ejection fraction (LVEF) ≤35％,who underwent Off-pump caronary bypass surgery or Cardiopulmonary coronary artery bypass between December 2000 and Novomber 2010 were studied.The outcome of early complication,mortality,LVEF were analyzed.Results LVEF and LVEDD were significantly increased in early postoperation (P ＜ 0.05 ).Use of Intra-aotric balloon counterpulsation(IABP) can decrease early mortality,and postopertive respiratory tract infections,renal insufficiency were found to be the main complications.Conclusions Preoperative low ejection fraction has no relationship with postoperative early mortality.using medicine to adjust heart function,strcity control blood pressure,blood glucose,heart rate preoperation,positive use of IABP postoperativon are key point to decrease early mortality.