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Objective:To investigate the current situation of kinesiophobia in patients after heart valve replacement surgery and to analyze its influencing factors, and to provide reference for the intervention research of patients with cardiophobia after cardiac valve replacement.Methods:Using cross-sectional survey method and convenient sampling method, 109 patients who underwent cardiac valve replacement surgery in department of cardiothoracic and vascular surgery of Guangxi Zhuang Autonomous Region People′s Hospital from March 2021 to January 2022 were selected as the study subjects. The patients were surveyed with the general questionnaire, Tampa Scale of Kinesiophobia and Visual Analogue Scale.Results:After heart valve replacement, the score of Tampa Scale of Kinesiophobia was (46.90 ± 9.30) points. The score of Visual Analogue Scale was (5.83 ± 1.01) points. The score of Tampa Scale of Kinesiophobia was positively correlated with the score of Visual Analogue Scale ( r=0.46, P<0.01). Multiple linear regression analysis showed that patient′s age, cardiac function level, left ventricular ejection fraction, pain were the main influencing factors of Kinesiophobia ( t values were -2.37-4.34, all P<0.05). Conclusions:Medical staff should understand and accurately assess the status of patient′s kinesiophobia after heart valve replacement surgery, identify high-risk groups of kinesiophobia, and take targeted nursing measures to effectively alleviate postoperative pain, thereby reducing the incidence of kinesiophobia in patients, helping patients to carry out early functional exercise, and prorroting physical recovery.
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@#Objective To investigate the predictive value of right atrial myocardial fibrosis in the prognosis of isolated tricuspid regurgitation surgery after left heart valve surgery. Methods The patients who underwent tricuspid valvuloplasty by the same operator in Guangdong Provincial People's Hospital from April 2016 to August 2021 due to long-term isolated severe tricuspid regurgitation after left heart valve surgery were included in the study. According to the degree of right atrial myocardial fibrosis, the patients were divided into three groups: a mild group, a moderate group, and a severe group. The clinical data of these patients were compared and analyzed. Results A total of 75 patients were enrolled, including 16 males and 59 females with an average age of 57.0±8.4 years. There were 30 patients in the mild group, 29 patients in the moderate group and 16 patients in the severe group. In terms of the preoperative data, there were statistical differences in cardiac function grade, right atrial diameter, tricuspid incompetence area among the three groups (P<0.05). In terms of the postoperative data, there were statistical differences among the three groups in the cardiopulmonary bypass time, mechanical ventilation time, ICU monitoring time, complication rate and mortality (P<0.05). Further pairwise comparison showed that, compared with the mild group, the severe group had longer mechanical ventilation time (P=0.024), longer ICU monitoring time (P=0.003) and higher incidence of postoperative complications (P=0.024), while the moderate group had no statistical difference in all aspects (P>0.05); compared with the moderate group, the severe group had longer ICU monitoring time (P=0.021) and higher incidence of complications (P=0.006). Conclusion The early outcome of tricuspid valvuloplasty in patients with isolated tricuspid regurgitation after left heart valve surgery with severe right atrial myocardial fibrosis is worse than that in the patients with mild and moderate fibrosis, suggesting that the degree of myocardial fibrosis in the right atrium can be a predictor of the effect of tricuspid regurgitation surgery and a judgement indicator of the surgery timing.
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Objective To explore the starting point of pharmaceutical care by clinical pharmacists for patients after heart valve replacement. Methods Combined with typical cases, the content, focus and effects of pharmaceutical care for patients after heart valve replacement were summarized. Results Clinical pharmacists provided pharmaceutical services such as anticoagulant care and warfarin dosage adjustment, infection monitoring and rational use and care of antibacterial, perioperative airway management, stress ulcer (SU) prevention and pharmaceutical care, and warfarin medication education for patients, which had promoted the rational use of drugs and improved the treatment results of patients. Conclusion Pharmaceutical care by clinical pharmacists could be helpful to improve the safety and efficacy of drug treatment for patients after heart valve replacement.
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OBJECTIVE To compare the anticoagulant effectiveness and safety of new oral anticoagulants （NOACs）and warfarin after heart valve replacement ，and to provide evidence-based reference for clinical drug use. METHODS Retrieved from PubMed，Cochrane Library ，Embase，Web of Science ，CNKI，Wanfang database and VIP ，clinical studies about the use of NOACs versus warfarin after heart valve replacement were collected during the inception to July 2021. After literature screening and data extrac tion，the quality of included randomized controlled trials （RCTs）were evaluat ed by bias risk assessment tool recommended by Cochrane system evaluator manual 5.2.0. After the quality of the included cohort studies was evaluated by Newcastle-Ottawa scale （NOS），RevMan 5.3 software was used for meta-analysis and sensitivity analysis. RESULTS A E-mail：carolmeng_0813@163.com total of 9 studies involving 4 962 patients were included ，of which 7 were RCTs and 2 were cohort studie s. Results of meta-analysis showed that after biological valve replacement/repair ，the incidence of stroke and systemic embolism （SSE）[OR＝0.71，95％CI（0.52，0.97），P＝0.03]，major bleeding [OR ＝0.40，95％CI （0.30，0.54），P＜0.000 01] and intracranial hemorrhage [OR ＝0.20，95％CI（0.04，0.95），P＝0.04] in trial group were significantly lower than warfarin group ；there was no significant difference in all-cause mortality between 2 groups [OR ＝1.25，95％CI（0.88， 1.79），P＝0.22]. After mechanical valve replacement/repair ，there were no significant difference in the incidence of SSE [OR ＝1.52， 95％CI（0.04，60.29），P＝0.82] or all-cause mortality [OR ＝0.26，95％CI（0.04，1.84），P＝0.18] between 2 groups. The results of subgroup analysis according to the follow-up time showed that after biological valve replacement/repair ，the incidence of SSE in trial group was significantly lower than that in control group when the follow-up time was ≤3 months [OR ＝0.20，95％CI（0.06， 0.74），P＝0.03]；but there was no significant difference in the incidence of major bleeding between 2 groups [OR ＝0.67，95％CI （0.19，2.38），P＝0.53]；when the follow-up time was longer than 3 months，there was no statistical significance in the incidence of SSE between 2 groups [OR ＝0.74，95％CI（0.54，1.02），P＝0.07]，while the incidence of major bleeding in trial group was significantly lower than control group [OR ＝0.39，95％CI（0.29，0.52），P＜0.001]. Subgroup analysis by study type showed that after biological valve replacement/repair ，the incidence of SSE in the RCT in trial group was significantly lower than that in control group [OR ＝0.51，95％CI（0.29，0.92），P＝0.03]，but there was no significant difference in the incidence of major bleeding between 2 groups[OR＝0.58，95％CI（0.33，1.03），P＝0.06]. In cohort study ，there was no significant difference in the incidence of SSE between 2 groups [OR ＝1.03，95％CI（0.40，2.66），P＝0.95]，while the incidence of major bleeding in trial group was significantly lower than control group [OR ＝0.20，95％CI（0.06，0.74），P＜0.001]. Sensitivity analysis results showed that the results of the above-mentioned meta-analysis were relatively robust. CONCLUSIONS For the patients underwent biological valve replacement/repair，the effectiveness and safety of NOACs are better than or similar to those of warfarin ；for the patients underwent mechanical valve replacement/repair ，there is no significant difference in the effectiveness and safety between NOACs and warfarin.
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Objective:To evaluate and compare the early and long-term outcomes of rheumatic patients who underwent left-side heart valve replacement with concomitant tricuspid valve replacement, and analyze the difference of early mortality and long-term survival rate between mild pulmonary artery systolic pressure (PASP) and moderate to severe PASP patients.Methods:From January 2009 to December 2018, 79 cases of patients were reviewed and summarized. The mean age before operation was (45.7±7.8) years old. These patients were divided into mild PASP group(<50 mmHg, 38 cases) (1 mmHg=0.133 kPa) and moderate-severe PASP group (>50 mmHg, 41 cases) . Kaplan- Meier method was used to estimate the overall long-term survival rate and the incidence of complications, and to compare the long-term survival rate of patients with mild and moderate -severe PASP elevation. Results:The mortality rate of early postoperative patients was 8.9% (7/79). The causes of death included: low cardiac output syndrome in 3 cases, multiple organ failure caused by pulmonary infection in 2 cases, acute renal insufficiency in 1 case, sudden cardiac arrest in 1 case. Although the mortality rate of early moderate-severe PASP group (12.2% vs. 5.3%) was higher than that of mild PASP group, there was no significant difference ( P>0.05). The mean follow-up time was (51.8±31.7) months (3-115 months). Kaplan- Meier method was used to estimate the 10-year survival rate, the rate of avoiding thrombosis, the rate of avoiding serious bleeding event and the rate of avoiding reoperation, which were (67.2±10.6)%, (85.7±6.2)%, (83.4± 6.9)% and (93.7 ± 3.7)%, respectively. Although the long-term survival rate of mild PASP (78.0±10.6) % was higher than that of moderate-severe PASP (62.8 ± 13.4) %, there was no significant difference ( P>0.05). Conclusion:The early mortality rate of rheumatic patients who underwent left-side heart valve replacement with concomitant tricuspid valve replacement is still relatively high. The recurrent heart failure is the major causes of long-term death.
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Objective@#To evaluate the efficacy and safety of different bridging anticoagulant therapies in patients undergoing mechanical heart valve replacement (MHVR) surgery.@*Methods@#Consecutive patients undergoing MHVR surgery from January 2018 to December 2018 in First Hospital of Lanzhou University were prospectively enrolled in this study. Patients were divided into unfractionated heparin (UFH) group and low molecular weight heparin (LMWH) group according to the postoperative bridging anticoagulation methods. Preoperative clinical data and postoperative related time and cost parameters, including drainage time, duration of stay in intensive care unit (ICU), postoperative time (interval from end of operation to discharge) and INR stabilization time (interval from start of bridge anticoagulation to INR value reaching the standard for 2 consecutive days) of all enrolled patients were collected, and all patients were followed up for 4 weeks and thromboembolic or bleeding events were analyzed. Multivariate logistic regression was used to determine the independent prognostic factors of thromboembolic or bleeding events after MHVR receiving various bridging anticoagulant therapies.@*Results@#A total of 217 patients were included in the study, including 120 patients in the UFH group and 97 patients in the LMWH group. Stroke occurred in two patients in the UFH group, while no stroke event occurred in the LMWH group. The incidence of bleeding events was significantly higher (9.28%(9/97) vs. 1.67%(2/120), P=0.02), while the drainage time, duration of stay in ICU, postoperative time, INR stabilization time were all significantly shorter in LMWH group than in UFH group (all P<0.05). Multivariate logistic regression analysis showed that bridging anticoagulation therapies (OR=0.18, 95%CI 0.04-0.86, P=0.03), fibrinogen level (OR=1.99, 95%CI 1.16-3.41, P=0.01) and creatinine level (OR=1.05, 95%CI 1.01-1.08, P=0.04) were independent prognostic factors for bleeding events.@*Conclusion@#LMWH use is associated with increased risk of bleeding events, but can significantly reduce the drainage time, duration of stay in ICU, postoperative time, INR stabilization time in patients post MHVR surgery.
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Objective: To evaluate the efficacy and safety of different bridging anticoagulant therapies in patients undergoing mechanical heart valve replacement (MHVR) surgery. Methods: Consecutive patients undergoing MHVR surgery from January 2018 to December 2018 in First Hospital of Lanzhou University were prospectively enrolled in this study. Patients were divided into unfractionated heparin (UFH) group and low molecular weight heparin (LMWH) group according to the postoperative bridging anticoagulation methods. Preoperative clinical data and postoperative related time and cost parameters, including drainage time, duration of stay in intensive care unit (ICU), postoperative time (interval from end of operation to discharge) and INR stabilization time (interval from start of bridge anticoagulation to INR value reaching the standard for 2 consecutive days) of all enrolled patients were collected, and all patients were followed up for 4 weeks and thromboembolic or bleeding events were analyzed. Multivariate logistic regression was used to determine the independent prognostic factors of thromboembolic or bleeding events after MHVR receiving various bridging anticoagulant therapies. Results: A total of 217 patients were included in the study, including 120 patients in the UFH group and 97 patients in the LMWH group. Stroke occurred in two patients in the UFH group, while no stroke event occurred in the LMWH group. The incidence of bleeding events was significantly higher (9.28%(9/97) vs. 1.67%(2/120), P=0.02), while the drainage time, duration of stay in ICU, postoperative time, INR stabilization time were all significantly shorter in LMWH group than in UFH group (all P<0.05). Multivariate logistic regression analysis showed that bridging anticoagulation therapies (OR=0.18, 95%CI 0.04-0.86, P=0.03), fibrinogen level (OR=1.99, 95%CI 1.16-3.41, P=0.01) and creatinine level (OR=1.05, 95%CI 1.01-1.08, P=0.04) were independent prognostic factors for bleeding events. Conclusion: LMWH use is associated with increased risk of bleeding events, but can significantly reduce the drainage time, duration of stay in ICU, postoperative time, INR stabilization time in patients post MHVR surgery.
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Humans , Anticoagulants/therapeutic use , Heart Valves , Heparin , Heparin, Low-Molecular-Weight , Thromboembolism/drug therapyABSTRACT
OBJECTIVE: To evaluate the safety in patients with heart valves replacement undergoing general surgery.METHODS: From 2010 to 2016,the clinical data of demographic characteristics,comorbidities,preoperative laboratory tests,and surgical operation related information of 164 cases with heart valves replacement after general surgery in Department of General Surgery,Zhongshan Hospital,Fudan University,were collected retrospectively.Univariate and multivariate analysis were applied to identify the risk factors associated with major bleeding events and non-hemorrhagic complications.RESULTS: Among 164 cases,12 patients(7.3%) presented major bleeding events,and 27 patients(16.5%)presented non-hemorrhagic complications.Seven patients(4.3%) suffered grade Ⅲ perioperative complications and one patient(0.6%) died(grade V).The incidence of major bleeding events was significantly higher in emergent patients than in elective surgery(25.0% vs.4.9%,P=0.007),and there was no significant difference in the incidence of nonhemorrhagic complications(15.0% vs.16.7%,P=1.000).Significant risk factors for major bleeding events included emergency surgery [odds ratio(OR) 6.455,95% confidence interval(CI) 1.672-24.472,P=0.008],operative time≥60 minutes(OR=14.989,95%CI 1.683-2015.140,P=0.009),as well as aortic valve replacement(OR=3.408,95%CI 1.001-12.191,P=0.050).Significant risk factors for non-hemorrhagic complications were gastrointestinal surgery(OR=4.323,95% CI 1.740-11.629,P=0.002) and atrial fibrillation(OR=2.717,95% CI 1.053-7.022,P=0.037).CONCLUSION: Patients with heart valve replacement can undergo elective general surgery safely.The risk of hemorrhagic complications in emergency surgery is acceptable,as long as the standardized perioperative anticoagulation and antithrombotic management is carried out.
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@#Objective To explore the safety and efficacy of mobile APP in telemanagement for patients who received oral warfarin anticoagulant therapy after mechanical heart valve replacement. Methods A prospective cohort study was performed. According to the inclusion and exclusion criteria, a total of 80 patients who underwent mechanical heart valve replacement for more than half a year and received oral warfarin anticoagulant therapy in outpatient department were included in our hospital from January 1, 2017 to December 31, 2017. These patients were divided into a telemanagement group (40 paitents, telemanagement using mobile APP) and a control group (40 patients, anticoagulant management in outpatient clinics) according to patients' wishes and local hospital international normalized ratio (INR) monitoring conditions. After 12-month follow-up, clinical effect of the two groups was compared. The INR, time in therapeutic range (TTR), fraction in therapeutic range (FTTR), anticoagulation-related complications and patient satisfaction were analyzed. Results During the follow-up period of anticoagulation, there was no significant difference in INR between the two groups (P=0.732). The average interval of INR monitoring in the telemanagement group was 3-65 (21.4 ± 12.5) days, while that in the control group was 7-93 (39.6 ± 14.7) days (P=0.012). TTR was 42.7% (6 027.6 d/14 116.0 d) in the control group and 67.9% (10 168.6 d/14 972.0 d) in the telemanagement group (P=0.018). And FTTR in the two groups was 45.6% (144/316) and 67.1% (432/644), respectively (P=0.015). No serious thromboembolism or hemorrhage events occurred in the 80 patients during the 12-month follow-up period. There was no significant difference in the incidence of anticoagulation-related complications, general bleeding and embolism between the two groups (P>0.05). Conclusion For patients with stable anticoagulation after cardiac mechanical valve replacement, it is safe and effective to telemanagement by mobile APP. Telemanagement can increase the frequency of anticoagulation monitoring without increasing anticoagulation risk, meanwhile, it also could obtain more convenient and rapid consultation, save time and economic costs,and improve the quality of life and patient satisfaction.
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Objective To explore the effect of peer education among discharged patients after mechanical heart valve replacement. Methods A total of 84 patients undergoing mechanical heart valve replacement in hospital from August to December 2016 were enrolled and randomly divided into two groups, 42 cases in each group. All of the patients received routine discharge guidance and outpatient follow-up after discharge from hospital, based on the same medical treatment, the experimental group were given peer education, and the intervention was provided from one month to six month after discharge, afterwards, anticoagulant knowledge, anticoagulant therapy compliance and complication rates were compared between the two groups discharged the same day, 1 months, 3 months, and 6 months after discharge. Results There was no significant difference in each of the evaluation index between the two groups discharged the same day (P>0.05). The anticoagulant knowledge and anticoagulant therapy compliance of the experimental group were higher than those of the control group at 1, 3, 6 months after the intervention (χ2=6.102, 7.378, 12.210, P<0.05 or 0.01), and the incidence of complications was lower than that of the control group at 6 months after the intervention (χ2=3.859, 5.765, 8.278, P<0.05 or 0.01). At 6 months after intervention, the incidence of complications in the experimental group was lower than that in the control group (χ2=5.486, P<0.05). Conclusion Peer education among discharged patients after mechanical heart valve replacement can improve their anticoagulant knowledge and anticoagulant therapy compliance, and reduce the incidence of complications caused by inappropriate anticoagulation.
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Objective To study the long-term follow-up results of Ross surgery.Methods Between October 1994 and February 2009,58 consecutive patients underwent a Ross procedure at our institution.The right ventricular outflow tract was repaired with a cryopreserved pulmonary homograft.All patients were scheduled for a yearly study thereafter that ended at the time of death or at closure of the follow-up visit.Mean follow-up was (12.6 ± 5.8) years (range:4.5 to 18.2 years).Results There were two early deaths (3 ％)and one late death (2％).Acturial survival at 16 years was (94.8 ± 3.1) ％.One patient required reoperation 1.5 years after his first Ross operation.Of the 55 survival patients,42 patients(76％) were in NYHA functional class Ⅰ and 13 patients(24％) were in NYHA functional class Ⅱ.Grade 1 or grade 2 autograft regurgitation was observed in seven patients(12％) at one year after the surgery.The sinus of Valsalva diameters were all ＜ 40 mm in these seven patients.Mter surgery,freedom from hemodynamically relevant autograft regurgitation was(87.9 ± 2.8) ％ at 16 years,whose left ventricular function was significantly improved and left ventricular end-diastolic diameter recovered to normal over the long term.None of the patients required reoperation due to pulmonary homograft failure.Conclusion The Ross procedure can be safely performed in patients with aortic valve disease.To date,mortality,morbidity,and reoperation relates are very low.Reasons for these superior results may include the following:diameter of the aortic valve annulus matching that of the pulmonary valve and patients were monitored with antihypertensive medications to keep systolic blood pressure under 120mmHg(1 mmHg =0.133kPa) to delay pressure lesions to the pulmonary autograft.
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Objective: To explore the effects of genetic factors and non-genetic factors on warfarin dosage in pregnant women after heart valve replacement. Methods: Totally 68 pregnant women were treated with warfarin throughout pregnancy. PCR-chip method was used to detect the polymorphism of CYP2C9 and VKORC1 gene,and the clinical data were collected. The effects of genetic factors and non-genetic factors on stable dosage of warfarin were statistically analyzed. Results: CYP2C9, VKORCl genotypes and weight had sig-nificant effects on warfarin dosage. The three variables could explain 44. 6% of warfarin individual differences. Conclusion: Genetic factors have significant effect on warfarin dosage in pregnant patients, so the detection of genetic polymorphism of CYP2C9 and VKORCl can be applied to individualize warfarin dosage in pregnant patients with heart valve replacement.
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Objective To investigate the current status of self-management in patients after mechanical heart valve replacement(MHVR) and the influential factors. Methods The convenience sampling method was used to obtain the sample in Chongqing Province, and 400 participants after MHVR at a month in 3 top three hospitals were recruited (Department of Cardiothoracic Surgery, the First Hospital of Chongqing Medical University. The Second Clinical Medical College of Third Military Medical University. The Third Clinical Medical College of Third Military Medical University). Self-Management Scale for patients after Mechanical Heart Valve Replacement edited by ourselves were used to collect the data. Results The score of patients were 79-119 (96.81 ± 7.86) points. The influential factors were sex, age, education level and the resident manner. Conclusions The self-management level of patients after MHVR is not so bad, the male, advanced age, live with distant relatives or housemaid, low education level's patients' self-management ability are low, the medical workers should strenghen health education in these patients.
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Objective To explore the relationships among social support , belief about medicine and adherence to anticoagulation treatment,and mediating effect of belief about medicine on the relationship between social support and adherence to anticoagulation treatment among patients with mechanical heart valve replacement. Methods Totally 154 patients were recruited. The social support scale, the modified Chinese Version Morisky Medication Adherence Scale( MMAS-8) and belief about medicine scale were used and the information on patients were collected through clinic and telephone interviews. Results The social support was correlated with belief about medicine (r=0.441, P<0.05). The belief about medicine was correlated with adherence to anticoagulation treatment (r=0.441, P<0.05). The social support was correlated with adherence to anticoagulation treatment (r=0.300, P<0.05) . The mediator effect of the belief about medicine was tested between social support and adherence to anticoagulation treatment. In the result, with the influence of belief about medicine .The social support was not correlated with adherence to anticoagulation treatment ( B=0.020,P>0. 05). Conclusion Belief about medicine plays a completely mediating role in the relation between social support and adherence to anticoagulation treatment.
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Objective To explore the effect of cardiac valve replacement surgery in the medium term on patients with giant left ventricular and its related risk factors.Methods Retrospective analysis the clinical data of 82 cases of valvular heart disease with giant left ventricle underwent heart valve replacement surgery.To compare the size and function of heart between preoperation and postoperation,and explore the relevant risk factors affecting the prognosis.Results The left atrial diameter,left ventricular end diastolic diameter,and left ventricular systolic diameter (LVESD) were decreased after the operation,and the difference was statistically significant (P ＜ 0.05).There was no significant difference between left ventricular ejection fraction and left ventricular shortening rate.But the NYHA classification showed significant difference (P ＜ 0.05).The risk factors related to the prognosis of patients were preoperative LVESD value ＞6.0 cm,heart function NYHA classification in grade Ⅳ,postoperative unuse of ACEI drugs or β-blockers (P ＜ 0.05).Conclusion The perioperative mortality is low in patients with valvular heart disease and giant left ventricle after heart valve replacement surgery.The curative effect is satisfactory,the shape and size of the heart in the medium term have obvious reverse remodeling process,and the cardiac function is also improved.Preoperative LVESD value ＞6.0 cm,heart function NYHA classification in grade Ⅳ,postoperative unuse of ACEI drugs or β-blockers are the major risk factors affecting prognosis of patients.
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It is reviewed in this article that the current situation of patients′ adherence to anticoagulation with warfarin after mechanical heart-valve replacement and the measures to improve the situation. Now the adherence situation of the patients is not satisfying to some extent. There are many things we can do to improve the adherence of patients and get a better anticoagulant effect, such as enhancing the health education according to the different background of patients, strengthening the social and psychological support, carrying out effective follow-up and information communication with the patients, the use of the medicine branch box, importing the foreign managing model of self-test and self-manage, expanding the special outpatient service for anticoagulation instruction. We may get a better adherence of anticoagulation with warfarin and improve the prognosis of patients.
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It is reviewed in this article that the current situation of patients′ adherence to anticoagulation with warfarin after mechanical heart-valve replacement and the measures to improve the situation. Now the adherence situation of the patients is not satisfying to some extent. There are many things we can do to improve the adherence of patients and get a better anticoagulant effect, such as enhancing the health education according to the different background of patients, strengthening the social and psychological support, carrying out effective follow-up and information communication with the patients, the use of the medicine branch box, importing the foreign managing model of self-test and self-manage, expanding the special outpatient service for anticoagulation instruction. We may get a better adherence of anticoagulation with warfarin and improve the prognosis of patients.
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@#The patients with mechanical prosthetic valve replacement need anticoagulant therapy for all their life. The incidence of thromboembolism and anticoagulation-related bleeding events still account for major postoperative complications after mechanical heart valve replacement. Most of the complications happen in the first half year after operation. Therefore, early anticoagulation therapy is very important. Of course, so far most guidelines focus stating their opinions on long-term anticoagulant therapy. However, there is no consensus about anticoagulant therapy in the early period of postoperation. In this review, we summarize early anticoagulant therapy of the patients with mechanical heart valve replacement through consulting domestic and abroad relevant research in recent years and give an overview of the present situations of early anticoagulant therapy.
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Objective To investigate the cerebral protection of dexmedetomidine in patients with heart valve replacement under CPB.Methods Totally 80 cases of patients with heart valve replacement under CPB in Seventh people's hospital of Zhengzhou city from January 2015 to December 2015 were selected and divided into observation group and control group,40 cases in each group.Patients in observation group were treated with dexmedetomidine before anesthetic induction and during the operation,and patients in control group were treated with same dose of saline solution.The arterio-venous oxygen content difference (Da-jvO2),jugular venous oxygen saturation (SjvO2),cerebral oxygen extraction rate (CERO2),serum myelin basic protein (MBP),serum neuron-specific enolase (NSE),and S1003 protein content before anesthetic induction (T0) and when the ascending aorta open (T1),After 10 min of CPB (T2) and postoperative 6 h (T3) were compared between two groups,and occurring rates of MMSE and POCD were also compared.Results SjvO2 values of two groups at T1 were significant higher than T0 (P ＜ 0.05),Da-jvO2,and CERO2 were significant lower than T0 (P ＜ 0.05),SjvO2 values of observation group at T1 and T2 were significant higher than those of control group and Da-jvO2 and CERO2 were significant lower than those of control group (P ＜ 0.05);At T2 and T3,MBP levels of observation group and control group were significant higher than T0 (P ＜ 0.05),and those in observation group were significant lower than control group (P ＜ 0.05);At T1,T2,and T3 of observation group and control group were significant higher than T0 (P ＜0.05),and NSE levels of observation group at T1,T2,T3 were significant lower than those of control group (P ＜ 0.05),S-100β levels of observation group at T2 and T3 were significant lower than those of control group (P ＜ 0.05).After 7 d,MMSE score of observation group was significant higher than that of control group and POCD occurring rate was lower (P ＜ 0.05).Conclusion Dexmedetornidine can improve cerebral ischemia hypoxia state and reduce brain damage in patients with heart valve replacement under CPB.
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Objective To investigate influence on the quality of life of psychological intervention combined with hydrochlorothiazide on the treatment of the patients undergoing heart valve replacement. Methods The control group after heart valve replacement surgery were accepted the routine drug combined with hydrochlorothiazide, at this basis, the study group were received targeted nursing interventions. The changes of quality of life (SF-36) before and after cardiac valve replacement in the two groups were recorded. The effect in the two groups were compared. Results There was no statistically significant in SF-36 in the two groups before heart valve replacement; After treatment, the SF-36 scale scores in the 2 groups were significantly higher than that before treatment, and the SF-36 scale score in the study group was significantly higher than that in the control group (P<0.05). Conclusion The combination of hydrochlorothiazide and psychological intervention in the patients undergoing cardiac valve replacement can significantly improve the quality of life and improve the prognosis.