Recent advances in exercise training in cardiac rehabilitation of patients after cardiac valve surgery / 中国实用护理杂志

Patients after cardiac valve surgery generally suffered from low exercise capacity, and lack of exercise can cause impaired exercise tolerance, reduced quality of life, and prolonged length of hospital stay, increased the risk of death. Exercise, as the core of cardiac rehabilitation, played an irreplaceable role in improving the cardiopulmonary function, exercise capacity, and health-related quality of life of patients after cardiac valve surgery. This article mainly reviewed the types and methods of exercise training after cardiac valve surgery, and the strategies for promoting exercise intervention, so as to provide references for medical staff to perform exercise interventions for patients after cardiac valve surgery.

Risk factors for perioperative acute kidney injury in adult cardiac valve surgery with cardiopulmonary bypass / 临床麻醉学杂志

Objective To investigate the risk factors of acute kidney injury (AKI) in patients undergoing cardiac valve surgery with cardiopulmonary bypass (CPB).Methods A retrospective cohort database study was conducted, involving 1 349 patients undergoing heart valve surgery with CPB technique.Logistic regression was used to screen out the risk factors of AKI after the surgery.Results Of the 1 349 patients, the incidence of AKI in valve surgery was 28.4%.One year older (OR=1.05, 95%CI 1.03-1.06, P<0.001), diabetes (OR=2.11, 95%CI 1.22-3.68, P=0.008), anemia (OR=1.50, 95%CI 1.05-2.21, P=0.026), each additional basic serum creatinine of 1 mg/dl (OR=1.01, 95%CI 1.01-1.02, P=0.001), each additional operation time of 1 hour (OR=1.28, 95%CI 1.15-1.41, P<0.001), plasma transfusion during surgery (OR=1.50, 95%CI 1.14-1.97, P=0.004) were the independent risk factors for AKI in multivariate logistic regression model.Conclusion AKI is a common and serious complication following cardiac valve surgery.More attention should be paid to the patients with elder age, anemia, prolonged operation time, diabetes, increased basic serum creatinine and requirement of plasma transfusion during surgery.

Risk factors for early cognitive dysfunction after cardiac valve surgery / 医学研究生学报

Objective Postoperative cognitive dysfunction (POCD) is a common complication of cardiac surgery, which seriously affects the prognosis of the patient.This study aimed to explore the risk factors for early POCD in patients undergoing cardiac valve surgery and the correlation between early POCD and the serum S100B protein level.Methods Eighty patients underwent mitral valve replacement surgery in combination with tricuspid plasty.At 1 day before and 5 days after surgery, we assessed the cognitive function of the patients and divided them into a POCD and a non-POCD group.We obtained such data as the age, sex, education, New EuroSCORE Ⅱ, and preoperative NYHA cardiac function grades and left ventricle ejection fraction (LVEF) of the patients, collected the venous blood to determine serum S100B protein concentration by ELISA, and analyzed the independent risk factors of early POCD using single-factor and binary logistic regression analyses.Results POCD was found in 20 (25%) of the patients, , Logistic regression analysis showed the independent risk factors for early POCD to be hyperglycemia (OR=6.038, 95% CI: 1.202-30.337), operation time (OR=6.423, 95% CI: 1.276-32.332), and aspartate aminotransferase (AST, 2 times higher than normal) (OR=12.878, 95% CI: 2.289-72.445).The serum S100B protein concentrations in the POCD group were (1.9±0.3) μg/L and (1.7±0.4) μg/L at 48 and 72 hours after cardiopulmonary bypass, significantly lower than (2.4±0.4) μg/L and (2.1±0.3) μg/L at 30 minutes and 24 hours (P<0.05), and so was it in the non-POCD group at 72 than at 48 hours postoperatively ([1.4±0.4]) vs [1.5±0.4] μg/L, P<0.05).Conclusion Long operation time, perioperative hyperglycemia and high AST are independent predictors and the serum S100B protein level is a significant marker of early POCD.

Evaluation of simplified renal index for renal replacement therapy after cardiac valve surgery / 中华胸心血管外科杂志

Objective To validate the value of Simplified Renal Index Score(SRI) in predicting acute renal injury requiring renal replacement therapy(RRT-AKI) after cardiac valve surgery in Chinese adult patients.Methods An analysis was conducted for all the adult patients who underwent cardiac valve surgery from January 2010 to December 2014 in Changhai Hospital,Shanghai.A total of 3 183 adult patients were included.Based on SRI Score,the patients were divided into 3 risk stages:0 to 1 point,2 to 3 point,and 4 to 8 point.The incidence of RRT-AKI was compared between different stages.And the prediction value of the SRI model was assessed by area under the receiver operating characteristic curve (AU-ROC) and the model calibration was assessed with the Hosmer-Lemeshow (H-L) test.Results After surgery 52 (1.6％) patients developed acute kidney impairment and subsequently underwent renal replacement therapy.Patients with low values of simplified renal index (0-1),medium(2-3) and high values (4 and more) were found to have increasingly higher risk for renal replacement therapy of 0.8％ (95％ CI:0.005-0.012) 、3.8％ (95％ CI:0.026-0.052) 、20％ (95％ CI:0.010-0.720),respectively.TheAU-ROCwas0.68(95％ CI:0.610-0.760,P＜0.01).The H-L test was x2 =2.45,P=0.29.Conclusion SRI model gives a certain clinical significance,suggesting that high-values patients may occur RRT-AKI with a significantly higher risk than low-values patients.However,SRI model cannot give an accurate prediction value for RRT-AKI in Chinese adult patients after cardiac valve surgery.Direct clinical use of the model should be considered cautiously.

Clinical value of early application of nesiritide after cardiac valve surgery / 中国生化药物杂志

Objective To identify the protective effects of early application of nesiritide on myocardial injury and cardiac function after cardiac valve surgery.Metheds 78 patients with cardiac valve surgery in the hospital from November 2013 to February 2015 were randomly divided into nesiritide group(n=38) and control group(n=40).Nesiritide group received the routine treatment plus 24-72 hour treatment of nesiritide [0.01 ug/(kg · min)], and control group received only the routine treatment.Observation index:①Cardiac troponin (cTnI) and MB isoenzyme of creatine kinase (CK-MB): venous blood was tested before and after operation 0h, 24 h and 72 h;②Serum creatinine (SCr): venous blood was tested before and after surgery 7 days;③Left ventricular ejection fraction ( LVEF): echocardiography was done before and after operation 7 days;④ICU residence time and mechanical ventilation time.Results There was no significant difference between two groups in cTnI and CK-MB at 24 hour after operation.However, at 72 hour after operation, cTnI in nesiritide group was(5.10 ±2.03)ng/mL, lower than that in control group[(8.94 ±3.35)ng/mL,P<0.05];CK-MB in nesiritide group was (23.24 ±14.67U/L), lower than that in control group[(36.27 ±12.18)U/L,P<0.05].There was no significant difference in SCr level between two groups after operation.At 7 day after operation, LVEF improved significantly in nesiritide group[(60.47 ±8.60)%] comparing with control group [(54.60 ±10.92)%] (P <0.05).There was no significant difference between the groups in ICU residence time.However, the mechanical ventilation time was significantly shorter in nesiritide group[(3.14 ±1.95)d] comparing with control group[(4.29 ±2.25)d](P<0.05). Conclusion Early application of nesiritide could alleviate myocardial injury and improve cardiac function after cardiac valve surgery.

Performance of SinoSCORE in predicting in-hospital mortality and postoperative complications after cardiac valve surgery / 第二军医大学学报

Objective: To evaluate the performance of the Chinese system for cardiac operative risk evaluation (Sino SCORE) in predicting the in-hospital mortality and postoperative complications in patients undergoing cardiac valve surgery. Methods: The clinical data of patients undergoing valve surgery in Changhai Hospital between 2005 and 2011 were retrospectively analyzed. Sino SCORE was used to calculate the in-hospital mortality risk. The relationship of Sino SCORE result with postoperative complications (low cardiac output syndrome, renal failure, lung infection, application of intra-aortic balloon pump [IABP], prolonged ventilation, prolonged postoperative ICU stay and reoperation) was verified. Discrimination degree of the model was tested by determining the area under the receiver operating characteristic (ROC) curve, and calibration of the model was evaluated by Hosmer-Lemeshow goodness-of-fit test. The optimal cut-off points for postoperative complications, which could be well predicted by Sino SCORE, were obtained by Youden index. Results: The mean age of the 3 407 enrolled patients was (49. 2 ± 13. 3) years. The area under ROC was 0. 754 (95%CI: 0. 701-0. 806), indicating good discrimination power of the model in predicting in-hospital mortality. The overall in-hospital mortality was 3. 05% (104/3 407). The predicted in-hospital mortality by Sino SCORE was (3. 1 ± 0. 1)%. Hosmer-Lemeshow calibration test yielded χ2 = 9. 454, P = 0. 490, suggesting a high calibration ability of the model. The areas under ROC of low cardiac output syndrome, renal failure, and application of IABP were 0. 708, 0. 711, and 0. 718, respectively, suggesting that Sino SCORE had a satisfactory performance in predicting post-operative low cardiac output syndrome, renal failure, and application of IABP. And the optimal cut-off points for the above three complications predicted by Sino SCORE were 5. 5, 7. 5, and 6. 0, respectively. Conclusion: Sino SCORE has a better performance in predicting the in-hospital mortality risk in Chinese patients undergoing valve surgery, and it can better predict post-operative low cardiac output syndrome, renal failure, and application of IABP.

Clinical Implications and Risk Factors of Acute Pancreatitis after Cardiac Valve Surgery

PURPOSE: Acute pancreatitis is one of the potentially lethal complications that occurs after cardiac surgery. We tried to identify risk factors for and the prognosis of acute pancreatitis after cardiac valve surgery with cardiopulmonary bypass. MATERIALS AND METHODS: We retrospectively analyzed a database of consecutive patients who underwent cardiac valve surgery with cardiopulmonary bypass between January 2005 and April 2010 at our institution. Patients were classified as having acute pancreatitis based on serum lipase concentration and clinical symptoms (lipase > or =180 U/L or > or =60 U/L with relevant symptoms). RESULTS: Of the 986 patients who underwent cardiac valve surgery with cardiopulmonary bypass, 58 (5.9%) patients developed post-operative pancreatitis. Post-operative hospital stay was significantly longer (29.7+/-45.6 days vs. 12.4+/-10.7 days, p=0.005) and in-hospital mortality rate was higher (15.5% vs. 2.0%, p<0.001) in patients with post-operative pancreatitis than those without. Hypertension, chronic kidney disease, and peri-operative use of norepinephrine were identified as independent risk factors for developing pancreatitis after cardiac valve surgery. CONCLUSION: We found that acute pancreatitis after cardiac valve surgery requires longer hospitalization and increases the in-hospital mortality rate. Clinicians should be aware that patients could develop pancreatitis after cardiac valve surgery, especially in patients with hypertension and chronic kidney disease treated with norepinephrine.

Effect of rehabilitation nursing on patients after cardiac valve surgery / 中国康复理论与实践

@#ObjectiveTo study the effect of the rehabilitation nursing and movement training on patients after cardiac valve surgery.Methods26 cases who accepted cardiac valve surgery were assessed with psycho-physiological and cardiac function, then make single rehabilitation nursing measures. Movement training was being done for 20 days as well as mental convalescence and health education of rehabilitation.ResultsCardiac function of all cases was promoted 1-2 grade after rehabilitation. Exercise stress was raised and movement time was prolonged than that of before rehabilitation (P<0.01). The heart rate, systolic pressure, diastolic pressure, binomial product (HR×SBP) ane the lowered S-T segment were also improved significantly after rehabilitation whether in the state at rest or motion with equal time and stress (P<0.01-0.05).ConclusionsRehabilitation nursing and movement training can reduce complications after cardiac valve surgery, raise cardiac reserve, and lower myocardial oxygen consumption. Meanwhile, it can improve myocardial ischemia and raise cardio-pulmonary function. It also can improve quantity of patients' life.