Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 149
Filter
1.
Chinese Journal of Anesthesiology ; (12): 1079-1082, 2021.
Article in Chinese | WPRIM | ID: wpr-911320

ABSTRACT

Objective:To identify the risk factors for postoperative acute kidney injury (AKI) in patients undergoing off-pump coronary artery bypass grafting (OPCABG).Methods:The medical records of patients who underwent elective OPCABG from January 1, 2018 to December 31, 2020 from the Heart Center of Henan Provincial People′s Hospital, were retrospectively collected.The patient′s gender, age, body mass index, history of diabetes, history of hypertension, history of hyperlipidemia, history of chronic obstructive pulmonary disease, history of cerebrovascular disease, history of myocardial infarction, New York Heart Association classification of cardiac function, Killip classification, values of last left ventricular ejection fraction measured by transthoracic echocardiography before operation, glycosylated hemoglobin, glucose and serum creatinine, duration of operation, intraoperative fluid intake and output such as red blood cell infusion, crystal fluid, colloid fluid, autologous blood, blood loss and urine volume, intraoperative hypotension, perioperative maximal blood glucose difference (MGD) and serum creatinine concentrations within 48 h and 7 days were recorded.Postoperative AKI was defined according to the Kidney Disease Improving Global Outcomes criteria and the patients were divided into AKI group and non-AKI group according to whether AKI occurred after surgery.Logistic regression analysis was used to identify the risk factors for AKI after OPCABG.Results:A total of 1 203 patients were included in this study, and the incidence of AKI after OPCABG was 28.1%.Logistic regression analysis showed that body mass index, history of hypertension and perioperative MGD were risk factors for AKI after OPCABG ( P<0.05). Conclusion:Body mass index, history of hypertension and perioperative MGD are risk factors for AKI after OPCABG.

2.
International Journal of Surgery ; (12): 384-387, 2021.
Article in Chinese | WPRIM | ID: wpr-907447

ABSTRACT

Objective:To explore the strategies for the treatment of difficult iliac artery approach in endovascular repair of abdominal aortic aneurysm.Methods:The clinical data of 275 patients with abdominal aortic aneurysm who underwent endovascular surgery at the Department of Vascular Surgery, People′s Hospital of Xinjiang Uygur Autonomous Region from March 2010 to March 2019 were retrospectively analyzed, and the general clinical data such as age, gender, and comorbidities of the patients were recorded. The resource index was to carry out corresponding measures to perform surgery for patients with difficult access, analyze the incidence of the type of difficult access, treatment measures and effects.Results:Two hundred and seventy-five patients underwent endovascular repair, 78 of them (28.3%) had difficulty in accessing the iliac artery, including 29 cases (10.5%) with mild iliac artery stenosis, 7 cases (2.54%) with severe stenosis, and 3 cases with occlusion ( 1.09%), 39 cases (14.2%) were twisted. For patients with vascular twist, super-hard guide wire was used to correct iliac artery angulation. For patients with iliac artery stenosis, balloon dilation was performed. For severe stenosis, the artificial blood vessel was passed through the lateral peritoneum. After road transplantation, stent placement and other treatments were successfully performed endovascular repair.Conclusions:Pathway vascular disease can cause difficulties in endovascular treatment of abdominal aortic aneurysms. Endovascular repair can be successfully performed after corresponding treatments according to different difficulties, and the long-term patency rate is good.

3.
Rev. bras. cir. cardiovasc ; 35(6): 906-912, Nov.-Dec. 2020. tab, graf
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1143983

ABSTRACT

Abstract Objective: To investigate the correlation between cardiac output values and renal neutrophil gelatinase-associated lipocalin (NGAL) levels as a biomarker of renal ischemia. Methods: Forty patients, who underwent off-pump coronary artery bypass (OPCAB) surgery and in whom the positioning of the heart was fixed with simple suspension sutures without a mechanical stabilizer, were included in the study. Continuous cardiac output (CO) measurements were recorded using the arterial pressure waveform analysis method (FloTrac sensor system) in the perioperative period. CO was recorded every minute during non-anatomical cardiac positioning for left anterior descending artery (LAD), diagonal artery (D), circumflex artery (Cx), and right coronary artery (RCA) bypasses. Serum NGAL samples were analyzed in the preoperative, perioperative, and postoperative periods. Results: The CO values measured at various non-anatomical cardiac positions during distal anastomosis for LAD, D, Cx, and RCA were significantly lower than pre- and postoperative values measured with the heart in normal anatomical position (3.45±0.78, 2.9±0.71, 3.11±0.56, 3.19±0.81, 5.03±1.4, and 4.85±0.78, respectively, P=0.008). There was no significant difference between CO values measured at various non-anatomical cardiac positions during distal anastomosis. Although there was no significant correlation between NGAL levels and age, duration of surgery, preoperative CO, D-CO, RCA-CO, and postoperative CO measurements, there was a significant correlation between NGAL levels and LAD-CO (P=0.044) and Cx-CO (P=0.018) at the postoperative 12th hour. Conclusion: Full revascularization may be achieved by employing the OPCAB technique while using simple suspension sutures without a mechanical stabilizer and by providing safe CO levels and low risk of renal ischemia.


Subject(s)
Humans , Male , Coronary Artery Bypass, Off-Pump , Lipocalin-2/metabolism , Cardiac Output , Coronary Vessels , Kidney
4.
Rev. bras. cir. cardiovasc ; 35(5): 797-814, Sept.-Oct. 2020. tab, graf
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1137348

ABSTRACT

Abstract Objective: There is currently much debate about which patients would benefit more after on- or off-pump coronary artery bypass grafting (CABG). The aim of this meta-analysis and meta-regression is to investigate the effect of age on short-term clinical outcomes after these approaches. Methods: To identify potential studies, systematic searches were carried out in the Excerpta Medica dataBASE (EMBASE), PubMed, Web of Science, and the Cochrane Central Register of Controlled Trials (CENTRAL). The search strategy included the key concepts of "cardiopulmonary bypass" AND "coronary artery bypass grafting" AND "off pump" OR "on pump". This was followed by a meta-analysis and meta-regression investigating the effect of age on the incidences of stroke, myocardial infarction (MI), and mortality. Results: Thirty-seven studies including 15,324 participants were analysed. Overall, there was a significant odds reduction for patients receiving off-pump CABG suffering a stroke (odds ratio [OR] 0.770, 95% confidence intervals [CI] 0.594, 0.998, P=0.048); however, when patients were subdivided according to different age bands, this difference disappeared. There were also no significant differences in the odds of mortality (OR 0.876, 95% CI 0.703, 1.093, P=0.241) or MI (OR 0.937, 95% CI 0.795, 1.105, P=0.439). Meta-regression analysis revealed no significant relationship between age and stroke (P=0.652), age and mortality (P=548), and age and MI (P=0.464). Conclusion: Patients undergoing CABG are becoming older and may suffer from multiple comorbidities increasing their risk profile. However, with respect to short-term clinical outcomes, the patient's age does not help in determining whether off- or on-pump is superior.


Subject(s)
Humans , Male , Stroke/etiology , Stroke/epidemiology , Coronary Artery Bypass, Off-Pump/adverse effects , Myocardial Infarction , Postoperative Complications , Quality of Life , Coronary Artery Bypass , Treatment Outcome
5.
Rev. bras. cir. cardiovasc ; 35(3): 396-398, May-June 2020. tab, graf
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1137278

ABSTRACT

Abstract Coronary artery bypass grafting is a commonly performed procedure for coronary revascularization. We describe the successful management of left ventricular dissecting hematoma, caused by the tissue stabilizer, while performing off-pump coronary artery bypass graft procedure.


Subject(s)
Humans , Coronary Artery Bypass, Off-Pump/adverse effects , Heart Ventricles/surgery , Treatment Outcome , Hematoma/surgery , Hematoma/etiology , Hematoma/diagnostic imaging
6.
Chinese Journal of Geriatrics ; (12): 47-50, 2020.
Article in Chinese | WPRIM | ID: wpr-869323

ABSTRACT

Objective To analyze the clinical efficacy of coronary artery bypass grafting(CABG)in patients of advanced age with left main coronary artery disease(LMCAD).Methods From 2005 to 2014,101 elderly patients (≥ 80 years)with LMCAD underwent off-pump CABG in our hospital.Among them,82 were male and 19 were female,with an average age of(81.4 ± 1.7)years.Seventy-six cases(75.2 %) had significant left main stenosis (≥ 70 %) and twenty-five cases had left main stenosis less than 70%.The average left ventricular end diastolic diameter was(48.2 ± 8.3) cm;left ventricular ejection fraction was more than 50% in 89 cases and 30% to 50/% in 12 cases.Fourteen cases had mitral insufficiency and one had ventricular aneurysm.In addition,56 patients had New York Heart Association functional classification Ⅰ to Ⅱ,and 45 patients had classification]] to Ⅳ.Ninety-nine patients had Canadian Vascular Society(CCS)classification of angina pectoris Ⅰ to Ⅲll,two had classification Ⅳ and thirteen had acute myocardial infarction.Six patients were implanted with intra-aortic balloon counterpulsation before CABG.Results The average operation time was(3.9 ± 0.8) h,the average number of bridging vessels were (3,0 ± 1.0) roots,ICU monitoring time was(50.2 ± 46.0) h,and ventilator assisted breathing time was (42.9 ± 68.5) h.Six patients (5.9 %) had secondary thoracotomy hemostasis,five(4.9 %) had secondary tracheal intubation,and four(4.0 %)had continuous dialysis.Intra-aortic balloon counterpulsation was implanted in 3cases (2.9 %) during operation and in 11 cases(10.9 %) after operation.Two cases (2.0 %) had perioperative myocardial infarction and 8 cases (7.9%) died after operation during hospitalization.The median follow-up time was 6(1-11)years,and 17(16.8%)had all-cause mortality.Conclusions Although the two independent high-risk factors,old age and left main stenosis often coexist,off-pump CABG and perioperative management are still safe and effective treatments.

7.
Chinese Journal of Geriatrics ; (12): 47-50, 2020.
Article in Chinese | WPRIM | ID: wpr-798988

ABSTRACT

Objective@#To analyze the clinical efficacy of coronary artery bypass grafting(CABG)in patients of advanced age with left main coronary artery disease(LMCAD).@*Methods@#From 2005 to 2014, 101 elderly patients(≥80 years)with LMCAD underwent off-pump CABG in our hospital.Among them, 82 were male and 19 were female, with an average age of(81.4±1.7)years.Seventy-six cases(75.2%)had significant left main stenosis(≥70%)and twenty-five cases had left main stenosis less than 70%.The average left ventricular end diastolic diameter was(48.2±8.3)cm; left ventricular ejection fraction was more than 50% in 89 cases and 30% to 50% in 12 cases.Fourteen cases had mitral insufficiency and one had ventricular aneurysm.In addition, 56 patients had New York Heart Association functional classification Ⅰ to Ⅱ, and 45 patients had classification Ⅲ to Ⅳ.Ninety-nine patients had Canadian Vascular Society(CCS)classification of angina pectoris Ⅰto Ⅲ, two had classification Ⅳ and thirteen had acute myocardial infarction.Six patients were implanted with intra-aortic balloon counterpulsation before CABG.@*Results@#The average operation time was(3.9±0.8)h, the average number of bridging vessels were(3.0±1.0)roots, ICU monitoring time was(50.2±46.0)h, and ventilator assisted breathing time was(42.9±68.5)h.Six patients(5.9%)had secondary thoracotomy hemostasis, five(4.9%)had secondary tracheal intubation, and four(4.0%)had continuous dialysis.Intra-aortic balloon counterpulsation was implanted in 3cases(2.9%)during operation and in 11 cases(10.9%)after operation.Two cases(2.0%)had perioperative myocardial infarction and 8 cases(7.9%)died after operation during hospitalization.The median follow-up time was 6(1-11)years, and 17(16.8%)had all-cause mortality.@*Conclusions@#Although the two independent high-risk factors, old age and left main stenosis often coexist, off-pump CABG and perioperative management are still safe and effective treatments.

8.
Rev. bras. cir. cardiovasc ; 34(1): 76-84, Jan.-Feb. 2019. tab, graf
Article in English | LILACS | ID: biblio-985233

ABSTRACT

Abstract Postoperative cognitive dysfunction is a common complication following cardiac surgery. The incidence of cognitive dysfunction is more pronounced in patients receiving a cardiac operation than in those undergoing a non-cardiac operation. Clinical observations demonstrated that pulsatile flow was superior to nonpulsatile flow, and membrane oxygenator was superior to bubble oxygenator in terms of postoperative cognitive status. Nevertheless, cognitive assessments in patients receiving an on-pump and off-pump coronary artery bypass surgery have yielded inconsistent results. The exact mechanisms of postoperative cognitive dysfunction following coronary artery bypass grafting remain uncertain. The dual effects, neuroprotective and neurotoxic, of anesthetics should be thoroughly investigated. The diagnosis should be based on a comprehensive cognitive evaluation with neuropsychiatric tests, cerebral biomarker inspections, and electroencephalographic examination. The management strategies for cognitive dysfunction can be preventive or therapeutic. The preventive strategies of modifying surgical facilities and techniques can be effective for preventing the development of postoperative cognitive dysfunction. Investigational therapies may offer novel strategies of treatments. Anesthetic preconditioning might be helpful for the improvement of this dysfunction.


Subject(s)
Humans , Postoperative Complications/etiology , Coronary Artery Bypass/adverse effects , Cognitive Dysfunction/etiology , Postoperative Complications/diagnosis , Postoperative Complications/prevention & control , Risk Factors , Electroencephalography , Cognitive Dysfunction/diagnosis , Cognitive Dysfunction/prevention & control
9.
Rev. bras. cir. cardiovasc ; 34(1): 111-113, Jan.-Feb. 2019. tab, graf
Article in English | LILACS | ID: biblio-985232

ABSTRACT

Abstract We report a case of a 23-year-old man who was diagnosed with Kawasaki disease that progressed to a coronary aneurysm in the left main coronary artery (LMA). He had suffered from acute coronary syndrome and then underwent an emergent percutaneous coronary angioplasty, in which a polyurethane-covered stent was placed inside the aneurysm. The stent was thrombosed one year later, despite the patient had been treated with anticoagulant and antiplatelet therapy. Emergency percutaneous intervention was then performed. LMA was reopened and stent malposition was observed. Therefore, urgent coronary bypass grafting was performed in which a high degree of competitive flow was observed through the reopened stent. LMA was ligated at the inflow of the aneurysm, resulting in an improvement of graft flow. Left main ligature has not been previously reported.


Subject(s)
Humans , Male , Young Adult , Coronary Aneurysm/surgery , Coronary Aneurysm/etiology , Coronary Artery Bypass/methods , Mucocutaneous Lymph Node Syndrome/surgery , Mucocutaneous Lymph Node Syndrome/complications , Coronary Aneurysm/diagnostic imaging , Treatment Outcome , Acute Coronary Syndrome/surgery , Computed Tomography Angiography/methods , Ligation , Mammary Arteries/surgery
10.
Rev. bras. cir. cardiovasc ; 34(1): 62-69, Jan.-Feb. 2019. tab, graf
Article in English | LILACS | ID: biblio-985230

ABSTRACT

Abstract Objective: This study aims to compare the early and medium outcomes of on-pump beating-heart (OPBH) coronary artery bypass grafting (CABG) and off-pump CABG (OPCABG) in patients with left ventricular ejection fraction (LVEF) between 30% and 40%. Methods: This is a retrospective study of ischemic heart disease patients with LVEF between 30% and 40% who underwent surgical revascularization from January 2013 to December 2017. Patients were divided into OPBH group (n=44) and OPCABG group (n=68), according to the surgical method. Clinical material with early and medium outcomes were investigated and compared between these groups. Results: The two groups had similar baseline. Two OPBH patients and 3 OPCABG patients died in the hospital, which had no statistical significance (P>0.05). OPBH patients received a greater number of grafts (3.74±0.84) and presented more improved LVEF (45.92±7.11%) than OPCABG patients (3.36±0.80) and (42.81±9.29%), respectively, which had statistical significance (P<0.05). An increased amount of drainage during the first 12 hours was found in the OPBH group (P<0.05). Reoperation for bleeding, duration of mechanic ventilation, and other early outcomes had no statistical significance between the two groups. During the medium-time follow-up, OPBH patients showed significantly lower major adverse cardiovascular events (MACE)-free survival time (P=0.049) than OPCABG patients. Conclusion: The OPBH technique was a safe and an acceptable alternative for surgical revascularization in patients with moderate left ventricular dysfunction which provided better mid-term MACE-free survival compared with OPCABG.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Coronary Artery Bypass/methods , Ventricular Dysfunction, Left/surgery , Coronary Artery Bypass, Off-Pump/methods , Stroke Volume , Time Factors , Severity of Illness Index , Echocardiography/methods , Coronary Artery Bypass/mortality , Retrospective Studies , Risk Factors , Treatment Outcome , Myocardial Ischemia/surgery , Ventricular Dysfunction, Left/mortality , Statistics, Nonparametric , Risk Assessment , Coronary Artery Bypass, Off-Pump/mortality , Kaplan-Meier Estimate , Hemodynamics
11.
Article in Chinese | WPRIM | ID: wpr-753152

ABSTRACT

To compare short‐and mid‐term therapeutic effect on aged patients with multi‐vessel coronary disease between minimally invasive coronary artery bypass grafting (MIDCAB) and coronary artery bypass grafting (CABG).Methods : A total of 72 patients with multi‐vessel disease , who were suitable for MIDCAB from 2016 to 2018 , were regarded as MIDCAB group .Another 96 patients with multi‐vessel disease , who were not suitable for MIDCAB , were enrolled as CABG group (received selective on‐pump CABG).Clinical data and incidence of major adverse cardio‐ and cerebrovascular events (MACCE ) within two‐year follow‐up were compared between two groups.Results : Men percentage of MIDCAB group was significantly higher than that of CABG group (83. 3% vs. 67. 7%, P=0.022) ; compared with CABG group , there were significant reductions in percentages of left anterior descending proximal lesions (61.5% vs.34.7%) and chronic total occlusion disease (57.3% vs.34. 7%) in MID‐CAB group ( P<0. 01 both) , there were no significant difference in other indexes between two groups , P> 0. 05 all.All subjects were followed up for two years , follow‐up rate was 90. 5% .There were no significant difference in incidence rates of all‐cause death and MACCE between two groups , P>0.05 all.Conclusion : There is no signifi‐cant difference in incidence rate of short‐and mid‐term events between CABG and MIDCAB in patients with multi‐vessel coronary disease .MIDCAB is recommended for proper patients in clinic .

12.
Article in Chinese | WPRIM | ID: wpr-753120

ABSTRACT

Objective :To compare short-term and midterm therapeutic effect between sirolimus-eluting stent implan-tation (SES-PCI) and coronary artery bypass graft (CABG) in aged patients with coronary heart disease (CHD) and multi-vessel coronary disease (MVD).Methods : Aged MVD patients undergoing selective revascularization were en-rolled and divided into CABG group (n=301) and SES-PCI group (n=289).Major adverse cardio-and cerebrovas-cular events (MACCE) were followed up for 30d ,one ,two and five years .Logistic multi-factor regression was used to analyze independent risk factors for different therapeutic methods .Results : Compared with CABG group after 30d follow-up ,there was significant reduction in all-cause mortality (6-3% vs.2-8%) and significant rise in a sec-ond revascularization rate (RVR ,1-3% vs.8-3%) in SES-PCI group , P<0-05 or <0-01 ;compared with CABG group during one ,two and five-year follow up ,there were significant reductions in all-cause mortality [one year :(11-6% vs.4-8%) ,five years :(23-3% vs.12-1%)] and incidence rate of cerebrovascular accidents [one year :(8-6% vs .3-5%) ,five years :(18-3% vs.6-9%)] ,and significant rise in incidence rate of non-fatal myocardial infarction [one year :(6-6% vs.11-8%) ,five years :(12-0% vs.24-9%)] and a second RVR [one year :(3-0%vs.16-3%) ,five years :(9-3% vs.24-6%)] in SES-PCI group , P<0-05 or <0-01- Logistic multi-factor regres-sion analysis indicated that DM and EH were independent risk factors for SES-PCI (OR= 45-772 ,13-218 , P=0-001 both) ,while peripheral vascular disease was independent protective factor for SES-PCI (OR= 0-007 , P=0-001).Conclusion : Compared with CABG ,there are significant reductions in short-term and midterm all-cause mortality ,and significant rise in a second RVR in MVD patients undergoing PCI .

13.
Chinese Journal of Geriatrics ; (12): 516-519, 2019.
Article in Chinese | WPRIM | ID: wpr-745548

ABSTRACT

Objective To evaluate the effect of Levosimendan on the prognosis in patients with severe coronary heart disease after operation.Methods A total of 485 severe coronary disease patients undergoing coronary artery bypass grafting from Teda International Cardiovascular Hospital and the Cardiac Surgery Department of the First Affiliated Hospital of China Medical University from May 2014 to June 2016 were enrolled.Of them,45 cases receiving Levosimendan postoperatively were assigned to the Levosimendan group,and according to propensity score matching,another 45 cases were selected as the control group in this study.Clinical data before treatment had no difference between the groups (P > 0.1).Postoperative prognosis was compared between the two groups.Results There were significant differences in heart rate,mean arterial pressure,central venous pressure,cardiac output and other hemodynamic parameters between the two groups 48h after operation.The heart ultrasound results showed that the left ventricular ejection fraction(IVEF) was increased [(0.53±0.12) %vs.(0.46±0.09)%,t =2.594,P=0.002],the postoperative ventilation time was reduced [(46.8±11.3) h vs.(58.5±16.3) h,t=-2.031,P=0.045]and the onset of bowel sounds became early [(16.5±5.9) h vs.(18.7±10.1) h,t =1.592,P=0.039]in the levosimendan group than in the control group 48h after operation.The incidences of new-onset acute kidney injury(20 % and 40 %,x2 =6.702,P =0.018),new-onset postoperative atrial fibrillation (15.6% and 44.4%,x2 =6.156,P =0.023) and perioperative myocardial infarction(11.1 % and 33.3%,x2 =6.429,P =0.021) had significant differences between the two groups(P<0.05),but there was no difference in ICU retention time,1-month mortality after operation,malignant arrhythmia incidence and auxiliary equipment use (P > 0.05).Conclusions Levosimendan can improve the early prognosis of severe coronary disease patients undergoing coronary artery bypass grafting and reduce the occurrence of postoperative organ dysfunction.

14.
Chinese Journal of Geriatrics ; (12): 508-512, 2019.
Article in Chinese | WPRIM | ID: wpr-745546

ABSTRACT

Objective To investigate the relationship between mean platelet volume(MPV)and saphenous vein graft restenosis in patients receiving coronary artery bypass grafting(CABG),and to analyze the clinical significance of MPV in the prediction of restenosis after CABG.Methods A total of 354 patients admitted into Tianjin chest hospital from September 2009 to September 2014 with suspected myocardial ischemic events 3 to 5 years after CABG treatment was enrolled for a retrospective analysis.According to the coronary angiography(CAG)results,patients were divided into the vein bridge vascular lesion group(saphenous vein graft diseases,SVGD)(n=233)and the venous bridge vascular patency group(saphenous vein graft,SVG)(n=121).Paired t test was used to analyze the relationship between different factors and the bridge vascular patency.The binary logistic regression was used to analyze the effects of MPV and other factors on bridge vascular patency.Venous bridge stenosis > 50% was considered to be clinically significant and to damage myocardial blood supply.Results The MPV was higher in the SVGD group than the SVG group [(10.2±1.5)fl vs.(9.6±1.5)fl,P<0.01].The logistic regression analysis showed that MPV(OR =1.268,95%CI:1.053-1.570,P=0.014),age(OR =1.007,95%CI:1.038-1.117,P=0.000),gender (OR=0.452,95%CI:0.250-0.816,P=0.008),diabetes mellitus(OR=2.319,95%CI:1.221-4.405,P =0.010)were the independent risk factors for venous bridge stenosis in the two groups,gender(OR=0.495,95%CI:0.251-0.976,P=0.042),diabetes mellitus(OR =2.237,95%CI:1.105-4.527,P =0.025),MPV(OR=1.334,95%CI;1.050 1.694,P=0.018),fibrinogen(OR=1.654,95%CI:1.020-2.682,P =0.041)were the independent risk factors for venous bridge stenosis in non-elderly patients,and age(OR =1.178,95%CI:1.116-1.244,P =1.178)was an independent risk factor for vein graft stenosis in elderly patients.The restenosis rate was higher in patients with MPV ≥ 12 fl(92.6% or 25/27) than in the patients with MPV < 12 fl(63.6% or 208/327).The receiver operating characteristics(ROC) curve showed that the areas under the curve of MPV,age,gender,diabetes,fibrinogen were 0.610,0.657,0.394,0.626,0.654,respectively,and the area under the curve of joint diagnosis was 0.796,showing that joint prediction value was higher than any single prediction value(P<0.01).Conclusions MPV level is an independent risk factor for vein graft stenosis,and has higher predictive value in combination with age,gender,diabetes and fibrinogen.

15.
Article in Chinese | WPRIM | ID: wpr-745455

ABSTRACT

Objective To evaluate the prognostic value of peak ejection rate (PER) and peak filling rate (PFR) in patients with left ventricular systolic dysfunction (LVSD) after acute myocardial infraction (AMI).Methods A total of 123 patients (103 males,20 females,age:(60.6± 11.2) years) with LVSD after AMI who underwent 99Tc-methoxyisobutylisonitnle (MIBI) gated SPECT myocardial perfusion imaging (GSMPI) from January 2014 to December 2015 were retrospectively analyzed.Summed rest score (SRS) and total perfusion deficit (TPD) were acquired by using quantitative perfusion SPECT (QPS) soft-ware.Left ventricular ejection fraction (LVEF),end-diastolic volume (EDV),end-systolic volume (ESV),PER,and PFR were calculated by using quantitative gated SPECT (QGS) software.The clinical parameters of patients were recorded and the cardiac events were taken as the endpoint of follow-up (median time:27 (range:9-50) months).Pearson correlation was used to analyze the correlation between PER and PFR.Receiver operating characteristic (ROC) curve was used to evaluate optimal cut-off values of PER and PFR for predicting cardiac events.Kaplan-Meier survival analysis and Cox proportional hazards model were also used for data analysis.Results There was a great correlation between PER and PFR (r =-0.931,P<0.001).Optimal cut-off values of PER and PFR for predicting cardiac events were-1.10 EDV/s and 1.09 EDV/s respectively.Kaplan-Meier survival analysis showed that cumulative survival rate without cardiac events was lower in patients (n=48) with-PER≤ 1.10 EDV/s than that in patients (n=75) with-PER> 1.10 EDV/s (16.7% vs 66.7%;x2=60.096,P<0.001),and the same rate in patients (n=50) with PFR ≤ 1.09 EDV/s was lower than that in patients (n=73) with PFR>1.09 EDV/s (16.0% vs 68.5%;x2=74.771,P<0.001).Cox multivariate analysis showed that PER (hazard ratio (HR)=0.40,95% CI:0.20-0.83) and PFR (HR=0.22,95% CI:0.12-0.47) were independent predictors for cardiac events.Conclusion There is a great correlation between PER and PFR in patients with LVSD after AMI and they are independent predictors for cardiac events.

16.
Journal of Chinese Physician ; (12): 347-350, 2019.
Article in Chinese | WPRIM | ID: wpr-744874

ABSTRACT

Objective To investigate the difference of curative effects and prognosis between coronary artery bypass grafting with and without cardiopulmonary bypass.Methods 152 patients who were operated using off-pump coronary artery bypass grafting (OPCABG) and 107 patients who were performed with on-pump coronary artery bypass grafting (CABG) in the authors'department during the period from October 2013 to October 2017 were included in the study.The differences of postoperative recovery and major complications between the two groups were analyzed.Results Compared with CABG group,patients in OPCABG group had shorter intensive care unit (ICU) monitoring time,electrocardio-monitoring time,duration of antibiotic treatment,time of drainage tube intubation,mechanical ventilation time,arterial piezometer tube monitoring time and length of hospital stay (P < 0.05).And postoperative draining fluid volume in patients of OPCABG group was also less than that in CABG group (P < 0.05).Additionally,there was no difference between the two groups in postoperative parameters including renal insufficiency,using intra-aortic balloon pump (IABP) machine,perioperative myocardial infarction,second operation for hemorrhage,the occurrence of postoperative arrhythmias and cerebrovascular accident (P > 0.05).However,the incidence of postoperative pulmonary infection was significantly higher in patients of CABG group than that in OPCABG group (P < 0.05).Conclusions The incidence of postoperative pulmonary infection was significantly decreased in OPCABG group compared with that in CABG group.And the postoperative recovery of patients undergoing off-pump coronary artery bypass grafting was superior to that of patients undergoing onpump coronary artery bypass grafting.

17.
Chinese Journal of Geriatrics ; (12): 985-988, 2019.
Article in Chinese | WPRIM | ID: wpr-797875

ABSTRACT

Objective@#To conduct a clinical analysis of off-pump coronary artery bypass grafting(CABG)in elderly patients with diabetes mellitus.@*Methods@#Clinical data of 115 elderly patients with or without diabetes mellitus undergone off-pump CABG from January 2012 to June 2018 were retrospectively analyzed.The impact of diabetes mellitus on the prognosis in elderly patients undergone off-pump CABG was analyzed.@*Results@#Compared with elderly non-diabetic patients, the incidences of pulmonary infection, perioperative myocardial infarction, neurological complications, psychiatric symptoms, low cardiac output syndrome, rethoracotomy, respiratory failure, arrhythmia, postoperative 30-day mortality, blood transfusion volume, mechanical ventilation time, postoperative 24-hour drainage volume, the length of hospital stay and large doses of dopamine usage(>10 μg·kg-1·min-1)increased lightly in elderly diabetic patients after off-pump CABG, but the difference had no statistical significance(all P>0.05). The incidences of postoperative renal insufficiency and incision complications were higher in elderly diabetic patients than in elderly non-diabetic patients(χ2=3.736、1.237, P=0.021、0.037).@*Conclusions@#Off-pump CABG is safe and effective for elderly diabetic patients if their blood glucose levels are controlled reasonably well.

18.
Chinese Journal of Surgery ; (12): 187-193, 2019.
Article in Chinese | WPRIM | ID: wpr-810493

ABSTRACT

Objective@#To investigate the influence of different discontinuation time of aspirin and clopidogrel before off-pump coronary artery bypass grafting (OPCABG) on postoperative bleeding and blood products transfusion requirement.@*Methods@#Three hundred and fifty-three coronary artery disease patients who underwent OPCABG from January 2017 to January 2018 at Department of Cardiac Surgery, Zhongshan Hospital, Fudan University were retrospectively analysed. There were 268 males and 85 females, aged (66.0±9.1)years. All patients were divided into three groups: (1) guideline-recommended group: patients who discontinued clopidogrel for >5 days without discontinuing aspirin before surgery; (2) without discontinuing group: patients who discontinued clopidogrel for ≤5 days without discontinuing aspirin before surgery; (3) discontinuing group: patients who discontinued clopidogrel for >5 days with discontinuing aspirin before surgery. Postoperative bleeding recorded as chest tube drainage (CTD) volume and blood products transfusion requirement and perioperative complications were recorded. CTD volumes within 12 hours after surgery between groups were compared by Mann-Whitney U tests, CTD volumes after 12 hours postoperatively were compared by repeated measures analysis of variance and blood products transfusion and complications incidence were compared by χ2 test or Fisher′s precise test.@*Results@#The 12 hours CTD volumes of guideline-recommended group, without discontinuing group, discontinuing group after surgery were 280(153) ml (M(QR)), 291(229) ml, 225(161) ml, respectively. There were no significant differences in postoperative 12 hours CTD volumes (P=0.865), red blood cells transfusion incidence (χ2=2.626, P=0.149) and fresh frozen plasma (FFP) transfusion incidence (χ2=1.258, P=0.324) between guideline-recommended group and without discontinuing group. However, the 12 hours CTD volumes were significantly higher in guideline-recommended group patients compared with disconutinuing group patients (U=5 247, P=0.002). No significant differences were observed in red blood cells (χ2=0.182, P=0.757) and FFP (χ2=0.083, P=0.839) transfusion rate between these two groups. Repeated measures analysis of variance indicated that when patients began to take antiplatelet drugs (aspirin and clopidogrel) after 12 hours postoperatively, the change of CTD volumes beyond 12 hours after surgery didn′t differ either between guideline-recommended group and without discontinuing group (F=0.019, P=0.941) or between guideline-recommended group and discontinuing group (F=2.447,P=0.113). Besides, the incidence of perioperative arrhythmia was significantly higher in guideline-recommended group patients compared with without discontinuing group patients (4.8% vs. 0, χ2=5.073, P=0.038).@*Conclusions@#OPCABG patients who discontinued aspirin before surgery had lower postoperative 12 hours CTD volumes but similar blood products transfusion rate and CTD volumes beyond 12 hours postoperatively compared with patients adhering to the current guideline-recommended protocol. And for patients who discontinued clopidogrel for ≤5 days, postoperative CTD volumes and blood products transfusion requirement were similar but the incidence of perioperative arrhythmia was significantly lower compared with guideline-treated patients.

19.
Article in Chinese | WPRIM | ID: wpr-823876

ABSTRACT

To explore influence of N‐acetylcysteine (NAC ) combined ulinastatin on pulmonary function in patients undergoing coronary artery bypass grafting (CABG ).Methods : A total of 94 patients needed CABG from our hospital were randomly and equally divided into ulinastatin group and combined treatment group (received NAC based on ulinastatin group ).Postoperative mechanical ventilation time ,in‐hospital time ,pulmonary function indexes and prognosis were compared between two groups .Results :Compared with ulinastatin group ,there was sig‐nificant rise in surgery time [ (172.35 ± 10. 70) min vs .(177. 98 ± 10.56) min] ,and significant reductions in post‐operative mechanical ventilation time [ (23. 41 ± 6. 27) h vs.(15. 98 ± 6.34) h] and in‐hospital time [ (24. 11 ± 3.33) d vs.(21. 39 ± 3. 45) d] , P<0.05 or <0.01 ;significant rise in partial pressure of oxygen in artery [ (85. 47 ± 9.16) mmHg vs .(98.26 ± 8. 96) mmHg] ,oxygenation index [ (504. 41 ± 44.76) mmHg vs .(541.53 ± 42.92) mmHg] ,and significant reductionsin alveolar‐arterial oxygen difference [ (51.69 ± 7.42) mmHg vs.(42. 13 ± 8. 64) mmHg] , respiratory index [ (0.60 ± 0.26) vs.(0. 43 ± 0. 12)] in combined treatment group after treatment , P=0.001 all.After treatment ,serum levels of interleukin (IL )‐6 ,IL‐8 and CD11b/CD18 were significantly higher than those of before treatment in two groups ( P=0.001 all) ,but levels of above inflammatory factors in combined treatment group were significantly lower than those of ulinastatin group , P=0. 001 all ;there were no severe infec‐tions ,pneumothorax and death in two groups after surgery .Conclusion : N‐acetylcysteine combined ulinastatincan significantly inhibit inflammatory reactions ,improve pulmonary function and relieve pulmonary injury in patients undergoing coronary surgery .

20.
Chinese Journal of Geriatrics ; (12): 985-988, 2019.
Article in Chinese | WPRIM | ID: wpr-791611

ABSTRACT

Objective To conduct a clinical analysis of off-pump coronary artery bypass grafting (CABG)in elderly patients with diabetes mellitus.Methods Clinical data of 115 elderly patients with or without diabetes mellitus undergone off-pump CABG from January 2012 to June 2018 were retrospectively analyzed.The impact of diabetes mellitus on the prognosis in elderly patients undergone off-pump CABG was analyzed.Results Compared with elderly non-diabetic patients,the incidences of pulmonary infection,perioperative myocardial infarction,neurological complications,psychiatric symptoms,low cardiac output syndrome,rethoracotomy,respiratory failure,arrhythmia,postoperative 30-day mortality,blood transfusion volume,mechanical ventilation time,postoperative 24-hour drainage volume,the length of hospital stay and large doses of dopamine usage (>10μg · kg-1 · min-1)increased lightly in elderly diabetic patients after off-pump CABG,but the difference had no statistical significance (all P > 0.05).The incidences of postoperative renal insufficiency and incision complications were higher in elderly diabetic patients than in elderly nondiabetic patients(x2 =3.736、1.237,P =0.021、0.037).Conclusions Off-pump CABG is safe and effective for elderly diabetic patients if their blood glucose levels are controlled reasonably well.

SELECTION OF CITATIONS
SEARCH DETAIL