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Objective To investigate the effect of intraoperative fluctuation in blood glucose concentration (BGCF) on short-term clinical outcomes in patients after off-pump coronary artery bypass graft (CABG) .Methods Two hundred and fourteen ASA Ⅰ -Ⅲ patients ( NYHA grade Ⅰ -Ⅲ ) of both sexes aged 18-64 yr with body mass index 23-29 kg/m2 underwent elective off-pump CABG. Their left ventricular ejection fraction was ≥30% .Blood samples were obtained once an hour for determination of blood glucose concentration (BGC) between 10 min after induction of anesthesia and 10 min after closure of sternum. The maximum and minimum BGCs were record-ed . Intraoperative BGCF was defined as the difference between the maximum and minimum BGCs. Other factors which may influence clinical outcome were also recorded, including prolonged ICU stay ( ≥24 h), prolonged me-chanical ventilation ( ≥12 h) , postoperative complications (cardiac insufficiency secondary to operation, arrhyth-mia, myocardial infarction, respiratory insufficiency, stroke, infection, pleural effusion and surgical bleeding) and prolonged postoperative hospital stay ( ≥ 7 d) . The patients were divided into 2 groups using intraoperative BGCF 400 mg/L as cutoff point: group L < 400 mg/L and group H ≥400 mg/L. Receiver operating characteristic (ROC)curve was used to evaluate if intraoperative BGCF was a good index of postoperative outcomes. Results The area under the ROC curve of intraoperative BGC against prolonged ICU stay was 0. 804 (0.739-0. 869), against prolonged mechanical ventilation 0. 604 ( 0.415-0.793 ), against postoperative complications 0.801 ( 0.720-0. 882 )and against postoperative hospital stay 0.615 (0.523-0.707). The duration of ICU stay was significantly longer and the incidences of complications and prolonged postoperative hospital stay were higher in group H than in group L (P < 0.01). Conclusion Intraoperative BGCF is closely related to postoperative outcomes in patients after offpump CABG. The patients with the BGC≥400 mg/L has a poor prognosis.
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Objective To investigate the effect of high-dose creatine phosphate (CP) on myocardial ischemia-reperfusion (I/R) injury in patients undergoing cardiac valve replacement. Methods Two hundred and forty-six ASA Ⅱ or Ⅲ patients aged 42-71 yr weighing 45-80 kg undergoing mitral-aortic valve replacement were randomly assigned into 2 groups: control group ( n = 122) and CP group ( n = 124). CP 10 g in 100 ml normal saline (NS) was infused over 60 min starting from the beginning of operation in group CP. In control group NS 100 ml was infused instead of CP. Blood samples were collected before anesthesia and on 1st and 5th postoperative day for determination of serum CK, CK-MB and LDH activity and cTnI concentration. The number of patients receiving dopamine and adrenaline at the time of return of spontaneous heart beat and 12, 24 and 48 h after operation was recorded. The incidence of arrhythmia (auricular fibrillation, ventricular arrhythmia), myocardial infarct and left ventricular ejection fraction (LVEF) were also compared between the 2 groups. Results Serum CK, CK-MB and LDH activity and cTnI concentration on 1st and 5th postoperative day, the doses of dopamine and adrenalin, the incidence of arrhythmia and myocardial infarct were significantly lower in group CP than in control group. The postoperative LVEF and the incidence of spontaneous recovery of spontaneous heart-beat were significantly higher in group CP than in control group. Conclusion Pretreatment with high dose CP can protect myocardium against I/R injury in patients undergoing cardiac valve replacement under CPB.
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Objective Aprotinin has been suspended in cardiac surgery since risks factors associated with mortality and other adverse events in western Literatures.This study was to investigate the effect of aprotinin on short-term outcomes in cardiac surgery in Chinese patients.Methods Two groups of patients who underwent cardiac surgery during equal period just before and after aprotinin was suspended in China.Aprotinin groupp(n=1699) was defined as operations from june 19,2007 to Dec 18,2007,when aprotinin was used in all the patients.Control group(n=2225)was defined as operations from Dec19,2007 to June 18,2008,when aprotinin was not umed.Postoperative outcomes between the two groups,including blood loes and transfusion requirement,in-hospital mortality and major adveme outcome events were compared,using univariate analysis and mulfivariable logistic regression analysis.Results Aprotinin group had less postoperative blood loes,transfusion requirement and reoperation for bleeching as compared with the control group.Application of aprotinin did not increase the risk of in-hospital mortality (0.5%vs.10%,P=0.08)and other major ad-verse events,including renal dysfunction,renal failure requiring dialysis,low cardiac output syndrome (LCOS),neurological and pulmonary complications.Aprltinin group also had and shorter mechanical ventilation time(P=0.04),a lowwer rate of delayed mechan-ical ventilation time(P=0.04)and a higher PaO2/FiO2 in the bolld gas analysis(P<0.001).which presented a better respiratory function.Multivariable Logistic regression analysis got identical results with univariate analysis.Conclusion The use of aprotinin in cardiac surgery could reduce blood loss and transfusion requirement significantly,and showed a protective effect on the lungs.In the mean time it did not increase the risk of mortality or major complications.We suggest further studies should be performed to make a decision of continuing or stopping the use of aprotinin in cardisc surgery in Chinese or Asian population.