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Objective Using meta-analysis method to compare the effect of liberal and restrictive transfusion strategies on the prognosis of adult patients undergoing cardiac surgery,and to provide evidence for evidence-based medicine.Methods By using the Cochrane system evaluation method,the database of Chinese and foreign countries,Chinese biomedical literature database,Chinese journal full-text database and so on were searched by computer.To search the literature from 1970 to 2018,and to collect clinical randomized controlled trials on blood transfusion strategy and prognosis in adult patients undergoing cardiac surgery.According to the evaluation method of Cochrane system,the effective data extracted is analyzed by meta with RevMan5.3 software.Results A total of 2 863 patients were included in 9 studies.Meta-analysis results showed that the death toll on 30 days after operation (RR value:1.02,95 ％ CI:0.79-1.32,I2 =2％,P =0.86),acute renal damage,infection,acute renal injury,pulmonary complications and hospital stay time were no statistical difference,but ICU retention time(RR value:-33.35,95％ CI:-61.7-1.01,I2 =38％,P =0.04) in the restrictive transfusion policy group was significantly lower than that of liberal blood transfusion strategy group.Conclusion The use of liberal or restrictive blood transfusion strategy in adult cardiac surgery has no significant impact on the prognosis and complications,but it can reduce the retention time of ICU after operation and significantly reduce the use of blood products and medical costs.
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Objective This study explored two methods of predicting the initial dose of heparin by heparin dose response curve(HDR)and in vitro heparin concentration progressive(HCP),and evaluated the predictive value of HCP for precise heparin dosage in patients undergoing cardiac surgery. Method Include 18-65 years old undergoing elective cardiac surgery patients,Before the start of the surgery internal jugular vein blood was taken in-to the HCP(2.5 mg/kg,3.0 mg/kg)test;The first injection of heparin 2 mg/kg via the internal jugular vein, then every 5 minutes each additional heparin 0.5 mg/kg to amount to 2.5 mg/kg,3.0 mg/kg,and measurement ACT and until ACT value≥480 s;According to HDR calculated per patient 2.5,3.0 mg/kg of ACT value;Respective-ly according to the HCP and HDR ACT values obtained by two methods with the actual measured by the correspond-ing value in the body. Results Comparing the ACT values measured by HDR and HCP with the corresponding ACT values in vivo:There are good similarity for heparinization ACT value between HCP and the actual body corresponding concentrations(r was 0.62 and 0.74,respectively),P<0.05;HDR results also have better similar-ity(r was 0.66 and 0.54,respectively),P < 0.05;However,HDR and HCP compared with the actual results in vivo found that in vitro HCP prediction results especially 3.0 mg/kg is more similar with the actual values.Conclu-sions HCP for predicting heparin dosage to meet extracorporeal circulation is more accurate.
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Objective To evaluate the relationship between antithrombin Ⅲ(ATⅢ)genetic pol-ymorphism and individual variation in anticoagulant effect of heparin in the patients of different nationalities. Methods Sixty patients of Uighur nationality and 60 patients of Han nationality, aged 18-64 yr, with body mass index of 21-25 kg∕m2, of American Society of Anesthesiologists physical statusⅠ-Ⅲ, undergo-ing elective cardiac surgery under cardiopulmonary bypass, were divided into Uighur group and Han group, respectively. ATⅢ gene polymorphism was detected by polymerase chain reaction(A∕G was heterozygous, A∕A and G∕G were homozygous). Heparin sodium was intravenously injected at 5 min before the start of cardiopulmonary bypass with an amount of ACT≥480 s. The amount of heparin and protamine, intraoper-ative blood transfusion and postoperative 24 h drainage(pericardium, mediastinum∕thoracic cavity)were recorded. Activated partial thromboplastin time and prothrombin time were measured at 10 min before opera-tion and 24 h after operation. Results Compared with Han group, the amount of heparin, ratio of prota-mine to heparin for heparin neutralization and requirement for intraoperative blood transfusion were signifi-cantly decreased, the postoperative drainage volume was decreased, activated partial thromboplastin time was shortened at 24 h after operation, the frequency of A∕A genotype was increased and the frequency of G∕G genotype was decreased at ATⅢ gene single-nucleotide polymorphism sites rs5877 and rs5878, and the minimum allele(A>G)frequency was increased in Uighur group(P<0.05). Conclusion ATⅢ gene polymorphism may be one of the mechanisms underlying individual variation in anticoagulant effect of hepa-rin between the patients of Uighur nationality and Han nationality.
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Objective To investigate the prevalence of early morning hypertension in elderly popu‐lation .Methods A total of 5569 elderly early morning hypertension patients with their age ≥60 years were divided into hypertension group (n= 2572) and non‐hypertension group (n= 2997) . The patients in hypertension group were divided into 60 -69 years old group ,70 -79 years old group ,and ≥80 years old group while those in non‐hypertension group were also divided into 60-69 years old group ,70-79 years old group ,and ≥80 years old group .The prevalence of ear‐ly morning hypertension and its distribution characteristics were analyzed in the elderly patients . Results The prevalence of early morning hypertension was 33 .0% in the 5569 elderly patients . The systolic blood pressure and diastolic blood pressure were significantly higher in female early morning hypertension patiens than in male early morning hypertension patients and the prevalence of isolated systolic hypertension was higher in male patients than in female patients of hyperten‐sion group .The prevatence of early morning hypertension wea significantly higher in female pa‐tients than in male patients (P=0 .000)and the prevalence of early morning hypertension was sig‐nificantly higher in 60-69 years old female patients than in 60 -69 years old male patients and in ≥ 80 years old male patients than in ≥80 years old female patients of non‐hypertension group (P=0 .000 ,P= 0 .001) .Conclusion Routine blood pressure measurement in the morning is a most effective and simple method to measure early morning hypertension .Elderly females should thus pay more attention to their early morning hypertension .