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Objective:To evaluate the effect of perioperative application of hydroxychloroquine on the prognosis of patients undergoing cardiac surgery.Methods:All SLE patients in the Department of Cardiovascular Surgery of the First Affiliated Hospital of Zhengzhou University who took hydroxychloroquine and glucocorticoid for more than 7 days before operation were enrolled in the observation group(28 cases), including 3 males and 25 females, aged(38.3±8.2)years old. Patients who did not use hydroxychloroquine but only used glucocorticoid before operation were included in the control group(24 cases), including 2 males and 22 females, aged(37.9 ±9.8)years old. There was no significant difference in preoperative clinical data between the two groups in terms of sex, age, BMI, course of systemic lupus erythematosus, hemoglobin, albumin, C-reactive protein, ALT, serum creatinine, ejection fraction, diabetes, hypertension, hyperlipidemia, smoking, alcoholism, preoperative atrial arrhythmia, ventricular arrhythmia, atrioventricular block and so on. The constituent ratio of preoperative operation plan was basically the same between the two groups. The postoperative complications and survival of the two groups were compared.Results:There was no significant difference in early clinical indexes between the two groups, such as cardiopulmonary bypass time( t=0.12, P=0.19), chest drainage volume( t=0.30, P=0.77), second thoracotomy hemostasis( χ2=1.17, P=0.46). There was no significant difference in drug-related complications such as new retinopathy, myocardial concentric hypertrophy, atrial arrhythmia( χ2=1.27, P=0.26), ventricular arrhythmia( χ2=0.98, P=0.32), atrioventricular block( χ2=0.06, P=0.82) and other drug-related complications between the observation group and the control group. There was no significant difference between the two groups in postoperative acute heart failure( χ2=1.17, P=0.28), acute liver insufficiency( χ2=1.17, P=0.28), sternal infection and IABP use( χ2=0.47, P=0.50). Compared with the control group, the incidence of acute renal insufficiency after operation was lower in the observation group( χ2=4.51, P=0.04). The incidence of new postoperative pneumonia was lower( χ2=8.26, P=0.01). The length of postoperative antibiotic use, the length of postoperative ICU hospital stay, the postoperative hospital stay and the total cost of hospitalization in the observation group were significantly less than those in the control group( z=2.71, 2.09, 2.02, 2.02, P=0.01, 0.04, 0.04, 0.04). Compared with the control group, the in-hospital mortality rate of patients in the observation group was lower than that in the control group(3.6% vs. 12.5%, χ2=0.47, P=0.50), and the 6-month and 1-year survival rates of the observation group were higher than those of the control group(92.9% vs.83.3%, 92.9% vs.79.2%; χ2=0.41, 2.17; P=0.53, 0.34), but the difference was not statistically significant. Conclusion:Perioperative administration of hydroxychloroquine can significantly reduce the incidence of postoperative acute renal insufficiency and pneumonia, reduce the duration of postoperative antibiotic use, postoperative ICU hospital stay, postoperative hospital stay, and the cost of hospitalization. Hydroxychloroquine may reduce the in-hospital mortality and improve the long-term survival rate after cardiac surgery, but long-term large sample clinical studies are still needed.
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Objective To analyze the risk factors affecting postoperative incisional infection in Crohn's disease (CD) patients after bowel resection.Methods The retrospective case-control study was conducted.The clinicopathologieal data of 239 CD patients who underwent bowel resection in the Sixth Affiliated Hospital of Sun Yat-sen University between January 2007 and December 2016 were collected.All patients underwent bowel resection.Observation indicators:(1) surgical situations;(2) follow-up;(3) risk factors analysis affecting postoperative incisional infection;(4) clinical factors affecting preoperative anemia.The follow-up using outpatient examination or ward diagnosis was performed to detect incisional infection within 30 days postoperatively up to January 2017.The normality test was done by Shapiro-Wilk.Measurement data with normal distribution were represented as x-±s,and comparison between groups was evaluated with the t test.Measurement data with skewed distribution were described as M (range),and comparison between groups was analyzed using the Wilcoxon ranksum test.The univariate analysis and multivariate analysis were done using the Logistic regression model.The P＜ 0.05 in univariate analysis was incorporated into multivariate analysis for analysis in the forward wald.Results (1) Surgical situations:of 239 patients,11 underwent emergency surgery and 228 underwent elective surgery;65 and 174 underwent respectively laparoscopic surgery and open surgery;179 received digestive tract reconstruction and anastomosis and 81 received enterostomy (21 combined with anastomosis and enterostomy).Among 239 patients,137,113,101,58,54 and 11 were complicated respectively with fiber stenosis,intestinal fistula,obstruction of small intestine,abscess,cellulitis and enterobrosis (some patients combined with multiple signs).(2) Follow-up:239 patients were followed up at 30 days postoperatively.During the follow-up,48 with incisional infection were improved by symptomatic treatment.(3) Risk factors analysis affecting postoperative incisional infection:① Results of univariate analysis showed that illness behavior,sedimentation rate of RBC ＞ 20 mm/h,preoperative anemia,preoperative chronic intestinal fistula,open surgery,intraoperative fiber stenosis and intraoperative intestinal fistula were risk factors affecting occurrence of postoperative incisional infection [odds ratio (0R)=2.530,2.579,4.233,2.988,2.554,0.503,3.052,95％ confidence interval (CI):1.218-2.259,1.141-5.833,1.598-11.210,1.522-5.864,1.082-6.029,0.265-0.954,1.555-5.993,P＜0.05].② Results of multivariate analysis showed that preoperative anemia and intraoperative intestinal fistula were independent risk factors affecting occurrence of postoperative incisional infection (OR =3.881,2.837,95％ CI:1.449-10.396,1.429-5.634,P＜0.05).(4) Clinical factors affecting preoperative anemia:cases (male) with preoperative anemia,body mass index (BMI),cases with sedimentation rate of RBC ＞ 20 mm/h,platelet (PLT) ＞ 300x109/L,elevated C-reactive protein,albumin (Alb) ＜35 g/L were respectively 120,(17.4±2.9)kg/m2,130,75,139,65 in patients with preoperative anemia and 65,(18.3±2.9)kg/m2,36,12,39,10 in patients without preoperative anemia,with statistically significant differences (x2 =17.966,t =2.210,x2 =12.219,14.440,14.661,12.272,P＜0.05).Conclusion The preoperative anemia and intraoperative intestinal fistula are independent risk factors affecting occurrence of postoperative incisional infection,and preoperative anemia is associated with perioperative inflammatory conditions.