The predictive value of preoperative prognostic nutritional index for postoperative acute kidney injury in 584 patients undergoing cardiac surgery / 中国胸心血管外科临床杂志

@#Objective    To determine the predictive value of the preoperative prognostic nutritional index (PNI) regarding the development of acute kidney injury (AKI) after non-coronary artery bypass grafting (CABG) cardiac surgery. Methods    The clinical data of 584 patients who underwent elective non-CABG cardiac surgery with cardiopulmonary bypass (CPB) in our hospital from May to September 2019 were reviewed. There were 268 (45.9%) males and 316 (54.1%) females, with a mean age of 52.1±11.6 years. The mean cardiopulmonary time and aortic-clamp time was 124.8±50.1 min and 86.4±38.9 min, respectively. Totally 449 (76.9%) patients received isolate valve surgery. We developed the risk prediction model of AKI using multivariable logistic regression. The predictive values of preoperative PNI, Cleveland Clinic Score (CCS) and risk prediction model were estimated by the area under the receiver operating characteristic curve (AUC) and Hosmer-Lemeshow goodness-of-fit test. The improvement of preoperative PNI to predictive values of CCS or AKI risk prediction models were defined by the net reclassification index (NRI) and variation of AUC. Results    The preoperative PNI could neither effectively predict the occurrence of AKI following non-CABG cardiac surgery (AUC=0.553, 95%CI 0.489-0.617, P=0.095) nor improve the predictive effect of other AKI predictive models. The risk prediction model of AKI structured by our study had high predictive value on AKI or severe AKI (stage 2-3) (AUC=0.741, 95%CI 0.686-0.796, P<0.001) and superior to CCS (AUC=0.512, 95%CI 0.449-0.576, P=0.703). Conclusion    The preoperative PNI can neither predict the occurrence of AKI following elective non-CABG cardiac  surgery nor improve the prediction values of other AKI prediction models.

Effects of anesthetics on postoperative pulmonary complications in patients undergoing cardiac surgery / 中国胸心血管外科临床杂志

@#Objective    To evaluate the association of anesthesia regime (volatile or intravenous anesthetics) with the occurrence of postoperative pulmonary complications (PPCs) in adult patients undergoing elective cardiac surgery under cardiopulmonary bypass (CPB). Methods    The electronic medical records of 194 patients undergoing elective cardiac surgery under CPB at West China Hospital, Sichuan University between September 2018 and February 2019 were reviewed, including 92 males and 102 females with an average age of 53 years. The patients were classified into a volatile group (n=94) or a total intravenous anesthesia (TIVA) group (n=100) according to anesthesia regimen during surgery (including CPB). The primary outcome was the incidence of PPCs within first 7 d after surgery. Secondary outcomes included incidence of reintubation, duration of mechanical ventilation, ICU stay and hospital stay. Results    There was no significant difference in the incidence of PPCs between the two groups (RR=1.020, 95%CI 0.763-1.363, P=0.896), with an incidence of 48.9% in the volatile group and 48.0% in the TIVA group. Secondary outcomes were also found no significant difference between the two groups (P>0.05). Conclusion    No association of anesthesia regimen with the incidence of PPCs is found in adult patients undergoing elective cardiac surgery under CPB.

Association of anesthetics with postoperative delirium in patients undergoing cardiac surgery / 中国胸心血管外科临床杂志

@#Objective    To determine whether there was a clinical relevant association between anesthetic regimen (propofol or inhalational anesthetics) and the occurrence of postoperative delirium (POD) in patients undergoing cardiac surgery. Methods    This retrospective study was conducted on patients with elective cardiac surgery under cardiopulmonary bypass (CPB) at West China Hospital of Sichuan University between October 2018 and March 2019. The patients were divided into a propofol group or an inhalational anesthetics group according to anesthetic regimen (including CPB). The primary outcome was the occurrence of POD during first 3 days after surgery. Logistic regression analysis was used to determine the relationship between anesthetic regimen and the occurrence of POD. Results    A total of 197 patients who met the inclusion criteria were included, with an average age of 53 years, and 51.8% (102/197) were females. POD occurred in 21.3% (42/197) patients. The incidence of POD was 21.4% in the propofol group and 21.2% in the inhalational anesthetics group; there was no significant difference between the two groups (RR=1.01, 95%CI 0.51-2.00, P=0.970). Logistic regression analysis did not find that anesthetic regimen was a risk factor for delirium after cardiac surgery after adjusting risk factors (OR=1.05, 95%CI 0.48-2.32, P=0.900). Conclusion    Anesthetic regimen (propofol or inhalational anesthetics) is not associated with an increased risk for POD in adult patients undergoing elective cardiac surgery under CPB.

Advances in research of the evaluation and management of mild traumatic brain injury / 中华急诊医学杂志

Traumatic brain injury (TBI)has been classified as mild,moderate,or severe,on the basis of the Glasgow coma scale (GCS)score.Mild TBI is estimated to account for 90% of all cases of TBI, and it has become a serious public health problem,with morbidity increasing year by year.At present,there is a lack of accepted uniform definition of mild TBI.Clinically,mild TBI and concussion are interchangeable terms.In recent years,advances in brain imaging,biomarkers determination,and neuropathology have encouraged people to revise and update their knowledge about mild TBI.In view of the high prevalence of mild TBI in the emergency and community,and the absence of the data concerning the long-term effects of mild TBI, further research is needed about how to reduce morbidity and costs, alleviate delayed consequences,and develop evidence-based interventions to improve outcomes.