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Objective To investigate the relationship between preoperative serum homocysteine (Hcy) level and acute kidney injury (AKI) after cardiac valve replacement surgery. Methods The data of the inpatients who accepted cardiac valve replacement surgery, age≥18 years, no renal replacement therapy before surgery, non - renal decompensation and preoperative serum creatinine (Scr)＜178 μmol/L, survival within 48 h after surgery, and with preoperative serum Hcy data in the First Affiliated Hospital of Guangxi Medical University from January 1, 2015 to December 31, 2017 was retrospectively analyzed. AKI was diagnosed in patients whose Scr increased more than 26.5 μmol/L (0.3 mg/dl) within 48 hours or 1.5 times higher than baseline within 7 days after surgery. According to this, patients were divided into AKI group and non-AKI group, and the affecting factors for AKI were compared between the two groups. Multivariate logistic regression was used to analyze the independent influencing factors of AKI. The relationship between serum Hcy level and AKI incidence was analyzed by Spearman correlation analysis. Whether the AKI occurred and serum Hcy levels were used as variables to map the receiver operating characteristic curve (ROC), and was used to assess the value of preoperative serum Hcy level for predicting AKI after cardiac valve replacement surgery. Results A total of 810 subjects were included in the study, including 375 males and 435 females. They were (50±11) years old (19-78 years old). Among them, 329 patients with AKI occurred within 7 days after heart valve replacement, and the incidence rate was 40.6% (male 45.9%, female 36.1%). The serum Hcy level in the AKI group was higher than that in the non-AKI group [(15.74±4.55) μmol/L vs (13.87 ± 3.85) μmol/L, t=6.106, P＜0.01]. Multivariate logistic regression analysis showed age (OR=1.030, 95% CI 1.014-1.045, P＜0.001), extracorporeal circulation time (OR=1.011, 95% CI 1.007-1.016, P＜0.001), Scr (OR=1.014, 95%CI 1.005-1.023, P=0.002), serum Hcy (OR=1.059, 95% CI 1.017-1.103, P=0.006), high level of Hcy (＞13.64 μmol/L) (OR=1.465, 95%CI 1.059-2.027, P=0.021) and moderate to severe hyperhomocystinemia (16≤Hcy≤100 μmol/L) [with normal HHcy (Hcy＜10 μmol/L) as reference, OR=2.180, 95% CI 1.245-3.816, P=0.006] were independent influencing factors of AKI after cardiac valve replacement surgery. Spearman correlation analysis showed that the incidence of postoperative AKI increased with the increase of preoperative serum Hcy level (rs=0.927, P＜0.001). The results of ROC curve showed that the area under the curve of the preoperative serum Hcy level predicting AKI after heart valve replacement was 0.701, and the cutoff value was 13.64 μmol/L, with the sensitivity 61.3%, specificity 70.9%. Conclusions Preoperative serum Hcy level is an influencing factor for AKI after cardiac valve replacement surgery. The higher the level of preoperative serum Hcy, the higher the incidence of AKI after cardiac valve replacement surgery. Patients with preoperative serum Hcy levels＞13.64 μmol/L have an increased risk of AKI after cardiac valve replacement surgery.
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Objective To evaluate the efficacy and safety of oprinon hydrochloride in increasing cardiac pump function and stabilizing hemodynamics and preventing common complications after cardiac valve replacement. Methods Sixty-two patients were admitted to the First Affiliated Hospital of Zhengzhou University from January to August 2018 to undergo cardiac valve replacement operation, post-operatively, 32 patients using oprinon hydrochloride were in the observation group and 30 patients using milrinone were in the control group. Both groups received basic treatment, additionally the observation group was given oprinon hydrochloride intravenous pump injection for 48 hours and the control group was given milrinone intravenous pump injection for 48 hours. The changes of vital signs (blood pressure, heart rate, respiratory rate), cardiac function, hemodynamics, biochemical indexes, electrocardiogram, cardiac color Doppler ultrasound and adverse reactions were observed before and after treatment in the two groups. The incidence of cardiovascular events (worsening, re-hospitalization and death) was followed up 1 month after discharge. Results The left ventricular ejection fraction (LVEF), central venous pressure (CVP), arterial oxygen saturation (SaO2), arterial partial pressure of oxygen (PaO2), N-terminal B-type natriuria (NT-proBNP), lactic acid, serum creatinine (SCr), blood sodium and potassium of the two groups after treatment were not statistically significant compared with those before treatment [LVEF: the control group was 0.52±0.09 vs. 0.60±0.09, the observation group was 0.62±0.12 vs. 0.50±0.11;CVP (mmHg, 1 mmHg = 0.133 kPa): the control group was 11.2±2.8 vs. 13.0±2.9, the observation group was 13.0±2.5 vs. 10.5±3.6; SaO2: the control group was 0.98 (0.90, 0.99) vs. 0.99 (0.98, 1.00), the observation group was 0.95 (0.94, 0.98) vs. 0.96 (0.90, 1.00); PaO2(mmHg): the control group was 100.5 (63.8, 135.3) vs. 99.5 (82.3, 179.5), the observation group was 95.0 (85.5, 129.0) vs. 75.5 (59.0, 138.3); NT-proBNP (pg/L): the control group was 1.45 (1.34, 3.31) vs. 0.92 (0.42, 1.81), the observation group was 0.47 (0.35, 1.37) vs. 2.07 (1.27, 4.44); lactic acid (mmol/L): the control group was 3.6 (2.4, 4.5) vs. 1.4 (1.2, 3.1), the observation group was 1.3 (1.1, 2.1) vs. 3.1 (1.4, 3.7); SCr (μmol/L): the control group was 106.7±35.9 vs. 84.4±20.3, the observation group was 96.5±40.7 vs. 77.1±23.1; sodium (mmol/L):the control group was 141.4±7.2 vs. 143.6±4.2, the observation group was 142.9±3.6 vs. 140.5±4.5; potassium (mmol/L): the control group was 4.6±0.9 vs. 4.8±0.6, the observation group was 4.8±0.6 vs. 4.1±0.6, all P > 0.05];the comparisons between the following indicators in levels before and after treatment in the two groups had statistical significant differences: the peripheral arterial pressure (PAP), white blood cell count (WBC), hemoglobin (Hb), platelet count (PLT), alanine aminotransferas (ALT) and aspartate aminotransferase (AST) [PAP (mmHg): the control group was 33.0 (24.0, 59.3) vs. 38.0 (34.8, 46.0), the observation group was 30.0 (25.0, 32.0) vs. 53.5 (29.3, 66.5); WBC (×109/L):the control group was 12.2 (10.4, 13.9) vs. 5.7 (4.4, 8.6), the observation group was: 8.4 (3.7, 11.8) vs. 8.6 (5.7, 12.4); Hb (g/L): the control group was 95.6±12.9 vs. 130.3±15.0, the observation group was 111.1±22.6 vs. 112.4±24.6; PLT (×109/L): the control group was 95.2±21.3 vs. 168.7±32.6, the observation group was 146.3±68.1 vs. 132.7±45.1;ALT (U/L): the control group was 36.5 (15.3, 80.5) vs. 14.0 (11.0, 19.0), the observation group was 15.0 (10.0, 32.3) vs. 20.3 (12.0, 35.8); AST (U/L): the control group was 33.0 (20.0, 83.0) vs. 16.5 (16.7, 28.8), the observation group was 35.5 (12.3, 56.8) vs. 75.5 (45.3, 140.3), all P < 0.05]; after treatment, the urea nitrogen (BUN) level in control group was higher than that before treatment (mmol/L: 11.4±4.7 vs. 7.1±2.5), while BUN in the observation group was decreased (mmol/L: 6.5 ±3.3 vs. 9.1±3.8), there was statistical significant difference in BUN level between the two groups after treatment (P < 0.05). The levels of systolic blood pressure and respiratory rate after treatment in the two groups were significantly higher than those before treatment (all P < 0.05). After treatment, the diastolic blood pressure in the observation group was increased, but there was no significant difference in the control group before and after treatment, and the diastolic blood pressure in the observation group after treatment was higher than that in the control group (mmHg: 67.8±9.9 vs. 62.0±10.5, P < 0.05). According to the New York Heart Association Heart (NYHA) function efficacy assessment score, the total effective rate of the observation group was higher than that of the control group [93.7% (30/32) vs. 83.3% (25/30), P > 0.05]. There was no statistical significant difference in the incidence of adverse reactions between the observation group and the control group [12.5% (4/32) vs. 30.0% (9/30), P > 0.05]. The patients in the two groups were followed up for one month after discharge, 9 cases (30.0%) in the control group were re-hospitalized due to heart failure, and 3 cases (9.4%) in the observation group were re-hospitalized due to heart failure, there was no statistical significant difference between the two groups in re-hospitalization rate (P > 0.05). Conclusion Oprinone hydrochloride can effectively improve cardiac function and maintain hemodynamic stability of patients after heart valve replacement surgery.
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Objective To evaluate the effect of limb remote ischaemic preconditioning on pul-monary function in patients undergoing cardiac valve replacement surgery with cardiopulmonary by-pass.Methods Seventy patients,32 males and 38 females,aged 18-70 years,weighing 45-90 kg, ASA physical status Ⅱ or Ⅲ,scheduled for elective cardiac valve replacement surgery with cardiopul-monary bypass,were divided into 2 groups using a random number table,35 in each group.Patients in group R received three cycles of right upper-limb 5 min ischemia (blood-pressure cuff inflation to≥ 200 mm Hg)and 5 min reperfusion (blood-pressure cuff deflation to 0 mm Hg)at 10 min after in-tubation.In group C,the cuff was placed around the arm but not inflated.At 10 min after intubation (T0),at 1 h after aortic declamping (T1)and at 6 h (T2),12 h (T3),24 h (T4)after surgery,arte-rial blood was sampled to conduct gas analysis,PaO2/FiO2ratio and alveolar-arterial oxygen gradient (A-aDO2)were calculated,and the dynamic lung compliance (Cd)and static lung compliance (Cs) were also recorded.The occurrence of pulmonary adverse events was recorded until discharge. Results Compared with T0,PaO2/FiO2was decreased in the two groups at T1-T4,A-aDO2was de-creased at T2-T4,Cs and Cd were increased in group C at T3,and were increased in group R at T2, T3(P<0.05).Compared with group C,the Cs and Cd at T2,T3were increased in group R.There were no significant differences between the two groups in the PaO2/FiO2,A-aDO2at T0-T4.The oc-currence of the pulmonary adverse events was decreased significantly in group R than in group C (P<0.05).The occurrence of pulmonary adverse events was declined significantly in group R than in group C (P<0.05).Conclusion Limb remote ischemic preconditioning can improve the lung compli-ance and reduce the occurrence of the pulmonary adverse events in patients undergoing cardiac valve replacement surgery.