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Objective:To explore the risk factors of early delayed recovery after right ventricular-extrapulmonary arterial(RV-PA)conduit reconstruction.Methods:From 2017 to 2021, the children with RV-PA conduit reconstruction, who were treated in our hospital were retrospectively analyzed.The demographic data and peri-operative clinical data of the patients were collected for statistical analysis.Results:Fifty-five patients were included in the study.The patients were sequenced by the length of ICU stay.The time at the 75th percentile was defined as the critical value for grouping.According to the ICU stay time of the children, they were divided into normal recovery group(ICU stay ≤7 days, n=40)and delayed recovery group(ICU stay>7 days, n=15).The mechanical ventilator time in the whole group was 24(0, 1 408)h, and the ICU stay time was 4(1, 67)d.Six cases required extracorporeal membrane oxygenation (ECMO) support, and two cases died.In the multivariate Logistic regression analysis of two groups, long cardiopulmonary bypass(CPB) time( OR=1.034, 95% CI 1.009-1.061, P=0.009)and poor right ventricular function( OR=9.536, 95% CI 1.010-90.037, P=0.049)were independent risk factors for early delayed recovery. Conclusion:The risk of RV-PA conduit reconstruction is high.The proportion of ECMO support is increased.The mortality rate is higher.Right heart dysfunction and prolonged CPB time are risk factors for delayed postoperative recovery.
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Objective:To investigate the pharmacokinetics of sugammadex in reversal of postoperative residual neuromuscular blockade in obese patients.Methods:Sixteen patients of both sexes, aged 18-65 yr, of American Society of Anesthesiologists physical statusⅠ or Ⅱ, with body mass index of ≥25 kg/m 2, scheduled for elective laparoscopic bariatric surgery, were selected.The patients were divided into 2 groups ( n=8 each) according to the degree of obesity: group O (25 kg/m 2≤BMI<40 kg/m 2) and group M (BMI≥40 kg/m 2). In group O and group M, vecuronium was administered by closed-loop muscle relaxant injection system to maintain moderate neuromuscular blockade.The administration was stopped at the end of surgery, and sugammadex 2 mg/kg was injected according to corrected body weight (CBW) of patients when the muscle relaxation monitoring T 2 recovered naturally.The recovery time of neuromuscular blockade and the occurrence of residual neuromuscular blockade within 3 h after surgery were recorded.Arterial blood samples were collected at 2, 3, 5, 10, 15, 20, 30, 60, 120, 240, 360 and 480 min after administration of sugammadex.The concentration of sugammadex in plasma was determined by ultra-performance liquid chromatography-mass spectrometry.The pharmacokinetic parameters were calculated with PKSolver software. Results:No residual neuromuscular blockade occurred, and the pharmacokinetics of sugammadex in plasma were consistent with the linear non-compartmental model in the two groups.Compared with group O, apparent clearance was increased ( P<0.05), and no significant change was found in other pharmacokinetic parameters, recovery time of neuromuscular blockade and concentrations of sugammadex in plasma at different time point ( P>0.05) in group M. Conclusion:The pharmacokinetics of sugammadex in reversal of postoperative residual neuromuscular blockade in obese patients are consistent with the linear non-compartmental model, and the clearance of sugammadex is higher in morbidly obese patients.
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Objective To explore the impact of different hemoglobin on postoperative cognitive functions in female patients underwent laparoscopic surgery. Methods 215 female patients who were underwent laparoscopic total hysterectomy or laparoscopic myomectomy from January 2016 to December 2016 in our hospital were selected. The patients were divided into 3 groups according to their hemoglobin:Group N with normal hemoglobin ,Group A with hemoglobin concentration of 9 ~ 11 g/L ,and Group B with hemoglobin concentration of 6 ~ 9 g/L. Same anesthesia and recovery plan were performed in all patients. Basic and operative information were recorded. The score of MoCA on the day before surgry ,the day after surgry ,3 days after surgry and 30 days after surgry were recorded. Blood samples were collected on the day before surgry and the day after surgry for the determina-tion of serum S-100β protein and IL-6 concentrations. Results No significant difference was found in basic and operative information among three groups. The recovery time was much longer in Group B than that in Group N. No difference were found among three group in the score of MoCA on the day before surgry and 30 days after surgry ,while the score in the day after surgry and 3 days after surgry were lower in Group B com-pared with Group N. The incidence of POCD were higher in Group B compared with Group N. Compared with the day before surgry ,the concentration of serum S-100β protein and IL-6 were much higher. And compared with Group N ,the concentration of serum S-100β protein was higher in Group A and B in the day after surgry , while IL-6 was higher in Group B. The concentration of serum S-100βprotein and IL-6 were much higher in Group B compared with Group A in the day after surgry. Conclusion Female patients with hemoglobin concen-tration of 6 ~ 9 g/L are susceptible to POCD ,which might be contributed by operative central nerve system damage induced by excessive inflammation.
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Objective To summarize the clinical efficacy of renal transplantation from donors of donation after brain death (DBD) complicated with acute kidney injury (AKI). Methods Fifty-nine DBD donors successfully undergoing renal transplantation were recruited in this investigation. According to the Scr level upon admission of intensive care unit (ICU), DBD donors were divided into the AKI group (n=14) and control group (n=45). A total of 101 recipients were assigned into the AKI group (n=23) and control group (n=78) correspondingly. The organ donation conditions of 59 donors were summarized. Main parameters of the donors before organ procurement were statistically compared between two groups. Postoperative kidney function, hospitalization condition and clinical outcomes of the recipients were statistically compared between two groups. Results Among 59 donors, 14 cases (24%) suffered from AKI. Two donors received continuous renal replacement therapy during organ maintenance. Compared with the donors in the control group, the APACHE Ⅱ score of the donors was significantly higher (P<0.05), the incidence of central diabetes insipidus was considerably higher (P<0.01), the Scr levels at admission of ICU and before organ procurement were significantly higher (both P<0.01) and the amount of urine at 24 h before organ procurement was dramatically less in the AKI group (P<0.01).Compared with the recipients in the control group, the Scr levels at postoperative 2 and 3 d were significantly higher (both P<0.05), the length of hospital stay was considerably longer (P<0.01) and the hospitalization expanse was significantly higher in the AKI group (P<0.05). No statistical significance was observed in the postoperative delayed recovery of renal graft function, incidence of acute rejection, infection and rehabilitation dialysis in the recipients between two groups (all P>0.05). At 3 months after transplantation, the recipients in two groups were discharged and the graft survival rate was 100%. Conclusions For renal transplantation from DBD donors complicated with AKI, active measures should be taken to maintain the organ and relieve the AKI, which yields similar clinical efficacy to renal transplantation from non-AKI donors and widens the origin of kidney graft.
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Objective To explore the clinical characteristics and risk factors in patients with peripartum cardiomyopathy (PPCM).Methods A total of 35 patients admitted in Peking Union Medical College Hospital and diagnosed with PPCM between January 1995 and December 2014 was included and analyzed in this study.The subjects were divided into two groups:the early recovery and delayed recovery.Early recovery was defined as normalization of left ventricle ejection fraction (LVEF) ≥ 50％ before 6 months post-diagnosis.Delayed recovery was defined if the length of time required for recovery of LVEF was longer than 6 months or death was reported during follow-up.Risk factors for delayed recovery were assessed.Results The incidence of PPCM was 1 per 1 067 deliveries between the study periods.The age of the 35 patients was (28.9±5.6) years old.Among them,20 (57.1％) patients were not in the first pregnancy,13 (37.1％) had delivered before,and 5 (14.3％) patients had twin pregnancies.The LVEF at diagnosis was (34.1 ±8.0) ％.62.9％ (22 cases) of the subjects were in the early recovery,while 37.1％ (13 cases) of the subjects were in the delayed recovery group,2 of whom suffered death.Multivariate logistic regression indicated that LVEF (OR =1.339,95％ CI 1.063-1.688,P =0.013) and left ventricle end-dilated diameter(OR 0.763,95％CI 0.607-0.960,P =0.021)were independent risk factors for delayed recovery.Conclusions PPCM is a rare but life-threatening complication of pregnancy.LVEF and left ventricle end-dilated diameter at diagnosis were two independent factors associated with the prognosis of PPCM.