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Resumen: La anticoagulación en el posoperatorio de cirugía cardíaca constituye todo un reto. La oportunidad de inicio, la dosis a utilizar y el tipo de anticoagulante, dependerán del procedimiento realizado, de la asociación de factores de riesgo trombótico y/o hemorrágico y de un estricto seguimiento clínico, a fin de lograr un adecuado nivel de protección y evitar complicaciones durante la estadía hospitalaria. Analizaremos tres escenarios de posoperatorio: pacientes con prótesis valvulares, fibrilación auricular y prevención de la enfermedad tromboembólica venosa, así como la prevención y el manejo de las complicaciones hemorrágicas, adecuando el tratamiento a los niveles de INR y a la presencia de sangrados. El trabajo en equipo, multi e interdisciplinario y la protocolización de las medidas a tomar, facilitan el manejo de este tipo de pacientes y reducen las complicaciones, muchas de ellas totalmente evitables.
Summary: Anticoagulation in the postoperative period of cardiac surgery constitutes a challenge. The timing of initiation, the anticoagulation dose to be used and the type of anticoagulant will depend on the procedure performed, the association of thrombotic and/or hemorrhagic risk factors, and strict clinical monitoring in order to achieve an adequate level of protection and avoid complications during hospital stay. We will analyze three postoperative situations: patients with valve prostheses, atrial fibrillation and prevention of venous thromboembolic disease as well as prevention and management of bleeding complications, adapting treatment to INR levels and presence of bleeding. Multi and interdisciplinary teamwork and the protocolization of the measures to be taken, facilitate the management of these patients and reduces complications, many of which are totally avoidable.
Resumo: A anticoagulação no pós-operatório de cirurgia cardíaca constitui um desafio. O momento de início, a dose de anticoagulação a ser utilizada, o tipo de anticoagulante vão depender do procedimento realizado, da associação de fatores de risco trombóticos e/ou hemorrágicos e de monitoramento clínico rigoroso para atingir um nível adequado de proteção e evitar complicações durante a internação. Analisaremos três cenários pós-operatórios: pacientes com próteses valvares, fibrilação atrial e prevenção de doença tromboembólica venosa, além da prevenção e manejo de complicações hemorrágicas, adequando o tratamento aos níveis de INR e à presença de sangramento. O trabalho em equipe multi e interdisciplinar e a protocolização das medidas a serem tomadas facilitam o manejo destes pacientes e reduzem complicações, muitas das quais são totalmente evitáveis.
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Objective To observe the effects of nasal feeding with different enteral nutrition (EN) agents, TPF-D emulsion and Briprin (SP) suspension on blood glucose level in patients with hyperglycemia under mechanical ventilation after cardiac surgery of extracorporeal circulation (CPB). Methods Forty patients with mechanical ventilation and hyperglycemia after CPB cardiac surgery admitted to the Department of Intensive Care Unit (ICU) of Jinhua People's Hospital from August 2016 to October 2018 were selected. According to the different EN preparations given after the surgery, the patients were divided into two groups: a TPF-D group (21 cases) and a Briprin group (19 cases). Both groups were given reasonable analgesia, sedation and other conventional treatment to maintain the hemodynamic stability and balances between water electrolytes and acid-base. EN therapy was applied within 24 ~48 hours after ICU admission and caloric requirements were calculated according to ideal body weight. The EN treatment in TPF-D group was given by TPF-D nasal feeding, the drip rate started from 20-30 mL/h and gradually increased to 50-100 mL/h according to patients' tolerance; in the Briprin group, EN was given by nasal feeding of SP, and the feeding mode was the same as that of TPF-D group. The mechanical ventilation time, postprandial 2 hours blood glucose level and blood glucose increase rate of the two groups were observed; the glycosylated albumin (GA) and serum triglyceride (TG) levels were measured 3 days after EN administration, and the first postoperative defecation time was also observed in the two groups. Results After EN therapy, there were no statistically significant differences in mechanical ventilation time and TG level after 3 days of EN treatment between the TPF-D group and the SP group [mechanical ventilation time (hours): 31.52±19.56 vs. 27.26±14.35, TG (mmol/L) after 3 days of EN therapy: 1.32±0.37 vs. 1.62±0.57, both P > 0.05]. The glucose level and glucose increase rate at postprandial 2 hours, and GA level after 3 days of EN therapy in TPF-D group were obviously lower than those in the SP group [glucose level 2 hours postprandial (mmol/L): 7.68±1.20 vs. 11.60±1.69, the glucose increase rate at 2 hours postprandial: (-0.01±0.15)% vs. (0.39±0.24)%, and GA after 3 days of EN therapy: (12.81±1.64)% vs. (16.32±2.35)%, all P < 0.01]. The time of the first bowel movement in the TPF-D group was earlier than that in the SP group (days: 2.48±0.51 vs. 3.84±0.69, P < 0.01). Conclusion The effect of applying TPF-D EN emulsion was less than that of SP suspension on glucose level in post-operative CPB patients with hyperglycemia and after mechanical ventilation, showing when using TPF-D, the stability of blood glucose is better and defecation earlier.
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Objective To investigate the effect on incidence of ventilator associated pneumonia(VAP),the cost of hospitalization with closed endotracheal suctioning and vital sign as well in postoperative cardiac patients.Methods 304 postoperative cardiac patients supporting by ventilation were enrolled in this cohort study during January,2012-November,2013 in The Second affiliated Hospital& Yuying Children Hospital of Wenzhou Medical University.All the subjects were randomly divided into observational group and control group by coin side.Closed endotracheal suctioning system was applied in observation group and opened mode was applied in control group.Compare the vital sign(heart rate,blood pressure,saturation) at the moment of aspiration,suction time,incidence of VAP,duration of ventilation,mortality,the cost of suction,hospital stays and hospitalization expense.Results The baseline is no significant difference between two groups.The fluctuation of blood pressure and heart rate is lower in observational group at 30 second since completed the suction(P ＜0.05),but saturation is higher at 30 second and 60 second since completed the suction respectively(P ＜ 0.05).There is no significant difference of incidence of unexpected tube displacement and pneumothorax between two groups.Average time of each suction of experimental groups is shorter than Control groups[(156 ± 6) s vs (225 ± 8) s,t =-84.86,P ＜ 0.01].VAP incidence is lower in experimental group (12.0％ vs.18.6％,x2 =4.37,P ＜ 0.05).Duration of ventilation is lower in experimental group[(72 ± 33) h vs.(98 ± 38) h,t =-6.35,P ＜ 0.05].The cost of suction is higher in observational group [(346 ± 15) RMB vs.(178 ± 26) RMB,t =69.00,P ＜ 0.01],but the hospitalization expense is lower in experimental group [(32 011 ± 2 525) yuan vs.(35 264 ± 3 846)yuan,t =-8.72,P ＜ 0.05].There is no significant difference in mortality between two groups (x2 =0.08,P ＞ 0.05).Conclusion Application of closed endotracheal suction system can result in reduction vital sign fluctuation and incidence of cross infection and reducing the workload of nurses and decreasing the complication of suction,shorting the duration of ventilation and hospitalization and saving the expense of hospitalization in postoperative cardiac patients comparing with open mode.It is worthy to be populized in cardiac care unit.
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PURPOSE: Cardiac troponin I (cTnI) is a highly sensitive and specific marker for myocardial injury, and is used to predict the outcomes in patients with acute coronary syndromes. Cardiovascular complications are the leading cause of morbidity and mortality in patients who underwent vascular surgical procedures. The aim of the study was to evaluate the association between the postoperative cTnI levels and a perioperative myocardial injury (MI) within 6 months after the vascular surgical procedures. METHODS: Eighty patients who underwent vascular surgery including an arterial bypass, amputation and a thrombectomy were included in this study. The blood samples were analyzed for cTnI immediately after surgery and 1, 2, and 3 days after surgery. RESULTS: An elevated cTnI was defined as a serum concentrations > 0.4 ng/ml in any of 4 samples. Seven patients (8.7%) had postoperative cTnI levels of > 0.4 ng/ml, which was associated with a higher risk of a postoperative cardiac event (P or =0.4 ng/ml may indicate myocardial damage after vascular surgical procedures. Therefore, the routine postoperative measurement of cTnI might be a useful predictive value of the postoperative cardiac events after vascular surgical procedures.