Objective： The relative preventative efficacy of amiodarone and lidocaine for ventricular fibrillation（VF） after release of an aortic cross-clamp（ACC） during open heart surgery has not been determined. This meta-...Objective： The relative preventative efficacy of amiodarone and lidocaine for ventricular fibrillation（VF） after release of an aortic cross-clamp（ACC） during open heart surgery has not been determined. This meta-analysis was designed to systematically evaluate the influence of amiodarone, lidocaine, or placebo on the incidence of VF after ACC. Methods： Prospective randomized controlled trials（RCTs） that compared the VF-preventative effects of amiodarone with lidocaine, or amiodarone or lidocaine with placebo were included. Pub Med, EMBASE, and the Cochrane Library were searched for relevant RCTs. Fixed or randomized effect models were applied according to the heterogeneity of the data from the selected studies. Results： We included eight RCTs in the analysis. Pooled results suggested that the preventative effects of amiodarone and lidocaine were comparable（relative risk（RR）=1.12, 95% confidence interval（CI）： 0.70 to 1.80, P=0.63）, but both were superior to the placebo（amiodarone, RR=0.71, 95% CI： 0.51 to 1.00, P=0.05; lidocaine, RR=0.63, 95% CI： 0.46 to 0.88, P=0.006）. The percentage of patients requiring electric defibrillation counter shocks（DCSs） did not differ significantly among patients administered amiodarone（RR=0.21, 95% CI： 0.04 to 1.19, P=0.08）, lidocaine（RR=2.44, 95% CI： 0.13 to 44.02, P=0.55）, or the placebo（RR=0.56, 95% CI： 0.25 to 1.25, P=0.16）. Conclusions： Amiodarone and lidocaine are comparably effective in preventing VF after ACC, but the percentage of patients who subsequently require DCSs does not differ among those administered amiodarone, lidocaine, or placebo.展开更多
Introduction: Patient’s transfer from the intensive care unit (ICU) to the general ward indicates their improving health status. However, the transfer produces anxiety when patients enter an unfamiliar environment wi...Introduction: Patient’s transfer from the intensive care unit (ICU) to the general ward indicates their improving health status. However, the transfer produces anxiety when patients enter an unfamiliar environment with different care protocols and circumstances. Objectives: This study aimed to examine the level of ICU transfer anxiety among open heart surgery patients and determine the psychosocial factors associated with ICU transfer anxiety among open heart surgery patients. Methods: Data were collected in a cardiac center in Kathmandu City, Nepal among 95 open heart surgery patients within 24 hours of their transfer from an ICU to a general ward. The study used four self-reported questionnaires, namely the modified Mishel Uncertainty in Illness Scale for Adults, modified Brief COPE Inventory, Nurses’ Support Questionnaire, and State Anxiety Inventory. Results: Fifty-two patients (54.7%) had a high level of transfer anxiety. Spearman’s rank correlation showed that uncertainty in illness, coping, and nurses’ support were significantly related to transfer anxiety (p < 0.001). Conclusion: The results of this study suggest nurses to address uncertainty in illness of the patients, improve their coping abilities, and provide need-based nursing support to them during the transitional phase. Besides, clinicians and governmental agencies should contribute to implication of transitional guidelines, which can reduce transfer anxiety and promote health and recovery of the patients.展开更多
Objective To be released specifically after myocardial damage. The goal of this study was to measure serum cardiac troponin I levels after open heart surgery in children, and to evaluate relevance between TnTi and per...Objective To be released specifically after myocardial damage. The goal of this study was to measure serum cardiac troponin I levels after open heart surgery in children, and to evaluate relevance between TnTi and perioperative multi-factors. Methods Fifty-seven consecutive pediatric patients undergoing elective correction of congenital heart diseases were divided into group A （ TOF, n =31 ） and group B （ VSD, n =26）. Blood sampies were drawn preoperatively, 5min（ T0 ） , 6h（ T6 ） , 12h（ T12 ） , 24h（ T24 ） , 48h（ T48 ） , 72h（ T72 ） after removal of aortic cross clamping. Myocardial protection consisted of moderate systemic hypothermia （ 30℃- 32℃ ）, cold crystalloid cardioplegia and topical cooling. Demographic information, cardiac defect, repair procedure, duration of bypass （ CPBT） , cross-clamping time （ CCT） , clinical score for cardiac function, electrocardiographic changes and outcomes were recorded. Results Compared with the baseline value, serum concentration of troponin I peaked at T0 （ P 〈 0. 01 ）, and fell to normal level at T72 （ P 〉 0. 05 ）. Peak CTnI was 118 and 55 times higher than the baseline value, respectively in group A and group B. There was a positive correlation between peak CTnI and CPBT, CCT （ r = 0. 51 ; P 〈 0. 01 ）, myocardial operative injury after ventriculotomy and muscle resection （ r = 0. 35, P 〈0. 01 ）. Also the peak CTnl value was correlated to the clinical score for cardiac function （r = -0. 52; P 〈0. 01）. 2.3μg/L was a cutoff value which was highly predictive for postoperative recovery and inotropic support. Conclusion Postoperative serum troponin I is a highly specific and sensitive marker for myocardial ischemia and injury; therefore, its measurement may contribute to the assessment of recovery and outcome after open heart surgery.展开更多
To evaluate the change of perioperative cell mediated immunity after cardiac operation with cardiopul-monary bypass (CPB), so as to provide some information for timely prevention and treatment against post-operative i...To evaluate the change of perioperative cell mediated immunity after cardiac operation with cardiopul-monary bypass (CPB), so as to provide some information for timely prevention and treatment against post-operative immunological disorder, 40 patients were studied. By searching for the effects of CPB and anes-thesia, interleukln-2 receptor (IL-2R) expression upon the surface of peripheral blood mononuclear cells(PBMC), as well as interleukin-2 (IL-2) production in vitro was traced 55 min after anesthesia, at end ofCPB, on postoperative 1, 7, and 14 day versus preanesthesia control. Our data demonstrated that expres-sion of IL-2R on PBMC was significantly suppressed in all comparing with the baseline value, meanwhile,IL-2 production in vitro also statistically dropped. However,no statistical difference was found on perioper-ative IL 2R expression and IL-2 synthesis in the cholecystectomy group. We conclude that postoperativeimmunological disorder seems to be the main factor, which could be denoted as reduced IL 2R expressionon PBMC and lL-2 synthesis in vitro for sepsis, even multiple system organ failure developed after cardiacsurgery.展开更多
Background: Cardiothoracic surgery is a common cause of acute respiratory failure and is associated with increased morbidity and mortality. We aimed to compare the outcomes of open heart surgery patients treated using...Background: Cardiothoracic surgery is a common cause of acute respiratory failure and is associated with increased morbidity and mortality. We aimed to compare the outcomes of open heart surgery patients treated using oxygen delivery devices with patients who receive NIV as a first-line therapy for hypoxemic respiratory failure. Materials and Methods: 40 patients who developed acute hypoxemic respiratory failure after open heart surgery and admitted to cardiothoracic ICU 20 patients received NIV and 20 patient received oxygen by venture mask. For all patients the following measurements were performed before and after CPAP AND Venture use: CBC, blood urea, serum creatinine body temperature, chest X-ray, Arterial blood gases (arterial pH, sodium bicarbonate, pcO2, SpO2 and PaO2-to-FiO2 ratio). Results: Mean PO2 and SO2 have increased after using of both venture and Cpap, increase in both PCO2 and HCO3 levels after using Venturi mask, CPAP mask was superior to venturi mask in avoiding the need of intubation, decreasing The ICU stay median length and also median length of hospitalization, all were lower in CPAP group than venture group. Also the mortality rate was lower in CPAP group than the venturi group. Conclusion: Using CPAP mask in severe AHRF following open heart surgery can avoid intubation, decreases the levels of tachypnea and arterial hypoxemia, decreases ICU stay, the length of hospitalization and also decreases the mortality rate compared with patients receiving high-concentration oxygen therapy with venture mask.展开更多
Objective To explore the effects of ultrafiltration technique in preventing and relieving pulmonary injury in children undergoing open heart surgery and cardiopulmonary bypass (CPB). Methods Thirty cases with congenit...Objective To explore the effects of ultrafiltration technique in preventing and relieving pulmonary injury in children undergoing open heart surgery and cardiopulmonary bypass (CPB). Methods Thirty cases with congenital heart defects were divided into a control group and an experimental group. In the control group,conventional cardiopulmonary bypass was used without ultrafiltration; while in the experimental group,cardiopulmonary bypass with balanced ultrafiltration and modified ultrafiltration were used. Pulmonary static compliance (C stat ),airway resistance (R aw ),alveolar-arterial oxygen difference (A-a DO 2),hematocrit (HCT),serum albumin (Alb),interleukin-6 (IL-6),endothelia-1 (ET-1) and thromboxane (TXB 2) were measured. Results The pulmonary function was improved,HCT and serum albumin concentrations were increased,and some harmful medium-size solutes were decreased in the experimental groups compared with the control group.Conclusions Combination of balanced ultrafiltration with modified ultrafiltration can effectively concentrate blood,exclude harmful inflammatory mediators,and attenuate lung edema and inflammatory responsive pulmonary injury.展开更多
Objective: To comparatively study the different effects of open heart surgery on brain tissues of patients with congenital and rheumatic heart disease. Methods: Forty patients with congenital heart disease (CHD, CHD g...Objective: To comparatively study the different effects of open heart surgery on brain tissues of patients with congenital and rheumatic heart disease. Methods: Forty patients with congenital heart disease (CHD, CHD group, n=20) or rheumatic heart disease (RHD, RHD group, n=20) underwent on-pump (cardiopulmonary bypass, CPB) heart-beating open heart surgery. Blood samples before CPB, and 20 minutes, 1 hour, 24 hours and 7 days after CPB were collected, and the levels of neuron-specific enolase (NSE) and protein S-100b in the plasma were determined with enzyme-linked immunoadsorbent assay (ELISA), respectively. All the patients were examined with electroencephalogram (EEG) before and 1 week after operation. The changes of NSE, S-100b and EEG compared to verify the difference of postoperative cerebral injury between CHD cases and RHD cases. Results: The plasma level of S-100b increased significantly 20 minutes after CPB and was still higher than the preoperative level at 24 hours after operation in both groups (P< 0.01). The plasma level of NSE increased more significantly in the CHD group than in the RHD group 20 minutes after CPB and it returned to the normal level 24 hours after CPB in the CHD group but remained at a high level in the RHD group (P< 0.01). The levels of NSE and S-100b returned to the normal levels on the 7th day after CPB. Abnormal EEG was found in 75% of the patients in the CHD group and 60% in the RHD group. Conclusions: On-pump heart-beating open heart surgery can cause certain cerebral injury in the patients with CHD or RHD. The injury was more severe and recovered more quickly in the CHD group than in the RHD group.展开更多
背景先天性心脏病患儿行开胸手术后疼痛的规范化管理十分重要,目前尚未形成系统的针对先天性心脏病患儿行开胸手术后疼痛管理的最佳证据。目的对先天性心脏病患儿行开胸手术后疼痛管理的最佳证据进行总结,为临床实践提供循证依据。方法...背景先天性心脏病患儿行开胸手术后疼痛的规范化管理十分重要,目前尚未形成系统的针对先天性心脏病患儿行开胸手术后疼痛管理的最佳证据。目的对先天性心脏病患儿行开胸手术后疼痛管理的最佳证据进行总结,为临床实践提供循证依据。方法系统检索UpToDate临床顾问、BMJ最佳临床实践、国际指南协作网、美国国立指南库、英国国家卫生与临床优化研究所、医脉通指南网、Cochrane Library、PubMed、Web of Science、Embase、CINAHL、万方数据知识服务平台、维普网、中国知网、中国生物医学文献服务系统及美国心脏病协会、美国心血管学会、欧洲心脏病协会、美国疼痛协会、加拿大安大略注册护士协会网站,获取关于先天性心脏病患儿行开胸手术后疼痛管理的临床决策、指南、专家共识、证据总结、系统评价及随机对照试验,检索时限为建库至2025-01-01,进行方法学质量评价后,依据主题对证据提取和汇总。结果共纳入15篇文献,其中指南1篇,专家共识1篇,系统评价3篇,随机对照试验10篇,通过阅读、提取、归纳最终总结了疼痛管理原则、疼痛评估、药物止痛策略、非药物止痛策略4个方面的26条证据。结论形成先天性心脏病患儿行开胸手术后疼痛管理中关于疼痛管理原则、疼痛评估、药物止痛策略、非药物止痛策略的最佳证据,可为临床医务工作者提供证据支持,提高临床护理质量。展开更多
<strong>Background:</strong> <span style="font-size:12px;font-family:Verdana;">Metabolic acidosis (MA) is a common finding on the surgical ward, more so in the intensive care unit. Diseases...<strong>Background:</strong> <span style="font-size:12px;font-family:Verdana;">Metabolic acidosis (MA) is a common finding on the surgical ward, more so in the intensive care unit. Diseases affecting the major organ systems of the body and higher grades of surgery are common risk factors for MA. It is associated with poor treatment outcome. </span><b><span style="font-size:12px;font-family:Verdana;">Aim</span></b><b><span style="font-size:12px;font-family:Verdana;">:</span></b><b><span style="font-size:10.0pt;font-family:;" "=""> </span></b><span style="font-size:12px;font-family:Verdana;">To determine the risk factors and clinical correlates of metabolic acidosis and assess its relationship with treatment outcome. </span><b><span style="font-size:12px;font-family:Verdana;">Methodology:</span></b><span style="font-size:12px;font-family:Verdana;"> A retrospective study at the “Tristate Heart and vascular Center” in Ilishan-Remo South west Nigeria, on patients that had cardiac and vascular surgeries </span><span style="font-size:12px;font-family:Verdana;">from</span><span style="font-size:10.0pt;font-family:;" "=""><span style="font-family:Verdana;font-size:12px;"> January 2015 to De</span><span style="font-family:Verdana;font-size:12px;">cember 2019. Three hundred and forty two participants took part in the </span><span style="font-family:Verdana;font-size:12px;">study. The demographic, clinical and laboratory findings were entered. Statistical analysis was with Student’s t-test and Chi square. </span></span><b><span style="font-size:12px;font-family:Verdana;">Results:</span></b><span style="font-size:12px;font-family:Verdana;"> Two hundred and six males and 136 females were studied. The incidence</span><span style="font-size:12px;font-family:Verdana;">s</span><span style="font-size:10.0pt;font-family:;" "=""><span style="font-family:Verdana;font-size:12px;"> of metabolic acidosis prior to induction, on post-operative day one (POD</span><sup><span style="font-family:Verdana;font-size:12px;">1</span></sup><span style="font-family:Verdana;font-size:12px;">) and on POD</span><sup><span style="font-family:Verdana;font-size:12px;">28</span></sup> <span style="font-family:Verdana;font-size:12px;">were 20.7%, 39.8% and 14.1%</span></span><span style="font-size:12px;font-family:Verdana;"> respectively</span><span style="font-size:12px;font-family:Verdana;">. Nine (2.6%) participants died</span><span style="font-size:10.0pt;font-family:;" "=""><span style="font-family:Verdana;font-size:12px;"> during admission, of this, 6 (66.7%) had MA at presentation but all (100%) had MA on POD</span><sup><span style="font-family:Verdana;font-size:12px;">1</span></sup><span style="font-family:Verdana;font-size:12px;">. The Risk factors for MA were advanced age, comorbidities, open heart surgery, elevated systolic blood pressure and low eGFR. Metabolic acidosis was a risk factor for prolonged hospital stay, perioperative death and declining kidney function which was commoner among participants with preexisting kidney dysfunction.</span></span><b><span style="font-size:12px;font-family:Verdana;"> Conclusion: </span></b><span><span>The incidence of metabolic acidosis was 20.7% at induction of anesthesia, rose to 39.8% on POD</span><sup><span>1</span></sup><span> and by POD</span><sup><span>28</span></sup><span>, it has significantly reduced to 14.1%. While advancing age and comorbidities were risk factors for MA, the occurrence of MA increased the risk of declining kidney function, prolonged hospital stay and death.</span></span>展开更多
Objective: Acute kidney disease develops 16% - 30% of patients with preoperative impaired renal functions. Our aim of this study was to compare postoperative renal outcomes using two open heart surgery techniques, on-...Objective: Acute kidney disease develops 16% - 30% of patients with preoperative impaired renal functions. Our aim of this study was to compare postoperative renal outcomes using two open heart surgery techniques, on-pump beating heart (OPBH) and conventional on-pump (COP), in patients who have preoperative low glomerular filtration rate (eGFR) as an indicator of creatinine clearance. Methods: From 2004 to 2015, 341 patients with preoperative creatinine clearance were lower than 90 ml/min/1.73m2 were selected for this study. On-Pump beating heart was performed in 111 patients (Group I). Conventional on-pump technique was used in 200 patients. In the remaining patients, we measured postoperative Tumor Necrosis Factor Alpha (TNF-alpha), cardiac troponin I (cTn-I), Brain natriuretic peptid (NT-Pro- BNP), creati-nine (Cr), blood urea nitrogen (BUN) and postoperative eGFR daily until day four after surgery. Results: There were no differences in baseline levels of TNF-alpha, NT-Pro-BNP, BUN, cTn-I, Cr levels between the groups. Cardiopulmonary bypass (CPB) time were much longer and cumulative inotrope use was significantly higher in patients underwent COP (P Conclusion: Our study showed that on-pump beating heart CABG technique provides a morbidity benefit and is associated with a lower risk of peroperative LOS in patients with mild renal disfunction. Our study results suggest that OPBH is superior to the COP in terms of postoperative renal injury and cardiac mediators.展开更多
From January 1982 to June 1990, 2730 patients with congenital heart defects (CHDS) were treated at Xinhua Hospital there were 537 cases of complex lesions. Fifty of 537 patients died, the hospital mortality rate was 9...From January 1982 to June 1990, 2730 patients with congenital heart defects (CHDS) were treated at Xinhua Hospital there were 537 cases of complex lesions. Fifty of 537 patients died, the hospital mortality rate was 9.31%. On the basis of our clinical experience, it is important that the accurate diagnosis was made promptly in neonate with complex CHDs. The surgical results can be improved by the use of PGEI and balloon atrial septostomy in the cyanotic neonate. For the congestive CHDs, the operation must be per formed in the early life to prevent pulmonary hypertension. Improved methods of preoperative and postoperative care have contributed to these results.展开更多
Background: The majority of prospective cardiac surgical patients in sub Saharan Africa lack access to open heart surgery. We reviewed our midterm results to identify the obstacles to growth and challenges with sustai...Background: The majority of prospective cardiac surgical patients in sub Saharan Africa lack access to open heart surgery. We reviewed our midterm results to identify the obstacles to growth and challenges with sustainability. Methods: Records of patients undergoing heart surgery at LASUTH from December 2004 to March 2006 were retrospectively reviewed for clinical and outcome data. Results: Twenty four patients age 10-50, mean 28.0 +/? 10.49 years and 13 (54.2%) males underwent surgery. 12 (50.0%) patients had mechanical valve replacements, 11 (45.8%) closure of septal defects and 1 (4.2%) left atrial myxoma resection. Logistic euroscore for valve patients was 5.81 +/? 4.74 while observed mortality was 8.3% (1/12). Overall 30 days operative mortality was 8.3% (2/24) and major morbidity 4.2% (1/24). Patients with septal defects closure stopped clinic visits within a year. Valve patients follow up was complete in 90.1% with mean duration of 55.2 +/? 15.3 months. Late events occurred only in females with mitral valve replacements. The 5-year freedom from thromboembolism and bleeding was 74.0% and survival 82.0% in valve patients. Conclusion: Despite limited resources heart surgery can safely be performed with good outcomes by trained local personnel under supervision of visiting foreign teams until they are proficient to operate independently. Patients with less complex congenital defects have excellent postsurgical outcomes, while patients with rheumatic valve replacement are subject to ongoing valve related morbidity and mortality therefore require lifetime follow up. Choice of prosthetic valve for the mostly indigent and poorly educated population remains a challenge. We now prefer stented tissue valve despite its known limitations, in child bearing age females desirous of childbirth and others unlikely to comply with anticoagulation regimen. Barriers to sustainability include poor infrastructures, few skilled manpower, inadequate funding and restricted patient access due to inability to pay without third party insurance or government Medicaid.展开更多
BACKGROUND Rhabdomyolysis(RML)as an etiological factor causing acute kidney injury(AKI)is sparsely reported in the literature.AIM To study the incidence of RML after surgical repair of an ascending aortic dissection(A...BACKGROUND Rhabdomyolysis(RML)as an etiological factor causing acute kidney injury(AKI)is sparsely reported in the literature.AIM To study the incidence of RML after surgical repair of an ascending aortic dissection(AAD)and to correlate with the outcome,especially regarding renal function.To pinpoint the perioperative risk factors associated with the development of RML and adverse renal outcomes after aortic dissection repair.METHODS Retrospective single-center cohort study conducted in a tertiary cardiac center.We included all patients who underwent AAD repair from 2011-2017.Post-operative RML workup is part of the institutional protocol;studied patients were divided into two groups:Group 1 with RML(creatine kinase above cut-off levels 2500 U/L)and Group 2 without RML.The potential determinants of RML and impact on patient outcome,especially postoperative renal function,were studied.Other outcome parameters studied were markers of cardiac injury,length of ventilation,length of stay in the intensive care unit),and length of hospitalization.RESULTS Out of 33 patients studied,21 patients(64%)developed RML(Group RML),and 12 did not(Group non-RML).Demographic and intraoperative factors,notably body mass index,duration of surgery,and cardiopulmonary bypass,had no significant impact on the incidence of RML.Preoperative visceral/peripheral malperfusion,though not statistically significant,was higher in the RML group.A significantly higher incidence of renal complications,including de novo postoperative dialysis,was noticed in the RML group.Other morbidity parameters were also higher in the RML group.There was a significantly higher incidence of AKI in the RML group(90%)than in the non-RML group(25%).All four patients who required de novo dialysis belonged to the RML group.The peak troponin levels were significantly higher in the RML group.CONCLUSION In this study,we noticed a high incidence of RML after aortic dissection surgery,coupled with an adverse renal outcome and the need for post-operative dialysis.Prompt recognition and management of RML might improve the renal outcome.Further large-scale prospective trials are warranted to investigate the predisposing factors and influence of RML on major morbidity and mortality outcomes.展开更多
文摘Objective： The relative preventative efficacy of amiodarone and lidocaine for ventricular fibrillation（VF） after release of an aortic cross-clamp（ACC） during open heart surgery has not been determined. This meta-analysis was designed to systematically evaluate the influence of amiodarone, lidocaine, or placebo on the incidence of VF after ACC. Methods： Prospective randomized controlled trials（RCTs） that compared the VF-preventative effects of amiodarone with lidocaine, or amiodarone or lidocaine with placebo were included. Pub Med, EMBASE, and the Cochrane Library were searched for relevant RCTs. Fixed or randomized effect models were applied according to the heterogeneity of the data from the selected studies. Results： We included eight RCTs in the analysis. Pooled results suggested that the preventative effects of amiodarone and lidocaine were comparable（relative risk（RR）=1.12, 95% confidence interval（CI）： 0.70 to 1.80, P=0.63）, but both were superior to the placebo（amiodarone, RR=0.71, 95% CI： 0.51 to 1.00, P=0.05; lidocaine, RR=0.63, 95% CI： 0.46 to 0.88, P=0.006）. The percentage of patients requiring electric defibrillation counter shocks（DCSs） did not differ significantly among patients administered amiodarone（RR=0.21, 95% CI： 0.04 to 1.19, P=0.08）, lidocaine（RR=2.44, 95% CI： 0.13 to 44.02, P=0.55）, or the placebo（RR=0.56, 95% CI： 0.25 to 1.25, P=0.16）. Conclusions： Amiodarone and lidocaine are comparably effective in preventing VF after ACC, but the percentage of patients who subsequently require DCSs does not differ among those administered amiodarone, lidocaine, or placebo.
文摘Introduction: Patient’s transfer from the intensive care unit (ICU) to the general ward indicates their improving health status. However, the transfer produces anxiety when patients enter an unfamiliar environment with different care protocols and circumstances. Objectives: This study aimed to examine the level of ICU transfer anxiety among open heart surgery patients and determine the psychosocial factors associated with ICU transfer anxiety among open heart surgery patients. Methods: Data were collected in a cardiac center in Kathmandu City, Nepal among 95 open heart surgery patients within 24 hours of their transfer from an ICU to a general ward. The study used four self-reported questionnaires, namely the modified Mishel Uncertainty in Illness Scale for Adults, modified Brief COPE Inventory, Nurses’ Support Questionnaire, and State Anxiety Inventory. Results: Fifty-two patients (54.7%) had a high level of transfer anxiety. Spearman’s rank correlation showed that uncertainty in illness, coping, and nurses’ support were significantly related to transfer anxiety (p < 0.001). Conclusion: The results of this study suggest nurses to address uncertainty in illness of the patients, improve their coping abilities, and provide need-based nursing support to them during the transitional phase. Besides, clinicians and governmental agencies should contribute to implication of transitional guidelines, which can reduce transfer anxiety and promote health and recovery of the patients.
文摘Objective To be released specifically after myocardial damage. The goal of this study was to measure serum cardiac troponin I levels after open heart surgery in children, and to evaluate relevance between TnTi and perioperative multi-factors. Methods Fifty-seven consecutive pediatric patients undergoing elective correction of congenital heart diseases were divided into group A （ TOF, n =31 ） and group B （ VSD, n =26）. Blood sampies were drawn preoperatively, 5min（ T0 ） , 6h（ T6 ） , 12h（ T12 ） , 24h（ T24 ） , 48h（ T48 ） , 72h（ T72 ） after removal of aortic cross clamping. Myocardial protection consisted of moderate systemic hypothermia （ 30℃- 32℃ ）, cold crystalloid cardioplegia and topical cooling. Demographic information, cardiac defect, repair procedure, duration of bypass （ CPBT） , cross-clamping time （ CCT） , clinical score for cardiac function, electrocardiographic changes and outcomes were recorded. Results Compared with the baseline value, serum concentration of troponin I peaked at T0 （ P 〈 0. 01 ）, and fell to normal level at T72 （ P 〉 0. 05 ）. Peak CTnI was 118 and 55 times higher than the baseline value, respectively in group A and group B. There was a positive correlation between peak CTnI and CPBT, CCT （ r = 0. 51 ; P 〈 0. 01 ）, myocardial operative injury after ventriculotomy and muscle resection （ r = 0. 35, P 〈0. 01 ）. Also the peak CTnl value was correlated to the clinical score for cardiac function （r = -0. 52; P 〈0. 01）. 2.3μg/L was a cutoff value which was highly predictive for postoperative recovery and inotropic support. Conclusion Postoperative serum troponin I is a highly specific and sensitive marker for myocardial ischemia and injury; therefore, its measurement may contribute to the assessment of recovery and outcome after open heart surgery.
文摘To evaluate the change of perioperative cell mediated immunity after cardiac operation with cardiopul-monary bypass (CPB), so as to provide some information for timely prevention and treatment against post-operative immunological disorder, 40 patients were studied. By searching for the effects of CPB and anes-thesia, interleukln-2 receptor (IL-2R) expression upon the surface of peripheral blood mononuclear cells(PBMC), as well as interleukin-2 (IL-2) production in vitro was traced 55 min after anesthesia, at end ofCPB, on postoperative 1, 7, and 14 day versus preanesthesia control. Our data demonstrated that expres-sion of IL-2R on PBMC was significantly suppressed in all comparing with the baseline value, meanwhile,IL-2 production in vitro also statistically dropped. However,no statistical difference was found on perioper-ative IL 2R expression and IL-2 synthesis in the cholecystectomy group. We conclude that postoperativeimmunological disorder seems to be the main factor, which could be denoted as reduced IL 2R expressionon PBMC and lL-2 synthesis in vitro for sepsis, even multiple system organ failure developed after cardiacsurgery.
文摘Background: Cardiothoracic surgery is a common cause of acute respiratory failure and is associated with increased morbidity and mortality. We aimed to compare the outcomes of open heart surgery patients treated using oxygen delivery devices with patients who receive NIV as a first-line therapy for hypoxemic respiratory failure. Materials and Methods: 40 patients who developed acute hypoxemic respiratory failure after open heart surgery and admitted to cardiothoracic ICU 20 patients received NIV and 20 patient received oxygen by venture mask. For all patients the following measurements were performed before and after CPAP AND Venture use: CBC, blood urea, serum creatinine body temperature, chest X-ray, Arterial blood gases (arterial pH, sodium bicarbonate, pcO2, SpO2 and PaO2-to-FiO2 ratio). Results: Mean PO2 and SO2 have increased after using of both venture and Cpap, increase in both PCO2 and HCO3 levels after using Venturi mask, CPAP mask was superior to venturi mask in avoiding the need of intubation, decreasing The ICU stay median length and also median length of hospitalization, all were lower in CPAP group than venture group. Also the mortality rate was lower in CPAP group than the venturi group. Conclusion: Using CPAP mask in severe AHRF following open heart surgery can avoid intubation, decreases the levels of tachypnea and arterial hypoxemia, decreases ICU stay, the length of hospitalization and also decreases the mortality rate compared with patients receiving high-concentration oxygen therapy with venture mask.
基金ThisresearchwassupportedbyagrantfromtheNationalNaturalScienceFoundationofChina (No 3 0 170 92 9)
文摘Objective To explore the effects of ultrafiltration technique in preventing and relieving pulmonary injury in children undergoing open heart surgery and cardiopulmonary bypass (CPB). Methods Thirty cases with congenital heart defects were divided into a control group and an experimental group. In the control group,conventional cardiopulmonary bypass was used without ultrafiltration; while in the experimental group,cardiopulmonary bypass with balanced ultrafiltration and modified ultrafiltration were used. Pulmonary static compliance (C stat ),airway resistance (R aw ),alveolar-arterial oxygen difference (A-a DO 2),hematocrit (HCT),serum albumin (Alb),interleukin-6 (IL-6),endothelia-1 (ET-1) and thromboxane (TXB 2) were measured. Results The pulmonary function was improved,HCT and serum albumin concentrations were increased,and some harmful medium-size solutes were decreased in the experimental groups compared with the control group.Conclusions Combination of balanced ultrafiltration with modified ultrafiltration can effectively concentrate blood,exclude harmful inflammatory mediators,and attenuate lung edema and inflammatory responsive pulmonary injury.
文摘Objective: To comparatively study the different effects of open heart surgery on brain tissues of patients with congenital and rheumatic heart disease. Methods: Forty patients with congenital heart disease (CHD, CHD group, n=20) or rheumatic heart disease (RHD, RHD group, n=20) underwent on-pump (cardiopulmonary bypass, CPB) heart-beating open heart surgery. Blood samples before CPB, and 20 minutes, 1 hour, 24 hours and 7 days after CPB were collected, and the levels of neuron-specific enolase (NSE) and protein S-100b in the plasma were determined with enzyme-linked immunoadsorbent assay (ELISA), respectively. All the patients were examined with electroencephalogram (EEG) before and 1 week after operation. The changes of NSE, S-100b and EEG compared to verify the difference of postoperative cerebral injury between CHD cases and RHD cases. Results: The plasma level of S-100b increased significantly 20 minutes after CPB and was still higher than the preoperative level at 24 hours after operation in both groups (P< 0.01). The plasma level of NSE increased more significantly in the CHD group than in the RHD group 20 minutes after CPB and it returned to the normal level 24 hours after CPB in the CHD group but remained at a high level in the RHD group (P< 0.01). The levels of NSE and S-100b returned to the normal levels on the 7th day after CPB. Abnormal EEG was found in 75% of the patients in the CHD group and 60% in the RHD group. Conclusions: On-pump heart-beating open heart surgery can cause certain cerebral injury in the patients with CHD or RHD. The injury was more severe and recovered more quickly in the CHD group than in the RHD group.
文摘背景先天性心脏病患儿行开胸手术后疼痛的规范化管理十分重要,目前尚未形成系统的针对先天性心脏病患儿行开胸手术后疼痛管理的最佳证据。目的对先天性心脏病患儿行开胸手术后疼痛管理的最佳证据进行总结,为临床实践提供循证依据。方法系统检索UpToDate临床顾问、BMJ最佳临床实践、国际指南协作网、美国国立指南库、英国国家卫生与临床优化研究所、医脉通指南网、Cochrane Library、PubMed、Web of Science、Embase、CINAHL、万方数据知识服务平台、维普网、中国知网、中国生物医学文献服务系统及美国心脏病协会、美国心血管学会、欧洲心脏病协会、美国疼痛协会、加拿大安大略注册护士协会网站,获取关于先天性心脏病患儿行开胸手术后疼痛管理的临床决策、指南、专家共识、证据总结、系统评价及随机对照试验,检索时限为建库至2025-01-01,进行方法学质量评价后,依据主题对证据提取和汇总。结果共纳入15篇文献,其中指南1篇,专家共识1篇,系统评价3篇,随机对照试验10篇,通过阅读、提取、归纳最终总结了疼痛管理原则、疼痛评估、药物止痛策略、非药物止痛策略4个方面的26条证据。结论形成先天性心脏病患儿行开胸手术后疼痛管理中关于疼痛管理原则、疼痛评估、药物止痛策略、非药物止痛策略的最佳证据,可为临床医务工作者提供证据支持,提高临床护理质量。
文摘<strong>Background:</strong> <span style="font-size:12px;font-family:Verdana;">Metabolic acidosis (MA) is a common finding on the surgical ward, more so in the intensive care unit. Diseases affecting the major organ systems of the body and higher grades of surgery are common risk factors for MA. It is associated with poor treatment outcome. </span><b><span style="font-size:12px;font-family:Verdana;">Aim</span></b><b><span style="font-size:12px;font-family:Verdana;">:</span></b><b><span style="font-size:10.0pt;font-family:;" "=""> </span></b><span style="font-size:12px;font-family:Verdana;">To determine the risk factors and clinical correlates of metabolic acidosis and assess its relationship with treatment outcome. </span><b><span style="font-size:12px;font-family:Verdana;">Methodology:</span></b><span style="font-size:12px;font-family:Verdana;"> A retrospective study at the “Tristate Heart and vascular Center” in Ilishan-Remo South west Nigeria, on patients that had cardiac and vascular surgeries </span><span style="font-size:12px;font-family:Verdana;">from</span><span style="font-size:10.0pt;font-family:;" "=""><span style="font-family:Verdana;font-size:12px;"> January 2015 to De</span><span style="font-family:Verdana;font-size:12px;">cember 2019. Three hundred and forty two participants took part in the </span><span style="font-family:Verdana;font-size:12px;">study. The demographic, clinical and laboratory findings were entered. Statistical analysis was with Student’s t-test and Chi square. </span></span><b><span style="font-size:12px;font-family:Verdana;">Results:</span></b><span style="font-size:12px;font-family:Verdana;"> Two hundred and six males and 136 females were studied. The incidence</span><span style="font-size:12px;font-family:Verdana;">s</span><span style="font-size:10.0pt;font-family:;" "=""><span style="font-family:Verdana;font-size:12px;"> of metabolic acidosis prior to induction, on post-operative day one (POD</span><sup><span style="font-family:Verdana;font-size:12px;">1</span></sup><span style="font-family:Verdana;font-size:12px;">) and on POD</span><sup><span style="font-family:Verdana;font-size:12px;">28</span></sup> <span style="font-family:Verdana;font-size:12px;">were 20.7%, 39.8% and 14.1%</span></span><span style="font-size:12px;font-family:Verdana;"> respectively</span><span style="font-size:12px;font-family:Verdana;">. Nine (2.6%) participants died</span><span style="font-size:10.0pt;font-family:;" "=""><span style="font-family:Verdana;font-size:12px;"> during admission, of this, 6 (66.7%) had MA at presentation but all (100%) had MA on POD</span><sup><span style="font-family:Verdana;font-size:12px;">1</span></sup><span style="font-family:Verdana;font-size:12px;">. The Risk factors for MA were advanced age, comorbidities, open heart surgery, elevated systolic blood pressure and low eGFR. Metabolic acidosis was a risk factor for prolonged hospital stay, perioperative death and declining kidney function which was commoner among participants with preexisting kidney dysfunction.</span></span><b><span style="font-size:12px;font-family:Verdana;"> Conclusion: </span></b><span><span>The incidence of metabolic acidosis was 20.7% at induction of anesthesia, rose to 39.8% on POD</span><sup><span>1</span></sup><span> and by POD</span><sup><span>28</span></sup><span>, it has significantly reduced to 14.1%. While advancing age and comorbidities were risk factors for MA, the occurrence of MA increased the risk of declining kidney function, prolonged hospital stay and death.</span></span>
文摘Objective: Acute kidney disease develops 16% - 30% of patients with preoperative impaired renal functions. Our aim of this study was to compare postoperative renal outcomes using two open heart surgery techniques, on-pump beating heart (OPBH) and conventional on-pump (COP), in patients who have preoperative low glomerular filtration rate (eGFR) as an indicator of creatinine clearance. Methods: From 2004 to 2015, 341 patients with preoperative creatinine clearance were lower than 90 ml/min/1.73m2 were selected for this study. On-Pump beating heart was performed in 111 patients (Group I). Conventional on-pump technique was used in 200 patients. In the remaining patients, we measured postoperative Tumor Necrosis Factor Alpha (TNF-alpha), cardiac troponin I (cTn-I), Brain natriuretic peptid (NT-Pro- BNP), creati-nine (Cr), blood urea nitrogen (BUN) and postoperative eGFR daily until day four after surgery. Results: There were no differences in baseline levels of TNF-alpha, NT-Pro-BNP, BUN, cTn-I, Cr levels between the groups. Cardiopulmonary bypass (CPB) time were much longer and cumulative inotrope use was significantly higher in patients underwent COP (P Conclusion: Our study showed that on-pump beating heart CABG technique provides a morbidity benefit and is associated with a lower risk of peroperative LOS in patients with mild renal disfunction. Our study results suggest that OPBH is superior to the COP in terms of postoperative renal injury and cardiac mediators.
文摘From January 1982 to June 1990, 2730 patients with congenital heart defects (CHDS) were treated at Xinhua Hospital there were 537 cases of complex lesions. Fifty of 537 patients died, the hospital mortality rate was 9.31%. On the basis of our clinical experience, it is important that the accurate diagnosis was made promptly in neonate with complex CHDs. The surgical results can be improved by the use of PGEI and balloon atrial septostomy in the cyanotic neonate. For the congestive CHDs, the operation must be per formed in the early life to prevent pulmonary hypertension. Improved methods of preoperative and postoperative care have contributed to these results.
文摘Background: The majority of prospective cardiac surgical patients in sub Saharan Africa lack access to open heart surgery. We reviewed our midterm results to identify the obstacles to growth and challenges with sustainability. Methods: Records of patients undergoing heart surgery at LASUTH from December 2004 to March 2006 were retrospectively reviewed for clinical and outcome data. Results: Twenty four patients age 10-50, mean 28.0 +/? 10.49 years and 13 (54.2%) males underwent surgery. 12 (50.0%) patients had mechanical valve replacements, 11 (45.8%) closure of septal defects and 1 (4.2%) left atrial myxoma resection. Logistic euroscore for valve patients was 5.81 +/? 4.74 while observed mortality was 8.3% (1/12). Overall 30 days operative mortality was 8.3% (2/24) and major morbidity 4.2% (1/24). Patients with septal defects closure stopped clinic visits within a year. Valve patients follow up was complete in 90.1% with mean duration of 55.2 +/? 15.3 months. Late events occurred only in females with mitral valve replacements. The 5-year freedom from thromboembolism and bleeding was 74.0% and survival 82.0% in valve patients. Conclusion: Despite limited resources heart surgery can safely be performed with good outcomes by trained local personnel under supervision of visiting foreign teams until they are proficient to operate independently. Patients with less complex congenital defects have excellent postsurgical outcomes, while patients with rheumatic valve replacement are subject to ongoing valve related morbidity and mortality therefore require lifetime follow up. Choice of prosthetic valve for the mostly indigent and poorly educated population remains a challenge. We now prefer stented tissue valve despite its known limitations, in child bearing age females desirous of childbirth and others unlikely to comply with anticoagulation regimen. Barriers to sustainability include poor infrastructures, few skilled manpower, inadequate funding and restricted patient access due to inability to pay without third party insurance or government Medicaid.
基金Supported by Hamad Medical Corporation,No.MRC-01-18-073.
文摘BACKGROUND Rhabdomyolysis(RML)as an etiological factor causing acute kidney injury(AKI)is sparsely reported in the literature.AIM To study the incidence of RML after surgical repair of an ascending aortic dissection(AAD)and to correlate with the outcome,especially regarding renal function.To pinpoint the perioperative risk factors associated with the development of RML and adverse renal outcomes after aortic dissection repair.METHODS Retrospective single-center cohort study conducted in a tertiary cardiac center.We included all patients who underwent AAD repair from 2011-2017.Post-operative RML workup is part of the institutional protocol;studied patients were divided into two groups:Group 1 with RML(creatine kinase above cut-off levels 2500 U/L)and Group 2 without RML.The potential determinants of RML and impact on patient outcome,especially postoperative renal function,were studied.Other outcome parameters studied were markers of cardiac injury,length of ventilation,length of stay in the intensive care unit),and length of hospitalization.RESULTS Out of 33 patients studied,21 patients(64%)developed RML(Group RML),and 12 did not(Group non-RML).Demographic and intraoperative factors,notably body mass index,duration of surgery,and cardiopulmonary bypass,had no significant impact on the incidence of RML.Preoperative visceral/peripheral malperfusion,though not statistically significant,was higher in the RML group.A significantly higher incidence of renal complications,including de novo postoperative dialysis,was noticed in the RML group.Other morbidity parameters were also higher in the RML group.There was a significantly higher incidence of AKI in the RML group(90%)than in the non-RML group(25%).All four patients who required de novo dialysis belonged to the RML group.The peak troponin levels were significantly higher in the RML group.CONCLUSION In this study,we noticed a high incidence of RML after aortic dissection surgery,coupled with an adverse renal outcome and the need for post-operative dialysis.Prompt recognition and management of RML might improve the renal outcome.Further large-scale prospective trials are warranted to investigate the predisposing factors and influence of RML on major morbidity and mortality outcomes.
