Objective Coronary artery bypass grafting （CABG） is gradually increasing in the elderly population. We aimed to investigate the risk factors and the results of CABG along with the long term survival in patients at a...Objective Coronary artery bypass grafting （CABG） is gradually increasing in the elderly population. We aimed to investigate the risk factors and the results of CABG along with the long term survival in patients at an age of 80 and older. Methods Between Januaa-y 2002 and December 201 I, a total of i01 consecutive patients at an age of S0 and older who underwent CABG in our hospital were included in the study. The patients were followed and the long-term survival was estimated. Results The mean age of the patients was 82.98 ~ 2.27 years. Sixty-four （63.4%） were males and 37 （36.6%） were females. Emergency surgery, duration of cardiopulmonary bypass, the intensive care unit （ICU） stay, inotropic support, intra aortic balloon pulsation application, amount oferythrocyte transfusion and flesh frozen plasma transfusion and ventilation period were significantly higher in the patients who died in the hospital. The duration of cardiopulmonary bypass （CPB） was found to be an inde- pendent predictor of mortality （OR： 1.18, 95% CI 1.01-1.38, P = 0.034）. The in-hospital mortality was 16.8%. Kaplan-Meier analyses revealed a survival ratio of 91.3% at one year, 82.9% at three years and 69.0% at five years. Conclusions Patients at the age of 80 and older can be candidates for the CABG procedure bearing in mind that they may have a longer ventilation period and intensive care unit stay. The morbidity and mortality of this age group is considered within an acceptable range. Approaches to minimize CPB, or the choice of off-pump surgery, may be a preventive method to lower the incidence of mortality. Hence, CABG may be performed in this age group with a satisfactory survival ratio.展开更多
Objectives:Patients after cardiac surgery with cardiopulmonary bypass(CPB)require a stay in the ICU postoperatively.This study aimed to investigate the incidence of prolonged length of stay(LOS)in the ICU after cardia...Objectives:Patients after cardiac surgery with cardiopulmonary bypass(CPB)require a stay in the ICU postoperatively.This study aimed to investigate the incidence of prolonged length of stay(LOS)in the ICU after cardiac surgery with CPB and identify associated risk factors.Methods:The current investigation was an observational,retrospective study that included 395 ICU patients who underwent cardiac surgery with CPB at a tertiary hospital in Guangzhou from June 2015 to June 2017.Data were obtained from the hospital database.Binary logistic regression modeling was used to analyze risk factors for prolonged ICU LOS.Results:Of 395 patients,137(34.7%)had a prolonged ICU LOS(>72.0 h),and the median ICU LOS was 50.9 h.Several variables were found associated with prolonged ICU LOS:duration of CPB,prolonged mechanical ventilation and non-invasive assisted ventilation use,PaO2/FiO2 ratios within 6 h after surgery,type of surgery,red blood cell infusion during surgery,postoperative atrial arrhythmia,postoperative ventricular arrhythmia(all P<0.05).Conclusions:These findings are clinically relevant for identifying patients with an estimated prolonged ICU LOS,enabling clinicians to facilitate earlier intervention to reduce the risk and prevent resulting delayed recovery.展开更多
目的观察注射用乌司他丁联合地塞米松磷酸钠注射液治疗急性呼吸窘迫综合征的临床效果。方法选取2016年3月—2017年3月成都市第二人民医院收治的急性呼吸窘迫综合征患者96例为研究的对象,将所有患者随机分为对照组和治疗组,每组各48例。...目的观察注射用乌司他丁联合地塞米松磷酸钠注射液治疗急性呼吸窘迫综合征的临床效果。方法选取2016年3月—2017年3月成都市第二人民医院收治的急性呼吸窘迫综合征患者96例为研究的对象,将所有患者随机分为对照组和治疗组,每组各48例。对照组静脉滴注地塞米松磷酸钠注射液,5 mg加入到5%葡萄糖注射液250 m L中,2次/d。治疗组在对照组的基础上静脉滴注注射用乌司他丁,5万单位加入到5%葡萄糖注射液250 m L中,2次/d。两组患者均连续治疗2周。观察两组的临床疗效,比较两组的住院时间、住重症监护室(ICU)时间、病死率和肺功能指标。结果治疗后,对照组和治疗组的总有效率分别为77.1%、95.8%,两组比较差异具有统计学意义(P<0.05)。治疗后,治疗组住院时间、住ICU时间、病死率均低于对照组,两组比较差异具有统计学意义(P<0.05)。治疗后,两组氧合指数均显著升高,治疗组呼吸频率显著降低,同组治疗前后比较差异具有统计学意义(P<0.05);且治疗组这些观察指标的改善程度明显优于对照组,两组比较差异具有统计学意义(P<0.05)。结论注射用乌司他丁联合地塞米松磷酸钠注射液治疗急性呼吸窘迫综合征具有较好的临床疗效,可以改善肺功能,缩短住院时间和住ICU时间,降低病死率,具有一定的临床推广应用价值。展开更多
Background and aims:Patients in the intensive care unit(ICU)with acute pancreatitis(AP)are at risk for extra-pancreatic complications given their severe illness and prolonged length of stay.We sought to determine the ...Background and aims:Patients in the intensive care unit(ICU)with acute pancreatitis(AP)are at risk for extra-pancreatic complications given their severe illness and prolonged length of stay.We sought to determine the rate of extra-pancreatic complications and its effect on length of stay(LOS)and mortality in ICU patients with AP.Methods:We performed a retrospective cohort study of ICU patients admitted to a tertiary-care center with a diagnosis of AP.A total of 287 ICU patients had a discharge diagnosis of AP,of which 163 met inclusion criteria.We calculated incidence rates of extra-pancreatic complications and performed a univariate and multi-variable analysis to determine predictors of LOS and mortality.Results:There were a total of 158 extra-pancreatic complications(0.97 extra-pancreatic complications per patient).Ninetyfive patients had at least one extra-pancreatic complication,whereas 68 patients had no extra-pancreatic complications.Patients with extra-pancreatic complications had a significantly longer LOS(14.7 vs 8.8 days,p<0.01)when controlling for local pancreatic complications.Patients with non-infectious extra-pancreatic complications had a higher rate of mortality(24.0%vs 16.2%,p=0.04).Patients requiring dialysis was an independent predictor for LOS and mortality(incidence risk ratio[IRR]1.73,95%confidence interval[CI]:1.263–2.378 and IRR 1.50,95%CI 1.623–6.843,p<0.01)on multi-variable analysis.Coronary events were also a predictor for mortality(p=0.05).Other extra-pancreatic complications were not significant.Conclusions:Extra-pancreatic complications occur frequently in ICU patients with AP and impact LOS.Patients with noninfectious extra-pancreatic complications have a higher mortality rate.After controlling for local pancreatic complications,patients requiring dialysis remained an independent predictor for LOS and mortality.展开更多
文摘Objective Coronary artery bypass grafting （CABG） is gradually increasing in the elderly population. We aimed to investigate the risk factors and the results of CABG along with the long term survival in patients at an age of 80 and older. Methods Between Januaa-y 2002 and December 201 I, a total of i01 consecutive patients at an age of S0 and older who underwent CABG in our hospital were included in the study. The patients were followed and the long-term survival was estimated. Results The mean age of the patients was 82.98 ~ 2.27 years. Sixty-four （63.4%） were males and 37 （36.6%） were females. Emergency surgery, duration of cardiopulmonary bypass, the intensive care unit （ICU） stay, inotropic support, intra aortic balloon pulsation application, amount oferythrocyte transfusion and flesh frozen plasma transfusion and ventilation period were significantly higher in the patients who died in the hospital. The duration of cardiopulmonary bypass （CPB） was found to be an inde- pendent predictor of mortality （OR： 1.18, 95% CI 1.01-1.38, P = 0.034）. The in-hospital mortality was 16.8%. Kaplan-Meier analyses revealed a survival ratio of 91.3% at one year, 82.9% at three years and 69.0% at five years. Conclusions Patients at the age of 80 and older can be candidates for the CABG procedure bearing in mind that they may have a longer ventilation period and intensive care unit stay. The morbidity and mortality of this age group is considered within an acceptable range. Approaches to minimize CPB, or the choice of off-pump surgery, may be a preventive method to lower the incidence of mortality. Hence, CABG may be performed in this age group with a satisfactory survival ratio.
基金This work was supported by the Science and Technology Planning Project of Guangdong Province,China[grant numbers 20160910].
文摘Objectives:Patients after cardiac surgery with cardiopulmonary bypass(CPB)require a stay in the ICU postoperatively.This study aimed to investigate the incidence of prolonged length of stay(LOS)in the ICU after cardiac surgery with CPB and identify associated risk factors.Methods:The current investigation was an observational,retrospective study that included 395 ICU patients who underwent cardiac surgery with CPB at a tertiary hospital in Guangzhou from June 2015 to June 2017.Data were obtained from the hospital database.Binary logistic regression modeling was used to analyze risk factors for prolonged ICU LOS.Results:Of 395 patients,137(34.7%)had a prolonged ICU LOS(>72.0 h),and the median ICU LOS was 50.9 h.Several variables were found associated with prolonged ICU LOS:duration of CPB,prolonged mechanical ventilation and non-invasive assisted ventilation use,PaO2/FiO2 ratios within 6 h after surgery,type of surgery,red blood cell infusion during surgery,postoperative atrial arrhythmia,postoperative ventricular arrhythmia(all P<0.05).Conclusions:These findings are clinically relevant for identifying patients with an estimated prolonged ICU LOS,enabling clinicians to facilitate earlier intervention to reduce the risk and prevent resulting delayed recovery.
文摘目的观察注射用乌司他丁联合地塞米松磷酸钠注射液治疗急性呼吸窘迫综合征的临床效果。方法选取2016年3月—2017年3月成都市第二人民医院收治的急性呼吸窘迫综合征患者96例为研究的对象,将所有患者随机分为对照组和治疗组,每组各48例。对照组静脉滴注地塞米松磷酸钠注射液,5 mg加入到5%葡萄糖注射液250 m L中,2次/d。治疗组在对照组的基础上静脉滴注注射用乌司他丁,5万单位加入到5%葡萄糖注射液250 m L中,2次/d。两组患者均连续治疗2周。观察两组的临床疗效,比较两组的住院时间、住重症监护室(ICU)时间、病死率和肺功能指标。结果治疗后,对照组和治疗组的总有效率分别为77.1%、95.8%,两组比较差异具有统计学意义(P<0.05)。治疗后,治疗组住院时间、住ICU时间、病死率均低于对照组,两组比较差异具有统计学意义(P<0.05)。治疗后,两组氧合指数均显著升高,治疗组呼吸频率显著降低,同组治疗前后比较差异具有统计学意义(P<0.05);且治疗组这些观察指标的改善程度明显优于对照组,两组比较差异具有统计学意义(P<0.05)。结论注射用乌司他丁联合地塞米松磷酸钠注射液治疗急性呼吸窘迫综合征具有较好的临床疗效,可以改善肺功能,缩短住院时间和住ICU时间,降低病死率,具有一定的临床推广应用价值。
文摘Background and aims:Patients in the intensive care unit(ICU)with acute pancreatitis(AP)are at risk for extra-pancreatic complications given their severe illness and prolonged length of stay.We sought to determine the rate of extra-pancreatic complications and its effect on length of stay(LOS)and mortality in ICU patients with AP.Methods:We performed a retrospective cohort study of ICU patients admitted to a tertiary-care center with a diagnosis of AP.A total of 287 ICU patients had a discharge diagnosis of AP,of which 163 met inclusion criteria.We calculated incidence rates of extra-pancreatic complications and performed a univariate and multi-variable analysis to determine predictors of LOS and mortality.Results:There were a total of 158 extra-pancreatic complications(0.97 extra-pancreatic complications per patient).Ninetyfive patients had at least one extra-pancreatic complication,whereas 68 patients had no extra-pancreatic complications.Patients with extra-pancreatic complications had a significantly longer LOS(14.7 vs 8.8 days,p<0.01)when controlling for local pancreatic complications.Patients with non-infectious extra-pancreatic complications had a higher rate of mortality(24.0%vs 16.2%,p=0.04).Patients requiring dialysis was an independent predictor for LOS and mortality(incidence risk ratio[IRR]1.73,95%confidence interval[CI]:1.263–2.378 and IRR 1.50,95%CI 1.623–6.843,p<0.01)on multi-variable analysis.Coronary events were also a predictor for mortality(p=0.05).Other extra-pancreatic complications were not significant.Conclusions:Extra-pancreatic complications occur frequently in ICU patients with AP and impact LOS.Patients with noninfectious extra-pancreatic complications have a higher mortality rate.After controlling for local pancreatic complications,patients requiring dialysis remained an independent predictor for LOS and mortality.
