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Impact of specialized nursing outpatient case management on postcoronary artery bypass grafting patients
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作者 Tong Li Fang-Hui Lu Qing Zhao 《World Journal of Clinical Cases》 SCIE 2024年第17期3035-3044,共10页
BACKGROUND Some patients with coronary atherosclerotic heart disease experience major adverse cardiac events(MACE)and require readmission after Coronary Artery Bypass Grafting(CABG)surgery.This is often attributed to ... BACKGROUND Some patients with coronary atherosclerotic heart disease experience major adverse cardiac events(MACE)and require readmission after Coronary Artery Bypass Grafting(CABG)surgery.This is often attributed to patients'unhealthy lifestyles and dietary habits,inadequate understanding of the disease,and poor disease management compliance.Thus,searching for more targeted nursing intervention models that can enhance patients'self-management abilities and reduce the risk of readmission after CABG surgery is significant.AIM To observe the impact of specialized nursing outpatient case management on patients after CABG surgery.METHODS A total of 103 patients who underwent CABG surgery in our hospital between April 2021 and April 2022 comprised the study sample.The patients were divided into two groups using an odd-even number grouping method.The control group received routine nursing care,while the case management group received specialized nursing outpatient case management.The differences in psychological status,adherence to medical treatment,self-care ability,knowledge mastery,quality of life scores,and the occurrence rate of MACE were compared between the two groups.RESULTS After the intervention,the case management group had lower scores on the selfrating depression scale and self-rating anxiety scale and lower MACE rate,as well as higher scores for adherence to a healthy diet,medication adherence,good lifestyle habits,regular exercise,and timely follow-up,higher scores on the Coronary Heart Disease Self-Management Scale,higher scores for managing adverse habits,symptoms,emotional cognition,emergency response,disease knowledge,general lifestyle,and treatment adherence,higher scores for understanding coronary heart disease,recognizing the importance of medication adherence,understanding selfcare points after CABG surgery,and being aware of post-CABG precautions,higher scores for physical well-being,disease condition,general health,social-psychological well-being,and work-related aspects(P<0.05).CONCLUSION Specialized nursing outpatient case management can enhance patient adherence to medical treatment,knowledge mastery,psychological well-being,and overall quality of life in patients after CABG surgery. 展开更多
关键词 Specialized nursing Case management coronary artery bypass grafting Adherence to medical treatment Knowledge mastery Psychological status
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Implications of Elevated Serum Cortisol in the Onset of Postoperative Delirium Following Off-Pump Coronary Artery Bypass Grafting: Insights from a Bangladesh-Based Single Center Experience
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作者 Vivek Kumar Jha Md Abir Tazim Chowdhury +6 位作者 Munama Magdum Manoj Tiwari Md Abul Bashar Maruf Md Saiful Islam Khan Priyanka Sinha Rajesh Naryan Kapar Md. Rezwanul Hoque 《World Journal of Cardiovascular Diseases》 CAS 2024年第4期252-267,共16页
Background: Following coronary artery bypass grafting (CABG), delirium emerges as a prevalent complication. This study aimed to assess the correlation between elevated serum cortisol levels and the occurrence of posto... Background: Following coronary artery bypass grafting (CABG), delirium emerges as a prevalent complication. This study aimed to assess the correlation between elevated serum cortisol levels and the occurrence of postoperative delirium subsequent to off-pump CABG. Methods: Conducted in the Department of Cardiac Surgery at BSMMU from October 2020 to September 2022, this comparative cross-sectional study included a total of 44 participants. Subjects, meeting specific criteria, were purposefully assigned to two groups based on off-pump CABG. Group A (n = 22) consisted of patients with normal serum cortisol levels, while Group B (n = 22) comprised individuals with high serum cortisol levels on the first postoperative day. Delirium onset was assessed at the bedside in the ICU on the 1st, 2nd, 3rd, 4th, and 5th postoperative days using standard tools, namely the Richmond Agitation Sedation score (RASS) and The Confusion Assessment Method (CAM-ICU). Data were collected based on the presence or absence of delirium. Statistical analysis utilized SPSS version 26.0, employing an independent Student’s t-test for continuous data and chi-square and Fischer’s exact test for categorical data. A p-value ≤ 0.05 was considered statistically significant. Results: Group-A had a mean age of 54.50 ± 17.97, and Group-B had a mean age of 55.22 ± 15.45, both with a male predominance (81.81% and 86.36% respectively). The mean serum cortisol level was significantly higher in Group B (829.71 ± vs. 389.98 ± 68.77). Postoperative delirium occurred in 27.3% of Group B patients, statistically significant compared to the 4.5% in Group A. However, patients in Group B who developed delirium experienced significantly longer postoperative ICU and hospital stays (79.29 ± 12.27 vs. 11.44 ± 2.85, p ≤ 0.05). There was one mortality in Group B, which was statistically not significant. Conclusion: This study observed a significant association between elevated serum cortisol levels in the postoperative period and the occurrence of postoperative delirium after off-pump coronary artery bypass grafting. 展开更多
关键词 coronary artery bypass grafting (CABG) Serum Cortisol Postoperative Delirium BANGLADESH
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Off-Pump Coronary Artery Bypass Grafting in Patients with Left Ventricular Dysfunction: Short-Term Results from a Single Center in Bangladesh
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作者 Muhit Abdullah Md. Abir Tazim Chowdhury +9 位作者 Satyajit Sharma Rehana Akther Munama Magdum Munjerin Refat Synthee Md. Zafar-Al-Nimari Saikat Das Gupta Saleh Ahmed Samir Kumar Biswas M. Quamrul Islam Talukder Farooque Ahmed 《World Journal of Cardiovascular Surgery》 2024年第9期145-156,共12页
Background: Off-pump coronary artery bypass grafting (OPCAB) is considered a safer alternative to on-pump surgery, especially in patients with left ventricular dysfunction (LVD). Objectives: This study assessed short-... Background: Off-pump coronary artery bypass grafting (OPCAB) is considered a safer alternative to on-pump surgery, especially in patients with left ventricular dysfunction (LVD). Objectives: This study assessed short-term outcomes and functional improvements in LVD patients post-OPCAB. Methods: The study included 200 coronary artery disease patients who underwent isolated off-pump coronary artery bypass grafting (OPCAB) at the National Heart Foundation Hospital and Research Institute between January 2019 and June 2020. Patients were categorized into Group 1, with a left ventricular ejection fraction (LVEF) of 30% - 39%, and Group 2, with an LVEF of 40% or higher. Echocardiographic assessments of left ventricular dimensions and ejection fraction were performed preoperatively, at discharge, and one month postoperatively. Results: In Group 1, preoperative left ventricular internal dimensions during diastole (LVIDd) and systole (LVIDs) were 53.48 ± 4.40 mm and 44.23 ± 3.93 mm, respectively, with a left ventricular ejection fraction (LVEF) of 35.28% ± 2.26%. At discharge, these values improved to 51.58 ± 4.04 mm (LVIDd), 41.23 ± 5.30 mm (LVIDs), and 39.25% ± 3.75% (LVEF). One month postoperatively, further improvements were observed: 46.29 ± 3.76 mm (LVIDd), 37.45 ± 3.68 mm (LVIDs), and 43.22% ± 4.67% (LVEF). Group 2 showed similar positive outcomes, with preoperative values of 47.09 ± 5.06 mm (LVIDd), 35.11 ± 5.25 mm (LVIDs), and 50.13% ± 7.25% (LVEF), improving to 42.37 ± 4.18 mm (LVIDd), 31.05 ± 4.19 mm (LVIDs), and 55.33% ± 7.05% (LVEF) at one month postoperatively. Both groups demonstrated significant improvements in left ventricular function and NYHA class, with most patients moving from class III/IV to I/II. Complications were minimal, and no mortality was observed. Conclusion: OPCAB is safe and effective for patients with LVEF 30% - 39% and LVEF ≥ 40%, providing significant short-term functional improvements without increased risk. 展开更多
关键词 Off-Pump coronary artery bypass grafting Left Ventricular Dysfunction (LVD) Short-Term Outcomes
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Sevoflurane Versus Propofol for Myocardial Protection in Patients Undergoing Coronary Artery Bypass Grafting Surgery: a Meta-analysis of Randomized Controlled Trials 被引量:11
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作者 Yun-tai Yao Li-huan Li 《Chinese Medical Sciences Journal》 CAS CSCD 2009年第3期133-141,共9页
Objective To systematically review randomized controlled trials to compare myocardial protection profiles of sevoflurane with propofol in patients undergoing coronary artery bypass grafting (CABG) surgery. Methods ... Objective To systematically review randomized controlled trials to compare myocardial protection profiles of sevoflurane with propofol in patients undergoing coronary artery bypass grafting (CABG) surgery. Methods Electronic databases were searched to identify all randomized controlled trials comparing sevoflurane with propofol for protecting myocardium in adult patients undergoing CABG surgery. Two authors independently extracted patients' perioperative data, including patients' baseline characteristics, surgical variables, and outcome data. For continuous variables, treatment effects were calculated as weighted mean difference (WMD) and 95% confidential interval (C/). For dichotomous data, treatment effects were calculated as odds ratio (OR) and 95% CI. Each outcome was tested for heterogeneity, and randomized-effects or fixed-effects model was used in the presence or absence of significant heterogeneity (Q test P〈0.05). Sensitivity analyses were done by examining the influence of statistical model on estimated treatment effects. Publication bias was explored through visual inspection of funnel plots of the outcomes. Statistical significance was defined as P〈0.05. Results Our search yielded 13 studies including 696 patients, and 402 patients were allocated into sevoflurane group and 294 into propofol group. There was no significant difference in postoperative mechanical ventilation time, inotropic support, mortality, myocardial infarction, and atrial fibrillation between the two groups (all P〉0.05). Patients randomized into sevoflurane group had higher post-bypass cardiac index (WMD=0.39, 95% CI: 0.18 to 0.60, P=0.0003), lower troponin I level (WMD=-0.82, 95% CI:-0.87 to -0.85, P=0.0002), lower incidence of myocardial ischemia (OR=0.37, 95% CI: 0.16 to 0.83, P=0.02), shorter ICU and hospital stay length (WMD=-10.99, 95% CI: -12.97 to -9.01, P〈0.00001; WMD=-0.78, 95% CI: -1.00 to -0.56, P〈0.00001, respectively). Conclusion This meta-analysis has found some evidence showing that sevoflurane has better myocardial protection than propofol in CABG surgery. 展开更多
关键词 SEVOFLURANE PROPOFOL myocardial protection coronary artery bypass grafting META-ANALYSIS
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Off-pump coronary artery bypass grafting using a bilateral internal mammary artery Y graft 被引量:10
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作者 Cheng-Xiong Gu Jun-Feng Yang +2 位作者 Hong-Chao Zhang Hua Wei Ling-Ke Li 《Journal of Geriatric Cardiology》 SCIE CAS CSCD 2012年第3期247-251,共5页
Objective To evaluate the outcome of off-pump coronary artery bypass grafting (OPCABG) using a bilateral internal mammary artery (BIMA) Y configuration graft to achieve total arterial myocardial revascularization.... Objective To evaluate the outcome of off-pump coronary artery bypass grafting (OPCABG) using a bilateral internal mammary artery (BIMA) Y configuration graft to achieve total arterial myocardial revascularization. Methods From October 2002 to December 2008, 208 patients (196 males and 12 females) underwent OPCABG using a BIMA Y configuration graft. The average age of the patients was 56.5 ± 11.3 years, with an age range of 33-78 years. A total of 167 (80.2%) cases had triple-vessel disease. Left main stem disease was found in 33 (15.9%) cases, and double-vessel disease was found in 8 (3.9%) cases. The semi-skeletonization technique was used to harvest the two internal mammary arteries (IMAs), and then the free right internal mammary artery was connected end-to-side to the left internal mammary artery (LIMA) in situ to complete the Y configuration graft. Off-pump and sequential anastomosis methods were used to perform coronary artery bypass surgery in all patients. Graft patency was assessed intm-operatively with the HT311 transit time flowmeter. Results A total of 728 distal anastomoses were performed in 208 patients, with the average being 3.5± 1.3 per person. No one died or experienced recurrent angina within 30 days after the operation. Conclusions OPCABG using the BIMA Y graft was safe and effective to achieve total arterial revascularization. This method avoids surgical operation on the ascending aorta and other incisions. 展开更多
关键词 Bilateral internal mammary arteries coronary artery bypass grafting Internal mammary artery OFF-PUMP
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Predictors of new-onset atrial fibrillation in elderly patients with coronary artery disease after coronary artery bypass graft 被引量:8
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作者 Rubanenko O Anatol'evna Fatenkov O Veniaminovic Khokhlunov S Mikhaylovich 《Journal of Geriatric Cardiology》 SCIE CAS CSCD 2016年第5期444-449,共6页
Objective To identify the factors associated with the development of postoperative atrial fibrillation (POAF) after coronary artery bypass graft (CABG) in elderly patients with coronary artery disease (CAD). Met... Objective To identify the factors associated with the development of postoperative atrial fibrillation (POAF) after coronary artery bypass graft (CABG) in elderly patients with coronary artery disease (CAD). Methods A total of 81 patients with CAD who underwent CABG were enrolled in the study. Patients were divided into two groups: Group 1, without postoperative atrial fibrillation (59 patients, 74.6% men, mean age 65.8 ~ 4.0 years); Group 2, with early new-onset atrial fibrillation after CABG (22 patients, 90.9% men, mean age 67.7 + 5.4 years). Interleukin (IL)-6, IL-8, IL-10, C-reactive protein (CRP), fibrinogen, superoxide dismutase (SOD), N-terminal pro-B-type natriuretic peptide (NT-proBNP), and troponin I were studied. Results During the observation period, atrial fibrillation occurred in 27.2% cases, an average of 4.9 ±3.8 days after surgery. In group 2, the left atrium (LA) dimension was larger than in group 1 (43.9 ± 3.4 mm vs. 37.6 ±3.9 rnm, P 〈 0.001). Patients with POAF had significantly higher IL-6 (72.7 ±60.8 pg/mL vs. 38.0 ± 34.6 pg/mL, P = 0.04), IL-8 (11.9 ± 6.0 pg/mL vs. 7.7± 5.4 pg/mL, P = 0.01) and SOD (2462.0 ± 2029.3 units/g vs. 1515.0 ± 1292.9 units/g, P = 0.04) compared with group without POAF. The multivariate analysis showed that the odds ratio (OR) for POAF development in patients with left atrium more than 39 mm was 2.1 [95% confidence interval (CI): 1.2-3.8, P = 0.0004], IL-6 levels more than 65.18 pg/mL-1.4 (95% Ch 1.1-2.7, P = 0.009), IL-8 levels more than 9.67 pg/mL-1.2 (95% CI: 1.1-3.7, P : 0.009), SOD more than 2948 units/g-1.1 (95% Ch 1.01-2.9, P = 0.04). Conclusions In our study, the independent predictors of postoperative atrial fibrillation after CABG in elderly patients were left atrium dimension and the increased postoperative concentration of IL-6, IL-8 and superoxide dismutase. 展开更多
关键词 Antioxidant Atrial fibrillation coronary artery bypass graft INTERLEUKINS TROPONIN
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The importance of depression and alcohol use in coronary artery bypass graft surgery patients:risk factors for delirium and poorer quality of life 被引量:7
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作者 Joanne M Humphreys Linley A Denson +1 位作者 Robert A Baker Phillip J Tully 《Journal of Geriatric Cardiology》 SCIE CAS CSCD 2016年第1期51-57,共7页
ObjectiveToinvestigate whether depression, anxiety and stress increase the risk for delirium and poor quality of life (QOL) after co-ronary artery bypass (CABG) surgery.MethodsA total of 180 CABG patients (mean a... ObjectiveToinvestigate whether depression, anxiety and stress increase the risk for delirium and poor quality of life (QOL) after co-ronary artery bypass (CABG) surgery.MethodsA total of 180 CABG patients (mean age of 63.5 ± 10.1 years, 82.2% males) completed baseline and postoperative self-report questionnaires to assess distress and QOL. Incident delirium was diagnosed postoperatively with a structured clinical interview and patients were monitored every day post-operatively for confusion and disturbance in consciousness.Results Delirium developed in 63 persons (35% of sample). After adjustment for covariates, delirium was significantly associated with depression [odds ratio (OR): 1.08; 95% confidence interval (CI): 1.03-1.13,P = 0.003], anxiety (OR: 1.07; 95% CI: 1.02-1.13,P= 0.01) and stress (OR: 1.05; 95% CI: 1.00-1.09,P= 0.03). Preoperative depression scores were associated with poorer QOL including bodily pain (β =-0.39,P = 0.013), vitality (β=-0.32,P = 0.020), social functioning (β=-0.51,P≤0.001), emotional role function (β=-0.44,P = 0.003) and general health (β=-0.33,P = 0.038). Among the covariates, harmful levels of alcohol use was consistently associated with poorer QOL.Conclusions Depression and harmful levels of alcohol use were consistently associated with poorer QOL whereas depression, anxiety and stress were associated with delirium risk. These findings point to further research examining depression and harmful levels of alcohol use in coronary heart disease populations undergoing coronary revascularization. 展开更多
关键词 coronary artery bypass grafts coronary heart disease DELIRIUM DEPRESSION Quality of life
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Redo Coronary Artery Bypass Grafting: On-Pump and Off-Pump Coronary Artery Bypass Grafting Revascularization Techniques 被引量:5
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作者 Song Wu Feng Wan +3 位作者 Zhe Zhang Hong Zhao Zhong-qi Cui Ji-yan Xie 《Chinese Medical Sciences Journal》 CAS CSCD 2015年第1期28-33,共6页
Objective To analyze the short-term outcomes of redo coronary artery bypass grafting(CABG) using on-pump and off-pump CABG techniques. Methods From January 2003 to August 2013, non-randomized 80 patients were treated ... Objective To analyze the short-term outcomes of redo coronary artery bypass grafting(CABG) using on-pump and off-pump CABG techniques. Methods From January 2003 to August 2013, non-randomized 80 patients were treated with redo CABG in the Department of Cardiac Surgery, Peking University Third Hospital. Among these patients, 40 underwent on-pump CABG technique(redo-ONCAB group) and 40 underwent off-pump CABG technique(redo-OPCAB group). Furthermore, transmyocardial laser revascularization was performed in high-risk patients who were not suitable to conventional grafting. Clinical data of the two groups were recorded and analyzed including operation time, coronary grafts, incomplete revascularization, postoperative ventilation, perioperative stroke, and low output syndrome, etc. Results There were no significantly differences in age, gender distribution, incidences of hypertension, stroke, and other clinical characteristics between redo-OPCAB group and redo-ONCAB group(all P>0.05), except for incidences of renal dysfunction and pulmonary disease(all P<0.05). The number of grafting vessels in the redo-ONCAB and redo-OPCAB groups was 2.1 ± 0.74 and 1.4 ±0.52 respectively. There was significant difference between the two groups(P=0.0243). Compared with the redo-ONCAB group, there was shorter operation time(P=0.0045), postoperative ventilation(P=0.0211) and intensive care unit stay(P=0.0400), as well as fewer use of platelet(P=0.0338) and blood transfusion(P=0.0034) in the redo-OPCAB group. The incidence of incomplete revascularization(P=0.0253) and the use of transmyocardial laser revascularization(P=0.0052) were higher in the redo-OPCAB group than those in the redo-ONCAB group(all P<0.05). However, no significant differences were showed for the incidence of the use of intra aortic balloon pump and continuous renal replacement therapy, perioperative stroke, low output syndrome, and in-hospital mortality between the two groups(all P>0.05). Conclusion Redo CABG is the safety and efficacy surgical procedure, and redo-OPCAB technique with better outcomes is commended especially in high-risk patients. 展开更多
关键词 REOPERATION coronary artery bypass grafting on pump off pump transmyocardial laser revascularization
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A nursing protocol targeting risk factors for reducing postoperative delirium in patients following coronary artery bypass grafting:Results of a prospective before-after study 被引量:6
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作者 Weiying Zhang Yan Sun +4 位作者 Yang Liu Wenjuan Qiu Xiaofei Ye Guihong Zhang Lingjuan Zhang 《International Journal of Nursing Sciences》 2017年第2期81-87,共7页
Objective: The results of postoperative delirium (POD) warrant testing for prevention. The purpose of this study was to determine whether a nursing intervention targeting risk factors could decrease the inci-dence of ... Objective: The results of postoperative delirium (POD) warrant testing for prevention. The purpose of this study was to determine whether a nursing intervention targeting risk factors could decrease the inci-dence of POD among patients who had coronary artery bypass grafting (CABG) in China.Methods: A prospective before-after study was conducted between April 2014 and April 2015. A nursing delirium intervention protocol targeting risk factors for delirium was performed for 141 patients un-dergoing CABG in a cardiothoracic ICU from November 2014 to April 2015. Intervention consisted of screening for delirium risk factors, followed by targeted risk factor modification, including pain control, early catheter removal, patient orientation using the 5W1H procedure, increased family visits, mini-mizing care-related interruptions, comfortable nursing and monitoring for sleeping difficulties. Out-comes of the Intervention Group were compared with those of the Control Group for 137 CABG patients from April 2014 to October 2014. Delirium was assessed using the confusion assessment method for the intensive care unit (CAM-ICU). The sample size was justified by PASS2000, based on previous data of delirium incidence in our institution (30%). Main results: Delirium incidence during the first seven postoperative days was significantly lower in the Intervention Group at 13.48%(19/141) vs. 29.93%(41/137) for the Control Group (x2=11.112, P=0.001). In addition, POD in the Intervention Group occurred between the 3rd and 6th postoperative days, while POD in the Control Group mainly occurred on the first three days postoperatively. Delirium in the Intervention Group occurred later than delirium in the Control Group (x2=12.743, P<0.001). Length of ICU stay was reduced significantly (Z= -6.026, P<0.001). Conclusion: The application of a nursing protocol targeting risk factors in this study seems to be asso-ciated with a lower incidence of POD in patients after CABG. This finding suggests that managing the predictors properly is one of the effective strategies to prevent delirium. 展开更多
关键词 Postoperative delirium coronary artery bypass grafting Risk factors Nursing protocol
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Long term outcomes of saphaneous vein graft intervention in elderly patients with prior coronary artery bypass graft 被引量:4
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作者 Ji-Hong WANG Wei LIU +2 位作者 Xin DU Chang-Sheng MA Xue-Si WU 《Journal of Geriatric Cardiology》 SCIE CAS CSCD 2014年第1期26-31,共6页
Objectives To investigate the procedure characteristics and long term follow-up ofpercutaneous coronary intervention (PCI) for sa phaneous vein graft (SVG) lesions in the elderly patients. Methods From December 20... Objectives To investigate the procedure characteristics and long term follow-up ofpercutaneous coronary intervention (PCI) for sa phaneous vein graft (SVG) lesions in the elderly patients. Methods From December 2005 to December 201 l, 84 graft lesions were treated percumneously. Seventeen were located at proximal anastomosis, 48 were located at SVG body, 19 were located at distal anastomosis. Pri mary endpoint was defined as major adverse cardiovascular events (MACE, composite of cardiac death, target vessel revascularization, acute myocardial infarction). Results The graft age was 6.7 i 4.0 years. Most anastomosis lesions (80.0%) presented within one year post coro-nary artery bypass grafting (CABG). Proximal anastomosis lesion had the lowest successful rate for PCI compared with graft body and distal anastomosis lesions (70.6% vs. 91.7%, 79.0%, P 〈 0.05). The distal embolic protection device was used in 19.1% of patients, most frequently used in body graft PCI (29.2%, P 〈 0.01). The diameter of the stent was smallest in distal anastomosis group (2.9 ±0.4 mm, P 〈 0.05). The highest post dilatation pressure was required in the proximal anastomosis (17.8 ± 2.7 atm, P 〈 0.05). The patients were followed up for 24.3 ±16.9 months. MACE occurred in 18.57% of patients. Incidence of MACE was highest among proximal anastomosis PCI (47.1% vs. body graft PCI 16.7%, distal anastomosis PCI 21.1%; P 〈 0.05). Old myocardial infarction was the predictive factor for the poor clinical outcomes (P〈 0.04). Conclusions PCI of SVG lesions is feasible with lower success rate. PCI of ostial graft anastomosis lesions had the lowest procedure success rate and highest MACE rate compared with graft body and distal anastomosis lesions. Old myocardial infarction was a predictive factor of poor outcomes. 展开更多
关键词 graft ANASTOMOSIS Percutaneous coronary intervention coronary artery bypass grafting
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Coronary artery bypass grafting with concomitant resection for carcinoma of lung 被引量:4
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作者 Yangyang Zhang,Yanhu Wu ,Biao Yuan,Xiang Liu,Sheng Zhao,Zhi Li,Yu Xia Department of Cardiothoracic Surgery,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,Jiangsu Province,China 《The Journal of Biomedical Research》 CAS 2010年第1期77-80,共4页
A 69-year-old woman with angina had a lesion in the left lower lobe on chest film. Angiography revealed coronary artery disease in three vessels. Combined off pump coronary artery bypass grafting (CABG) and left low... A 69-year-old woman with angina had a lesion in the left lower lobe on chest film. Angiography revealed coronary artery disease in three vessels. Combined off pump coronary artery bypass grafting (CABG) and left lower lobectomy were performed through median sternotomy. This approach avoids complications due to staged operations and cardiopulmonary bypass (CPB). This report shows that simultaneous off pump CABG and pulmonary operations can be performed safely in patients with coronary artery disease (CAD) associated with lung cancer. 展开更多
关键词 lung cancer coronary artery disease luo- resection off-pump coronary artery bypass grafting
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The effect of slow deep breathing relaxation exercise on pain levels during and post chest tube removal after coronary artery bypass graft surgery 被引量:3
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作者 Mohamad I.Jarrah Issa M.Hweidi +5 位作者 Sirin A.Al-Dolat Hossam N.Alhawatmeh Salwa M.Al-Obeisat Lama I.Hweidi Aysam I.Hweidi Osama A.Alkouri 《International Journal of Nursing Sciences》 CSCD 2022年第2期155-161,I0003,共8页
Objectives:This study aimed to evaluate the effectiveness of slow deep breathing relaxation exercise(SDBRE)in reducing patients’pain levels during chest tube removal(CTR)post coronary artery bypass grafting(CABG)surg... Objectives:This study aimed to evaluate the effectiveness of slow deep breathing relaxation exercise(SDBRE)in reducing patients’pain levels during chest tube removal(CTR)post coronary artery bypass grafting(CABG)surgery.Methods:In 2019,fifty post-CABG patients were conveniently selected from a cardiac intensive care unit in Jordan’s major referral heart institute.The patients were randomly assigned to either an intervention group or a control group.A total of 25 patients were assigned into the experimental group who received slow deep breathing relaxation Exercise(SDBRE)alongside the conventional care before CTR.The remaining 25 patients constituted the control group(50%)that had CTR following conventional care.The Visual Analogue Scale(VAS)was used to measure the participants’pain levels during three phases:before CTR(Time 1),5-min post CTR(Time 2),and 15-min post CTR(Time 2)to compare the intervention effect between the two groups.Results:The data analysis findings for the control and intervention group of patients showed that there was a statistically significant decline in their pain level across time for both groups(H¼32.71,P<0.01;H=47.23,P<0.01)respectively.The intervention group had significantly lower pain levels than the control group at Time 2(3.50[1.20,5.30]vs.7.90[7.00,9.00],P<0.01)and Time 3(0.00[0.00,1.30]vs.3.60[2.40,4.10]P<0.01).Conclusions:Using SDBRE during CTR is an effective technique for reducing pain which can minimize the need for analgesics and their associated adverse effects. 展开更多
关键词 Breathing exercises Chest tubes removal coronary artery bypass grafting PAIN Patients JORDAN
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Application of Endoscopic Vein Harvesting in Obese Patients Undergoing Coronary Artery Bypass Grafting 被引量:3
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作者 Peng BAI Yi-xuan WANG +3 位作者 Si CHEN Jin-ping LIU Nian-guo DONG Jun-wei LIU 《Current Medical Science》 SCIE CAS 2018年第4期691-696,共6页
This study aims to evaluate the clinical outcomes of endoscopic vein harvesting (EVH) for coronary artery bypass grafting (CABG) in obese patients. Totally, 153 obese patients who underwent EVH (n=81) or standar... This study aims to evaluate the clinical outcomes of endoscopic vein harvesting (EVH) for coronary artery bypass grafting (CABG) in obese patients. Totally, 153 obese patients who underwent EVH (n=81) or standard bridging technique (SBT, n=72) in CABG surgery from May 2012 to October 2014 in our hospital were enrolled in this retrospective non-randomized controlled study. The general situation of operation, postoperative complications and short medium-term outcomes were analyzed. The baseline characteristics were similar between these two groups (P〉0.05). There were no statistical differences in total operation time (226±28 min vs. 224±30 min, P〉0.05), number of damaged vessels (0.12±0.05 vs. 0.16±0.06, P〉0.05) and short medium-term outcomes including revascularization rate (1.25% vs. 2.78%, P〉0.05), vessel dysfunction rate (11.25% vs. 11.11%, P〉0.05) and mortality (0.00% vs. 0.00%, P〉0.05). Use of EVH was associated with significant reduction of total harvesting time (41±6 min vs. 63±11 min, P〈0.05), incision length (4.4±1.1 cm vs. 18.2±4.5 cm, P〈0.05) and postoperative lower extremity complications (P〈0.05). EVH can reduce the risk of wound complications, whereas does not influence short- and medium-term outcomes in obese patients. It can be considered a reliable procedure of harvesting vessel conduits for obese patients undergoing CABG. 展开更多
关键词 minimally invasive endoscopy saphenous vein harvesting OBESITY coronary artery bypass grafting
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Long term outcomes of drug-eluting stent versus coronary artery bypass grafting for left main coronary artery disease: a meta-analysis 被引量:3
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作者 Kong-Yong CUI Shu-Zheng LYU +9 位作者 Xian-Tao SONG Fei YUAN Feng XU Min ZHANG Ming-Duo ZHANG Wei WANG Dong-Feng ZHANG Jing DAI Jin-Fan TIAN Yun-Lu WANG 《Journal of Geriatric Cardiology》 SCIE CAS CSCD 2018年第2期162-172,共11页
Background It is still controversial whether percutaneous coronary intervention with drug-eluting stent (DES) is safe and effective compared to coronary artery bypass graft surgery (CABG) for unprotected left main... Background It is still controversial whether percutaneous coronary intervention with drug-eluting stent (DES) is safe and effective compared to coronary artery bypass graft surgery (CABG) for unprotected left main coronary artery (ULMCA) disease at long-term follow up (≥3 years). Methods Eligible studies were selected by searching PubMed, EMBASE, and Cochrane Library up to December 6, 2016. The primary endpoint was a composite of death, myocardial infarction (MI) or stroke during the longest follow-up. Death, cardiac death, MI, stroke and repeat revascularization were the secondary outcomes. Results Four randomized controlled trials and twelve adjusted observational studies involving 14,130 patients were included. DES was comparable to CABG regarding the occurrence of the primary endpoint (FIR = 0.94, 95% CI: 0.86-1.03). Besides, DES was significantly associated with higher incidence of MI (HR = 1.56, 95% CI: 1.09-2.22) and repeat revascularization (HR = 3.09, 95% CI: 2.33-4.10) compared with CABG, while no difference was found between the two strategies regard as the rate of death, cardiac death and stroke. Furthermore, DES can reduce the risk of the composite endpoint of death, MI or stroke (HR = 0.80, 95% CI: 0.67-0.95) for ULMCA lesions with SYNTAX score ≤32. Conclusions Although with higher risk of repeat revascularization, PCI with DES appears to be as safe as CABG for ULMCA disease at long-term follow up. In addition, treatment with DES could be an alternative interventional strategy to CABG for ULMCA lesions with low to intermediate anatomic complexity. 展开更多
关键词 coronary artery bypass graft Dmg-eluting stent Long term Unprotected left main coronary disease
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Risk factors for acute kidney injury following coronary artery bypass graft surgery in a Chinese population and development of a prediction model 被引量:3
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作者 Yang LI Xue-Jian HOU +5 位作者 Tao-Shuai LIU Shi-Jun XU Zhu-Hui HUANG Peng-Yun YAN Xiao-Yu XU Ran DONG 《Journal of Geriatric Cardiology》 SCIE CAS CSCD 2021年第9期711-719,共9页
BACKGROUND Acute kidney injury(AKI)after coronary artery bypass graft(CABG)surgery is associated with significant morbidity and mortality.This retrospective study aimed to establish a risk score for postoperative AKI ... BACKGROUND Acute kidney injury(AKI)after coronary artery bypass graft(CABG)surgery is associated with significant morbidity and mortality.This retrospective study aimed to establish a risk score for postoperative AKI in a Chinese population.METHODS A total of 1138 patients undergoing CABG were collected from September 2018 to May 2020 and divided into a derivation and validation cohort.AKI was defined according to the Kidney Disease Improving Global Outcomes(KDIGO)criteria.Multivariable logistic regression analysis was used to determine the independent predictors of AKI,and the predictive ability of the model was determined using a receiver operating characteristic(ROC)curve.RESULTS The incidence of cardiac surgery–associated acute kidney injury(CSA-AKI)was 24.17%,and 0.53%of AKI patients required dialysis(AKI-D).Among the derivation cohort,multivariable logistic regression showed that age≥70 years,body mass index(BMI)≥25 kg/m2,estimated glomerular filtration rate(eGFR)≤60 mL/min per 1.73 m2,ejection fraction(EF)≤45%,use of statins,red blood cell transfusion,use of adrenaline,intra-aortic balloon pump(IABP)implantation,postoperative low cardiac output syndrome(LCOS)and reoperation for bleeding were independent predictors.The predictive model was scored from 0 to32 points with three risk categories.The AKI frequencies were as follows:0-8 points(15.9%),9-17 points(36.5%)and≥18 points(90.4%).The area under of the ROC curve was 0.730(95%CI:0.691-0.768)in the derivation cohort.The predictive index had good discrimination in the validation cohort,with an area under the curve of 0.735(95%CI:0.655-0.815).The model was well calibrated according to the Hosmer-Lemeshow test(P=0.372).CONCLUSION The performance of the prediction model was valid and accurate in predicting KDIGO-AKI after CABG surgery in Chinese patients,and could improve the early prognosis and clinical interventions. 展开更多
关键词 AKI RED Risk factors for acute kidney injury following coronary artery bypass graft surgery in a Chinese population and development of a prediction model
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Predictors of post coronary artery bypass grafting atrial fibrillation 被引量:5
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作者 Tongtong Shen Qijun Shan Biao Yuan Bing Yang Chun Chen Dongjie Xu Minglong Chen Jiangang Zou Kejiang Cao 《Journal of Nanjing Medical University》 2007年第3期139-142,共4页
Objective: To investigate the incidence and relative risk factors of post coronary artery bypass grafting(post-CABG) atrial fibrillation (AF). Methods: 312 patients with CABG were reviewed and divided into an AF... Objective: To investigate the incidence and relative risk factors of post coronary artery bypass grafting(post-CABG) atrial fibrillation (AF). Methods: 312 patients with CABG were reviewed and divided into an AF group and a non-AF group. Statistical analysis was used to compare the data between the two groups and screen for risk factors of post-CABG AF. Results: 103/312 (33.01%) patients developed post-CABG AF. Univariate analysis showed that patients in AF group compared with those in non-AF group were more likely to have advanced age (≥ 70 years), early postoperative withdrawal of β-blockers, hypertension, left atrial enlargement (≥40 mm), a history of AF, prolonged p-wave duration (≥ 120 ms) and increased number of grafts (≥13). Multivariate logistic regression analysis showed that advanced age (≥70 years), early postoperative withdrawal of β-blockers, hypertension, left atrial enlargement (≥40 mm) and a history of AF were highly related to post-CABG AF. Conclusion: The incidence of AF in patients following CABG was 33.01% in this study. Advanced age, early postoperative withdrawal of 13-blockers, hypertension, left atrial enlargement and a history of AF were independent risk factors of post-CABG AF. 展开更多
关键词 coronary artery bypass grafting atrial fibrillation risk factors
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Clinical Observation on Quality of Life in Coronary Artery Bypass Grafting Patients Treated According to Syndrome Differentiation of TCM 被引量:2
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作者 阮新民 林宇 +6 位作者 江巍 胡佳心 陈秋雄 吴焕林 陈伯钧 周汉槎 黄春林 《Chinese Journal of Integrated Traditional and Western Medicine》 2004年第1期43-43,共1页
Objective: To evaluate the clinical effect and quality of life (QOL) in coronary artery bypass grafting (CABG) patients treated according to syndrome differentiation of TCM. Methods: Eighty-two CABG patients were allo... Objective: To evaluate the clinical effect and quality of life (QOL) in coronary artery bypass grafting (CABG) patients treated according to syndrome differentiation of TCM. Methods: Eighty-two CABG patients were allocated in the control group (n = 39) treated with conventional method of western medicine, and the TCM-treated group (n 展开更多
关键词 CABG TCM Clinical Observation on Quality of Life in coronary artery bypass grafting Patients Treated According to Syndrome Differentiation of TCM
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Clinical application of individualized total arterial coronary artery bypass grafting in coronary artery surgery 被引量:1
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作者 Wei-Guang Chen Bai-Chun Wang +2 位作者 Yong-Ri Jiang Ye-Yang Wang Yang Lou 《World Journal of Clinical Cases》 SCIE 2021年第19期5073-5081,共9页
BACKGROUND Total arterial revascularization is associated with increased patency and long-term efficacy and decreased perioperative morbidity and mortality and incidence of cardiac-related events and sternal wound inf... BACKGROUND Total arterial revascularization is associated with increased patency and long-term efficacy and decreased perioperative morbidity and mortality and incidence of cardiac-related events and sternal wound infection compared with conventional coronary artery bypass surgery(CABG),in which the left internal mammary artery(LIMA)is typically grafted to the left anterior descending artery with additional saphenous vein grafts often used.This study determined whether these favorable clinical results could be realized at the authors’institute.AIM To summarize the early efficacy and clinical experience of individualized total arterial coronary artery bypass grafting surgery.METHODS CABG was performed on 35 patients with non-single-vessel coronary artery disease by adopting total arterial grafts at Fourth Affiliated Hospital of Harbin Medical University between April 2016 and December 2019.LIMA was used in 35 patients,radial artery(RA)was used in 35 patients,and right gastroepiploic artery(RGEA)was used in 9 patients.Perioperative complications were observed,short-term graft patency rate was followed-up,and quality of life was assessed.RESULTS All patients underwent off-pump coronary artery bypass and the surgeries were successful.All of them were discharged without any complications or deaths.During the follow-up,it was found that patients’angina symptoms were relieved and New York Heart Association classification for cardiac function was class I to class II.A total of 90 vessels were grafted with no occlusion for internal mammary artery,three occlusions for RA,and one occlusion for RGEA.CONCLUSION The individualized total arterial strategy based on the vessels targeting individual anatomic characteristics can achieve complete revascularization with satisfactory short-term grafting patency rate. 展开更多
关键词 Total arterial revascularization coronary artery bypass grafting Radial artery Right gastroepiploic artery
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Surgical strategies for severely atherosclerotic(porcelain)aorta during coronary artery bypass grafting 被引量:1
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作者 Gokce Sirin 《World Journal of Cardiology》 2021年第8期309-324,共16页
Porcelain aorta(PA)is an asymptomatic atherosclerotic disease,characterized by circumferential calcification throughout the whole perimeter of the aorta.It is seen in 2%to 9.3%of patients undergoing elective coronary ... Porcelain aorta(PA)is an asymptomatic atherosclerotic disease,characterized by circumferential calcification throughout the whole perimeter of the aorta.It is seen in 2%to 9.3%of patients undergoing elective coronary artery bypass grafting(CABG)and makes manipulation of the ascending aorta impossible.It has been clearly shown that most emboli seen and detected during the CABG procedure occur during aortic cross-clamping and aortic side-clamping.Manipulation of porcelain or a severely atherosclerotic aorta increases the risk of perioperative stroke.The incidence of stroke after CABG is between 0.48%and 2.9%,and the risk is correlated with the extent and severity of the atherosclerotic disease.A conventional CABG procedure involves successive steps that include cannulation of the ascending aorta,application of a cross-clamp to the aorta,and partial clamping of the aorta to create the proximal anastomosis.Therefore in procedures that involve cannulation,clamping,or proximal anastomosis,and where aortic manipulation is inevitable,preassessment of the atherosclerotic aortic plaques is crucial.Although many surgeons still rely on intraoperative manual aortic palpation,this approach has very low sensitivity and underestimates the severity of the atherosclerotic illness.Imaging methods including preoperative computed tomography or intraoperative epiaortic ultrasonography enable modification of the surgical technique according to the severity of atherosclerosis.Various surgical techniques have been described to reduce the risk of atheroembolism that may lead to cerebrovascular events in patients with severely atherosclerotic ascending aorta.Anaortic or“no-touch”techniques that do not utilize aortic manipulation may significantly decrease the development of neurological complications by avoiding aortic maneuvers known to cause emboli.In cases where severe atherosclerotic disease or other factors preclude safe use of the ascending aorta,modifications in the surgical techniques,such as switching to different cannulation sites including the axillary/subclavian,femoral and innominate arteries,or using hypothermic ventricular fibrillation and in-situ pedicled arterial grafts,or performing proximal anastomoses at alternative anatomical locations will enable CABG operations to be performed safely with low morbidity and mortality rates in patients with porcelain aortas. 展开更多
关键词 coronary artery bypass grafting Cardiopulmonary bypass Severe atherosclerotic aorta Porcelain aorta Stroke MORTALITY
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Role of intraoperative transesophageal echocardiography in coronary artery bypass grafting 被引量:1
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作者 Xinchun Chen 《Journal of Nanjing Medical University》 2007年第1期1-7,共7页
Transesophapeal echocardiography (TEE) can be used as a diagnostic tool during cardiac surgery to direct the surgical procedure and diagnose unanticipated problems. TEE has also been one of the most important means ... Transesophapeal echocardiography (TEE) can be used as a diagnostic tool during cardiac surgery to direct the surgical procedure and diagnose unanticipated problems. TEE has also been one of the most important means of monitoring myocardial ischemia dur- ing coronary artery bypas grafting procedures. The cardiac anesthesiologist can apply intraoperative TEE in evaluating coronary artery anatomy and aorta atherosclerosis, assessing diastolic left ventricular function and preload,measuring intracardiac pressure and cardiac output,detecting ischaemic mitral regurgitation,intracardiac air and pericardial effusion. 展开更多
关键词 transesophageal echocardiography coronary artery bypass grafting ANESTHESIA mycardial ischemia cardiac output regional wall motion abnormality
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