Intraoperative Blood Glucose Levels and Postoperative Acute Kidney Injury in Pediatric Patients Having Congenital Heart Surgery under Cardiopulmonary Bypass

Purpose:This study sought to explore the effect of intraoperative mean blood glucose levels and variability on postoperative acute kidney injury(AKI)in children undergoing congenital cardiac surgery.Methods:We conducted a prospective nested case-control study in children(age<18 years)undergoing congenital heart surgery with cardiopulmonary bypass(CPB)at the Fuwai Hospital between April 01,2022 and July 30,2022.Cases were individuals who developed AKI within the first postoperative 7 days(AKI group)and controls were those without AKI(Non-AKI group)according to KDIGO criteria.AKI and Non-AKI groups unmatched and 1:1 matched by age,sex,and baseline serum creatinine were separately analyzed.Multivariate logistic and conditional logistic regressions were used to assess the associations between blood glucose variables and AKI.Results:688 consecutively approached patients were included in the final analysis.On multivariate analysis,intra-CPB(adjusted odds ratio[OR]0.802;95%confidence interval[CI],0.706 to 0.912;p=0.001)and post-CPB(adjusted OR 0.830;95%CI,0.744 to 0.925;p=0.001)blood glucose levels were associated with postoperative AKI.There were no significant differences in pre-CPB blood glucose(adjusted OR 0.926;95%CI,0.759 to 1.129;p=0.446)or intraoperative glycemic fluctuations(adjusted OR 0.905;95%CI,0.723 to 1.132;p=0.382)between AKI and Non-AKI groups.Results based on matched cases and controls were consistent with those from the unmatched analyses.Conclusion:Higher intraoperative blood glucose levels during and after CPB were protective factors against postoperative AKI in pediatric patients after congenital heart surgery.

Management of gallstones and gallbladder disease in patients undergoing gastric bypass

The appropriate management of gallstones and gallbladder disease in patients undergoing gastric bypass remains unknown.Several therapeutic modalities are used and include performing cholecystectomy on all patients at the time of gastric bypass,performing concomitant cholecystectomy only when patients have gallstones and performing cholecystectomy only in the presence of both symptoms and gallstones.Some groups administer ursodeoxycholic acid for gallstone prevention in the postoperative period.All treatment modalities are analyzed and their results and rationality are discussed.

Safety and effectiveness of neuromuscular electrical stimulation in cardiac surgery:A systematic review

BACKGROUND Lack of mobilization and prolonged stay in the intensive care unit(ICU)are major factors resulting in the development of ICU-acquired muscle weakness(ICUAW).ICUAW is a type of skeletal muscle dysfunction and a common complication of patients after cardiac surgery,and may be a risk factor for prolonged duration of mechanical ventilation,associated with a higher risk of readmission and higher mortality.Early mobilization in the ICU after cardiac surgery has been found to be low with a significant trend to increase over ICU stay and is also associated with a reduced duration of mechanical ventilation and ICU length of stay.Neuromuscular electrical stimulation(NMES)is an alternative modality of exercise in patients with muscle weakness.A major advantage of NMES is that it can be applied even in sedated patients in the ICU,a fact that might enhance early mobilization in these patients.AIM To evaluate safety,feasibility and effectiveness of NMES on functional capacity and muscle strength in patients before and after cardiac surgery.METHODS We performed a search on Pubmed,Physiotherapy Evidence Database(PEDro),Embase and CINAHL databases,selecting papers published between December 2012 and April 2023 and identified published randomized controlled trials(RCTs)that included implementation of NMES in patients before after cardiac surgery.RCTs were assessed for methodological rigor and risk of bias via the PEDro.The primary outcomes were safety and functional capacity and the secondary outcomes were muscle strength and function.RESULTS Ten studies were included in our systematic review,resulting in 703 participants.Almost half of them performed NMES and the other half were included in the control group,treated with usual care.Nine studies investigated patients after cardiac surgery and 1 study before cardiac surgery.Functional capacity was assessed in 8 studies via 6MWT or other indices,and improved only in 1 study before and in 1 after cardiac surgery.Nine studies explored the effects of NMES on muscle strength and function and,most of them,found increase of muscle strength and improvement in muscle function after NMES.NMES was safe in all studies without any significant complication.CONCLUSION NMES is safe,feasible and has beneficial effects on muscle strength and function in patients after cardiac surgery,but has no significant effect on functional capacity.

Quality of life and functional capacity in patients after cardiac surgery intensive care unit

Coronary heart disease and aortic stenosis are prevalent cardiovascular diseases worldwide,leading to morbidity and mortality.Coronary artery bypass grafting(CABG)and surgical aortic valve replacement(SAVR)have therapeutic benefits,including improved postoperative quality of life(QoL)and enhanced patient functional capacity which are key indicators of cardiac surgery outcome.In this article,we review the latest studies of QoL outcomes and functional capacity in patients who underwent cardiac surgery.Many standardized instruments are used to evaluate QoL and functional conditions.Preoperative health status,age,length of intensive care unit stay,operative risk,type of procedure,and other pre-,intra-,and postoperative factors affect postoperative QoL.Elderly patients experience impaired physical status soon after cardiac surgery,but it improves in the following period.CABG and SAVR are associated with increases of physical and mental health and functional capacity in the immediate postoperative and the long long-term.Cardiac rehabilitation improves patient functional capacity,QoL,and frailty following cardiac surgery.

The Effect of Repeat Cardiopulmonary bypass on Epicardial Microflow and Graft Flow during Intraoperative Heart Failure

Objective\ The relationship between graft blood flow, epicardial microflow, mean arterial pressure and hemorheologic changes was studied during intraoperative heart failure. Methods\ These parameters were done to evaluate the use of repeated cardiopulmonary bypass support for the intraoperative heart failure following aorto coronary bypass surgery. Included in this study were 10 patients with a mean age of 70 and unstable angina undergoing coronary bypass grafting and suffering from intraoperative heart failure. The epicardiai microflow, graft flow, mean arterial pressure and blood cell filterability were measured. Resluts\ During heart failure, the mean arterial pressure fell by 41%(P<0.01), graft flow by 67%(P<0.01) and epicardialmicroflow by 64%(P<0.01). After 15 to 56 min of assisted cardiopulmonary bypass support, the epicardial microflow and graft flow were partially restored, while red cell and white cell filterability was reduced by 31% and 64% respectively (P<0.01). There were significant correlations between graft flow, epicardial microflow, blood cell filterability and cardiopulmonary bypass time. All patients recovered and were discharged from the hospital.Conclusion\ It is concluded that the use of temporary assisted CPB support to treat intrapoperative heart failure allows the recovery of the myocardium and thereby restores the mean arterial pressure. The recovery of graft flow and epicardial flow occurred to a lesser extent. The CPB support seemed to be suitable for about 60 min probably because of increasing disturbance to the blood cell filterability, graft flow and the epicardial microcirculation.\;

Study on the relationship between syndrome characteristics degree and inflammatory factor and negative emotional scale in"double heart disease"patients with Qi stagnation blood stasis and heart gallbladder heat stagnation

Objective:To Discuss the correlation between Hypersensitivity C-reactive Protein(Hs-CRP),Total Cholesterol(TC),Triglyceride(TG),negative emotion scale and TCM syndrome scores in“Double Heart Disease”patients with Qi stagnation blood stasis and heart gallbladder heat stagnation.Method:Fifty-two patients in Western Medicine Diagnosis of Double Heart Disease,in TCM syndrome identified as Qi stagnation blood stasis Heart gallbladder heat stagnation syndrome,detects it Hs-CRP,TC,TG levels by ELISA,use TCM Syndromes Scale to evaluate TCM Syndrome,use the Pittsburgh Sleep Quality Index(PSQI)and Self-rating symptom scale(SCL-90)to assess anxiety and sleep levels,analyze the correlation between TCM syndrome scores and Hs-CRP,TC,TG level,PSQI index,SCL-90 index.Result:There was a significant positive correlation between Hs-CRP,TG level and TCM Syndrome scores(P<0.05);TC level was postively correlated with TCM Syndrome scores,but there was no statistical significance(P>0.05);There was a significant positive correlation between PSQI index,SCL-90 index and TCM Syndrome scores(P<0.05).Conclusion:In“Double Heart Disease”patients with Qi stagnation blood stasis and heart gallbladder heat stagnation,there have characteristic syndrome changes in terms of inflammatory factor level,blood lipid level and negative emotion score;Which the above indexes can reflect the severity of TCM syndromes to a certain extent and provide the basis for the effective intervention treatment of TCM.

Depression in adults with congenital heart disease-public health challenge in a rapidly expanding new patient population

There is a growing population of adults with congenital heart disease(CHD) due to improved survival beyond childhood.It has been suggested that adults with CHD may be at increased risk for mental health problems,particularly depression.The reported incidence of depression in CHD varies from 9% to 30%.This review examines the evidence for a higher depression rate in CHD vs general population.Possible explanations are offered from a variety of disease models,ranging from brain injury to the psychoanalytical approach.Risk factors for an abnormal emotional adjustment and depression include early exposure to stress from illness and medical interventions in infancy,separation from the parents during hospitalizations and brain organic syndromes.Later in life,patients often have to cope with physical limitations.Recent improvements in care may be protective.Current patients may benefit from an earlier age at first surgical intervention,fewer reoperations and inclusion to the mainstream schooling,among other factors.At this point,there is little systematic knowledge about evidence-based therapeutic interventions for depression in adults with CHD.Health care providers of patients with CHD should be aware of mental health challenges and may take a more proactive approach to identifying patients at risk for depression.

Comparison of clinical outcomes and postoperative recovery between two open heart surgeries:minimally invasive right subaxillary vertical thoracomy and traditional median sternotomy

Objective: To compare the clinical outcomes of minimally invasive right subaxillary vertical thoracotomy and traditional median stemotomy through right atrium in treatment of common congenital heart diseases. Methods: Clinical data of 59 cases of common congenital heart diseases treated with minimally invasive right axillary vertical thoracotomy from May, 2011 to February, 2013 and 77 cases of same diseases with traditional median stemotomy in the past three years were retrospectively analyzed, including atrial septal defect, membranous ventricular septal defect and partial endocardial cushion defect. The results were compared from the two groups, including the time for operation and cardiopulmonary bypass, amount of blood transfusion, postoperative drainage, ventilation time, hospital stay, and prognosis. Results: No severe complications happened in both groups, like deaths or secondary surgery caused by bleeding. No significant differences were in CPB time and postoperative ventilator time between groups (P>0.05), while for all of the operative time, the length of incision, postoperative drainage and hospital stay, minimally invasive right axillary vertical thoracotomy was superior to median stemotomy, with statistically significant differences (P<0.05). In six month followup after operation, no complications of residual deformity and pericardial effusion were found in both groups by doing echocardiography, but mild pectus carinatum was found in 8 patients in the traditional median sternotomy group (traditional group), whereas patients in another group were well recovered. Conclusions: Minimally invasive right subaxillary vertical thoracotomy for common congenital heart diseases is as safe as traditional median stemotomy, without the increasing incidence of postoperative complications. Additionally, compared with traditional median stemotomy, minimally - invasive right subaxillary vertical thoracotomy is better in the aspects of hidden incision, appearance, and postoperative recovery.

The importance of depression and alcohol use in coronary artery bypass graft surgery patients：risk factors for delirium and poorer quality of life

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.

The Treatment of Ostial Coronary Arteriopathy Secondary to Thoracic Irradiation With Off-pump Coronary Artery Bypass Grafting: A Case Report and Review of Literatures

Objectives We report a case in which a patient who suffered from angina secondary to mediastinal irradiation and have been treated by off-pump coronary artery bypass （OPCAB） in our hospital since 3 years ago. A 34-year-old man presented with angina for 8 years after receiving radiation therapy for Hodgkin＇s lymphoma. We retrospectively reviewed all the cases of OPCAB in our hospital and followed-up data for up to 3 years post-operatively. Mediastinal irradiation is probably the cause of significant ostial stenosis of left main coronary and right coronary artery. OPCAB grafting was performed on this patient 3 years ago. His angina disappeared after operation, and he recovered well during follow-up. Conclusions Patients with malignancies who have received mediastinal irradiation should be carefully followed up and routinely screened for the premature development of coronary artery disease. OPCAB may be an appropriate treatment for coronary artery disease caused by mediastinal irradiation.

Effect of Hemodilution on Fluctuation of Cerebral Oxygen Saturation during Cardiopulmonary Bypass in Children with Cyanotic Congenital Heart Disease

Background:In patients with cyanotic congenital heart disease(CHD),cerebral oxygenation may be maintained by elevations in hematocrit(Hct).Hemodilution accompanying cardiopulmonary bypass(CPB),however,can disrupt cerebral oxygen balance,leading to fluctuations in cerebral oxygen saturation(ScO_(2)).The present study investigated the effects of Hct changes on the fluctuation of ScO_(2)during CPB in cyanotic CHD using performance measurement(PM).Methods:Children with CHD(51 acyanotic and 46 cyanotic)who had undergone cardiac surgery using CPB were enrolled.Median performance error(MDPE),median absolute performance error(MDAPE),and wobble parameters of ScO_(2)were calculated before(reference value),during,and after CPB.Correlations of PM parameters with Hct and reductions in Hct(ΔHct)were also evaluated.Results:Before CPB,patients with cyanotic CHD had lower MDPE and larger wobble than those with acyanotic CHD,although mean ScO_(2)did not differ significantly between the two groups.During CPB,ScO_(2)of acyanotic CHD increased asΔHct increased,but PM variables were not associated withΔHct.In cyanotic CHD,MDPE(r=−0.324,p=0.032)and MDAPE(r=0.339,p=0.024)correlated significantly withΔHct during CPB.After CPB,MDPE(r=0.574,p=0.025)and MDAPE(r=−0.543,p=0.036)were significantly correlated with Hct in children with cyanotic CHD who underwent palliative surgery.Conclusion:Therefore,ScO_(2)fluctuation during CPB in children with cyanotic CHD may be affected by the decrease in Hct,suggesting that excessive hemodilution can negatively influence the maintenance of cerebral oxygenation in these patients.

心脏不停跳冠脉搭桥术同期行瓣膜置换术对冠心病合并心脏瓣膜病患者预后的影响

目的分析心脏不停跳冠脉搭桥术同期行瓣膜置换术治疗冠心病(CHD)合并心脏瓣膜病患者的效果。方法回顾性收集2021年8月至2023年8月河南省胸科医院接收的CHD合并心脏瓣膜病患者92例为研究对象,依据1∶1配对原则进行分组,其中接受心脏不停跳冠脉搭桥术同期行瓣膜置换术46例纳入不停组,接受停跳体外循环下冠脉搭桥术同期行瓣膜置换术46例纳入停跳组。对比两组手术指标、并发症状况、心功能分级状况、心脏超声指标[左室射血分数(LVEF)、左房舒张末前后径(LAEDD)、左室舒张末期内径(LVEDD)]、心肌受损指标[心肌肌钙蛋白Ⅰ(cTnⅠ)、肌酸激酶同工酶(CK-MB)]。结果不停组手术时间、住院时间、ICU入住时间短于停跳,24 h引流量少于停跳组(P<0.05)。不停组术后3个月心功能分级优于停跳组(P<0.05),LAEDD、LVEDD小于停跳组,LVEF高于停跳组(P<0.05)。术后7 d不停组血清CK-MB、cTnⅠ水平低于停跳组(P<0.05)。结论心脏不停跳冠脉搭桥术同期行瓣膜置换术治疗CHD合并心脏瓣膜病患者效果确切,可有效缩短康复进程,改善心功能,减轻心肌损伤,且安全性高。

针刺联合安神定志汤加减治疗失眠心胆气虚证临床研究

目的:观察针刺联合安神定志汤加减治疗失眠心胆气虚证的临床疗效。方法:采用随机数字表法将94例失眠心胆气虚证患者分为观察组、对照组各47例。对照组给予安神定志汤加减治疗,观察组在对照组基础上配合针刺治疗,2组连续治疗4周。比较2组治疗前后中医证候积分、睡眠质量;比较2组治疗前后焦虑、抑郁评分及神经递质水平,并评估2组临床疗效及治疗安全性。结果:观察组总有效率91.49%,高于对照组76.60%(P<0.05)。治疗后,2组匹兹堡睡眠质量指数(PSQI)评分、睡眠状况自评量表(SRSS)评分、焦虑自评量表(SAS)评分、抑郁自评量表(SDS)评分、中医证候积分及多巴胺(DA)水平均较治疗前降低(P<0.05),5-羟色胺(5-HT)水平升高(P<0.05);观察组治疗后PSQI评分、SRSS评分、SAS评分、SDS评分、中医证候积分及DA水平低于对照组(P<0.05),5-HT水平高于对照组(P<0.05)。2组均未发生严重不良反应。结论:针刺联合安神定志汤加减治疗失眠心胆气虚证效果显著,能改善患者睡眠质量,缓解焦虑、抑郁等负面情绪,平衡神经递质水平,安全性较高。

夏橘化瘀胶囊治疗气虚血瘀型冠状动脉旁路移植术后再发心绞痛的临床效果

目的 探讨夏橘化瘀胶囊治疗气虚血瘀型冠状动脉旁路移植术后再发心绞痛的临床效果。方法 选取2021年1月至12月山东省潍坊市中医院收治的70例行冠状动脉旁路移植术后再发心绞痛患者为研究对象,采用随机数字表法将其分为对照组和观察组,各35例。对照组采用西医常规治疗,观察组采用西医常规治疗+夏橘化瘀胶囊,两组均连续治疗3个月。比较两组中医证候疗效,比较两组治疗前后心绞痛发病频率、持续时间、西雅图心绞痛量表评分、N-末端B型利钠肽前体(NT-pro BNP)、超敏C反应蛋白(hs-CRP)水平,同时记录患者相关安全性指标。结果 观察组中医证候疗效优于对照组(P<0.05)。治疗后,两组心绞痛发病频率少于治疗前、持续时间短于治疗前,且观察组心绞痛发病频率少于对照组、持续时间短于对照组(P<0.05)。治疗后,两组西雅图心绞痛量表各项评分均高于治疗前,且观察组高于对照组(P<0.05)。治疗后,两组血清NT-pro BNP、hs-CRP水平低于治疗前,且观察组低于对照组(P<0.05)。两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论 夏橘化瘀胶囊对冠状动脉旁路移植术后再发心绞痛有明显改善作用,且安全性较高,具有重要的临床应用价值。

房颤射频消融术对心脏搭桥合并心脏瓣膜手术患者心功能、心肌损伤及预后的影响

目的探究房颤射频消融术(RA)对心脏搭桥合并心脏瓣膜手术患者心功能、心肌损伤及预后的影响。方法选取我院2022年2月至2023年3月接受心脏搭桥合并心脏瓣膜手术患者50例,随机数字表法将其分为观察组25例(房颤RA治疗)与对照组25例(保守药物治疗)。对比两组手术相关指标、不同时间点心肌损伤[肌酸激酶同工酶(CK-MB)、肌钙蛋白I(cTnI)、N末端脑钠肽前体(NT-proBNP)]及心功能[左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)]指标,术后随访3个月,统计患者窦性心律转复及心脑血管不良事件(MACCE)发生率。结果观察组体外循环时间比对照组长,总住院时间比对照组短,差异均有统计学意义(P<0.05)。两组术后血清CK-MB、cTnI、NT-proBNP水平均呈现先上升、后下降趋势(P<0.05);观察组术后2 h血清CK-MB、cTnI、NT-proBNP水平均显著高于对照组(P<0.05),但两组间术后48 h上述指标差异均无统计学意义(P>0.05)。术后3个月,观察组比对照组LVEF[(49.78±2.35)%vs.(45.03±2.17)%]显著上升,LVEDD[(54.93±4.30)mm vs.(57.38±4.16)mm]、LVESD[(39.62±4.37)mm vs.(46.15±5.23)mm]显著下降(P<0.05)。观察组术后第1天、出院时及术后3个月窦性心律转复率均显著高于对照组(P<0.05),术后3个月内MACCE两组对比差异无统计学意义(P>0.05)。结论房颤RA能有效改善心脏搭桥合并心脏瓣膜手术患者心功能,提高窦性心律转复率,短期预后好,但可能引发一过性心肌酶上升。

补阳还五汤联合坐位八段锦治疗冠心病搭桥术患者的临床疗效及对其心功能、炎症因子、应激指标的影响

目的 观察补阳还五汤联合坐位八段锦治疗冠心病搭桥术患者的临床疗效及对其心功能、炎症因子、应激指标的影响。方法 选取2020年6月—2023年6月期间江苏省苏北人民医院心脏大血管外科收治的300例冠状动脉搭桥手术患者,采用随机数字表法分为对照组和试验组,每组各150例。对照组按常规处理,试验组在常规治疗方法基础上,予补阳还五汤联合坐位八段锦治疗,均治疗3周。观察比较两组患者临床疗效,治疗前后中医证候积分、心肌损伤标志物[氨基末端脑利钠肽前体(N terminal pro B type natriuretic peptide,NT-proBNP)、心肌肌钙蛋白I(Cardiac troponin I,cTnI)、肌酸激酶同工酶(Creatine kinase isoenzymes,CK-MB)、肌红蛋白(Myoglobin,Mb)],心脏超声检查指标[左心室舒张末期内径(Left ventricular end diastolic diameter,LVEDD)、左室舒张末期容积(Left ventricular end-diastolic volume,LVEDV)、左室射血分数(Left ventricular ejection fraction,LVEF)、心脏指数(Cardiac index,CI)]、炎性指标[超敏C反应蛋白(hypersensitive C-reactive proteinhs,CRP)、肿瘤坏死因子α(Tumour necrosis factor-α,TNF-α)]及应激指标[皮质醇(Cortisol,COR)、胱抑素C(Cystatin C,Cys C)]。结果 治疗后试验组临床总有效率92.00%(138/150)明显高于对照组81.33%(122/150),差异有统计学意义(P<0.05)。治疗后两组患者中医证候评分均较治疗前降低,差异有统计学意义(P<0.05);且试验组中医证候评分明显低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者心肌损伤标志物NT-proBNP、cTnI及CK-MB含量均较治疗前明显降低,差异有统计学意义(P<0.05);且试验组心肌损伤标志物NT-proBNP、cTnI及CK-MB含量均明显低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者LVEDD和LVEDV指标均较治疗前降低,LVEF和CI指标均较治疗前升高,差异有统计学意义(P<0.05);且试验组LVEDD和LVEDV指标均明显低于对照组,LVEF和CI指标均明显高于对照组,差异有统计学意义(P<0.05)。治疗后两组患者炎性指标hs-CRP、TNF-α含量均较治疗前降低,差异有统计学意义(P<0.05);且试验组炎性指标hs-CRP、TNF-α含量均明显低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者应激指标COR、 CysC水平均较治疗前降低,差异有统计学意义(P<0.05);且试验组应激指标COR、 CysC水平均明显低于对照组,差异有统计学意义(P<0.05)。结论 在常规西药治疗的基础上给予补阳还五汤联合坐位八段锦,可明显改善冠心病搭桥术患者心功能,减轻炎症及应激反应。

冠心病患者OPCABG术后新发心房颤动的危险因素分析及干预措施

目的探讨冠心病患者非体外循环冠状动脉旁路移植术(OPCABG)术后新发心房颤动的危险因素并建立logistic回归模型,分析该模型对术后新发心房颤动的预测价值,为临床制定干预措施提供参考。方法回顾性选取2021年10月至2023年8月河南省胸科医院收治的175例冠心病患者,依据OPCABG术后5 d是否新发心房颤动分为发生组49例、未发生组126例。比较两组临床资料,经多因素logistic回归分析术后新发心房颤动的影响因素,并建立logistic回归模型。采用受试者工作特征(ROC)曲线评价该模型对术后新发心房颤动的预测效能,Hosmer-Lemeshow法评价该模型的拟合度。结果左心房容积指数、术后主动脉内球囊反搏(IABP)辅助、右冠状动脉近段狭窄≥75%及术前中性粒细胞淋巴细胞比值(NLR)、血清生长分化因子15(GDF-15)为术后新发心房颤动的独立危险因素(P<0.05)。logistic回归模型预测术后新发心房颤动的曲线下面积(AUC)为0.928,敏感度、特异度分别为89.80%、85.71%,且具有良好校准能力。结论左心房容积指数、术后IABP辅助、右冠状动脉近段狭窄≥75%及术前NLR、血清GDF-15为冠心病患者OPCABG术后新发心房颤动的独立危险因素,基于上述影响因素建立logistic回归模型,该模型对术后新发心房颤动具有一定预测价值,临床可依据该模型筛选高危人群,采取积极干预措施,以降低术后新发心房颤动的发生风险。

支链氨基酸代谢物对风湿性心脏瓣膜病体外循环术后低心排血量的预测价值

目的:探讨支链氨基酸代谢物对风湿性心脏瓣膜病病人行体外循环术后发生低心排血量事件的预测价值。方法:选取2019年1月—2022年1月我院收治的风湿性心脏瓣膜病病人154例作为研究对象,根据体外循环术后是否出现低心排血量,将病人分为低心排血量组(52例)和非低心排血量组(102例)。对比分析两组病人情况,多因素Logistic回归分析低心排血量事件的影响因素。Cox比例风险模型调整混杂变量,分析支链氨基酸代谢物和传统标志物与低心排血量事件的关联性。GRACE风险评分探讨支链氨基酸和传统标志物结合后对低心排血量的预测能力。Cox回归评价支链氨基酸代谢物和传统标志物之间的交互作用。建立回归方程y=1-1/(1+e-z)预测模型并进行验证。结果:脑钠肽、肌钙蛋白I、亮氨酸、缬氨酸、异亮氨酸等是低心排血量事件的独立危险因素。随着脑钠肽、肌钙蛋白I、亮氨酸、缬氨酸、异亮氨酸水平的升高,与低心排血量事件的关联效应也更强。支链氨基酸代谢物和传统标志物结合,会提高GRACE风险评分对低心排血量的预测能力。异亮氨酸联合脑钠肽前体对低心排血量事件的预测效应最高。经Bootstrap自抽样,预测模型区分度、准确度较好。结论:支链氨基酸代谢物和低心排血量密切相关。支链氨基酸代谢物加入传统标志物中,会提高对低心排血量的预测能力,有助于改善风湿性心脏瓣膜病病人预后。

安神定志汤联合经颅磁刺激治疗心胆气虚型失眠临床研究

目的:观察安神定志汤联合经颅磁刺激(TMS)治疗心胆气虚型失眠的临床疗效。方法:选取98例心胆气虚型失眠患者,按随机数字表法分为对照组和研究组各49例。对照组给予艾司唑仑片治疗,研究组给予安神定志汤联合TMS治疗。2组均治疗4周。比较2组临床疗效、中医证候积分、匹兹堡睡眠质量指数(PSQI)评分、睡眠进程参数、神经递质及不良反应发生率。结果:治疗4周后,研究组总有效率89.80%,高于对照组73.47%(P<0.05)。2组睡眠时间、睡眠质量、入睡时间、睡眠障碍、睡眠效率、日间功能障碍评分均较治疗前降低(P<0.05),研究组上述6项PSQI细则评分均低于对照组,差异均有统计学意义(P<0.05)。2组睡眠潜伏期、快速眼动睡眠(REM)潜伏期、觉醒时间均较治疗前缩短(P<0.05),总睡眠时间均较治疗前延长(P<0.05),睡眠效率均较治疗前提高(P<0.05);研究组睡眠潜伏期、REM潜伏期、觉醒时间均短于对照组(P<0.05),总睡眠时间长于对照组(P<0.05),睡眠效率高于对照组(P<0.05)。2组主症、次症积分及中医证候总分均较治疗前降低(P<0.05),研究组主症、次症积分及中医证候总分均低于对照组(P<0.05)。2组5-羟色胺(5-HT)水平均较治疗前升高,多巴胺(DA)水平均较治疗前降低(P<0.05);研究组5-HT水平高于对照组,DA水平低于对照组(P<0.05)。治疗期间,研究组不良反应发生率4.08%,低于对照组18.37%(P<0.05)。结论:安神定志汤联合TMS治疗心胆气虚型失眠临床疗效较好,可有效改善睡眠质量,调节神经递质,安全性好。