A 75-year-old male patient had stable angina pectoris After coronary angiography we decided to perform a coronary artery bypass graft surgery. Twenty years ago the patient underwent radical cystectomy and bilateral ur...A 75-year-old male patient had stable angina pectoris After coronary angiography we decided to perform a coronary artery bypass graft surgery. Twenty years ago the patient underwent radical cystectomy and bilateral ureterosigmoidostomy because of bladder cancer After that, his micturition was via the rectum. We did not experience that before. As is known, monitoring of urine output is very important after cardiac surgery The patient was consulted with an urologist for how to monitor urine output in him. Transrectal catheterization was recommended for our follow-up, but before the catheterization bowel cleansing is necessary. Four-vessel on-pump coronary artery bypass graft surgery was performed without any problem. Peroperative urine volume and arterial blood gas results were normal. Urine output is a sensitive variable reflecting the patient's effective blood volume and tissue perfusion. Urinary catheterization is a standard for all cardiac surgeries and it allows the patients' urine to drain freely from the bladder for collection. Monitoring of urine output in patients with ureterosigmoidostomy is impossible by standard urinary catheterization method. In this casewe performed transrectal catheterization for Urine flow follow-up. Urine flow follow-up is essential after the open-heart surgery and it can be measured in different ways, as in our case.展开更多
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 an...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.展开更多
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 therap...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.展开更多
Background Acute myocardial infarction can result in left ventricularaneurysm, which may in turn cause congestive heart failure, ventricular arrhythmia andthromboembolic events. This study evaluates results achieved w...Background Acute myocardial infarction can result in left ventricularaneurysm, which may in turn cause congestive heart failure, ventricular arrhythmia andthromboembolic events. This study evaluates results achieved with a modified linear closure of leftventricular aneurysms during off-pump coronary artery bypass surgery. Methods From January 2001 toMay 2004, 75 patients were operated on for nonruptured, postinfarctional, left ventricular aneurysmduring off-pump coronary artery bypass surgery. Repair was completed on the beating heart tominimize ischaemia and allow assessment of wall function and viability to guide closure. Allpatients presented with symptoms of angina and congestive heart failure or ventricular arrhythmia.The majority (75% ) of the patients were in NYHA functional class Ⅲ or Ⅳ. Preoperative ejectionfraction was 26% ±9%. The mean left ventricular, end diastolic diameter was (57. 5 ±7. 1) mm. Theventricular preoperative and postoperative performances were compared. χ~2 test and Student' s ttest were used to analyse the outcomes. A P value less than 0. 05 was considered significant.Results Hospital mortality was 1. 3% (1/75). Coronary artery bypass was performed with an average of(3. 3 ±1.2) grafts per patient. At the time of followup, all the patients had no symptoms. Themean NYHA class and ejection fraction increased significantly (P < 0.001 ) . The mean leftventricular, end diastolic diameter decreased significantly (P <0. 001). Conclusions Surgicalclosure of left ventricular aneurysm can be performed during off-pump coronary artery bypass. Theoperation is associated with a low inhospital mortality and morbidity. A postoperative improvementin the early term cardiac functions and symptoms and quality of life was documented, increasing ourexpectations of an increased long-term survival.展开更多
Background Cardiopulmonary bypass (CPB) produces a well documented diffuse inflammatory response that affects multiple organ systems. To avoid the deleterious effects of cardiopulmonary bypass, off pump coronary art...Background Cardiopulmonary bypass (CPB) produces a well documented diffuse inflammatory response that affects multiple organ systems. To avoid the deleterious effects of cardiopulmonary bypass, off pump coronary artery bypass grafting is becoming increasingly popular world wide. We reviewed our experience of complete coronary artery revascularization on the beating heart without CPB. Methods From Aug 1998 to Aug 2000, 860 off pump revascularizations (99%since January 1999) were performed at Manipal Hospital Heart Foundation. The patients consist of males 757(88%), females 103(12%). Averaged age 64.2±15 years. All surgeries were performed through a median sternotomy. Exposure techniques are tailored to individual vessels and cardiac regions. Local immobilization is performed with octopus. Vascular control is achieved with occluders and shunts. Results Among 860 off pump CABG patients. Single graft 72 (8.3%), two grafts 208 (24.2%), three grafts 469 (54.5%), four grafts 101 (11.8%), five graft 10 (1.2%). The average number of grafts per patient was 2.72±0.32. Operative mortality was 0.69%(6 patients). Anesthetic time 3.9±1.2hours, extubation time 6±2.5 hours, Blood requirement 360±90 ml, Preoperative LVEF 60.2±8.5%, Post LVEF 64.1±14%Low cardiac output 48 patients (5.6%), IABP requirement: 25 patients(2.9%), 25 patients converted to CPB during OP CAB(2.9%)and 20 of them were done with on pump beating heart. 25 patients showed myocardial ischemic and 16 patients showed perioperative myocardial infarction. ICU stay 1.1±0.8 days, hospital stay 6.2±1.1 days. Conclusion Off-pump coronary artery bypass in complete revascularization is a safe, effective technique and suitable.展开更多
目的探究同期行心脏瓣膜术与冠状动脉旁路移植术治疗心脏瓣膜病患者对其心肌损伤及炎症因子水平的影响。方法随机选取2019年3月—2022年7月徐州医科大学附属医院收治的90例心脏瓣膜病患者为研究对象,依据随机数表法分为非同期组与同期组...目的探究同期行心脏瓣膜术与冠状动脉旁路移植术治疗心脏瓣膜病患者对其心肌损伤及炎症因子水平的影响。方法随机选取2019年3月—2022年7月徐州医科大学附属医院收治的90例心脏瓣膜病患者为研究对象,依据随机数表法分为非同期组与同期组,每组45例,非同期组采用心脏瓣膜术与冠状动脉旁路移植术不同期手术治疗,同期组采用心脏瓣膜术联合冠状动脉旁路移植术同期手术治疗。对比两组患者术后恢复情况、治疗前后心肌损伤指标、炎症因子水平以及心功能指标。结果术后,同期组的呼吸机使用时间(65.62±10.77)h、重症加强护理病房(intensive care unit,ICU)时间(6.85±1.47)d、住院时间(15.86±3.64)d均短于非同期组,差异有统计学意义(t=12.222、19.418、9.825,P<0.05)。同期组心肌肌钙蛋白I、N末端脑钠肽前体、血清肌酸激酶同功酶水平均低于非同期组,差异有统计学意义(P<0.05)。同期组白介素-6、超敏C反应蛋白、肿瘤坏死因子-α水平均低于非同期组,差异有统计学意义(P<0.05)。同期组的左心室射血分数高于非同期组,心胸比、左心室舒张末期内径低于非同期组,差异有统计学意义(P<0.05)。结论心脏瓣膜病患者实施同期行心脏瓣膜术与冠状动脉旁路移植术治疗,可以缩短呼吸机使用时间、住院时间等,改善其心肌受损情况,降低其体内的炎症因子水平,稳定患者心功能,对患者病情恢复有积极影响。展开更多
文摘A 75-year-old male patient had stable angina pectoris After coronary angiography we decided to perform a coronary artery bypass graft surgery. Twenty years ago the patient underwent radical cystectomy and bilateral ureterosigmoidostomy because of bladder cancer After that, his micturition was via the rectum. We did not experience that before. As is known, monitoring of urine output is very important after cardiac surgery The patient was consulted with an urologist for how to monitor urine output in him. Transrectal catheterization was recommended for our follow-up, but before the catheterization bowel cleansing is necessary. Four-vessel on-pump coronary artery bypass graft surgery was performed without any problem. Peroperative urine volume and arterial blood gas results were normal. Urine output is a sensitive variable reflecting the patient's effective blood volume and tissue perfusion. Urinary catheterization is a standard for all cardiac surgeries and it allows the patients' urine to drain freely from the bladder for collection. Monitoring of urine output in patients with ureterosigmoidostomy is impossible by standard urinary catheterization method. In this casewe performed transrectal catheterization for Urine flow follow-up. Urine flow follow-up is essential after the open-heart surgery and it can be measured in different ways, as in our case.
文摘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.
文摘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.
文摘Background Acute myocardial infarction can result in left ventricularaneurysm, which may in turn cause congestive heart failure, ventricular arrhythmia andthromboembolic events. This study evaluates results achieved with a modified linear closure of leftventricular aneurysms during off-pump coronary artery bypass surgery. Methods From January 2001 toMay 2004, 75 patients were operated on for nonruptured, postinfarctional, left ventricular aneurysmduring off-pump coronary artery bypass surgery. Repair was completed on the beating heart tominimize ischaemia and allow assessment of wall function and viability to guide closure. Allpatients presented with symptoms of angina and congestive heart failure or ventricular arrhythmia.The majority (75% ) of the patients were in NYHA functional class Ⅲ or Ⅳ. Preoperative ejectionfraction was 26% ±9%. The mean left ventricular, end diastolic diameter was (57. 5 ±7. 1) mm. Theventricular preoperative and postoperative performances were compared. χ~2 test and Student' s ttest were used to analyse the outcomes. A P value less than 0. 05 was considered significant.Results Hospital mortality was 1. 3% (1/75). Coronary artery bypass was performed with an average of(3. 3 ±1.2) grafts per patient. At the time of followup, all the patients had no symptoms. Themean NYHA class and ejection fraction increased significantly (P < 0.001 ) . The mean leftventricular, end diastolic diameter decreased significantly (P <0. 001). Conclusions Surgicalclosure of left ventricular aneurysm can be performed during off-pump coronary artery bypass. Theoperation is associated with a low inhospital mortality and morbidity. A postoperative improvementin the early term cardiac functions and symptoms and quality of life was documented, increasing ourexpectations of an increased long-term survival.
文摘Background Cardiopulmonary bypass (CPB) produces a well documented diffuse inflammatory response that affects multiple organ systems. To avoid the deleterious effects of cardiopulmonary bypass, off pump coronary artery bypass grafting is becoming increasingly popular world wide. We reviewed our experience of complete coronary artery revascularization on the beating heart without CPB. Methods From Aug 1998 to Aug 2000, 860 off pump revascularizations (99%since January 1999) were performed at Manipal Hospital Heart Foundation. The patients consist of males 757(88%), females 103(12%). Averaged age 64.2±15 years. All surgeries were performed through a median sternotomy. Exposure techniques are tailored to individual vessels and cardiac regions. Local immobilization is performed with octopus. Vascular control is achieved with occluders and shunts. Results Among 860 off pump CABG patients. Single graft 72 (8.3%), two grafts 208 (24.2%), three grafts 469 (54.5%), four grafts 101 (11.8%), five graft 10 (1.2%). The average number of grafts per patient was 2.72±0.32. Operative mortality was 0.69%(6 patients). Anesthetic time 3.9±1.2hours, extubation time 6±2.5 hours, Blood requirement 360±90 ml, Preoperative LVEF 60.2±8.5%, Post LVEF 64.1±14%Low cardiac output 48 patients (5.6%), IABP requirement: 25 patients(2.9%), 25 patients converted to CPB during OP CAB(2.9%)and 20 of them were done with on pump beating heart. 25 patients showed myocardial ischemic and 16 patients showed perioperative myocardial infarction. ICU stay 1.1±0.8 days, hospital stay 6.2±1.1 days. Conclusion Off-pump coronary artery bypass in complete revascularization is a safe, effective technique and suitable.
文摘目的探究同期行心脏瓣膜术与冠状动脉旁路移植术治疗心脏瓣膜病患者对其心肌损伤及炎症因子水平的影响。方法随机选取2019年3月—2022年7月徐州医科大学附属医院收治的90例心脏瓣膜病患者为研究对象,依据随机数表法分为非同期组与同期组,每组45例,非同期组采用心脏瓣膜术与冠状动脉旁路移植术不同期手术治疗,同期组采用心脏瓣膜术联合冠状动脉旁路移植术同期手术治疗。对比两组患者术后恢复情况、治疗前后心肌损伤指标、炎症因子水平以及心功能指标。结果术后,同期组的呼吸机使用时间(65.62±10.77)h、重症加强护理病房(intensive care unit,ICU)时间(6.85±1.47)d、住院时间(15.86±3.64)d均短于非同期组,差异有统计学意义(t=12.222、19.418、9.825,P<0.05)。同期组心肌肌钙蛋白I、N末端脑钠肽前体、血清肌酸激酶同功酶水平均低于非同期组,差异有统计学意义(P<0.05)。同期组白介素-6、超敏C反应蛋白、肿瘤坏死因子-α水平均低于非同期组,差异有统计学意义(P<0.05)。同期组的左心室射血分数高于非同期组,心胸比、左心室舒张末期内径低于非同期组,差异有统计学意义(P<0.05)。结论心脏瓣膜病患者实施同期行心脏瓣膜术与冠状动脉旁路移植术治疗,可以缩短呼吸机使用时间、住院时间等,改善其心肌受损情况,降低其体内的炎症因子水平,稳定患者心功能,对患者病情恢复有积极影响。
