We sought to assess the incidence of aspirin resistance after off-pump coronary artery bypass （OPCAB） surgery, and investigate whether clopidogrel can improve aspirin response and be safely applied early after OPCAB...We sought to assess the incidence of aspirin resistance after off-pump coronary artery bypass （OPCAB） surgery, and investigate whether clopidogrel can improve aspirin response and be safely applied early after OPCAB surgery. Sixty patients who underwent standard OPCAB surgery were randomized into two groups. One group （30 patients） received mono-antiplatelet treatment （MAPT） with aspirin 100 mg daily and the other group received dual anfiplatelet treatment （DAPT） with aspirin 100 mg daily plus clopidogrel 75 mg daily. Platelet aggregations in response to arachi- donic acid （PLAA） and adenosine diphosphate （ADP） （PLADP） were measured preoperatively and on days 1 to 6, 8 and 10 after the antiplatelet agents were administered. A PLAA level above 20% was defined as aspirin resistance. Postoperative bleeding and other perioperative variables were also recorded. There were no significant differences between the two groups in baseline characteristics, average number of distal anastomosis, operation time, postoperative bleeding, ventilation time and postoperative hospital stay. However, the incidence of aspirin resistance was significantly lower in the DAPT group than that in the MAPT group on the first and second day after antiplatelet agents were given （62.1% vs, 32.1%, 34.5% vs. 10.7%, respectively, both P 〈 0.05）. There was no significant difference in postoperative complication between the two groups. DAPT with aspirin and clopidogrel can be safely applied to OPCAB patients early after the procedure. Moreover, clopidogrel reduces the incidence of OPCAB-related aspirin resistance.展开更多
Pericardial rupture following blunt chest trauma is rare and associated with high mortality rate ranging from 30% to 64%. We review 42 cases which have been reported in the literature in last 17 years and report a cas...Pericardial rupture following blunt chest trauma is rare and associated with high mortality rate ranging from 30% to 64%. We review 42 cases which have been reported in the literature in last 17 years and report a case of our own. We have found that 83% of the cases were men with a mean age of 49 years. The most frequent cause was traffic accidents (79%). Preoperative diagnosis of traumatic rupture of the pericardium has been improved in recent 17 years, and the result is satisfactory. Early detection, timely treatment is the key. Pneumopericardium may be a valuable radiographic clue for diagnosis. The management of pericardial rupture is mainly to avoid the risk of cardiac strangulation or acute tamponade. If the injury is recognized timely, treatment is simple and effective.展开更多
基金supported by a grant from the National Natural Science Foundation of China(81170181)a Program for Development of Innovative Research Team in the First Affiliated Hospital of Nanjing Medical Universitya Project Funded by the Priority Academic Program Development of Jiangsu Higher Education Institutes(PAPD)
文摘We sought to assess the incidence of aspirin resistance after off-pump coronary artery bypass （OPCAB） surgery, and investigate whether clopidogrel can improve aspirin response and be safely applied early after OPCAB surgery. Sixty patients who underwent standard OPCAB surgery were randomized into two groups. One group （30 patients） received mono-antiplatelet treatment （MAPT） with aspirin 100 mg daily and the other group received dual anfiplatelet treatment （DAPT） with aspirin 100 mg daily plus clopidogrel 75 mg daily. Platelet aggregations in response to arachi- donic acid （PLAA） and adenosine diphosphate （ADP） （PLADP） were measured preoperatively and on days 1 to 6, 8 and 10 after the antiplatelet agents were administered. A PLAA level above 20% was defined as aspirin resistance. Postoperative bleeding and other perioperative variables were also recorded. There were no significant differences between the two groups in baseline characteristics, average number of distal anastomosis, operation time, postoperative bleeding, ventilation time and postoperative hospital stay. However, the incidence of aspirin resistance was significantly lower in the DAPT group than that in the MAPT group on the first and second day after antiplatelet agents were given （62.1% vs, 32.1%, 34.5% vs. 10.7%, respectively, both P 〈 0.05）. There was no significant difference in postoperative complication between the two groups. DAPT with aspirin and clopidogrel can be safely applied to OPCAB patients early after the procedure. Moreover, clopidogrel reduces the incidence of OPCAB-related aspirin resistance.
文摘Pericardial rupture following blunt chest trauma is rare and associated with high mortality rate ranging from 30% to 64%. We review 42 cases which have been reported in the literature in last 17 years and report a case of our own. We have found that 83% of the cases were men with a mean age of 49 years. The most frequent cause was traffic accidents (79%). Preoperative diagnosis of traumatic rupture of the pericardium has been improved in recent 17 years, and the result is satisfactory. Early detection, timely treatment is the key. Pneumopericardium may be a valuable radiographic clue for diagnosis. The management of pericardial rupture is mainly to avoid the risk of cardiac strangulation or acute tamponade. If the injury is recognized timely, treatment is simple and effective.
