ObjectiveTo evaluate the feasibility to use ultrasonic cardiac output monitoring (USCOM) for patients after coronary artery bypass grafting. MethodsClinical data of 32 patients undergoing off-pump coronary artery bypass grafting in General Hospital of Shenyang Military Region between April and June 2013 were retrospectively analyzed. There were 17 male and 15 female patients with their age of 46-76 (63.2±7.6) years. USCOM and pulmonary artery catheterization (PAC) were used to measure cardiac output (CO) synchronously,and the results were compared between USCOM and PAC. ResultsSixty-four pairs of data were collected from those 32 patients. No adverse event was observed with either USCOM or PAC. Mean CO was 4.27±0.92 L/min with USCOM and 4.49±0.75 L/min with PAC respectively,which were not statistically different (P=0.12) but significantly correlated (r=0.84,P<0.001). ConclusionThere is close correlation between USCOM and PAC for CO measurement. USCOM can not only measure CO accurately,but also has the advantages of being noninvasive,easy to perform and low cost.
ObjectiveTo investigate the influence of 6% hydroxyethyl starch (HES, 130/0.4)on blood coagulation of patients after off-pump coronary artery bypass grafting (opCAB)by thromboelastography (TEG). MethodsOne hundred patients undergoing elective opCAB in Department of Cardiovascular Surgery, General Hospital of Shenyang Military Area Command between May and July 2013 were enrolled in this study. All the patients were randomly divided into 2 groups using random number table method with 50 patients in each group. In the experimental group (G1 group), there were 27 males and 23 females with their age of 64.9±4.4 years, who received intravenous 6% HES (130/0.4)20 ml/kg in 4 hours postoperatively. In the control group (G2 group), there were 31 males and 19 females with their age of 63.1±5.8 years, who received intravenous lactated ringers 20 ml/kg in 4 hours postoperatively. After postoperative ICU admission, full blood count, coagulation tests and TEG were examined. Chest and mediastinal drainage was recorded at 6 hours and 24 hours postoperatively. ResultsThere was no statistical difference in chest and mediastinal drainage 24 hours postoperatively between the 2 groups (591.7±171.7 ml vs. 542.4±174.0 ml, P > 0.05). None of the patients received reexploration for bleeding. There was no statistical difference in hemoglobin, hematocrit, platelet count or traditional coagulation index between the 2 groups (P > 0.05). TEG showed no significant change in coagulation time after intravenous fluid infusion in either group. Reaction time was slightly extended in both groups, but there was no statistical difference in reaction time between the 2 groups (P > 0.05). Maximum amplitude (MA)of G1 group was significantly decreased after intravenous fluid infusion (55.9±10.0 mm vs. 62.8±7.9 mm, P < 0.05), but still within the normal range. There was no significant change in MA after intravenous fluid infusion in G2 group. ConclusionIntravenous infusion of 6% HES (130/0.4)20 ml/kg can reduce platelet function and clot strength, but does not significantly increase postoperative chest or mediastinal drainage, or the incidence of postoperative reexploration for bleeding. It's safe to administer 6% HES (130/0.4)for patients after OPCAB.
ObjectiveTo investigate acute physiologic and chronic health evaluation Ⅱ(APACHE Ⅱ) score system for severity evaluation and prognosis prediction of patients undergoing cardiac surgery. MethodsA total of 3 566 patients who were admitted in ICU after cardiac surgery in the Department of Cardiovascular Surgery of General Hospital of Shenyang Military between December 1, 2011 and August 31, 2013 were enrolled in this study. There were 1 873 males and 1 693 females with their average age of 45.8±23.7 years (range, 10 days to 82 years). All the patients were evaluated with APACHE Ⅱ and expected mortality was calculated. Receiver operating characteristic(ROC) curve was drawn to compare expected and actual mortality and evaluate predictive value of APACHE Ⅱ. ResultsA total of 3 373 patients survived the operation, and 193 patients died postoperatively with the mortality of 5.41%. The area under the ROC curve was 0.917 (P=0.000) with 95% confidence interval of[0.885,0.949]. The cut-off point of APACHE Ⅱ was 15.50, with a sensitivity of 80.3%,a specificity of 95.6%,an accuracy rate of 79.5%,a positive predictive value of 86.9%,and a negative predictive value of 93.1%. Expected and actual mortality increased with increasing APACHE Ⅱ,which were both positively correlated. ConclusionAPACHE Ⅱ score system can be used to evaluate severity and predict prognosis of patients undergoing cardiac surgery, which provides reference for rational utilization of ICU resource.
目的总结75岁以上高龄冠心病患者行冠状动脉旁路移植术（CABG）的围手术期临床经验，以提高手术疗效。 方法2014年2～6月沈阳军区总医院心外科为20例75～84岁冠状动脉粥样硬化患者行非体外循环冠状动脉旁路移植术，其中男11例、女9例，主要病变均为三支冠状动脉严重狭窄或伴左主干狭窄，其中5例患者伴急性心肌梗死，所有患者均为限期手术。分析全组手术时间、住院时间、围手术期并发症、术后结果等。 结果全组均采用左乳内动脉吻合前降支，大隐静脉吻合其他分支，平均桥血管数量为3.2支；平均手术时间3.3 h；术后平均呼吸机辅助时间9.6 h；术后平均重症监护时间26.4 h；术后平均住院时间为12.3 d。术后出现阵发性心房颤动3例；术后呼吸机辅助期间低氧血症2例，术后因咳痰无力及误吸并发严重肺炎1例；术后明显腹胀、纳差6例，其中1例因腹胀行短期胃肠减压及完全胃肠道外营养，1例因纳差再次入院治疗；术后伤口愈合不良清创缝合1例。所有患者均痊愈出院，心功能改善，心绞痛症状消失。 结论对于高龄患者，非体外循环冠状动脉旁路移植术疗效满意；胃肠功能、呼吸功能及手术耐受力为影响高龄患者围手术期恢复较为突出的因素，应采取更为积极的治疗和应对策略。