Abstract： Objective To validate the value of Cleveland Clinical Score to predict acute renal failure（ARF） requiring renal replacement therapy （RRT） and in-hospital death in Chinese adult patients after cardiac surgery. Methods A retrospective analysis was conducted for all the patients who underwent cardiac surgery from January 2005 to December 2009 in Renji Hospital of School of Medicine, Shanghai Jiaotong University. A total of 2 153 adult patients, 1 267 males and 886 females，were included. Their age ranged from 18 to 99 years with an average age of 58.70 years. Cleveland Clinical Score was used to predict ARF after cardiac surgery. ARF was defined as the need for RRT. Based on Cleveland Clinical Score, the patients were divided into four risk categories of increasing severity：0 to 2 point（n=979）, 3 to 5 point （n=1 116）, 6 to 8 point（n=54）, 9 to 13 point（n=4）. The rates of ARF, multiple organ system failure （MOSF）, and mortality were compared among the 4 categories. The predictive accuracy of postoperative ARF and hospital mortality was assessed by area under the receiver operating characteristic curve （AUC-ROC）. Results In the four categories, the rate of postoperative ARF was 0.92%, 1.88%, 12.96%, and 25.00%, respectively； MOSF rate was 1.23%, 1.88%, 3.70%, and 25.00%, respectively; mortality was 0.92%, 4.21%, 25.93%, and 50.00%, respectively. There was significant dif ference among the four categories in ARF rate （χ2=55.635, P=0.000），MOSF rate（χ2=16.080, P=0.001）, and mortality （χ2=71.470, P=0.000）. The AUC-ROC for Cleveland Clinical Score predicting ARF rate and hospital mortality was 0.775 （95%CI 0.713 to 0.837, P=0.000）and 0.764（95%CI, 0.711 to 0.817, P=0.000）, respectively. Conclusion Cleveland Clinical Score can accurately predict postoperative ARF and hospital mortality in a large, unselected Chinese cohort of adult patients after cardiac surgery. It can be used to provide evidence for effective preventive measures for patients at high risk of postoperative ARF.
Objective To investigate the application of sequential noninvasive ventilation (NIV) in weaning patients off mechanical ventilation after coronary artery bypass grafting (CABG). Methods From July 2007 to July 2009, 52 patients who underwent CABG with mechanical ventilation for no less than 24 hours and P/F Ratio lower than 150 mm Hg were divided into two groups with random number table. In the sequential NIV group (SNIV group), there were 19 patients including 16 males and 3 females whose ages were 69.26±8.10 years. In the prolonged mechanical ventilation group (PMV group), there were 33 patients including 28 males and 5 females whose ages were 70.06±7.09 years. Clinical data of these two groups were compared and the influence of NIV on the circulation and respiration of the patients were observed. Results The SNIV group weaned off mechanical ventilation earlier than the PMV group (26.46±3.66 h vs. 38.65±9.12 h, P=0.013). The SNIV group held shorter total ventilation time (29.26±21.56 h vs.54.45±86.57 h,P=0.016), ICU stay time (2.44±2.99 d vs. 4.89±7.42 d, P=0.028) and postoperative hospital time (10.82±4.31 d vs. 14.01±19.30 d, P=0.039) than the PMV group. Furthermore, the SNIV group had lower pneumonia rate (5.26% vs. 30.30%, P=0.033) and total postoperative complication rate (10.53% vs.45.45%, P=0.030) than the PMV group. However, there was no significant difference (Pgt;0.05) between the two groups in the successful weaning rate, repeated tracheal intubation rate, tracheotomy rate and mortality 30 days after operation. After NIV, SNIV group had no significant change in heart rate, central vein 〖CM(1585mm〗pressure, pulmonary arterial pressure and pulmonary arterial wedge pressure than the baseline value, while systolic pressure (129.66±19.11 mm Hg vs. 119.01±20.31 mm Hg, P=0.031), cardiacindex ［3.01±0.30 L/(min.m2) vs. 2.78±0.36 L/(min.m2), P=0.043］ and P/F Ratio (205.95±27.40 mm Hg vs. 141.33±9.98 mm Hg, P=0.001) were obviously elevated. Conclusion Sequential NIV is a effective and safe method to wean CABG patients off mechanical ventilation.
Objective To investigate the prognosis and risk factors of cardiac surgical patients with preoperative renal dysfunction，and evaluate the accuracy of estimated glomerular filtration rate （eGFR） as a predictor of adverse outcomes. Methods A total of 2 151 adult patients undergoing cardiac surgery in Renji Hospital，School of Medicine of Shanghai Jiaotong University from January 2005 to December 2009 were included in this study. There were 1 267 male patientsand 884 female patients with their average age of 58.7 （18-99）years. Clinical characteristics of patients with preoperative renal dysfunction，severity of postoperative acute kidney injury （AKI）and patients’ outcomes were analyzed. Multivariate logistic regression was performed to analyze perioperative risk factors of postoperative AKI. Receiver operating characteristic（ROC） curve was used to evaluate the accuracy of eGFR to predict patients undergoing postoperative renal replacement therapy （RRT） and in-hospital death. Results A total of 221 patients （10.27%） had preoperative renal dysfunction，among whom 124 patients （56.11%） developed postoperative AKI. Patients with preoperative renal dysfunction were older，had more comorbidities including hypertension and diabetes mellitus，were more likely to receive postoperative RRT，and had worse outcomes. Patients with decreased preoperative eGFR had significantly higher in-hospital mortality. Patients with preoperative renal dysfunction who developed postoperative AKI had the worst prognosis. Multivariate logistic regression showed that hypertension （OR=4.497，P=0.003），postoperative central venous pressure （CVP） ＜6 cm H2O （OR=16.410，P=0.000） and postoperative CVP＞14 cm H2O （OR= 5.178，P=0.013） were independent predictors of postoperative AKI for patients with preoperative renal dysfunction. The areas under the ROC curves of eGFR to predict in-hospital mortality and postoperative RRT were 0.691 and 0.704 respectively （95% CI 0.630-0.752，P=0.000；95% CI 0.614-0.795，P=0.001）. Conclusion Patients with preoperative renal dysfunction are older，have more comorbidities，higher likelihood to develop postoperative AKI and worse prognosis. Hypertension，postoperative CVP＜6 cm H2O and postoperative CVP＞14 cm H2O are independent predictors of postoperative AKI for patients with preoperative renal dysfunction. We believe eGFR can accurately predict the risk of adverse kidney outcomes and in-hospital death of patients undergoing cardiac surgery.
Objective To investigate clinical outcomes and perioperative management of off-pump coronary artery bypass grafting （OPCAB） for patients following acute myocardial infarction （AMI）.?Methods?From January 2006 to March 2010， 239 consecutive patients underwent OPCAB on the 14-27 （20.55±3.91） d following AMI（AMI group）in Renji Hospital，School of Medicine of Shanghai Jiaotong University. Preoperative MB isoenzyme of creatine kinase（CK-MB） level was （15.82±6.24） U/L and cardiac troponin I（cTnI） was （0.07±0.04） ng/ml. Clinical data of 406 patients without myocardial infarction history who underwent OPCAB during the same period were also collected as the control group for comparison.?Results?The 30-day mortality of AMI group was 2.51% （6/239）. The causes of death were circulatory failure in 4 patients， ischemic necrosis of lower extremity caused by intra-aortic balloon pump （IABP） in 1 patient and pneumonia with septic shock in 1 patient. Dopamine usage in AMI group was significantly higher than that of the control group （61.51% vs. 37.44%， P=0.001）. Intraoperative or postoperative IABP implantation was more common in AMI group， but there was no statistical difference between the two groups（P＞0.05） . Postoperative drainage and blood transfusion in AMI group were significantly larger than those of the control group （385.18±93.22 ml vs. 316.41±70.05 ml， P=0.022；373.68±69.54 ml vs. 289.78±43.33 ml， P=0.005， respectively）. But there was no statistical difference in re-exploration rate between the two groups （P＞0.05）. There was no statistical difference in the incidence of postoperative new onset atrial fibrillation between the two groups （P＞0.05）. Incidence of acute kidneyinjury of AMI group was significantly higher than that of the control group （13.81% vs. 8.62%， P=0.038）. Postoperative 30-day mortality of AMI group was higher than that of the control group， but there was no statistical difference between the two groups （2.51% vs. 1.48%，P＞0.05）. There was no statistical difference in ICU stay time and postoperative hospital stay between the two groups （2.01±0.95 d vs. 1.78±0.98 d；10.33±4.16 d vs. 9.89±4.52 d， respectively， P＞0.05）. A total of 211 patients （88.28%）in AMI group were followed up for 2.89±1.02 years， and 28 patients （11.72%） were lost during follow-up. Twenty-five patients died during follow-up including 14 cardiac deaths. One-year survival rate was 97.63%， and five-year survival rate was 88.15%.?Conclusion?It’s comparatively safe to perform OPCAB for patients at 2-4 weeks following AMI when their CK-MB and cTnI levels have returned to normal range.
Abstract： Objective To evaluate the incidence and prognosis of postoperative acute kidney injury （AKI） in patients after cardiovascular surgery， and analyse the value of AKI criteria and classification using the Acute Kidney Injury Network （AKIN） definition to predict their in-hospital mortality. Methods A total of 1 056 adult patients undergoing cardiovascular surgery in Renji Hospital of School of Medicine， Shanghai Jiaotong University from Jan. 2004 to Jun. 2007 were included in this study. AKI criteria and classification under AKIN definition were used to evaluate the incidence and in-hospital mortality of AKI patients. Univariate and multivariate analyses were used to evaluate preoperative， intraoperative， and postoperative risk factors related to AKI. Results Among the 1 056 patients， 328 patients（31.06%） had AKI. In-hospital mortality of AKI patients was significantly higher than that of non-AKI patients （11.59% vs. 0.69%， P＜0.05）. Multivariate logistic regression analysis suggested that advanced age （OR=1.40 per decade）， preoperative hyperuricemia（OR=1.97）， preoperative left ventricular failure （OR=2.53）， combined CABG and valvular surgery （OR=2.79）， prolonged operation time （OR=1.43 per hour）， postoperative hypovolemia （OR=11.08） were independent risk factors of AKI after cardiovascular surgery. The area under the ROC curve of AKIN classification to predict in-hospital mortality was 0.865 （95% CI 0.801-0.929）. Conclusion Higher AKIN classification is related to higher in-hospital mortality after cardiovascular surgery. Advanced age， preoperative hyperuricemia， preoperative left ventricular failure， combined CABG and valvular surgery， prolonged operation time， postoperative hypovolemia are independent risk factors of AKI after cardiovascular surgery. AKIN classification can effectively predict in-hospital mortality in patients after cardiovascular surgery， which provides evidence to take effective preventive and interventive measures for high-risk patients as early as possible.
Objective To observe the life quality and the immune function of colorectal cancer patients treated by huaier granule combined with FOLFOX4 chemotherapy. Methods A total of 76 cases of colorectal cancer with chemotherapy indications were divided into two groups at random. Huaier granule and FOLFOX4 chemotherapy was applied in trial group， meanwhile， placebo and FOLFOX4 chemotherapy in control group. The changes of life quality， common condition， and immune state in two groups before and after treatment were abserved. Results The effective rate in the trial group was 92.1％ （35/38）， and in the control group was 65.8％ （25/38）， χ2=7.91， P＜0.005. The life quality improving rate in the trial group was 78.9％ （30/38）， and in the control group was 31.6％ （12/38）， χ2=6.33， P＜0.05. The CD3 increase rate in the trial group was 65.8％（25/38）， and in the control group was 23.7 ％ （9/38）， χ2=7.96， P＜0.005， the CD4/CD8 increase rate in the trial group was 68.4 ％（26/38） , and in the control group was 28.9％ （11/38）， χ2=10.53， P＜0.005. Conclusions Huaier granule can significantly improv the clinical symptoms, life quality, and immune state. Huaier granule combined with FOLFOX4 chemotherapy is a new effective scheme to cure colorectal cancer， is worth further generalization．
【Abstract】 Objective To study the image of the muscular and cutaneous branches of supratrochlear artery by internal and external carotid angiography and to design the frontal flap for nasal reconstruction. Methods The muscular and cutaneous branches of supratrochlear artery of 30 adults were investigated through internal and external carotid angiography and three-dimensional reconstruction of vessels to explore the courses of branches of supratrochlear artery and their communication with supraorbital artery. According to image observation, the frontal flap was designed and used to perform nasal reconstruction in 11 cases of nasal defects, including 7 males and 4 females with an average age of 23 years (range, 15-48 years). The nasal defect ranged from 3.0 cm × 2.5 cm to 5.0 cm × 3.5 cm. Results Internal carotid angiography and three-dimensional imaging of the vessels showed that supratrochlear artery was found in 30 patients, with a diameter of (0.9 ± 0.6) mm. The superficial cutaneous branch appeared constantly with a diameter of (0.7 ± 0.3) mm. Deep muscular branch traveled among frontal muscle, with a diameter of (0.5 ± 0.5) mm and a length of (32.0 ± 6.2) mm, and it was missing in 4 patients, the branches communicated with each other and with supraorbital artery. All flaps survived with good appearance and without cartilage exposure. After 4 months to 3 years of follow-up, the postoperative aesthetic appearance and function of nasal tip, alar, and columella were satisfactory; the height and slope length of the external nose were moderate; and the reconstructed nose had good texture and normal ventilation function without constriction of naris. Conclusion Imaging studies support the fact that supratrochlear artery has constant cutaneous branch. The application of frontal flap pedicled with cutaneous branch can improve the effectiveness of nasal reconstruction.