ObjectiveTo investigate the correlation between perioperative blood transfusion and hepatic postoperative infection. MethodsOne hundred and thirty patients undergoing hepatic operation were analyzed retrospectively on the relation of perioperative blood transfusion with postoperative infective morbidity and mortality in the period 1989-1999. The patients were divided into blood transfused group and nontransfused group. The major or minor hepatectomy was performed in 53 patients with hepatic malignancy and benign diseases. ResultsIn the blood transfused group, the infective morbidity and perioperative mortality rate was 38.5% and 16.7% respectively, significantly higher than those in nontransfused group (11.5% and 3.8% respectively), P＜0.05. The total lymphocyte count was lower in transfused group than that in nontransfused group. The postoperative antibiotics used time and length of hospital stay were (9.7±4.2) days and (18.7±13.1) days respectively in transfused group than those in nontransfused group (5.3±2.3) days and (12.7±5.2) days respectively. ConclusionThe results suggest that hepatic postoperative infective morbidity and mortality are related with perioperative blood transfusion. Any strategy to reduce blood loss in liver surgery and decrease blood transfusion would be helpful to lower postoperative infective morbidity.
Abstract： Objective To explore the impact of obesity on postoperative morbidity and mortality after pneumonectomy. Methods Clinical data of 3 494 patients with pulmonary diseases who underwent pneumonectomy in Shanghai Pulmonary Hospital from September 2003 to December 2007 were retrospectively analyzed. All the 3 494 patients were divided into two groups according to the patients’ preoperative body mass index （BMI）. There were 3 340 patients in the non-obesity group （BMI＜28 kg/m2） including 2 502 males and 838 females with their average age of 61.9±10.7 years， and 154 patients in the obesity group （BMI≥28 kg/m2） including 87 males and 67 females with their average age of 59.7±9.6 years. Univariate analysis and logistic regression were used to analyze the impact of obesity （BMI≥28 kg/m2） on postoperative morbidity after pneumonectomy. Results There were a total of 26 cases of perioperative death， including 23 patients in the non-obesity group and 3 patients in the obesity group. There was no statistical difference in mortality between the two groups ［0.7% （23/3 340） vs. 1.9% （3/154）， P=0.118］. There was no statistical difference in any particular postoperative morbidity or incidence of pulmonary complications between the two groups （P＞0.05）. Other than pulmonary complications， the incidence of postoperative complication in other body systems of the obesity group was significant higher than that of the non-obesity group （P＜0.05）. The incidence of cerebrovascular accidents， myocardial infarction and acute renal failure of the obesity group was significant higher than those of the non-obesity group （P＜0.05）. Logistic regression showed that obesity （BMI≥28 kg/m2） was not an independent risk factor for postoperative morbidity after pneumonectomy ［B=0.648， OR=1.911， 95% CI（0.711， 5.138），P=0.199］. Conclusion Obesity is not a significant risk factor of postoperative mortality or morbidity after pneumonectomy.
Objective To explore the predictive value of Charlson comorbidity index(CCI)in the prognosis of aged chronic obstructive pulmonary disease (COPD)patients. Methods A retrospective review was performed for 350 hospitalized aged COPD patients who admitted in Xuanwu Hospital of Capital Medical University from January 2010 to January 2015.The clinical data were recorded including age,body mass index (BMI),comorbidities (CCI score),FEV1%pred,the times of acute exacerbation of COPD a year before admission,and in-hospital mortality.The risk factors of acute exacerbation and in-hospital mortality were analyzed by multivariable logistic regression. Results There were 177 patients who had experienced acute exacerbation more than 2 times per year and 173 patients who had experienced acute exacerbation less than 2 times per year.Multivariable logistic regression analysis showed that CCI [OR=1.559,95% CI(1.309,1.856),P=0.000] and FEV1%pred [OR=0.979,95% CI(0.964,0.994),P=0.006] were the independent predictors for acute exacerbation of COPD.The in-hospital mortality rate was 10.3%(36/314). Multivariable logistic regression analysis showed that CCI [OR＝1.894,95% CI (1.422,2.523),P=0.000],age [OR=1.153,95% CI(1.063,1.251),P=0.001],FEV1%pred [OR=0.916,95% CI(0.878,0.955),P=0.000],BMI [OR=0.849,95% CI(0.749,0.962),P=0.011],acute exacerbation more than 2 times per year [OR=6.340,95% CI(1.469,27.366),P=0.013] were the independent predictors for mortality. Conclusion CCI is an independent risk factor associated with in-hospital mortality and acute exacerbation of COPD.
Objective To estimate the relationship of methods and drugs for management of constrictive pericarditis during pericardiectomy. Methods We reviewed the records of 45 patients (mean age, 40.24±15.34 years) with a diagnosis of constrictive pericarditis who underwent pericardiectomy in our hospital from 2012 through 2014 year. During operation, inotropic agents, vasodilators and diuretics were used. According to the diuretics, patients were divided into two groups including a furosemide group(group F) with 38 patients and a lyophilized recombinant human brain natriuretic peptide (lrhBNP) group with 7 patients(group B). Results Preoperatively, 30 patients were pulmonary congestion, which was diagnosed by chest radiographs. Pericardiectomy was finished by off pump in 43 patients. Another 2 patients required cardiopulmonary bypass (CPB) for pericardiectomy. In the group F 52.6% of the patients needed vasodilators to reduce cardiac preloading following pericardiectomy. None of other vasodilators were used in the group B. After pericardiectomy, the fluctuation of systolic and diastolic pressure decreased significantly in the group B (P=0.01, respectively). In the group F, the fluctuation of diastolic pressure decreased significantly (P＜0.05). Low cardiac output was the most common postoperative problem. One patient accepted postoperative extracorporeal membrane oxygenation (ECMO) support. Postoperative poor renal function was found in 42.2% of the patients. Three of them needed hemofiltration. Postoperative poor renal function accompanied by poor hepatic function was found in 15.6% of the patients. One of them used dialysis and artificial liver. Three patients were respiratory failure with longer mechanical ventilation and tracheotomy. The overall perioperative mortality rate was 6.7% (3 patients). All patients, who died or used with hemofiltration, artificial liver and ECMO were found in the group F. Conclusion More stable haemodynamics after pericardiectomy may occur with using lrhBNP. lrhBNP may reduce postoperative major morbidity and mortality. Because of the small group using lrhBNP in our study, more patients using lrhBNP for pericardiectomy need to be studied.
Objective To assess the independent risk factors of in-hospital mortality and morbidity after surgical procedure for Stanford type A aortic dissection (TAAD). Methods Between May 2013 and May 2015, 341 TAAD patients were treated with surgical procedure in Fu Wai Hospital. There were 246 males and 95 females with a mean age of 47.42±11.54 years (range 29-73 years). Among them, 87 patients suffered severe complications or death after the procedure (complication group) and the other 254 patients recovered well without any severe complications (no complication group). Perioperative clinical data were compared between the two groups. Results Mean age of patients in the complication group was significantly higher than that of the no complication group (49.91±11.22 yearsvs. 46.57±11.54 years,P=0.019). The incidence of preoperative ischemic organ injury in the complication group was significantly higher than that in the no complication group: cerebral ischemia (18.4%vs. 5.9%,P=0.001), spinal cord injury (16.1%vs. 4.7%,P=0.001), acute kidney injury (31.0%vs. 10.6%,P=0.000). The incidence of branch vessels involvement in the complication group was significantly higher than that in the no complication group: coronary artery involvement (52.9%vs. 17.1%,P=0.000), supra-aortic vessels involvement (73.6%vs. 53.9%,P=0.001), celiac artery involvement (37.9%vs. 22.0%,P=0.003), mesenteric artery involvement (18.4%vs. 9.8%,P=0.030), and unilateral or bilateral renal artery involvement (27.6%vs. 9.8%,P=0.000). Surgical time of patients in the complication group was significantly longer than that of the no complication group, including cardiopulmonary bypass time (205.05±63.65 minvs. 167.67±50.24 min,P<0.05) and cross-clamp time (108.11±34.79 minvs. 90.75±27.33 min,P<0.05). Multiple regression analysis found that age, preoperative concomitant cerebral ischemic injury, preoperative concomitant acute renal injury, preoperative limb sensory and/or motor dysfunction, coronary artery involvement, cardiopulmonary bypass time were independent risk factors of postoperative death and severe complications in TAAD patients. However, risk of postoperative mortality and morbidity significantly decreased after the concomitant coronary artery bypass graft [OR=0.167 (0.060, 0.467),P=0.001]. Conclusion The high risk factors of postoperative complication in TAAD patients are explored to provide an important clinical basis for preoperative identification of patients at high risk and we need pay more attention to the prevention of these postoperative complications.
Objective To explore impact of climate change on aortic dissection and to put forward a new way about prediction and prevention of aortic dissection. Methods We retrospectively analyzed the characteristics of acute aortic dissection patients came from Hebei province in Fuwai Hospital between 2010 and 2016 year. Meanwhile, we collected monthly maximum temperature, minimum temperature, average temperature, average pressure, amount of rainfall, sunshine, humidity and other meteorological data. Generalized model was implied to explore climate change and the incidence of aortic dissection. Results A total of 1 121 acute aortic dissection patients from Hebei province were admitted in Fuwai Hospital during the period of 6 years. There were 774 patients were type A aortic dissection, and 347 patients were type B aortic dissection. The average age was 51.4±12.0 years. There were 873 males and 248 females. There were 889 (79.3%) patients with hypertension, 99 (8.83%) with Marfan syndrome. It was found that temperature, humidity and air pressure were all statistically significant for indication aortic dissection through single variable analysis (P<0.01). The temperature was only variable by one-way analysis of variance (P<0.01). The lowest temperature has the best predictive effect on the occurrence of aortic dissection. The relative risk was 1.02 with 95% confidence interval 1.02 to 1.03. Conclusion The change of climatic conditions can affect the occurrence of aortic dissection, and the lowest temperature is an important trigger factor for aortic dissection onset.
Choroidal metastasis of lung cancer is rare in clinical, which is easy to missed diagnosis or misdiagnosis, special research and discussion are not much. This article mainly introduces the current situation of choroidal metastasis of lung cancer in China, the characteristics of clinical and ophthalmoscopic examination, angiography and imaging, the methods of early detection, early diagnosis and the progress of individualized comprehensive treatment. It is expected to attract the attention of thoracic surgeons, conducive to improve the quality of life and prognosis of patients.
ObjectivesTo explore the safety and efficacy of beta-blockers (BBs) in patients with chronic obstructive pulmonary disease (COPD) and its effect on prognosis. MethodsThe data of 366 patients with acute exacerbation of COPD in this department were analyzed retrospectively. The use rate and related events of BBs were evaluated, including comorbidity, indications, contraindications and related clinical indicators. ResultsOf the 366 patients, 156 (42.6%) had at least one indication of the use of BBs, but only 53 (34.0%) of these patients used BBs, and 61 patients (39.1%) had no contraindications but did not use BBs. At admission, 72 patients (19.7%) were treated with BBs, 177 (45.6%) with antiplatelet drugs, 145 (39.6%) with statins, and angiotensin converting enzyme inhibitor/angiotensin II receptor blocker was used in 168 (45.9%) patients. Twenty-five patients (6.8%) had ischemic heart disease during hospitalization. Fifty-seven patients (15.6%) had cardiovascular and cerebrovascular events during admission. The patients with cardiovascular and cerebrovascular events had longer hospitalization (P<0.01) and higher in-hospital mortality (P=0.02). ConclusionsPatients with COPD have a clear indication of BBs use, but the clinical use rate is still very low. Further research is needed to explore the prescription disorders of BBs in patients with COPD.
ObjectiveTo evaluate the prognosis of benign esophageal perforation by Pittsburgh scoring system (perforation severity scores, PSS) combined with co-disease index (Charlson comorbidity index, CCI).MethodsThirty patients with benign esophageal perforation from August 2016 to August 2018 in our hospital diagnosed by imaging or endoscopy were selected, including 14 males and 16 females, aged 68.660±10.072 years. After treatment, we retrospectively analyzed whether there was any complication in the course of treatment, the healing of esophageal perforation at discharge and the follow-up after discharge. And the patients were divided into a stable group (20 patients with no complication, clear healing of esophageal perforation at discharge or death during follow-up) and an unstable condition group (10 patients with complications, esophageal perforation at discharge or death during follow-up). Complete clinical data of all the patients were obtained and were able to be calculated by the scores of PSS and CCI scoring system. The difference of PSS and CCI scores between the two groups was compared, and the clinical value of PSS combined with CCI score in the prognosis of benign esophageal perforation was analyzed.ResultsIn the stable group, the PSS was 2.750±1.372 (95%CI 2.110 to 3.390), CCI score was 2.080±1.055 (95%CI 1.650 to 2.500) with a statistical difference between the two systems (P=0.000). In the unstable group, PSS was 7.300 ±1.829 (95%CI 7.300 to 8.120), CCI was 4.640±1.287 (95%CI 4.220 to 5.060) with a statistical difference between the two systems (P<0.05). The area under the receiver operating characteristic curve of PSS and CCI scores in the prognostic evaluation of benign esophageal perforation was 0.982 and 0.870 respectively, which was statistically significant (P<0.05).ConclusionEsophageal perforation is a dangerous condition. It is of great practical value to evaluate the condition of esophageal perforation by PSS and CCI scores.
ObjectivesTo compare the efficacy of acute physiology and chronic health evaluationⅡ (APACHEⅡ), national early warning score (NEWS), pulmonary embolism severity index (PESI) and Charlson comorbidity index (CCI) on pulmonary embolism (PE) prognosis.MethodsClinical data of patients with PE treated in The Second Xiangya Hospital of Central South University from 2010 to 2017 were retrospectively analyzed. They were divided into death group and survival group, and four clinical scores were calculated. The differences of risk factors between the two groups were compared. Logistic regression analysis was used to obtain the independent risk factors related to mortality. The ROC working curve was used to compare the capability of four clinical scores for PE mortality. SPSS 24.0 and Medcalc 18.2.1 software were used for statistical analysis. ResultsA total of 318 patients with PE were included, and the mortality rate was 13.2%. The APACHEⅡ, NEWS, PESI and CCI of the death group were higher than those of the survival group. There were significant differences between two groups (P<0.05). It was confirmed by logistic regression analysis that cerebrovascular disease, heart rate, leukocyte, troponin T, arterial partial pressure of oxygen, right ventricular dysfunction (RVD) were independent risk factors for 90-day mortality. The areas under the ROC curve of APACHEⅡ, CCI, PESI, NEWS were 0.886, 0.728, 0.715 and 0.731, respectively. The area under the ROC curve of APACHEⅡ was the largest, which was better than NEWS, CCI and PESI (P<0.05), and there was no significant difference among NEWS, CCI and PESI.ConclusionsAPACHEⅡ may be the best predictor of mortality in PE patients, which is superior to NEWS, CCI and PESI.