Objective To explore the affecting factors on sinus rhythm maintenance after electric cardioversion for patients with atrial fibrillation (Af) after cardiac valve replacement. Methods One hundred fifty two valvular disease patients with Af after cardiac valve replacement were randomized to 2 groups: Amiodarone group and control group (without anti arrhythmic drugs) after cardioversion. Af recurrence was observed during one year follow up. Results (1) No significant difference of Af recurrence betwe...
Objective To analyze the effect of myocardial protection between modified Del Nido cardioplegia and St. Thomas Hospital Cardioplegia in adult patients with aortic valve and mitral valve replacement. Methods From January 2014 to June 2016, 140 patients underwent aortic valve and mitral valve replacement in our hospital. According to different cardioplegia, the patients were divided into two groups including a modified Del Nido cardioplegia group (70 patients, 37 males, 33 females at mean age of 53.13±9.52 years) and a St. Thomas cardioplegia group (70 patients, 32 males, 38 females, at age of 50.71±9.29 years). We collected clinical data of the patients before operation (T1), 2 h after aortic unclamping (T2), 24 h after operation (T3) and 48 h after operation (T4). Indexes of muscle enzymes including blood center creatine kinase (CK), creatine kinase isoenzyme (CK-MB) concentration and liver function indexes including urea nitrogen (BUN), creatinine (Cr), alanine aminotransferase (ALT), aspartate aminotransferase (AST) concentrations, and compared the postoperative and follow-up clinical data. Results There was no statistical difference in age, weight, gender, ejection fraction baseline data between the two groups (P>0.05). All patients were successfully completed combined valve replacement under cardiopulmonary bypass. The cardiopulmonary time was no statistical difference between the two groups (P>0.05). However, compared with St. Thomas cardioplegia group, modified Del Nido group was less in perfusion (1.19±0.39vs. 2.99±0.75, P<0.001), shorter in aortic clamping time (P=0.003). No statistical difference was found in defibrillation rate after resuscitation between the two groups (P=0.779). Biochemical indicators were not statistically different at different time points between the two groups (P>0.05). Conclusion Modified Del Nido cardioplegia has the same effect on myocardial protection with St. Thomas cardioplegia in adult patients. It reduces the frequency of reperfusion, and shortens the clamping time. There is no additional injury in the important organs such as liver, kidney. Modified Del Nido cardioplegia myocardial protection ability in adult heart valve surgery is feasible.
摘要:目的: 在风湿性心脏病患者瓣膜置换术中,评价罗库溴铵在麻醉诱导期间对患者心肌氧供和氧耗平衡的影响。 方法 :选择86例在中低温体循环下行瓣膜置换术的患者,采用随机双盲法分配成罗库溴铵组(n=42例)和维库溴铵组(n=41例)。给予咪唑安定(005～01 mg/kg)及芬太尼(10～15μg/kg)及等效剂量的罗库溴铵06 mg/kg或维库溴铵01 mg/kg(Org. Comp)进行麻醉诱导。监测麻醉诱导前至插管后10分钟(1次/1分)期间两组患者心肌氧供和氧耗的变化。 结果 :与基础值相比,罗库溴铵组患者在插管后5分钟期间心率增加了174%～135%,动脉收缩压增加了1694%～143%,平均动脉压增加了151%～132%。同期心率收缩压乘积增加了2267%～1396% (〖WTBX〗P lt;005)。心率和动脉血压在插管后1～7分钟期间明显高于同期的维库溴铵组患者(〖WTBX〗P lt;005)。 结论 :在ASA ⅢⅣ级、心功ⅡⅢ级风心病瓣膜病变患者进行瓣膜置换术中, 06 mg/kg罗库溴铵有潜在增加患者心肌耗氧量的作用。Abstract: Objective: To evaluate the effects of rocuronium on myocardial oxygen supplydemand in patients with rheumatic heart disease (RHD) during induction. Methods : 86 patients of either sex (ASA status ⅢⅣ; New York Heart Association classes ⅡⅢ) scheduled for valve replacement surgery were included in this randomized clinical trial (RCT). SwanGanz catheter was placed via right internal jugular vein before the induction of anaesthesia. Anaesthesia was induced with midazolam 00501mg.kg-1 and fentanyl 1015 μg·kg-1. The patients were randomized to receive either rocuronium 06 mg·kg-1 (group R, 〖WTBX〗n= 42) or vecuronium 01 mg·kg-1 (group V, 〖WTBX〗n= 41) to facilitate tracheal intubation when bispectral index (BIS) value dropped to 60 All data were recorded at the time before anaesthesia (Tb), loss of consciousness (Ts), administration of muscle relaxant (Tm), 1 min after administration of muscle relaxant (T1), when trainoffour stimulation (TOF) reached 0 (T2) and 1,2,3,4,5,7,10 min after tracheal intubation (T39).〖WTHZ〗Results : Heart rate (HR) increased by 174%135%, systemic arterial systolic pressure (SAP) increased by 1694%143%, mean arterial systolic pressure (MAP) increased by 151%132% and product of heart rate and arterial systolic pressure(RPP) increased 2267%1396% respectively during 5 minutes after intubation as compared with baseline in group R, which were significantly higher than those in group V during 5 minutes after intubation (〖WTBX〗P lt;005). Conclusion : An intubation dose of rocuronium should be used cautiously in patients with rheumatic heart disease (ASA status ⅢⅣ; NYHA classes IIⅢ).
目的 探讨心脏机械瓣膜置换术后患者出院指导的综合方法，评价其效果。 方法 将2010年9月－2011年1月242例心脏机械瓣膜置换术患者按入院先后顺序随机分成试验组和对照组。试验组患者采用综合出院指导方案，对照组采用常规宣教方法，在6个月后对两组患者进行调查，评价综合指导方案的效果，并进行统计学分析。 结果 试验组患者均未出现不良并发症，对照组有1例出院后未遵医嘱服药及定期复查，死于血管栓塞；有2例出现血管栓塞，2例牙龈出血，经及时治疗后好转。 结论 对心脏机械瓣膜置换术患者出院时，发放健康教育资料及定期随访指导的综合出院指导方案，可以降低术后并发症，提高患者认知水平和满意度，帮助患者提高依从性，提高生存质量。
Objective To develop and validate a nomogram prediction model for pulmonary infection in patients following cardiac valve replacement surgery, providing a reference for early screening of high-risk populations and implementing targeted preventive measures. Methods Clinical data of patients who underwent cardiac valve replacement surgery at the Second Affiliated Hospital of Anhui Medical University from January 2020 to October 2023 were collected. Patients were randomly assigned to a modeling group and a validation group in a 7 : 3 ratio. Based on the occurrence of pulmonary infection post-surgery, patients were divided into a pulmonary infection group and a non-pulmonary infection group. Risk factors for pulmonary infection after cardiac valve replacement were analyzed using least absolute shrinkage and selection operator (LASSO) regression and logistic regression to establish a risk prediction model, which was subsequently validated. Model evaluation was conducted using the area under the receiver operating characteristic curve (AUC), calibration curves, and decision curve analysis. Results A total of 689 patients were included, comprising 354 males and 335 females, with a median age of 58.0 (50.0, 68.0) years. The incidence of pulmonary infection was 16.0% (110/689). Independent risk factors for pulmonary infection following cardiac valve replacement included emergency admission, smoking history, chronic obstructive pulmonary disease, duration of cardiopulmonary bypass, duration of tracheal intubation, and postoperative renal injury. The AUC for the modeling group was 0.911 [95%CI (0.877, 0.946) ], with a Hosmer-Lemeshow χ2-value of 6.577 (P=0.583) in the modeling group. The AUC value was 0.891 [95%CI (0.840, 0.941) ], with a Hosmer-Lemeshow χ2-value of 5.486 (P=0.705) in the validation group. The model demonstrated good discrimination, calibration, and net benefit. Conclusion The established nomogram prediction model has significant predictive value and can be applied to risk assessment and individualized treatment for pulmonary infection in patients following cardiac valve replacement surgery.