• 【从未分离,未收获的RIMA进入ial动脉移植物:一种在CABG手术中避免近端吻合到主动脉的方法。】 复制标题 收藏 收藏
    DOI:10.1016/s1010-7940(00)00585-6 复制DOI
    作者列表:Pehkonen E,Seppänen S,Niemelä K,Majahalme S
    BACKGROUND & AIMS: :Performing the proximal anastomosis of a free arterial graft to the ascending aorta is problematic, especially if the wall of the aorta is calcified or thickened. We describe a method, which makes it possible to avoid this procedure.
    背景与目标: :对升主动脉进行游离动脉移植物的近端吻合是有问题的,尤其是在主动脉壁钙化或增厚的情况下。我们描述了一种方法,可以避免此过程。
  • 【冠状动脉搭桥术(CABG)的候选患者中的地中海饮食质量指数和饮食植物化学指数。】 复制标题 收藏 收藏
    DOI:10.1186/s12872-017-0544-z 复制DOI
    作者列表:Farhangi MA,Najafi M,Jafarabadi MA,Jahangiry L
    BACKGROUND & AIMS: BACKGROUND:The aim of the present research was to evaluate the relationship between Mediterranean dietary quality index (Med-DQI) and dietary phytochemical index (DPI) with metabolic risk factors of cardiovascular disease in candidates for coronary artery bypass graft (CABG) surgery. METHODS:This was a cross-sectional study on 454 patients aged 35-80 years as candidates of CABG and hospitalized in Tehran Heart Center. Anthropometric and demographic characteristics were obtained from all participants and a 138-item semi-quantitative food frequency questionnaire (FFQ) was used to evaluate Med-DQI and DPI. Biochemical parameters including HbA1C, serum lipids, albumin, creatinine and C-reactive protein (CRP) were assessed by commercial laboratory methods. RESULTS:Patients with higher scores of "saturated fatty acids" had lower serum albumin concentrations (P < 0.05). High scores of "cholesterol" subgroup was also accompanied with higher serum Hb A1C percent (P = 0.04). Significantly higher concentrations of serum creatinine were also observed in categorizes with lower "fish" scores. Patients with lower phytochemical intakes had significantly higher Med-DQI scores. CONCLUSION:According to our findings, high dietary intakes of saturated fatty acids and cholesterol were associated with low serum albumin and Hb A1C concentration. Further studies are needed to better clarify these associations and possible underlying mechanisms.
    背景与目标: 背景:本研究的目的是评估冠状动脉搭桥术(CABG)候选者的地中海饮食质量指数(Med-DQI)和饮食植物化学指数(DPI)与心血管疾病的代谢危险因素之间的关系。
    方法:这是一项横断面研究,对454位35-80岁的CABG候选人并在德黑兰心脏中心住院的患者进行了研究。从所有参与者获得人体测量学和人口统计学特征,并使用138个项目的半定量食物频率问卷(FFQ)来评估Med-DQI和DPI。通过商业实验室方法评估了包括HbA1C,血脂,白蛋白,肌酐和C反应蛋白(CRP)在内的生化参数。
    结果:“饱和脂肪酸”得分较高的患者血清白蛋白浓度较低(P <0.05)。高分的“胆固醇”亚组还伴有更高的血清Hb A1C百分比(P = 0.04)。在“鱼”得分较低的类别中也观察到明显较高的血清肌酐浓度。植物化学摄入量较低的患者的Med-DQI评分显着较高。
    结论:根据我们的发现,高饮食中饱和脂肪酸和胆固醇的摄入与低血清白蛋白和Hb A1C浓度有关。需要进一步研究以更好地阐明这些关联和可能的潜在机制。
  • 【高风险CABG之前他汀类药物对术后多器官功能的影响。】 复制标题 收藏 收藏
    DOI:10.1155/2020/9519736 复制DOI
    作者列表:Wang J,Yuan W,Zhang K,Liu N,Liu D,Zhou Y
    BACKGROUND & AIMS: Background:The purpose of this cohort study was to investigate the independent relationship between preoperative statin therapy (PST) and postoperative severe multiorgan failure, measured by the Sequential Organ Failure Assessment (SOFA) maximum greater than 11, in high-risk patients undergoing isolated coronary artery bypass grafting (CABG). Methods:The present study is a perspective, single-center, cohort analysis enrolling high-risk patients undergoing CABG from Jan 1, 2018, to Dec 31, 2018, in Beijing Anzhen hospital. Results:Among a total of 880 high-risk patients undergoing isolated CABG included in this study, 503 (57.2%) experienced statin therapy before CABG. The SOFA maximum was significantly lower in the PST group compared with the control group (7.8 ± 3.0 v 9.2 ± 3.4, P < 0.0001). Multivariate logistic regression analysis demonstrated the incidence of the severe multiorgan dysfunction, measured by SOFA maximum ≥11, was dramatically reduced in the PST group (OR, 0.68, 95% CI 0.50-0.92, P=0.013). Furthermore, preoperative statin therapy (PST) might be associated with a decreased risk of postoperative major adverse cardiovascular and cerebral events and acute kidney injury, but an increased risk of postoperative hepatic inadequacy. Conclusion:SOFA maximum was significantly lower in the PST group compared with the control group and the incidence of the severe multiorgan dysfunction was dramatically reduced in the PST group. The findings of this study might shed new light on questions of positive or negative effects of PST on multiple organ function after high-risk CABG, so as to ultimately improve high-risk patient in-hospital outcomes from CABG.
    背景与目标: 背景:该队列研究的目的是调查在接受单独冠状动脉治疗的高危患者中,他汀类药物治疗(PST)与术后严重多器官功能衰竭之间的独立关系,并通过序贯器官衰竭评估(SOFA)最大值大于11来衡量。动脉旁路移植术(CABG)。
    方法:本研究是一项透视,单中心,队列分析,纳入了2018年1月1日至2018年12月31日在北京安贞医院接受CABG治疗的高危患者。
    结果:本研究共纳入880名接受孤立CABG的高危患者,其中503名(57.2%)在他汀类药物治疗前经历过他汀类药物治疗。与对照组相比,PST组的SOFA最大值显着降低(7.8±±3.0 v 9.2±±3.4,P <0.0001)。多因素logistic回归分析表明,PSO组中严重的多器官功能障碍的发生率通过SOFA最大值≥11进行了测定,从而显着降低(OR,0.68,95%CI 0.50-0.92,P = 0.013)。此外,术前他汀类药物治疗(PST)可能会降低术后重大不良心血管和脑事件以及急性肾损伤的风险,但会增加术后肝功能不全的风险。
    结论:与对照组相比,PST组的SOFA最大值显着降低,PST组严重多器官功能障碍的发生率显着降低。这项研究的结果可能会为高危CABG后PST对多器官功能的正面或负面影响问题提供新的思路,从而最终改善CABG对高危患者的住院结果。
  • 【CABG之后的生存率-比EuroSCORE预测的要好,并且等于总人口。】 复制标题 收藏 收藏
    DOI:10.1080/14017430802354085 复制DOI
    作者列表:Engebretsen KV,Friis C,Sandvik L,Tønnessen T
    BACKGROUND & AIMS: OBJECTIVES:Examine short- and intermediate-term survival after coronary artery bypass grafting (CABG) and compare this to survival of the general population and to that predicted by EuroSCORE. DESIGN:One thousand three hundred and fifty one consecutive patients undergoing CABG were prospectively included. Survival status was ascertained through the Norwegian National Registry. RESULTS:Compared to the general population, no statistical significant difference in survival was seen in operated patients. Overall mortality rate was 0.8% after 30 days, 2.8%, 4.0% and 7.1% at one, two and three years, respectively. When patients were divided into four groups according to EuroSCORE, mortality increased significantly with increasing score, as expected. However, EuroSCORE overestimated mortality. CONCLUSION:Patients operated with CABG at our institution have similar survival as in the general Norwegian population. Although overestimating mortality by almost five-fold, we found a strong association between EuroSCORE and short-time survival, and an association between EuroSCORE and intermediate-term survival.
    背景与目标: 目的:检查冠状动脉搭桥术(CABG)后的短期和中期生存率,并将其与一般人群的生存率以及EuroSCORE预测的生存率进行比较。
    设计:前瞻性地纳入了1351例连续接受CABG的患者。生存状况通过挪威国家登记处确定。
    结果:与普通人群相比,手术患者的生存率无统计学差异。 30天后的总死亡率为0.8%,一年,两年和三年分别为2.8%,4.0%和7.1%。按照EuroSCORE将患者分为四组时,死亡率随着得分的增加而显着增加,这与预期的一样。但是,EuroSCORE高估了死亡率。
    结论:在我们机构接受CABG手术的患者生存率与挪威普通人群相似。尽管高估了将近五倍的死亡率,但我们发现EuroSCORE与短期生存率之间存在密切关联,而EuroSCORE与中期生存率之间存在密切联系。
  • 【肺部疾病患者的外科手术心肌血运重建术(CABG):心脏跳动与体外循环搭桥。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Covino E,Santise G,Di Lello F,De Amicis V,Bonifazi R,Bellino I,Spampinato N
    BACKGROUND & AIMS: BACKGROUND:Adverse effects on the respiratory system can be severe in many instances after coronarv artery bypass grafting (CABG) with cardiopulmonary bypass (CPBP). Recently, operative techniques without CPBP have gained widespread consent, thanks to the newly developed retractors that allow satisfactory immobilisation of the surgical field. METHODS:Thirty-seven patients operated upon in our Institution between April 1997 and April 1998 showed an obstructive and/or restrictive pulmonary disease. Twenty-one patients were operated on without CBPB (group A), while 16 patients were operated using CPBP (group B, control). The allocation in each group had been randomised. RESULTS:The length of the operation in group A was less than in group B (196+/-35 minutes vs 235+/-60 minutes), (p=0.014). A significant difference was found in postoperative bleeding: 562+/-381 ml vs 776+/-378 (p=0.046), in postoperative red cell count, hemoglobin level and Hct. Permanence on the ventilator was 19.1+/-13 hours in group B and 13.1+/-6.1 hours in group A (p=0.03). The length of stay in ICU was significantly different: 33.8+/-16.2 hours for group A vs 53.6+/-29.3 hours for group B (p=0.01). No respiratory failure occurred in group A; two patients experienced slow weaning from ventilation assistance and one died from that complication in group B. CONCLUSIONS:Myocardial revascularization without CPBP allows a better postoperative clinical course in patients with advanced pulmonary disease.
    背景与目标: 背景:冠状动脉搭桥术(CABG)和体外循环(CPBP)在许多情况下,对呼吸系统的不良影响可能很严重。近来,由于新开发的牵开器能够令人满意地固定手术区域,因此没有CPBP的手术技术已获得广泛认可。
    方法:1997年4月至1998年4月在我们机构接受手术的37例患者出现阻塞性和/或限制性肺部疾病。 21例无CBPB的患者接受了手术(A组),而16例采用CPBP的患者接受了手术(B组,对照组)。各组的分配已随机化。
    结果:A组的手术时间少于B组(196 / -35分钟vs 235 / -60分钟),(p = 0.014)。在术后出血中发现了显着差异:562 / -381 ml对776 / -378(p = 0.046),术后红细胞计数,血红蛋白水平和Hct。 B组呼吸机的持久性为19.1 / -13小时,A组呼吸机的持久性为13.1 /-6.1小时(p = 0.03)。在ICU的住院时间明显不同:A组为33.8 /-16.2小时,B组为53.6 /-29.3小时(p = 0.01)。 A组未发生呼吸衰竭; B组中有2例患者在通气辅助下断奶缓慢,其中1例因并发症而死亡。
    结论:没有CPBP的心肌血运重建术可以使晚期肺部疾病患者获得更好的术后临床过程。
  • 【在CABG手术后通过电话提供的协作式护理治疗抑郁症的十二个月成本效益:一项随机对照试验。】 复制标题 收藏 收藏
    DOI:10.1016/j.genhosppsych.2014.05.012 复制DOI
    作者列表:Donohue JM,Belnap BH,Men A,He F,Roberts MS,Schulberg HC,Reynolds CF 3rd,Rollman BL
    BACKGROUND & AIMS: OBJECTIVE:To determine the 12-month cost-effectiveness of a collaborative care (CC) program for treating depression following coronary artery bypass graft (CABG) surgery versus physicians' usual care (UC). METHODS:We obtained 12 continuous months of Medicare and private medical insurance claims data on 189 patients who screened positive for depression following CABG surgery, met criteria for depression when reassessed by telephone 2 weeks following hospitalization (nine-item Patient Health Questionnaire ≥10) and were randomized to either an 8-month centralized, nurse-provided and telephone-delivered CC intervention for depression or to their physicians' UC. RESULTS:At 12 months following randomization, CC patients had $2068 lower but statistically similar estimated median costs compared to UC (P=.30) and a variety of sensitivity analyses produced no significant changes. The incremental cost-effectiveness ratio of CC was -$9889 (-$11,940 to -$7838) per additional quality-adjusted life-year (QALY), and there was 90% probability it would be cost-effective at the willingness to pay threshold of $20,000 per additional QALY. A bootstrapped cost-effectiveness plane also demonstrated a 68% probability of CC "dominating" UC (more QALYs at lower cost). CONCLUSIONS:Centralized, nurse-provided and telephone-delivered CC for post-CABG depression is a quality-improving and cost-effective treatment that meets generally accepted criteria for high-value care.
    背景与目标: 目的:确定协作治疗(CC)方案治疗冠状动脉搭桥术(CABG)术后相对于医生的常规治疗(UC)抑郁症的12个月成本效益。
    方法:我们获得了连续12个月的医疗保险和私人医疗保险理赔数据,这些数据包括189例CABG术后抑郁症呈阳性的患者,住院2周后通过电话重新评估符合抑郁症的标准(9项患者健康问卷≥10),以及被随机分配到为期8个月的集中式,由护士提供并通过电话进行的抑郁症CC干预或医生的UC。
    结果:在随机分组后的12个月,CC患者的费用中位数比UC低2068美元,但统计学上相似(P = .30),并且各种敏感性分析均未见明显变化。每增加一个质量调整生命周期(QALY),CC的成本效益比为-9889美元(-$ 11,940到-$ 7838),并且在愿意支付20,000美元的门槛时,有90%的可能性具有成本效益。每增加一个QALY。自举成本效益飞机还证明了CC“主导” UC的可能性为68%(以较低的成本获得更多的QALY)。
    结论:集中的,由护士提供的和电话提供的CC-CABG后抑郁症治疗是一种质量改善且具有成本效益的治疗方法,符合公认的高价值护理标准。
  • 【升主动脉粥样硬化对CABG术后长期生存的影响。】 复制标题 收藏 收藏
    DOI:10.1016/j.ejcts.2005.07.004 复制DOI
    作者列表:Schachner T,Zimmer A,Nagele G,Hangler H,Laufer G,Bonatti J
    BACKGROUND & AIMS: OBJECTIVE:Ascending aortic atherosclerosis is a risk factor for perioperative morbidity and mortality in coronary surgery. It was the aim of our study to determine the role of atherosclerosis of the ascending aorta and other factors for the survival rate during long-term follow-up after CABG. METHODS:From 500 out of 580 CABG patients (aged 67 (33-85) years, 77% male), who underwent intraoperative epiaortic ultrasound for assessment of ascending aortic wall thickness, a complete follow up regarding long-term survival was achieved. The median follow-up time was 55 (1-78) months. RESULTS:53/500 (11%) patients died within the follow-up period, and the cumulative survival rate was 95, 90, and 84% after 1, 3, and 5 years, respectively (including hospital deaths). A significantly lower long-term survival was present in patients with: an age of 70 years or more (P<0.001), COPD (P=0.005), preoperative elevated serum creatinine of >1.2mg/dl (P=0.007), preoperative LVEF <40% (P=0.033), ascending aortic wall thickness of 4mm or more (P=0.001), carotid artery disease (P<0.001), peripheral vascular disease (P<0.001), and acute operation (P=0.009). Multivariate analysis revealed carotid artery disease, LVEF <40%, peripheral vascular disease, and advanced age to be independent risk factors. CONCLUSION:Patients with ascending aortic atherosclerosis are at risk for a decreased long-term survival after CABG. Besides, preoperative elevated serum creatinine, COPD, carotid artery disease, LVEF <40%, peripheral vascular disease, and advanced age are risk factors for a decreased long-term survival after CABG.
    背景与目标: 目的:升主动脉粥样硬化是冠状动脉手术围手术期发病和死亡的危险因素。本研究的目的是确定CABG术后长期随访中升主动脉的动脉粥样硬化的作用以及其他因素对存活率的影响。
    方法:在580例CABG患者(年龄67岁(33-85岁),男性77%)中,有500例接受了术中表皮超声检查以评估主动脉壁厚度的增加,从而获得了关于长期生存的完整随访。中位随访时间为55(1-78)个月。
    结果:53/500(11%)患者在随访期内死亡,在1、3和5年后(包括医院死亡),累积生存率分别为95%,90%和84%。年龄在70岁或以上(P <0.001),COPD(P = 0.005),术前血清肌酐升高> 1.2mg / dl(P = 0.007)的患者的远期生存率显着降低LVEF <40%(P = 0.033),升主动脉壁厚4mm以上(P = 0.001),颈动脉疾病(P <0.001),周围血管疾病(P <0.001)和急性手术(P = 0.009) 。多因素分析显示,颈动脉疾病,LVEF <40%,周围血管疾病和高龄是独立的危险因素。
    结论:升主动脉粥样硬化的患者有CABG术后长期生存降低的风险。此外,术前血清肌酐升高,COPD,颈动脉疾病,LVEF <40%,周围血管疾病和高龄是CABG术后长期生存率降低的危险因素。
  • 【CABG患者血管壁中的巨细胞病毒和增殖信号。】 复制标题 收藏 收藏
    DOI:10.1055/s-2006-923891 复制DOI
    作者列表:Westphal M,Lautenschlager I,Backhaus C,Loginov R,Kundt G,Oberender H,Stamm C,Steinhoff G
    BACKGROUND & AIMS: OBJECTIVE:To further elucidate the mechanism by which cytomegalovirus (CMV) may promote atherosclerosis, we studied the expression pattern of cellular inflammatory and proliferative signals in the aortic wall of CMV(+) and CMV(-) patients undergoing coronary artery bypass grafting (CABG). METHODS:Aortic biopsies and blood samples of 68 CABG patients were investigated for CMV-DNA by PCR and IN SITU hybridisation. Expression of pp65 antigen, adhesion molecules (ICAM-1, VCAM-1, E-selectin), growth factors (PDGF-AA, TGF-beta), and the cellular proliferation factor Ki-67 was studied by immunohistochemistry. Logistic regression was used to test the correlation between the presence of CMV, vascular inflammation, and traditional noninflammatory risk factors for atherosclerosis. RESULTS:CMV-DNA was detected in the aortic tissue of 52 (76%) patients, and was localised predominantly in vascular smooth muscle cells. In CMV(+) patients, the expression of adhesion molecules and growth factors in the aortic endothelium was increased compared with CMV(-) patients. A positive correlation of elevated CRP, the induction of adhesion molecules and growth factors and CMV(+) was found. Female gender, smoking, and hyperlipidaemia were identified as risk factors for CMV(+). CONCLUSIONS:CMV-DNA in smooth muscle cells induces local growth factor expression as well as endothelial activation, both of which can promote the progression of atherosclerosis. Since traditional atherogenic risk factors increase the likelihood of aortic CMV manifestation, we suggest that CMV plays a crucial role in mediating the progression of atherosclerosis.
    背景与目标: 目的:为进一步阐明巨细胞病毒(CMV)促进动脉粥样硬化的机制,我们研究了在冠状动脉搭桥术(CABG)的CMV()和CMV(-)患者主动脉壁中细胞炎性信号和增殖信号的表达模式。
    方法:采用PCR和原位杂交技术对68例CABG患者的主动脉活检和血样进行CMV-DNA检测。通过免疫组织化学研究了pp65抗原,粘附分子(ICAM-1,VCAM-1,E-选择素),生长因子(PDGF-AA,TGF-beta)和细胞增殖因子Ki-67的表达。 Logistic回归用于检验CMV的存在,血管炎症与动脉粥样硬化的传统非炎症危险因素之间的相关性。
    结果:CMV-DNA在52名患者(76%)的主动脉组织中被检测到,并且主要定位在血管平滑肌细胞中。与CMV(-)患者相比,在CMV()患者中,主动脉内皮中粘附分子和生长因子的表达增加。发现CRP升高,粘附分子和生长因子的诱导与CMV()呈正相关。女性,吸烟和高脂血症被确定为CMV()的危险因素。
    结论:平滑肌细胞中的CMV-DNA诱导了局部生长因子的表达以及内皮的激活,两者均可以促进动脉粥样硬化的发展。由于传统的动脉粥样硬化危险因素会增加主动脉CMV表现的可能性,因此我们建议CMV在介导动脉粥样硬化的进展中起关键作用。
  • 【CABG非接触大隐静脉移植物的手术方面:3个月的临床和血管造影随访。】 复制标题 收藏 收藏
    DOI:10.21470/1678-9741-2018-0352 复制DOI
    作者列表:Samano N,Pinheiro BB,Souza D
    BACKGROUND & AIMS: :With more than 800,000 coronary artery bypass grafting (CABG) operations annually worldwide and the saphenous vein being the most common conduit used, there is no question that improving saphenous vein graft patency is one of the most important tasks in CABG. This video describes the no-touch harvesting procedure of the saphenous vein on an 80-year old man with hypertension, hyperlipidemia and a previous myocardial infarction with percutaneous coronary intervention to the right coronary artery. He was complaining of exertional chest pain and was diagnosed with stable angina pectoris. The coronary angiography showed advanced three vessel disease with significant stenoses in the left anterior descending (LAD) artery, two marginal arteries (MAs) and the posterior descending artery (PDA), in addition to an occluded diagonal artery (DA). The patient received a triple sequential no-touch vein graft to the PDA and two MAs together with a double sequential no-touch vein graft to the DA and LAD. A vein graft was used to bypass the LAD due to the age of the patient and the low degree of stenosis in the LAD. The no-touch harvesting technique is described in detail in the film with complete narration. A follow-up of this patient was performed at three months both clinically and with a computed tomography angiography (CTA). No angina pectoris symptoms were reported by the patient and the wounds in the chest and lower limb were completely healed. The CTA showed patent no-touch saphenous vein grafts to all the distal anastomoses.
    背景与目标: :全球每年有超过800,000例冠状动脉旁路移植术(CABG)进行操作,并且隐静脉是最常用的导管,毫无疑问,提高隐静脉移植的通畅性是CABG中最重要的任务之一。该视频介绍了一位80岁高血压,高血脂和先前有心肌梗塞的大隐静脉的非接触式采集过程,该患者经右冠状动脉经皮冠状动脉介入治疗。他抱怨劳累性胸痛,被诊断出稳定的心绞痛。冠状动脉造影显示,除了闭塞的对角动脉(DA)外,左前降支(LAD)动脉,两个边缘动脉(MAs)和后降支动脉(PDA)均伴有明显狭窄的晚期三血管疾病。该患者接受了PDA和两个MA的三连贯非接触式静脉移植,同时还接受了DA和LAD的双连贯非接触式静脉移植。由于患者年龄大和LAD狭窄程度低,因此使用静脉移植物绕过LAD。电影中以完整的叙述详细描述了非接触式收割技术。在临床和计算机断层扫描血管造影(CTA)的三个月中对该患者进行了随访。患者未报告心绞痛症状,胸部和下肢的伤口已完全治愈。 CTA显示所有远端吻合口均采用无接触隐性大隐静脉移植。
  • 【在CABG期间使用碳水化合物和Omega-3输注禁食缩写的好处:一项双盲对照随机试验。】 复制标题 收藏 收藏
    DOI:10.21470/1678-9741-2018-0336 复制DOI
    作者列表:Feguri GR,Lima PRL,Franco AC,Cruz FRH,Borges DC,Toledo LR,Segri NJ,Aguilar-Nascimento JE
    BACKGROUND & AIMS: OBJECTIVE:To assess postoperative clinical data considering the association of preoperative fasting with carbohydrate (CHO) loading and intraoperative infusion of omega-3 polyunsaturated fatty acids (ω-3 PUFA). METHODS:57 patients undergoing coronary artery bypass grafting (CABG) were randomly assigned to receive 12.5% maltodextrin (200 mL, 2 h before anesthesia), (CHO, n=14); water (200 mL, 2 h before anesthesia), (control, n=14); 12.5% maltodextrin (200 mL, 2 h before anesthesia) plus intraoperative infusion of ω-3 PUFA (0.2 g/kg), (CHO+W3, n=15); or water (200 mL, 2 h before anesthesia) plus intraoperative infusion of ω-3 PUFA (0.2 g/kg), (W3, n=14). The need for vasoactive drugs was analyzed, in addition to postoperative inflammation and metabolic control. RESULTS:There were two deaths (3.5%). Patients in CHO groups presented a lower incidence of hospital infection (RR=0.29, 95% CI 0.09-0.94; P=0.023), needed fewer vasoactive drugs during surgery and ICU stay (P<0.05); and had better blood glucose levels in the first six hours of recovery (P=0.015), requiring less exogenous insulin (P=0.018). Incidence of postoperative atrial fibrillation (POAF) varied significantly among groups (P=0.009). Subjects who receive ω-3 PUFA groups had fewer occurrences of POAF (RR=4.83, 95% CI 1.56-15.02; P=0.001). Patients in the W3 group had lower ultrasensitive-CRP levels at 36 h postoperatively (P=0.008). Interleukin-10 levels varied among groups (P=0.013), with the highest levels observed in the postoperative of patients who received intraoperative infusion of ω-3 PUFA (P=0.049). CONCLUSION:Fasting abbreviation with carbohydrate loading and intraoperative infusion of ω-3 PUFA is safe and supports faster postoperative recovery in patients undergoing on-pump CABG.
    背景与目标: 目的:评估术前禁食与碳水化合物(CHO)负荷和术中输注omega-3多不饱和脂肪酸(ω-3PUFA)的关联,以评估术后临床数据。
    方法:57例接受冠状动脉搭桥术(CABG)的患者被随机分配接受12.5%的麦芽糊精(麻醉前2 h,200 mL),(CHO,n = 14);水(200 mL,麻醉前2 h)(对照,n = 14); 12.5%麦芽糊精(200 mL,麻醉前2小时)加上术中ω-3PUFA输注(0.2 g / kg),(CHO W3,n = 15);或用水(麻醉前2 h,200 mL)加术中输注ω-3PUFA(0.2 g / kg),(W3,n = 14)。除了术后炎症和代谢控制外,还分析了对血管活性药物的需求。
    结果:有两人死亡(3.5%)。 CHO组患者的医院感染发生率较低(RR = 0.29,95%CI 0.09-0.94; P = 0.023),在手术和ICU停留期间需要较少的血管活性药物(P <0.05);并且在恢复的前六个小时血糖水平更高(P = 0.015),所需的外源胰岛素较少(P = 0.018)。各组术后房颤的发生率差异显着(P = 0.009)。接受ω-3PUFA组的受试者发生POAF的次数较少(RR = 4.83,95%CI 1.56-15.02; P = 0.001)。 W3组患者术后36 h的超敏CRP水平较低(P = 0.008)。白细胞介素10水平在各组之间不同(P = 0.013),在术中输注ω-3PUFA的患者术后观察到最高水平(P = 0.049)。
    结论:快速补充碳水化合物负荷量和术中输注ω-3PUFA是安全的,并支持接受泵上CABG的患者术后恢复更快。
  • 【伊朗德黑兰接受冠状动脉旁路移植术(CABG)手术的患者胃肠道穿孔的预测因子。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Alebouyeh N,Toefigh M,Ghasemzadeh N,Mirheydari S,Azargashb E
    BACKGROUND & AIMS: BACKGROUND:Gastrointestinal perforation after coronary artery bypass graft (CABG) surgery is often difficult to diagnose and is associated with high morbidity and mortality rates. The aim of this study was to determine risk factors for this complication in the studied population to further improve prophylaxis and diagnosis in the region of study. METHODS:Of 8,975 consecutive patients undergoing CABG during 10 years (1995-2005), 15 (0.16%) developed gastrointestinal perforation requiring laparatomy. Data from patients who experienced gastrointestinal perforation were analyzed using univariate tests in a controlled retrospective design. RESULTS:Prolonged bypass time and preoperative heparin administration were found to be significant (P<0.05) risk factors. CONCLUSION:Low splanchnic blood flow and vasoconstriction might be underlying factors associated with both predictors. With current findings, however, clear inference about preoperative and postoperative predictors and their relation is not possible. With more information, the next step would be to build a prediction model in recognition of gastrointestinal perforation after CABG on the basis of the predisposing factors.
    背景与目标: 背景:冠状动脉搭桥术(CABG)术后的胃肠道穿孔通常难以诊断,并与高发病率和高死亡率相关。这项研究的目的是确定所研究人群中这种并发症的危险因素,以进一步改善研究区域的预防和诊断。
    方法:在10年间(1995-2005年)的8,975例连续接受CABG的患者中,有15例(0.16%)发生了需要开腹手术的胃肠道穿孔。在受控的回顾性设计中,使用单变量检验对经历了胃肠道穿孔的患者的数据进行了分析。
    结果:延长旁路时间和术前给予肝素是重要的危险因素(P <0.05)。
    结论:低内脏血流量和血管收缩可能是与这两个预测因素相关的潜在因素。然而,根据目前的发现,不可能明确推断出术前和术后的预测因素及其关系。有了更多的信息,下一步将是基于诱发因素建立CABG后识别胃肠道穿孔的预测模型。
  • 【辛伐他汀进行术前血脂控制可降低CABG术后血栓形成和血栓并发症的风险。】 复制标题 收藏 收藏
    DOI:10.1016/s1010-7940(99)00034-2 复制DOI
    作者列表:Christenson JT
    BACKGROUND & AIMS: OBJECTIVE:It has earlier been suggested that postoperative thrombocytosis frequently occur after coronary artery bypass grafting (CABG) and may be linked to lipid disturbances. A prospective randomized study was undertaken to evaluate if preoperative lipid-control, using HMG-CoA-reductase inhibitor (Zocor), simvastatin, reduces the risk of postoperative thrombocytosis. METHODS:Seventy-seven patients with symptomatic coronary artery disease and hypercholesterolemia (total cholesterol > or =6.2 mmol/l), planned for CABG where randomly assigned to; undergo CABG without preoperation lipid control (group I, n = 37) or undergo simvastatin-treatment (20 mg daily) to control their lipids (4 weeks) prior to CABG (group II, n = 40). RESULTS:Patient characteristics and operation data did not differ between the groups. Serum-cholesterol, cholesterol/HDL-cholesterol, LDL-cholesterol, Apolipoprotein A1 and Plasminogen were all significantly higher in group I patients compared with group II just prior to surgery. Other laboratory parameters did not differ. RESULTS:In group II, total cholesterol and cholesterol/HDL-cholesterol quota were significantly lowered by simvaststin (-2 and -29%, respectively). Postoperative thrombocytosis (platelet counts > or =400000/microl) occurred significantly more frequently in group I 81% (30/37) compared with 3% (1/40) in group II, P<0.0001. Myocardial infarction after the 7th postoperative day was more often diagnosed in group I, 14 vs. 0% in group II. Postoperative transient renal failure occurred also more frequently in group I, 24% compared with 8% in group II. Other postoperative complications and laboratory data did not differ. CONCLUSIONS:This study once again underlines the importance of lipid control using HMG-CoA-reductase inhibitors (e.g. Zocor) in patients with established coronary artery disease. For the first time it is shown that lipid-control with simvastatin prior to CABG reduces the risk of postoperative thrombocytosis, thus lowers the risk for thrombotic complications.
    背景与目标: 目的:早期曾有人提出冠状动脉搭桥术(CABG)后常发生术后血小板增多症,并可能与脂质紊乱有关。进行了一项前瞻性随机研究,以评估术前使用HMG-CoA-还原酶抑制剂(Zocor)辛伐他汀进行脂质控制是否能降低术后血小板增多症的风险。
    方法:77例有症状的冠状动脉疾病和高胆固醇血症(总胆固醇>或= 6.2 mmol / l)的患者计划随机分配至CABG;在未进行术前血脂控制的情况下进行CABG治疗(I组,n = 37)或在进行CABG治疗前(4周)进行辛伐他汀治疗(每天20 mg)以控制血脂(II组,n = 40)。
    结果:两组之间的患者特征和手术数据没有差异。 I组患者的血清胆固醇,胆固醇/ HDL胆固醇,LDL胆固醇,载脂蛋白A1和纤溶酶原均显着高于手术前的II组。其他实验室参数没有差异。
    结果:在第二组中,辛伐他汀显着降低了总胆固醇和胆固醇/高密度脂蛋白胆固醇(分别为-2%和-29%)。 I组术后血小板增多症(血小板计数>或= 400000 /μl)的发生率明显高于II组3%(1/40)的81%(30/37),P <0.0001。术后第7天心肌梗死在I组中被更频繁地诊断出,14组比II组中的0%更容易被诊断出。 I组术后短暂性肾功能衰竭的发生率也更高,为24%,而II组为8%。其他术后并发症和实验室数据无差异。
    结论:这项研究再次强调了使用HMG-CoA-还原酶抑制剂(例如Zocor)控制血脂对已确诊的冠心病患者的重要性。首次显示在CABG之前用辛伐他汀进行脂质控制可降低术后血小板增多症的风险,从而降低血栓并发症的风险。
  • 【有CABG既往史的患者中TAVR与SAVR在院内结局的倾向匹配比较:来自全国住院患者样本的见解。】 复制标题 收藏 收藏
    DOI:10.1002/ccd.27708 复制DOI
    作者列表:Nalluri N,Atti V,Patel NJ,Kumar V,Arora S,Nalluri S,Nelluri BK,Maniatis GA,Kandov R,Kliger C
    BACKGROUND & AIMS: BACKGROUND:The incidence of patients with previous history of coronary artery bypass grafting (CABG) presenting for aortic valvular replacement has been consistently on the rise. Repeat sternotomy for surgical aortic valve replacement (SAVR) carries an inherent risk of morbidity and mortality when compared to Transcatheter aortic valve replacement (TAVR). METHODS:The Nationwide inpatient sample (NIS) from 2012 to 2014 was queried using the International Classification of Diseases-Ninth edition, Clinical Modification (ICD-9-CM) codes to identify all patients ≥ 18 years with prior CABG who underwent TAVR (35.05 and 35.06) or SAVR (35.21 and 35.22). Propensity score matching (1:1) was performed and in-hospital outcomes were compared between matched cohorts. RESULTS:From 2012 to 2014, there was progressive increase in the annual number of TAVR procedures from 1485 to 4020, with a decrease in patients undergoing SAVR from 2330 to 1955 (Ptrend  < 0.0001) in the above population. There was no significant difference in in-hospital mortality rates. Compared to SAVR, TAVR was associated with lower risk of stroke (1.2% vs. 3.3%, P = 0.009), AKI (12.9% vs. 21.3%, P < 0.0001), myocardial infarction (0.9% vs. 2.7%, P = 0.01) and major bleeding (9.1% vs. 25.1%, P < 0.0001). TAVR was associated with higher risk of pacemaker implants (9.6% vs. 4.9%, P = 0.001) and trend toward lower risk of vascular complications (2.3% vs. 4.1%, P = 0.05). CONCLUSION:In this large cohort of patients with previous CABG, there is no significant difference in in-hospital mortality between TAVR and SAVR. TAVR was associated with lower risk of in-hospital outcomes.
    背景与目标: 背景:具有主动脉瓣置换术的冠状动脉旁路移植术(CABG)既往史的患者的发病率一直在上升。与经导管主动脉瓣置换术(TAVR)相比,重复进行胸骨切开术进行外科主动脉瓣置换术(SAVR)具有固有的发病和死亡风险。
    方法:使用国际疾病分类-第九版临床修改(ICD-9-CM)代码查询2012年至2014年的全国住院患者样本(NIS),以识别所有接受过TAVR且先前CABG≥18岁的患者(35.05和35.06)或SAVR(35.21和35.22)。进行倾向得分匹配(1:1),并比较匹配队列之间的院内结局。
    结果:从2012年到2014年,TAVR每年的手术数量从1485例增加到4020例,而上述人群中接受SAVR的患者从2330例下降到1955年(趋势tr <0.0001)。住院死亡率无显着差异。与SAVR相比,TAVR与中风的风险较低(1.2%比3.3%,P = 0.009),AKI(12.9%比21.3%,P <0.0001),心肌梗塞(0.9%比2.7%,P = 0.01)和大出血(9.1%对25.1%,P <0.0001)。 TAVR与起搏器植入物的较高风险(9.6%vs. 4.9%,P = 0.001)和血管并发症风险降低的趋势(2.3%vs. 4.1%,P = 0.05)相关。
    结论:在这一大群既往患有CABG的患者中,TAVR和SAVR之间的院内死亡率无显着差异。 TAVR与院内预后降低相关。
  • 【硒,维生素C和N-乙酰半胱氨酸不能降低非体外循环CABG后发生急性肾脏损伤的风险:一项随机临床试验。】 复制标题 收藏 收藏
    DOI:10.21470/1678-9741-2017-0071 复制DOI
    作者列表:Amini S,Robabi HN,Tashnizi MA,Vakili V
    BACKGROUND & AIMS: OBJECTIVE:The aim of this study was to investigate the impact of perioperative administration of N-acetylcysteine, selenium and vitamin C on the incidence and outcomes of acute kidney injury after off-pump coronary bypass graft surgery. METHODS:291 patients requiring elective off-pump coronary bypass graft surgery were randomized to receive either N-acetylcysteine, vitamin C and selenium 600 mg, 1500 mg, 0.5 mg, and nothing orally twice a day, respectively, from the day before to 2 days after surgery. They were assessed for the development of acute kidney injury using Acute Kidney Injury Network criteria, time of onset, its severity and duration, duration of mechanical ventilation, intensive care unit and hospital length of stay, and in-hospital mortality. RESULTS:272 patients completed the study. The total incidence of acute kidney injury was 22.1% (n=60) with 14 (20.9%), 15 (22.1%), 21 (31.8%), and 10 (14.1%) patients in the vitamin C, NAC, selenium, and control groups, respectively (P=0.096). We did not register significant differences in the incidence, the time of occurrence, the severity and the duration of acute kidney injury, as well as the duration of mechanical ventilation, the intensive care unit and hospital length of stay, and the in-hospital mortality among the four groups. CONCLUSION:We found that perioperative administration of N-acetylcysteine, vitamin C and selenium were not effective in preventing acute kidney injury and associated morbidity and mortality after off-pump coronary bypass graft surgery.
    背景与目标: 目的:本研究旨在探讨围手术期使用N-乙酰半胱氨酸,硒和维生素C对非体外循环冠状动脉搭桥手术后急性肾损伤的发生率和结局的影响。
    方法:291名需要进行选择性非体外循环冠状动脉搭桥手术的患者从前一天到第二天随机两次分别接受N-乙酰半胱氨酸,维生素C和硒600 mg,1500 mg,0.5 mg口服,每天两次不口服。手术后的几天。使用急性肾损伤网络标准,发病时间,严重程度和持续时间,机械通气时间,重症监护病房和住院时间以及住院死亡率对他们进行了急性肾脏损伤的评估。
    结果:272例患者完成了研究。维生素C,NAC,硒,和对照组(P = 0.096)。在发病率,发生时间,急性肾损伤的严重程度和持续时间,机械通气时间,重症监护病房和住院时间以及住院死亡率方面,我们没有发现显着差异。在四个组中。
    结论:我们发现围手术期服用N-乙酰半胱氨酸,维生素C和硒不能有效地预防非体外循环冠状动脉搭桥手术后的急性肾脏损伤以及相关的发病率和死亡率。
  • 【在纽约使用劣质私营部门CABG中心的VA患者的特征。】 复制标题 收藏 收藏
    DOI:10.1177/1077558707304738 复制DOI
    作者列表:Weeks WB,Fisher ES
    BACKGROUND & AIMS: :Little is known about the quality of care that veterans obtain in the private sector. To explore this issue, we identified the hospital in which 4,008 veterans enrolled in the Veterans Administration (VA) obtained coronary artery bypass graft (CABG) surgery in the New York private sector between 1997 and 2000. We used published risk-adjusted mortality rates to assign New York CABG centers to performance quintiles. VA patients with the lowest incomes were 2.4 times more likely than those in the highest incomes to use the highest-mortality hospitals (95 percent CI: 2.0-3.0). Compared with white patients, black (OR 1.8; 95 percent CI: 1.2-2.8) and Hispanic VA patients (OR 1.6; 95 percent CI: 0.9-2.8) were more likely to use the highest-mortality hospitals. About one third of patients using the highest-mortality hospitals lived closer to low-mortality hospitals. Efforts to direct VA patients' care to high-performance hospitals could improve outcomes and reduce racial and ethnic disparities in care.
    背景与目标: :关于退伍军人在私营部门获得的护理质量知之甚少。为了探讨这个问题,我们确定了1997年至2000年之间,退伍军人管理局(VA)招募的4,008名退伍军人在纽约的私营部门进行了冠状动脉搭桥术(CABG)手术的医院。将纽约CABG中心分配给绩效五分位数。收入最低的VA患者使用死亡率最高的医院的可能性是收入最高的VA患者的2.4倍(95%CI:2.0-3.0)。与白人患者相比,黑人(OR 1.8; 95%CI:1.2-2.8)和西班牙裔VA患者(OR 1.6; 95%CI:0.9-2.8)更倾向于使用死亡率最高的医院。使用死亡率最高的医院的患者中,约有三分之一居住在死亡率较低的医院附近。将VA患者的护理直接转移到高性能医院的努力可以改善治疗效果,并减少种族和种族之间的护理差距。

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