ObjectiveTo investigate the effect of delayed sternal closure (DSC) on sternal wound debridement after pediatric cardiac surgery. MethodsWe retrospectively analyzed clinical data of 491 pediatric patients underwent DSC in Guangdong General Hospital between June 2009 and June 2014. There were 333 males and 158 females with age of 1 day to 153.37 (5.68±17.24) months. The rate of sternal wound debridement between the DSC patients and the non-DSC patients was compared. ResultsA total of 454 pediatric patients with DSC initiated in the operation room. And 37 patients with DSC initiated in intensive care unit after emergency sternotomy. A total of 392 patients with delayed sternal closure were discharged. Eight patients gave up treatment for family reasons and 91 patients died. Patients with DSC had higher incidence of sternal wound debridement than the patients with non-DSC did (χ2=6.693, P=0.010). ConclusionDSC is an effective treatment for children with severe cardiac surgery, while it causes higher incidence of sternal wound debridement.
ObjectiveTo systematically evaluate short-term efficacy of omega-3(ω-3) polyunsaturated fatty acidsupplemented parenteral nutrition in postoperative gastrointestinal malignancy. MethodsThe literatures published randomized control trials (RCT) were searched in PubMed, Embase, Scopus, Cochrane Library, CNKI, Weipu, and Wanfang Databases. The immune efficacy outcomes ofω-3 polyunsaturated fatty acid-supplemented parenteral nutrition in patients with gastrointestinal malignancy were compared. All the relevant studies were screened and the data were extracted before January 2015. The quality of included literatures was assessed by the risk of bias table provided on Cochrane Library. Statistical analysis was performed by Revman 5.3 software. ResultsSixteen RCTs involving 1019 patients (511 in the study group, 508 in the control group) were enrolled into the analysis. The results of meta analysis:①In the cell immunity:The proportions of CD3, CD4, CD4/CD8 in the study group were significantly higher than those in the control group[CD3:WMD=6.09, 95% CI (2.40, 9.77), P=0.001; CD4:WMD=5.25, 95% CI (3.30, 7.20), P < 0.00001; CD4/CD8:WMD=0.40, 95% CI (0.22, 0.58), P < 0.0001].②In the humoral immunity:The levels of IgA and IgG in the study group were significantly higher than those in the control group[IgA:WMD=0.56, 95% CI (0.36, 0.77), P < 0.00001; IgG:WMD=2.88, 95% CI (0.63, 5.13), P=0.01].③The count of lymphocyte in the study group was significantly higher than that in the control group[WMD=0.27, 95% CI (0.10, 0.43), P=0.002].④In the cytokines:The levels of interleukin-6 and tumor necrosis factor (TNF)-αin the study group were significantly lower than those in the control group[interleukin-6:WMD=-16.75, 95% CI (-25.00, -8.50), P < 0.0001; TNF-α:WMD=-6.25, 95% CI (-10.55, -1.95), P=0.004].⑤The rate of postoperative infective complications in the study group was significantly lower than that in the control group[OR=0.36, 95% CI (0.20, 0.66), P=0.0008]. ConclusionFor postoperative patients with gastrointestinal malignancy, ω-3 polyunsaturated fatty acid-supplemented parenteral nutrition could improve immune function, decrease postoperative inflammatory reaction, and reduce rate of infective complications.
ObjectiveTo explore surgical methods and risk factors of anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA). MethodsClinical data of 28 ALCAPA patients who underwent surgical repair from October 1993 to September 2013 in Beijing Anzhen Hospital were retrospectively reviewed. There were 8 male and 20 female patients with their age of 0.6-l6.8 (4.3±0.7)years including 10 patients less than 1 years old. Surgical procedures included simple ligation of left coronary artery, intrapulmonary tunnel procedure (Takeuchi)and direct coronary reimplantation of the anomalous artery. Postoperative death, complication and cardiac function were observed. ResultsAmong the 28 patients, 1 patient received simple ligation of left coronary artery, and 7 patients received intrapulmonary tunnel procedure (Takeuchi), among whom 2 patients died postoperatively. Twenty patients received direct implantation of the anomalous artery into the ascending aorta, and 3 patients died postoperatively. Five patients who died postoperatively were 10.20±3.27 months old, including 3 patients with moderate mitral regurgitation (MR)and 2 patients with mild MR preoperatively. Preoperative heart function of the patients who died postoperatively was significantly reduced. Preoperative left ventricular ejection fraction of the patients who died postoperatively was significantly lower than that of the patients who survived (36.6%±8.5% vs. 60.9%±10.7%, P=0.000). Low cardiac output syndrome was the reason for all postoperative death. All survival patients were followed up from 1 month to 18 years. One patient who underwent intra-pulmonary tunnel procedure (Takeuchi)received pulmonary artery balloon dilatation for pulmonary supravalvular stenosis 15 years after discharge. None of the other patients received a secondary operation. During follow-up, left ventricular function was improved. Growth and development of all the patients was normal. MR did not significantly aggravate in all the patients. ConclusionPatients with younger age and worse left ventricular function have greater surgical risks of ALCAPA.
ObjectiveTo investigate the clinical manifestations, diagnosis and treatment of diaphrammatic paralysis (DP) in infants with congenital heart disease (CHD) after cardiac surgery. MethodsBetween October 2008 and June 2014, among 2 962 infant patients ( < 1 year) underwent cardiac surgery for congenital heart disease, postoperative DP was diagnosed in 31 patients. The paralysed hemidiaphragm was left side in 10 patients, right side in 15 patients, and bilateral in 6 patients. There were 22 males and 9 females. The age at operation was 1-12 (4.5±4.2) months on the average. The body weight at operation was 2.9 to 8.5 (5.6±2.2) kg on the average.All children received mechanical ventilation. ResultsNo patient died in this study.There was a statistical difference between preoperative and postoperative mechanical ventilation time at 123-832 (420±223) hours versus 15-212 (75±58) hours (P < 0.05). ConclusionsDP caused by phrenic nerve injury during surgical intervention for congenital heart disease is an important risk factor in terms of morbidity during the postoperative period. Diaphragmatic plication appears a good option, especially in infant children, to wean patients from mechanical ventilation and to prevent long-term side effects of mechanical ventilation.
ObjectiveTo carry out a retrospective study of the reporting quality and current situation of the systematic reviews (SRs)/meta-analyses (MAs) in pediatric field in China, as well as compliance with the PRISMA and MOOSE guidelines. MethodsSeven core Chinese pediatric journals were hand-searched. Two reviewers extracted data independently using predesigned data extraction form, crosschecked data, and discussed to solve discrepancy. The PRISMA and MOOSE guidelines were used to assess the reporting quality respectively, and subgroup analysis was conducted by different total cites and different published time. SPSS 22.0 was used to for statistical analysis. Percentage was used to describe categorical data and Chi-square test was used to compare the difference among groups. ResultsA total of 157 SRs/MA were included. The proportion of SRs/MA related to interventions was the biggest (61.1%, 96 SRs/MA). (1) The coincidence rate of SRs/MA related to interventions in the PRISMA checklist was better:the coincidence rate of twenty entries was above 50%; (2) The coincidence rate of observational SRs/MA in the MOOSE guidelines was not so good:the coincidence rate of 15 entries was less than 50%, even some of them were less than 20%. There were no significant difference between different total cites (≤5 vs. > 5) in PRISMA and MOOSE guidelines. (3) The coincidence rate of SRs/MA related to interventions had been improved to some extent in most of items after the PRISMA guidelines published, and the differences were statistically significant respectively in No. 8, 19, 20, and 23 (P≤0.05). ConclusionsThe number of SRs/MA published in the pediatric journals in China is increasing generally, the coincidence rate of SRs/MAs related to interventions have been obviously improved after the PRISMA guidelines published, and it's better than the coincidence rate of observational SRs/MAs in MOOSE guidelines. In a word, we should pay more attention to the quality of SRs/MAs, but not just the number.
ObjectiveTo summarize clinical experience and results of surgical treatment of subaortic membrane (SM). MethodsClinical data of 32 SM patients who underwent surgical resection of SM between March 2009 and September 2013 in Beijing Anzhen Hospital were retrospectively analyzed. There were 22 male and 10 female patients with their age of 0.5-14.0 (3.6±3.2)years and body weight of 5.5-43.0 (17.2±9.5)kg. Among the 32 patients, 7 patients had isolated SM, and 25 patients had other intracardiac lesions including ventricular septal defect in 21 patients, mitral regurgi-tation in 1 patient, patent ductus arteriosus (PDA)in 1 patient, SM occurrence after PDA occlusion in 1 patient and surgical correction for coarctation of the aorta in another patient. Eighteen patients had aortic insufficiency (AI)in different degree. ResultsSM diagnosis was missed by preoperative echocardiography in 1 patient. Mean cardiopulmonary bypass time was 71.7±21.7 minutes, aortic cross-clamping time was 48.7±15.1 minutes, ICU stay was 2.2±1.7 days, and postoperative hospital stay was 7.9±2.5 days. There was no in-hospital death in this group. Postoperatively, 1 patient had second-degree atrioventricular block which returned to sinus rhythm 6 days after the operation. All the patients were followed up for 2-54 months after discharge. During follow-up, AI of 6 patients with isolated SM was relieved, and AI of 5 SM patients with other intracardiac lesions was relieved (P=0.003). Among the 7 patients with isolated SM, preoperative moderate AI in 4 patients changed to mild AI in 3 patients and trivial AI in 1 patient, and preoperative mild AI in 3 patients changed to trivial AI in 2 patients. Among the 25 patients with other intracardiac lesions, preoperative mild AI in 8 patients changed to trivial AI in 3 patients, and preoperative moderate AI in 3 patients changed to mild AI in 1 patients and trivial AI in another patient. There was no SM recurrence during follow-up in this group. ConclusionSM diagnosis may be missed by preo-perative echocardiography, and early surgical correction is needed once the diagnosis is established. Meticulous surgical techniques are necessary during the operation. Postoperative SM recurrence may happen, so regular follow-up is required after discharge.