Objective To identify the relationship between preoperative left ventricular dysfunction and perioperative risk factors in coronary artery bypass grafting (CABG). Methods The clinical data of 192 patients who underwent CABG from November 2015 to October 2016 were analyzed retrospectively. The patients were divided into three groups by preoperative left ventricular ejection fraction (LVEF) in echocardiography: a serious left ventricular dysfunction group (LVEF≤35%, 23 patients, 15 males and 8 females at age of 63.91±5.36 years), a moderate left ventricular dysfunction group (35%<LVEF<50%, 24 patients, 20 males and 4 females at age of 66.29±6.03 years) and a normal left ventricular function group (LVEF≥50%, 145 patients, 86 males and 59 females at age of 66.60±6.41 years). Results The overall mortality was 4.16% (8/192), 17.39% (4/23) in patients with LVEF≤35% and 2.76% (4/145) in those with LVEF≥50%. Preoperative LVEF≤35%, hypoxia, assisted circulation, acute kidney injury (AKI) and postoperative continuous renal replacement therapy (CRRT) were risk factors of perioperative mortality in coronary artery surgery. LVEF≤35% and CRRT were independent preditors of mortality. There were significant differences in mortality and postoperative complications between the serious left ventricular dysfunction group and other two groups. Conclusion Postoperative mortality and complications are obviously serious in the patients with LVEF≤35%. We should pay more attention to preoperative risk factors. Postoperative individual manipulation, intra-aortic balloon pump and CRRT can enhance survival of those patients.
Objective According to health technology assessment (HTA) methodology, to assess the efficacy and safety of different doses of metoprolol in the treatment of atrial fibrillation (AF). Methods Based on the principles of HTA, we searched some important medical databases including MEDLINE, EMBASE, The Cochrane Library and CMCC, as well as several national special heart disease databases and side effect centers. We selected eligible studies based on the inclusion and exclusion criteria and critically assessed their quality. Results Intravenous metoprolol 10 mg - 15 mg could control rapid ventricular rate in patients with chronic AF. On either rest or exercise, oral metoprolol 150 mg/d had a better control of rapid ventricular rate than 50 mg/d in patients with chronic AF. For preventing postoperative AF (POAF), the intravenous metoprolol 20 mg group and the 30 mg group could decrease the incidence of POAF compared to the 10 mg group. Oral metoprolol 150 mg/d was more effective than 100 mg/d in preventing POAF. In addition, intravenous metoprolol therapy was well-tolerated and more effective than oral metoprolol therapy in preventing atrial fibrillation after cardiac surgery. Results from several national side effect centers demonstrated that the incidence of adverse reactions associated with metoprolol was low. Conclusion Present evidence showed that high dose of metoprolol was superior to low dose in treating AF, however, the evidence available is insufficient. It is suggested that adequate evidence through further studies are needed. The safety profile of different doses of metoprolol is similar.
目的:研究地震对非伤员的其他内外科危重患者急诊医疗的影响。方法:采用病例对照研究方法,研究和分析汶川地震发生前后一周急诊科内外科危重患者情况。结果:地震后内外科危重患者数量明显减少,转诊患者和救护车来诊比例降低,但抢救患者比例增加,优化处理流程后急诊诊疗时间明显缩短。结论:虽然地震期间急诊科内外科危重患者总量减少,但存在抢救患者比例增加和院前急救资源减少的问题。应该重视这部分患者的急救医疗需求以及优化处理流程。
目的:观察显微镜直视下经外路手术治疗孔源性视网膜脱离的临床疗效。方法:孔源性视网膜脱离38例(38眼),术前在三面镜下检查裂孔位置、大小及脱离范围;在手术显微镜直视下行裂孔及变性区定位,放出视网膜下液,在裂孔及周围行视网膜冷凝,作硅胶垫压及环扎带。最后顶起硅胶垫压块,证实裂孔位于巩膜脊前坡上,视裂孔位置及眼压情况,玻璃体腔内注入C3F8。术后观察视力、眼压、葡萄膜反应及视网膜复位情况。结果:视网膜裂孔封闭36眼(94.74％),视网膜完全复位34眼(89.47％),视网膜下积液2眼(5.26％),于7～10d吸收。有２眼术后发现垫压嵴偏离视网膜裂孔,经再次手术调整后视网膜复位。术后视力提高28眼(73.68％)。结论:显微镜直视下经外路视网膜脱离手术视野清晰,操作简便,手术效果良好。
目的:观察新鲜羊膜移植联合丝裂霉素C治疗复发性翼状胬肉的临床疗效。方法:对32例(38眼)复发性翼状胬肉行翼状胬肉切除联合新鲜羊膜移植加丝裂霉素C治疗,观察术后角膜上皮愈合、胬肉复发情况。结果:术后随访3～24个月,有2眼复发,复发率为5.26%。结论:新鲜羊膜移植联合丝裂霉素Ｃ治疗复发性翼状胬肉降低了复发率,无严重手术并发症,是一种安全有效的手术方法。
目的:探讨女性强直性脊柱炎患者的临床特点。方法:回顾性分析华西医院风湿免疫科2003年1月1日至2009年1月1日住院收治的女性强直性脊柱炎患者住院病历共计46例,抽取与女性患者入院时间及病程大致相等的男性病历40例,记录发病年龄、病程、首发症状、临床表现、实验室检查,并对两组数据进行比较,调查女性患者中血小板计数与血沉、C-反应蛋白、球蛋白的相互关系。结果:发病年龄女性组为(30±11)岁,男性组为(24±7)岁(P＝0.003);首发症状、主要临床表现、关节活动受限和病情活动指标在两组无统计学差异(Pgt;0.05)。相关分析显示,血小板计数与C-反应蛋白、血沉、球蛋白分别存在较好的正相关关系(C反应蛋白:r=0.608,P=0.000;血沉:r=0.558,P=0.000;球蛋白r=0.411,P=0.005)。女性组中HLAB27阳性患者与阴性患者的年龄差异无统计学意义(P＞0.05)。结论:女性强直性脊柱患者的发病年龄大于男性,患者的血小板计数有助于评价病情活动。
Severe trauma is a challenging medical problem. Uncontrolled post-traumatic hemorrhage and traumatic coagulation dysfunction are closely related to the prognosis of these patients. In May 2019, the pan-European, multidisciplinary Task Force for Advanced Bleeding Care in Trauma published the fifth edition of the European guideline on management of major bleeding and coagulopathy following trauma. To assist Chinese in better understanding of the latest developments, this paper translated the main treatment recommendations in the guideline and interpreted the updated content from the fourth edition.
The hemodynamic management of adult patients with distributed shock often includes the use of catecholamines vasoconstrictor drugs. It was unclear whether adding vasopressin or vasopressin analogs to catecholamine therapy was beneficial for the treatment of patients with distributed shock. The Canadian Society of Intensive Care recently updated its clinical practice guideline to provide recommendations for the addition of vasopressin to catecholamine boosters in adults with distributed shock. This paper interprets it to assist domestic doctors for better understanding of the latest progress.
Objective To know about the baseline and quality of clinical prophylaxis and treatment study on communicable diseases in China, by identifying and assessing the clinical studies published in Chinese Journal of Infectious Diseases for 18 years. Method Handsearching page by page to identify and register the clinical studies from the journal, the definition of randomized controlled trial (RCT) and controlled clinical trial (CCT) strictly according to the Cochrane Collaboration Handbook (1997). Results There were totally 214 clinical studies during the 18 years, including 67 RCTs, 67 CCTs and 80 Non-CCTs. The average sample size of the RCTs was 103.0±70.2 (range from 17 to 296). Counted by every 5 years period (3 years period from 1998 to 2000), the proportion of RCTs in clinical studies was increasing steadily. The proportion were 22.9% from 1983 to 1987 (11/48), 29.2% from 1988 to 1992 (14/48), 41.9% from 1993 to 1997 (26/62), 28.6% from 1998 to 2000 (16/56) respectively. The main diseases studied in 214 clinical studies include: virus hepatitis (65 studies), hemorrhagic fever with renal syndrome (19 studies), typhoid fever (11 studies), bacterial infection (13 studies), bacillary dysentery (5 studies), epidemic encephalitis B (3 studies) and parasitosis (9 studies). Conclusion RCT study design should be applied as much as possible. The quality of clinical studies on communicable diseases in China remains to be improved. Multi-center and large-scale collaborative study is worthy to advocate.
Objective To investigate the effectiveness of extreme lateral channel debridement and fusion combined with posterior fixation for lumbar spinal tuberculosis. Methods A retrospective analysis was made on the clinical data of 17 patients with lumbar spinal tuberculosis undergoing extreme lateral channel debridement and fusion combined with posterior fixation between December 2008 and December 2014. There were 10 males and 7 females, aged 20-69 years (mean, 42.6 years). The disease duration was 1-6 months (mean, 3.4 months). The involved segments included L1, 2 in 5 patients, L2, 3 in 6 patients, L3, 4 in 3 patients, and L4, 5 in 3 patients. Based on American Spinal Injury Association (ASIA) classification, there were 2 cases of grade C, 13 cases of grade D, and 2 cases of grade E. The visual analogue scale (VAS) score, Japanese Orthopaedic Association (JOA) score, and Barthel index were used to evaluate the effectiveness, and the improvement rate of JOA score and Barthel index was calculated at the same time. Lumbar X-ray film and CT were taken regularly to evaluate lumbar kyphotic Cobb angle correction and bony fusion. Results The operation was successfully performed in 17 patients, and pathological examination showed tuberculosis. All cases were followed up 24-48 months (mean, 35.3 months). Lumbar X-ray film and CT showed that necrotic bone and abscess were cleared completely, and lumbar kyphosis correction was satisfactorily in all cases. Bony fusion was achieved within 6 months, and clinical cure was obtained within 18 months in all cases; no recurrence was found during follow-up period. No loosening or breakage of internal fixation was observed. At last follow-up, ASIA classification was recovered to grade D and grade E from grade C in 2 cases, to grade E from grade D in 11 cases and had no change in 2 cases (grade D). Two cases of ASIA grade E showed no neurological deficit. The VAS score, JOA score, Barthel index, and lumbar kyphotic Cobb angle were significantly improved at 2 weeks after operation and at last follow-up when compared with preoperative ones (P<0.05). At last follow-up, the improvement rate of JOA score was 75.2%±6.2% and the improvement rate of Barthel index was 75.7%±10.8%. Conclusion To use extreme lateral channel debridement and fusion combined with posterior fixation is an effective treatment for lumbar spinal tuberculosis.