共查询到20条相似文献,搜索用时 31 毫秒
1.
Leonardo Augusto Miana Luiz Fernando Canêo Carla Tanamati Juliano Gomes Penha Vanessa Alves Guimar?es Nana Miura Filomena Regina Barbosa Gomes Galas Marcelo Biscegli Jatene 《Brazilian Journal Of Cardiovascular Surgery》2015,30(4):409-416
Introduction
Post-cardiotomy myocardial dysfunction requiring mechanical circulatory support occurs in about 0.5% of cases. In our environment, the use of extracorporeal membrane oxygenation has been increasing in recent years.Objective
To evaluate the impact of investment in professional training and improvement of equipment in the rate of weaning from extracorporeal membrane oxygenation and survival.Methods
A retrospective study. Fifty-six pediatric and/or congenital heart patients underwent post-cardiotomy extracorporeal membrane oxygenation at our institution between November 1999 and July 2014. We divided this period into two phases: phase I, 36 cases (before the structuring of the extracorporeal membrane oxygenation program) and phase II, 20 cases (after the extracorporeal membrane oxygenation program implementation) with investment in training and equipment). Were considered as primary outcomes: extracorporeal membrane oxygenation weaning and survival to hospital discharge. The results in both phases were compared using Chi-square test. To identify the impact of the different variables we used binary logistic regression analysis.Results
Groups were comparable. In phase I, 9 patients (25%) were weaned from extracorporeal membrane oxygenation, but only 2 (5.5%) were discharged. In phase II, extracorporeal membrane oxygenation was used in 20 patients, weaning was possible in 17 (85%), with 9 (45%) hospital discharges (P<0.01). When the impact of several variables on discharge and weaning of extracorporeal membrane oxygenation was analyzed, we observe that phase II was an independent predictor of better results (P<0.001) and need for left cavities drainage was associated with worse survival (P=0.045).Conclusion
The investment in professional training and improvement of equipment significantly increased extracorporeal membrane oxygenation results. 相似文献2.
Isaac Newton Guimar?es Andrade Fernando Ribeiro de Moraes Neto Tamirys Guimar?es Andrade 《Brazilian Journal Of Cardiovascular Surgery》2014,29(1):9-15
Objective
To evaluate the use of the EuroSCORE as a predictor of postoperative morbidity after cardiac surgery.Methods
We retrospectively analyzed the charts of 900 patients operated on and admitted to the intensive care unit postoperatively at the Royal Portuguese Hospital of Recife. We included all patients with complete medical records, excluding those who died during surgery, underwent transplantation or correction of congenital heart disease. We evaluated the development of respiratory infection, cerebrovascular accident, and dialysis-dependent renal failure, and the EuroSCORE was compared in terms of the three complications using the Mann-Whitney test. The calibration model for predicting the morbidities being studied was evaluated using the test set of Homer-Lemeshow goodness. The accuracy of the model was assessed using the area under the ROC curve (AUROC).Results
The model showed good calibration in predicting respiratory infection, acute renal failure and stroke (P=0.285, P=0.789, P=0.45, respectively), with good accuracy for respiratory infection (AUROC=0.710 and P<0.001) and dialysis-dependent renal failure (AUROC=0.834 and P<0.001), but no accuracy to predict stroke (AUROC=0.519). The high-risk patients were more likely to develop respiratory infection (OR=9.05, P<0.001) and dialysis-dependent renal failure (OR=39.6, P<0.001). The probability of developing respiratory infection and dialysis-dependent renal failure was less than 10% with EuroSCORE up to 7 and more than 70% with EuroSCORE greater than 15.Conclusion
EuroSCORE proved to be a good predictor of major postoperative morbidity in cardiac surgery: respiratory and dialysis-dependent renal failure. 相似文献3.
Edgard Ferreira de Araújo Eduardo Gregório Chamlian Alexey Pomares Peroni Wilson Lopes Pereira Sylvio Matheus de Aquino Gandra Luiz Antonio Rivetti 《Brazilian Journal Of Cardiovascular Surgery》2014,29(1):31-36
Introduction
Chagas disease is a major cause of cardiomyopathy and sudden death in our country. It has a high mortality when their patients develop New York Heart Association (NYHA) class IV.Objective
The objective of this study is to analyze the clinical outcome of patients with Chagas'' cardiomyopathy with congestive heart failure with optimized pharmacological therapy, undergoing cardiac resynchronization therapy.Methods
Between January 2004 and February 2009, 72 patients with Chagas'' cardiomyopathy in NYHA class III and IV underwent cardiac resynchronization therapy and were monitored to assess their clinical evolution. We used the t test or the Wilcoxon test to compare the same variable in two different times. A P value < 0.05 was established as statistically significant.Results
The average clinical follow-up was 46.6 months (range 4-79 months). At the end of the evaluation, 87.4% of patients were in NYHA class I or II (P<0.001). There was response to therapy in 65.3% of patients (P<0.001), with an overall mortality of 34.7%.Conclusion
In patients with chronic Chagas cardiomyopathy undergoing cardiac resynchronization therapy, we found the following statistically significant changes: improvement in NYHA class and increase of left ventricle ejection fraction, a decrease of the systolic final diameter and systolic final left ventricle volume and improvement of patient survival. 相似文献4.
Handerson Nunes dos Santos Ellen Hettwer Magedanz Jo?o Carlos Vieira da Costa Guaragna Natalia Nunes dos Santos Luciano Cabral Albuquerque Marco Antonio Goldani Jo?o Batista Petracco Luiz Carlos Bodanese 《Brazilian Journal Of Cardiovascular Surgery》2014,29(2):140-147
Objective
To determine the risk factors related to the development of stroke in patients undergoing cardiac surgery.Methods
A historical cohort study. We included 4626 patients aged > 18 years who underwent coronary artery bypass surgery, heart valve replacement surgery alone or heart valve surgery combined with coronary artery bypass grafting between January 1996 and December 2011. The relationship between risk predictors and stroke was assessed by logistic regression model with a significance level of 0.05.Results
The incidence of stroke was 3% in the overall sample. After logistic regression, the following risk predictors for stroke were found: age 50-65 years (OR=2.11 - 95% CI 1.05-4.23 - P=0.036) and age >66 years (OR=3.22 - 95% CI 1.6-6.47 - P=0.001), urgent and emergency surgery (OR=2.03 - 95% CI 1.20-3.45 - P=0.008), aortic valve disease (OR=2.32 - 95% CI 1.18-4.56 - P=0.014), history of atrial fibrillation (OR=1.88 - 95% CI 1.05-3.34 - P=0.032), peripheral artery disease (OR=1.81 - 95% CI 1.13-2.92 - P=0.014), history of cerebrovascular disease (OR=3.42 - 95% CI 2.19-5.35 - P<0.001) and cardiopulmonary bypass time > 110 minutes (OR=1.71 - 95% CI 1.16-2.53 - P=0.007). Mortality was 31.9% in the stroke group and 8.5% in the control group (OR=5.06 - 95% CI 3.5-7.33 - P<0.001).Conclusion
The study identified the following risk predictors for stroke after cardiac surgery: age, urgent and emergency surgery, aortic valve disease, history of atrial fibrillation, peripheral artery disease, history of cerebrovascular disease and cardiopulmonary bypass time > 110 minutes. 相似文献5.
Marco Ant?nio Vieira Guedes Pablo Maria Alberto Pomerantzeff Carlos Manuel de Almeida Brand?o Marcelo Luiz Campos Vieira Flávio Tarasoutchi Pablo da Cunha Spinola Fábio Biscegli Jatene 《Brazilian Journal Of Cardiovascular Surgery》2015,30(3):325-334
Introduction
Mitral valve repair is the treatment of choice to correct mitral insufficiency, although the literature related to mitral valve annulus behavior after mitral repair without use of prosthetic rings is scarce.Objective
To analyze mitral annulus morphology and function using real time tridimensional echocardiography in individuals submitted to mitral valve repair with Double Teflon technique.Methods
Fourteen patients with mitral valve insufficiency secondary to mixomatous degeneration that were submitted to mitral valve repair with the Double Teflon technique were included. Thirteen patients were in FC III/IV. Patients were evaluated in preoperative period, immediate postoperative period, 6 months and 1 year after mitral repair. Statistical analysis was made by repeated measures ANOVA test and was considered statistically significant P<0.05.Results
There were no deaths, reoperation due to valve dysfunction, thromboembolism or endocarditis during the study. Posterior mitral annulus demonstrated a significant reduction in immediate postoperative period (P<0.001), remaining stable during the study, and presents a mean of reduction of 25.8% comparing with preoperative period. There was a significant reduction in anteroposterior and mediolateral diameters in the immediate postoperative period (P<0.001), although there was a significant increase in mediolateral diameter between immediate postoperative period and 1 year. There was no difference in mitral internal area variation over the cardiac cycle during the study.Conclusion
Segmentar annuloplasty reduced the posterior component of mitral annulus, which remained stable in a 1-year-period. The variation in mitral annulus area during cardiac cycle remained stable during the study. 相似文献6.
Dimas Tadahiro Ikeoka Viviane Aparecida Fernandes Otavio Gebara Jose Carlos Teixeira Garcia Pedro Gabriel Melo de Barros e Silva Marcelo Jamus Rodrigues Valter Furlan Antonio Claudio do Amaral Baruzzi 《Brazilian Journal Of Cardiovascular Surgery》2014,29(1):51-58
Objective
Report the experience with the Society of Thoracic Surgeons scoring system in a Brazilian population submitted to isolated coronary artery bypass graft surgery.Methods
Data were collected from January-2010 to December-2011, and analyzed to determine the performance of the Society of Thoracic Surgeons scoring system on the determination of postoperative mortality and morbidity, using the method of the receiver operating characteristic curve as well as the Hosmer-Lemeshow and the Chi-square goodness of fit tests. From the 1083 cardiac surgeries performed during the study period 659 represented coronary artery bypass graft procedures which are included in the present analysis. Mean age was 61.4 years and 77% were men.Results
Goodness of fit tests have shown good calibration indexes both for mortality (X2=6.78, P=0.56) and general morbidity (X2=6.69, P=0.57). Analysis of area under the ROC-curve (AUC) demonstrated a good performance to detect the risk of death (AUC 0.76; P<0.001), renal failure (AUC 0.79; P<0.001), prolonged ventilation (AUC 0.80; P<0.001), reoperation (AUC 0.76; P<0.001) and major morbidity (AUC 0.75; P<0.001) which represents the combination of the assessed postoperative complications. STS scoring system did not present comparable results for short term hospital stay, prolonged length of hospital stay and could not be properly tested for stroke and wound infection.Conclusion
Society of Thoracic Surgeons scoring system presented a good calibration and discrimination in our population to predict postoperative mortality and the majority of the harmful events following coronary artery bypass graft surgery. Analysis of larger samples might be needed to further validate the use of the score system in Brazilian populations. 相似文献7.
Sibel Unsal-Delialioglu Kurtulus Kaya Sule Sahin-Onat Fazil Kulakli Canan Culha Sumru Ozel 《The journal of spinal cord medicine》2010,33(3):243-248
Objective:
To determine the incidence and etiology of fever and the risk factors related to fever in adults with spinal cord injury (SCI) at the rehabilitation stage.Design/Subjects:
A retrospective examination of records of 392 consecutive adult patients with traumatic SCI who received inpatient rehabilitation program.Setting:
A national rehabilitation center in Turkey.Outcome Measures:
Incidence and etiology of fever, period of hospitalization (days).Results:
A total of 187 patients (47.7%) had fever at least once during their rehabilitation program. The most common etiology was urinary tract infection. The rate of fever occurrence was significantly higher in patients with complete SCI (P = 0.001). In patients with fever, the use of an indwelling catheter was significantly higher compared with clean intermittent catheterization and spontaneous voiding (P = 0.001). The hospitalization period of patients with fever was significantly longer than that of patients without fever (P = 0.006).Conclusions:
A high rate of fever was seen in patients with SCI during rehabilitation. Fever was caused by various infections, of which urinary tract infection was the most common. Patients with motor complete injuries and those with permanent catheters constituted higher risk groups. Fever prolonged the length of rehabilitation stay and hindered active participation in the rehabilitation program. 相似文献8.
Luiz Augusto Ferreira Lisboa Omar Asdrubal Vilca Mejia Luiz Felipe Pinho Moreira Luís Alberto Oliveira Dallan Pablo Maria Alberto Pomerantzeff Luís Roberto Palma Dallan Maria Raquel B. Massoti Fabio B. Jatene 《Brazilian Journal Of Cardiovascular Surgery》2014,29(1):1-8
Introduction
The most widely used model for predicting mortality in cardiac surgery was recently remodeled, but the doubts regarding its methodology and development have been reported.Objective
The aim of this study was to assess the performance of the EuroSCORE II to predict mortality in patients undergoing coronary artery bypass grafts or valve surgery at our institution.Methods
One thousand consecutive patients operated on coronary artery bypass grafts or valve surgery, between October 2008 and July 2009, were analyzed. The outcome of interest was in-hospital mortality. Calibration was performed by correlation between observed and expected mortality by Hosmer Lemeshow. Discrimination was calculated by the area under the ROC curve. The performance of the EuroSCORE II was compared with the EuroSCORE and InsCor (local model).Results
In calibration, the Hosmer Lemeshow test was inappropriate for the EuroSCORE II (P=0.0003) and good for the EuroSCORE (P=0.593) and InsCor (P=0.184). However, the discrimination, the area under the ROC curve for EuroSCORE II was 0.81 [95% CI (0.76 to 0.85), P<0.001], for the EuroSCORE was 0.81 [95% CI (0.77 to 0.86), P<0.001] and for InsCor was 0.79 [95% CI (0.74-0.83), P<0.001] showing up properly for all.Conclusion
The EuroSCORE II became more complex and resemblance to the international literature poorly calibrated to predict mortality in patients undergoing coronary artery bypass grafts or valve surgery at our institution. These data emphasize the importance of the local model. 相似文献9.
Fernando A. Atik Claudio Ribeiro da Cunha 《Brazilian Journal Of Cardiovascular Surgery》2014,29(2):131-139
Objective
EuroSCORE has been used in cardiac surgery operative risk assessment, despite important variables were not included. The objective of this study was to validate EuroSCORE on mortality prediction in a Brazilian cardiovascular surgery center, defining the influence of type of procedure and surgical team.Methods
Between January 2006 and June 2011, 2320 consecutive adult patients were studied. According to additive EuroSCORE, patients were divided into low risk (score<2), medium risk (3 - 5), high risk (6 - 11) and very high risk (>12). The relation between observed mortality (O) and expected mortality (E) according to logistic EuroSCORE was calculated for each of the groups, types of procedures and surgeons with > 150 operations, and analyzed by logistic regression.Results
EuroSCORE correlated to the observed mortality (O/E=0.94; P<0.0001; area under the curve 0.78). However, it overestimated the mortality in very high risk patients (O/E=0.74; P=0.001). EuroSCORE tended to overestimate isolated myocardial revascularization mortality (O/E=0.81; P=0.0001) and valve surgery mortality (O/E=0.89; P=0.007) and it tended to underestimate combined procedures mortality (O/E=1.09; P<0.0001). EuroSCORE overestimated surgeon A mortality (O/E=0.46; P<0.0001) and underestimated surgeon B mortality (O/E=1.3; P<0.0001), in every risk category.Conclusion
In the present population, EuroSCORE overestimates mortality in very high risk patients, being influenced by type of procedure and surgical team. The most appropriate surgical team may minimize risks imposed by preoperative profiles. 相似文献10.
Paulo Sérgio da Silva Márcio Portugal Trindade Cartacho Casimiro Cardoso de Castro Marcello Fonseca Salgado Filho Ant?nio Carlos Aguiar Brand?o 《Brazilian Journal Of Cardiovascular Surgery》2015,30(4):449-458
Objective
To evaluate the influence of pulmonary hypertension in the ultra-fast-track anesthesia technique in adult cardiac surgery.Methods
A retrospective study. They were included 40 patients divided into two groups: GI (without pulmonary hypertension) and GII (with pulmonary hypertension). Based on data obtained by transthoracic echocardiography. We considered as the absence of pulmonary hypertension: a pulmonary artery systolic pressure (sPAP) <36 mmHg, with tricuspid regurgitation velocity <2.8 m/s and no additional echocardiographic signs of PH, and PH as presence: a sPAP >40 mmHg associated with additional echocardiographic signs of PH. It was established as influence of pulmonary hypertension: the impossibility of extubation in the operating room, the increase in the time interval for extubation and reintubation the first 24 hours postoperatively. Univariate and multivariate analyzes were performed when necessary. Considered significant a P value <0.05.Results
The GI was composed of 21 patients and GII for 19. All patients (100%) were extubated in the operating room in a medium time interval of 17.58±8.06 min with a median of 18 min in GII and 17 min in GI. PH did not increase the time interval for extubation (P=0.397). It required reintubation of 2 patients in GII (5% of the total), without statistically significant as compared to GI (P=0.488).Conclusion
In this study, pulmonary hypertension did not influence on ultra-fast-track anesthesia in adult cardiac surgery. 相似文献11.
Ozan Erdem Mehmet Erdem Memeto?lu Ali ?hsan Tekin ümit Arslan ?zgür Akkaya Rasim Kutlu ?lhan G?lba?? 《Brazilian Journal Of Cardiovascular Surgery》2015,30(4):459-465
Objective
This study aimed to show the effects of intra-operative diltiazem infusion on flow in arterial and venous grafts in coronary artery bypass graft surgery.Methods
Hundred fourty patients with a total of 361 grafts [205 (57%) arterial and 156 (43%) venous] underwent isolated coronary surgery. All the grafts were measured by intraoperative transit time flow meter intra-operatively. Group A (n=70) consisted of patients who received diltiazem infusion (dose of 2.5 microgram/kg/min), and Group B (n=70) didn''t receive diltiazem infusion.Results
Mean graft flow values of left internal mammary artery were 53 ml/min in Group A and 40 ml/min in Group B (P<0.001). Pulsatility index (PI) values of left internal mammary artery for Group A and Group B were 2.6 and 3.0 respectively (P<0.001). No statistically significant difference was found between venous graft parameters.Conclusion
We recommend an effect of diltiazem infusion in increasing graft flows in coronary artery bypass graft operations. 相似文献12.
José Guilherme Rodrigues de Paula Moacir Fernandes de Godoy Márcio Ant?nio dos Santos Flávio Corrêa Pivatelli Alan Vinicius Gamero Osti Luciano Folchine Trindade Diego Novelli Marcelo Arruda Nakazone 《Brazilian Journal Of Cardiovascular Surgery》2014,29(2):177-185
Objective
In the clinical scenario of ST-segment elevation acute myocardial infarction, several patients with multivessel coronary atherosclerotic disease are discharged without a defined strategy to monitor the residual atherosclerotic lesions. The clinical endpoints evaluated were cardiovascular death, symptoms of angina pectoris, rehospitalization for a new acute coronary syndrome, and the necessity of reintervention during the two-year follow-up.Methods
This observational, prospective, and historical study included multivessel coronary atherosclerotic disease patients who were admitted to a tertiary care university hospital with ST-segment elevation acute myocardial infarction and underwent primary percutaneous coronary intervention with stent implantation only at the culprit lesion site; these patients were monitored in the outpatient clinic according to two treatments: the Clinical Group - CG (optimized pharmacological therapy associated with counseling for a healthy diet and cardiac rehabilitation) or the Intervention Group - IG (new staged percutaneous coronary intervention or surgical coronary artery bypass graft surgery combined with the previously prescribed treatment).Results
Of 143 patients consecutively admitted with ST-segment elevation acute myocardial infarction, 57 were eligible for the study (CG=44 and IG=13). Regarding the clinical endpoints, the cardiovascular death rate did not differ between the CG and IG. The symptom of angina pectoris and the rehospitalization rate for a new episode of acute coronary syndrome were accentuated in the CG (P=0.020 and P=0.049, respectively) mainly in individuals with evidence of ischemia evidenced by myocardial scintigraphy (P<0.001 and P=0.001, respectively) which culminated in an even greater need for reintervention (P=0.001) in this subgroup of patients.Conclusion
The staged intervention was demonstrated to be safe and able to reduce angina pectoris and rehospitalization for a new episode of acute coronary syndrome. In addition, it decreases the likelihood of unplanned reinterventions of patients without ischemia evidenced by myocardial scintigraphy. 相似文献13.
Isaac Newton Guimar?es Andrade Diego Torres Aladin de Araújo Fernando Ribeiro de Moraes Neto 《Brazilian Journal Of Cardiovascular Surgery》2015,30(3):360-364
Objective
To assess the impact of respiratory tract infection in the postoperative period of cardiac surgery in relation to mortality and to identify patients at higher risk of developing this complication.Methods
Cross-sectional observational study conducted at the Recovery of Cardiothoracic Surgery, using information from a database consisting of a total of 900 patients operated on in this hospital during the period from 01/07/2008 to 1/07/2009. We included patients whose medical records contained all the information required and undergoing elective surgery, totaling 109 patients with two excluded. Patients were divided into two groups, WITH and WITHOUT respiratory tract infection, as the development or respiratory tract infection in hospital, with patients in the group without respiratory tract infection, the result of randomization, using for the pairing of the groups the type of surgery performed. The outcome variables assessed were mortality, length of hospital stay and length of stay in intensive care unit. The means of quantitative variables were compared using the Wilcoxon and student t-test.Results
The groups were similar (average age P=0.17; sex P=0.94; surgery performed P=0.85-1.00) Mortality in the WITH respiratory tract infection group was significantly higher (P<0.0001). The times of hospitalization and intensive care unit were significantly higher in respiratory tract infection (P<0.0001). The presence of respiratory tract infection was associated with the development of other complications such as renal failure dialysis and stroke P<0.00001 and P=0.002 respectively.Conclusion
The development of respiratory tract infection postoperative cardiac surgery is related to higher mortality, longer periods of hospitalization and intensive care unit stay. 相似文献14.
Jamil Alli Murad Junior Marcelo Arruda Nakazone Mauricio de Nassau Machado Moacir Fernandes de Godoy 《Brazilian Journal Of Cardiovascular Surgery》2015,30(2):182-187
Objective
We evaluated whether the preoperative serum concentration of brain natriuretic peptide (BNP) is a predictor of in-hospital mortality in patients that underwent cardiac surgery.Methods
We continuously evaluated 488 patients that underwent cardiac valve surgery or coronary artery bypass grafting (CABG) between January of 2009 and July of 2012. Follow up of these patients were done prospectively for 30 days postoperatively.Results
Data analysis showed that the overall mortality rate was equal to 9.6%, Receiver Operating Charactheristic (ROC) curve analysis found the optimal cut-off value of BNP equal to 382 pg/mL for overall mortality (AUC=0.73, 95% CI=0.66 to 0.81, P<0.001). Multivariate analysis showed that the value of BNP higher than 382 pg/mL (P=0.033, HR=2.05, 95% CI=1.6 to 3.98) was an independent predictor of overall mortality at 30 days postoperatively.Conclusion
We concluded that the preoperative serum concentration of BNP is an independent predictor of mortality in patients undergoing valve surgery or coronary artery bypass graft. 相似文献15.
Lucas Regatieri Barbieri Marcelo Luiz Peixoto Sobral Glaucio Mauren da Silva Ger?nimo Gilmar Geraldo dos Santos Evandro Sbaraíni Fabio Kirzner Dorfman Noedir Ant?nio Groppo Stolf 《Brazilian Journal Of Cardiovascular Surgery》2013,28(4):442-448
Introduction
Postoperative atrial fibrillation is the most common arrhythmia in cardiac surgery, its incidence range between 20% and 40%.Objective
Quantify the occurrence of stroke and acute renal insufficiency after myocardial revascularization surgery in patients who had atrial fibrillation postoperatively.Methods
Cohort longitudinal bidirectional study, performed at Portuguese Beneficent Hospital (SP), with medical chart survey of patients undergoing myocardial revascularization surgery between June 2009 to July 2010. From a total of 3010 patients were weaned 382 patients that presented atrial fibrillation preoperatively and/or associated surgeries. The study was conducted in accordance with national and international following resolutions: ICH Harmonized Tripartite Guidelines for Good Clinical Practice - 1996; CNS196/96 Resolution, and Declaration of Helsinki.Results
The 2628 patients included in this study were divided into two groups: Group I, who didn''t show postoperative atrial fibrillation, with 2302 (87.6%) patients; and group II, with 326 (12.4%) who developed postoperative atrial fibrillation. The incidence of stroke in patients was 1.1% without postoperative atrial fibrillation vs. 4% with postoperative atrial fibrillation (P<0.001). Postoperative acute renal failure was observed in 12% of patients with postoperative atrial fibrillation and 2.4% in the group without postoperative atrial fibrillation (P<0.001), that is a relation 5 times greater.Conclusion
In this study there was a high incidence of stroke and acute renal failure in patients with postoperative atrial fibrillation, with rates higher than those reported in the literature. 相似文献16.
Ant?nio Alceu dos Santos Alexandre Gon?alves Sousa Raquel Ferrari Piotto Juan Carlos Montano Pedroso 《Brazilian Journal Of Cardiovascular Surgery》2013,28(4):509-517
Introduction
Transfusions of one or more packed red blood cells is a widely strategy used in cardiac surgery, even after several evidences of increased morbidity and mortality. The world''s blood shortage is also already evident.Objective
To assess whether the risk of mortality is dose-de>pendent on the number of packed red blood cells transfused after coronary artery bypass graft.Methods
Between June 2009 and July 2010, were analyzed 3010 patients: transfused and non-transfused. Transfused patients were divided into six groups according to the number of packed red blood cells received: one, two, three, four, five, six or more units, then we assess the mortality risk in each group after a year of coronary artery bypass graft. To calculate the odds ratio was used the multivariate logistic regression model.Results
The increasing number of allogeneic packed red blood cells transfused results in an increasing risk of mortality, highlighting a dose-dependent relation. The odds ratio values increase with the increased number of packed red blood cells transfused. The death''s gross odds ratio was 1.42 (P=0.165), 1.94 (P=0.005), 4.17; 4.22, 8.70, 33.33 (P<0.001) and the adjusted death''s odds ratio was 1.22 (P=0.43), 1.52 (P=0.08); 2.85; 2.86; 4.91 and 17.61 (P<0.001), as they received one, two, three, four, five, six or more packed red blood cells, respectively.Conclusion
The mortality risk is directly proportional to the number of packed red blood cells transfused in coronary artery bypass graft. The greater the amount of allogeneic blood transfused the greater the risk of mortality. The current transfusion practice needs to be reevaluated. 相似文献17.
Kyriakos Spiliopoulos Laura Gansera Hans Christian Weiland Tibor Schuster Walter Eichinger Brigitte Gansera 《Brazilian Journal Of Cardiovascular Surgery》2014,29(3):308-315
Introduction
Cardiac surgeons stress may impair their quality of life and professional practice.Objective
To assess perceived chronic stress and coping strategies among cardiac surgeons.Methods
Twenty-two cardiac surgeons answered two self-assessment questionnaires, the Trier Inventory for Chronic Stress and the German SGV for coping strategies.Results
Participants mean age was 40±14.1 years and 13 were male; eight were senior physicians and 14 were residents. Mean values for the Trier Inventory for Chronic Stress were within the normal range. Unexperienced physicians had significantly higher levels of dissatisfaction at work, lack of social recognition, and isolation (P<0.05). Coping strategies such as play down, distraction from situation, and substitutional satisfaction were also significantly more frequent among unexperienced surgeons. "Negative" stress-coping strategies occur more often in experienced than in younger colleagues (P=0.029). Female surgeons felt more exposed to overwork (P=0.04) and social stress (P=0.03).Conclusion
Cardiac surgeons show a tendency to high perception of chronic stress phenomena and vulnerability for negative coping strategies. 相似文献18.
SR Kulkarni E Fletcher AK McConnell KR Poskitt MR Whyman 《Annals of the Royal College of Surgeons of England》2010,92(8):700-705
INTRODUCTION
The aim of this pilot study was to assess the effect of pre-operative inspiratory muscle training (IMT) on respiratory variables in patients undergoing major abdominal surgery.PATIENTS AND METHODS
Respiratory muscle strength (maximum inspiratory [MIP] and expiratory [MEP] mouth pressure) and pulmonary functions were measured at least 2 weeks before surgery in 80 patients awaiting major abdominal surgery. Patients were then allocated randomly to one of four groups (Group A, control; Group B, deep breathing exercises; Group C, incentive spirometry; Group D, specific IMT). Patients in groups B, C and D were asked to train twice daily, each session lasting 15 min, for at least 2 weeks up to the day before surgery. Outcome measurements were made immediately pre-operatively and postop-eratively.RESULTS
In groups A, B and C, MIP did not increase from baseline to pre-operative assessments. In group D, MIP increased from 51.5 cmH2O (median) pre-training to 68.5 cmH2O (median) post-training pre-operatively (P < 0.01). Postoperatively, groups A, B and C showed a fall in MIP from baseline (P < 0.01, P < 0.01) and P = 0.06, respectively). No such significant reduction in postoperative MIP was seen in group D (P = 0.36).CONCLUSIONS
Pre-operative specific IMT improves MIP pre-operatively and preserves it postoperatively. Further studies are required to establish if this is associated with reduced pulmonary complications. 相似文献19.
Paulo Ernando Ferraz Cavalcanti Michel Pompeu Barros de Oliveira Sá Cecília Andrade dos Santos Isaac Melo Esmeraldo Mariana Leal Chaves Ricardo Felipe de Albuquerque Lins Ricardo de Carvalho Lima 《Brazilian Journal Of Cardiovascular Surgery》2015,30(2):148-158
Objective
To determine whether stratification of complexity models in congenital heart surgery (RACHS-1, Aristotle basic score and STS-EACTS mortality score) fit to our center and determine the best method of discriminating hospital mortality.Methods
Surgical procedures in congenital heart diseases in patients under 18 years of age were allocated to the categories proposed by the stratification of complexity methods currently available. The outcome hospital mortality was calculated for each category from the three models. Statistical analysis was performed to verify whether the categories presented different mortalities. The discriminatory ability of the models was determined by calculating the area under the ROC curve and a comparison between the curves of the three models was performed.Results
360 patients were allocated according to the three methods. There was a statistically significant difference between the mortality categories: RACHS-1 (1) - 1.3%, (2) - 11.4%, (3)-27.3%, (4) - 50 %, (P<0.001); Aristotle basic score (1) - 1.1%, (2) - 12.2%, (3) - 34%, (4) - 64.7%, (P<0.001); and STS-EACTS mortality score (1) - 5.5 %, (2) - 13.6%, (3) - 18.7%, (4) - 35.8%, (P<0.001). The three models had similar accuracy by calculating the area under the ROC curve: RACHS-1- 0.738; STS-EACTS-0.739; Aristotle- 0.766.Conclusion
The three models of stratification of complexity currently available in the literature are useful with different mortalities between the proposed categories with similar discriminatory capacity for hospital mortality. 相似文献20.
Karla Reichert Helison Rafael Pereira do Carmo Fany Lima Anali Galluce Torina Karlos Alexandre de Souza Vilarinho Pedro Paulo Martins de Oliveira Lindemberg Mota Silveira Filho Elaine Soraya Barbosa de Oliveira Severino Orlando Petrucci 《Brazilian Journal Of Cardiovascular Surgery》2013,28(4):524-530