Use of blood products and risk of stroke after coronary artery bypass surgery

Background

The impact of blood transfusion on the development of post-operative stroke after coronary artery bypass grafting (CABG) is not well established. We, therefore, investigated this issue.

Materials and methods.

Complete data on peri-operative blood transfusion were available for 2,226 patients who underwent CABG in three Finnish hospitals.

Results

Stroke occurred post-operatively in 53 patients (2.4%). Logistic regression showed that pre-operative creatinine (OR 1.003, 95% CI 1.000–1.006), extracardiac arteriopathy (OR 2.344, 95% CI 1.133–4.847), pre-operative atrial fibrillation (OR 2.409, 95% CI 1.149–5.052), and the number of packed red blood cell units transfused (OR 1.121, 95% CI 1.065–1.180) were significantly associated with post-operative stroke. When the various blood product transfusions instead of transfused units were included in the multivariable analysis, solvent/detergent treated plasma (Octaplas^®) transfusion (OR 2.149, 95% CI 1.141–4.047), but not red blood cell transfusion, was significantly associated with postoperative stroke. Use of blood products ranging from no transfusion (stroke rate 1.6%) to combined transfusion of red blood cells, platelets and Octaplas^® was associated with a significant increase in post-operative stroke incidence (6.6%, adjusted analysis: OR 1.727, 95% 1.350–2.209). Patients who received >2 units of red blood cells, >4 units of Octaplas^® units and >8 units of platelets had the highest stroke rate of 21%. CART analysis showed that increasing amount of transfused Octaplas^®, platelets and history of extracardiac arteriopathy were significantly associated with post-operative stroke.

Conclusions

Transfusion of blood products after CABG has a strong, dose-dependent association with the risk of stroke. The use of Octaplas^® and platelet transfusions seem to have an even larger impact on the development of stroke than red blood cell transfusions.     

Streptococcus pneumoniae Serotype 15A in Psychiatric Unit,Rhode Island,USA, 2010–2011

During a pneumococcal disease outbreak in a pediatric psychiatric unit in a hospital in Rhode Island, USA, 6 (30%) of 20 patients and staff were colonized with Streptococcus pneumoniae serotype 15A, which is not included in pneumococcal vaccines. The outbreak subsided after implementation of antimicrobial drug prophylaxis and enhanced infection control measures.     

小剂量舒芬太尼联合曲马多用于术后静脉镇痛的观察

目的:评价小剂量舒芬太尼联合曲马多用于术后静脉自控镇痛(PCIA)的有效性和安全性。方法:选择90例下腹部横切口剖宫产手术患者,ASAⅠ~Ⅱ,无特殊病史。所有患者采用腰硬联合麻醉,按照PCI用药方法随机分为:T组,曲马多1000mg+格拉司琼5mg;S组,舒芬太尼150ug+格拉司琼5mg;S+T组,曲马多500mg+舒芬太尼50ug+格拉司琼5mg;均用生理盐水稀释到100ml。术毕给予首剂量5ml,背景输注2ml/h,PCA 1ml/次,锁定时间15min。记录术后4h、8h、12h、24h、36h、48h各时间点镇痛、镇静评分和不良反应。结果:镇痛、镇静评分在各时间点组间比较差异无统计学意义(P>0.05),S+T组不良反应发生率明显下降,组间比较有统计意义(P<0.05)。结论:小剂量舒芬太尼联合曲马多术后静脉镇痛不仅能减少药物用量而且能取得满意效果,降低不良反应的发生率,提高镇痛的安全性。     

周边虹膜切除术与超声乳化人工晶状体植入术治疗早期原发性闭角型青光眼的疗效比较

目的比较周边虹膜切除术与超声乳化联合人工晶状体植入术治疗早期原发性闭角型青光眼的临床效果。方法选择仅局部用药即可控制眼压在正常范围内的早期闭角型青光眼合并白内障患者48例(54眼),应用周边虹膜切除术对28例(32眼)早期闭角型青光眼进行手术治疗,其结果与同类病人(20例22眼)的超声乳化联合人工晶状体植入术治疗结果进行比较。术前,术后一个月内每周一次,半年内每月一次,半年后三个月一次做眼压、裂隙灯检查直至1年。比较两者在术后眼压控制、视力恢复及前房情况,并作统计学分析。结果应用周边虹膜切除术治疗组术后平均眼内压为15.2±3.1mmHg,而同类病人经超声乳化联合人工晶状体植入术治疗后平均眼内压为14.9±2.6mmHg。分别经周边虹膜切除术和超声乳化联合人工晶状体植入术治疗,两类病人眼内压在术后早期无明显差异(P>0.05)。经超声乳化联合人工晶状体植入术治疗,18眼(81.8%)最佳矫正视力提高,0.4者占63.6%,经周边虹膜切除术治疗术后最佳矫正视力无明显提高,其中8眼视力不增反降,最佳矫正视力0.4者占18.8%,两者差异有显著性(P<0.05)。经周边虹膜切除术治疗术后中央前房深度无明显变化,而经超声乳化联合人工晶状体植入术治疗术后中央前房深度显著加深,两者差异性明显(P<0.05)。结论原发性闭角型青光眼早期患者施行超声乳化联合人工晶状体植入术,术后房角显著加宽,中央前房深度显著加深,矫正视力也不同程度提高,且并发症少。     

临床护士工作压力现状调查分析及对策

目的了解护士工作压力来源情况并提出相应对策,为医院管理者采取有效措施减轻护士工作压力提供参考。方法采用问卷调查对广州市某"三甲"医院的202名护士工作压力感受及来源进行分析。结果护士工作压力感受:87.6%的护士感觉工作压力大,11.9%的护士感觉工作压力一般,0.5%的护士感觉工作压力小;工作压力的主要来源为:工作量大、夜班较多、护患关系、培训考试、职称晋升等。结论护士工作压力状况不容忽视,医院及护理管理者应支持和认同护士工作,重视护士内心感受,科学管理人力资源,减轻护士工作量,制订有效措施减轻护士工作压力。     

RPGR-Associated Retinal Degeneration in Human X-Linked RP and a Murine Model

Purpose. We investigated the retinal disease due to mutations in the retinitis pigmentosa GTPase regulator (RPGR) gene in human patients and in an Rpgr conditional knockout (cko) mouse model. Methods. XLRP patients with RPGR-ORF15 mutations (n = 35, ages at first visit 5-72 years) had clinical examinations, and rod and cone perimetry. Rpgr-cko mice, in which the proximal promoter and first exon were deleted ubiquitously, were back-crossed onto a BALB/c background, and studied with optical coherence tomography and electroretinography (ERG). Retinal histopathology was performed on a subset. Results. Different patterns of rod and cone dysfunction were present in patients. Frequently, there were midperipheral losses with residual rod and cone function in central and peripheral retina. Longitudinal data indicated that central rod loss preceded peripheral rod losses. Central cone-only vision with no peripheral function was a late stage. Less commonly, patients had central rod and cone dysfunction, but preserved, albeit abnormal, midperipheral rod and cone vision. Rpgr-cko mice had progressive retinal degeneration detectable in the first months of life. ERGs indicated relatively equal rod and cone disease. At late stages, there was greater inferior versus superior retinal degeneration. Conclusions. RPGR mutations lead to progressive loss of rod and cone vision, but show different patterns of residual photoreceptor disease expression. Knowledge of the patterns should guide treatment strategies. Rpgr-cko mice had onset of degeneration at relatively young ages and progressive photoreceptor disease. The natural history in this model will permit preclinical proof-of-concept studies to be designed and such studies should advance progress toward human therapy.     

不放液巩膜扣带术联合玻璃体腔注气治疗孔源性视网膜脱离的分析

目的 探讨不放液巩膜扣带术联合玻璃体腔注气治疗孔源性视网膜脱离的效果.方法 回顾性分析65例(65只眼)孔源性视网膜脱离行不放液巩膜扣带术联合玻璃体腔消毒空气注射患者的临床资料,分析视网膜复位率、视网膜下液吸收情况、术后视力、主要并发症等.随访时间2周至1年.结果 视网膜复位63例,手术成功率96.92％,49例视网膜下液在3天内吸收,占77.78％,术后视力进步者50例,占79.36％,主要并发症为术后高眼压和玻璃体混浊.结论 在掌握好手术适应证的情况下,不放液巩膜扣带术联合玻璃体腔注气是治疗孔源性视网膜脱离的有效方法,患者术后恢复快,手术并发症较少.