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Emmanuel Akintoye Frank Sellke Roberto Marchioli Luigi Tavazzi Dariush Mozaffarian 《The Journal of thoracic and cardiovascular surgery》2018,155(1):242-251.e10
Objective
The study objective was to evaluate the impact of various surgical characteristics and practices on the risk of postoperative atrial fibrillation and other adverse outcomes after cardiac surgery.Methods
By using the prospectively collected data of patients who underwent cardiac surgery in 28 centers across the United States, Italy, and Argentina, the details of surgery characteristics were collected for each patient and the outcomes, including postoperative atrial fibrillation, major adverse cardiovascular events, and mortality. These were evaluated via multivariable-adjusted models.Results
In 1462 patients, a total of 460 cases of postoperative atrial fibrillation, 33 major adverse cardiovascular events, 23 cases of 30-day mortality, and 46 cases of 1-year mortality occurred. We found that type of surgery and cardiopulmonary bypass use predicted the occurrence of postoperative atrial fibrillation. Compared with coronary artery bypass grafting alone, there was a higher risk of postoperative atrial fibrillation with valvular surgery alone (odds ratio, 1.4; 95% confidence interval, 1.1-1.9), and the risk was even higher with concomitant valvular and coronary artery bypass grafting surgery (odds ratio, 1.8; 95% confidence interval, 1.2-2.7). Compared with no bypass, use of cardiopulmonary bypass was associated with higher risk of postoperative atrial fibrillation (odds ratio, 2.4; 95% confidence interval, 1.7-3.5), but there were significant age and sex differences of the impact of bypass use among patients undergoing coronary artery bypass grafting (P for interaction = .04). In addition, compared with spontaneous return of rhythm, ventricular pacing was associated with a higher risk of major adverse cardiovascular events (odds ratio, 5.0; 95% confidence interval, 1.4-18), whereas concomitant coronary artery bypass grafting and valvular surgery was associated with a higher risk of 30-day mortality (hazard ratio, 4.3; 95% confidence interval, 1.2-14) compared with coronary artery bypass grafting alone. Occurrence of postoperative atrial fibrillation was associated with greater length of stay and 1-year mortality (hazard ratio, 2.2; 95% confidence interval, 1.2-3.9).Conclusions
In this multicenter trial, we identified specific adverse outcomes that are associated with concomitant valvular and coronary artery bypass graft surgery, cardiopulmonary bypass, ventricular pacing, and occurrence of postoperative atrial fibrillation. 相似文献33.
目的评价重症监护护理评分系统在CCU患者分层护理中的应用效果。方法选取2013年12月至2014年6月收治的175例患者为对照组,2014年7月至2015年1月收治的182例患者为观察组,对照组根据不同的病种给予常规护理,观察组责任护士根据重症监护护理评分系统对患者护理需求情况进行评分,主要包括血压、心律、通气功能、换气功能、重要脏器供血情况、营养及代谢情况等,依据其评分分值的高低分层级进行护理。结果观察组CCU患者护理质量、住院时间、医疗费用、对护理人员满意度及并发症发生率与对照组比较差异均具有统计学意义(P0.01或P0.05)。结论应用重症监护护理评分系统提高了患者护理质量,缩短CCU住院时间,降低了并发症发生率。 相似文献
34.
目的 总结CCU新护士临床培训方法.方法 通过选拔带教老师、制定培训目标、实施培训计划的步骤,在CCU病区连续10年对新毕业护士采取一对一三年制续贯培训法.结果 10年中培养出1名总护士长、5名护士长及3名硕士研究生和8名护理骨干.结论 一对一三年制续贯培训法,使CCU护理教学更连续、更系统,更有利于优秀带教老师发挥榜样作用. 相似文献
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无缝隙护理服务模式在CCU的应用 总被引:1,自引:0,他引:1
目的 探讨无缝隙护理服务模式在CCU中应用的效果.方法 选取2009年11月至2010年10月CCU住院的418例患者为观察组,实施无缝隙护理服务模式;选取2008年11月至2009年10月住院的378例患者为对照组,实施传统护理模式.对2组各项相关指标进行对比分析,进行效果评价.结果 观察组在患者综合满意度,护理质量方面较对照组有明显提高,护理缺陷与护理投诉次数明显降低.结论 无缝隙护理服务模式可以提高患者护理质量和满意度,值得临床推广应用. 相似文献
36.
Mycoplasma bovis causes pneumonia, otitis media, and arthritis in young calves, resulting in economic losses to the cattle industry worldwide. M. bovis pathogenesis results in part from excessive immune responses. Lipid-associated membrane proteins (LAMPs) can potently induce host innate immunity. However, interactions between M. bovis-derived LAMPs and Toll-like receptors (TLRs), or signaling pathways eliciting active inflammation and NF-κB activation, are incompletely understood. Here, we found that IL-1β expression was induced in embryonic bovine lung (EBL) cells stimulated with M. bovis-derived LAMPs. Subcellular-localization analysis revealed nuclear p65 translocation following EBL cell stimulation with M. bovis-derived LAMPs. An NF-κB inhibitor reversed M. bovis-derived LAMP-induced IL-1β expression. TLR2 and myeloid differentiation primary response gene 88 (MyD88) overexpression increased LAMP-dependent IL-1β induction. TLR2-neutralizing antibodies reduced IL-1β expression during LAMP stimulation. LAMPs also inhibited IL-1β expression following overexpression of a dominant-negative MyD88 protein. These results suggested that M. bovis-derived LAMPs activate IL-1β production through the NF-κB pathway via TLR2 and MyD88. 相似文献
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A real-time monitoring system for physiological signals, developed for patients in coronary care units (CCUs), is described.
This system monitors the signals that have the greatest clinical value in a CCU environment (ECG and cardiovascular pressures),
taking charge of detecting dangerous situations and of extracting information significant to the correct monitoring of the
patient. The information it extracts, mainly from the ECG, is presented to the user in an ergonomic way using written reports
and graphs which collect and compile the information, facilitating its interpretation. Some utilities have been developed
to allow the user to modify certain monitoring conditions as well as to correct results derived from them, thereby improving
the reliability of the monitoring process. The system uses a multimicroprocessor architecture (imposed by the need to perform
a large number of tasks in real time) with a block based on the VME bus, charged with acquiring and processing the monitored
signals, and an IBM-compatible PC/XT which is used as a system user interface and a massive storage device in which the information
resulting from the monitoring of signals is stored. 相似文献
39.