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1.
Elizabeth D. Krebs Robert B. Hawkins J. Hunter Mehaffey Clifford E. Fonner Alan M. Speir Mohammed A. Quader Jeffrey B. Rich Leora T. Yarboro Nicholas R. Teman Gorav Ailawadi 《The Journal of thoracic and cardiovascular surgery》2019,157(4):1533-1542.e2
Objectives
Expedient extubation after cardiac surgery has been associated with improved outcomes, leading to postoperative extubation frequently during overnight hours. However, recent evidence in a mixed medical-surgical intensive care unit population demonstrated worse outcomes with overnight extubation. This study investigated the impact of overnight extubation in a statewide, multicenter Society of Thoracic Surgeons database.Methods
Records from 39,812 patients undergoing coronary artery bypass grafting or valve operations (2008-2016) and extubated within 24 hours were stratified according to extubation time between 06:00 and 18:00 (day) or between 18:00 and 6:00 (overnight). Outcomes including reintubation, mortality, and composite morbidity-mortality were evaluated using hierarchical regression models adjusted for Society of Thoracic Surgeons predictive risk scores. To further analyze extubation during the night, a subanalysis stratified patients into 3 groups: 06:00 to 18:00, 18:00 to 24:00, and 24:00 to 06:00.Results
A total of 20,758 patients were extubated overnight (52.1%) and were slightly older (median age 66 vs 65 years, P < .001) with a longer duration of ventilation (4 vs 7 hours, P < .001). Day and overnight extubation were associated with equivalent operative mortality (1.7% vs 1.7%, P = .880), reintubation (3.7% vs 3.4%, P = .141), and composite morbidity-mortality (8.2% vs 8.0%, P = .314). After risk adjustment, overnight extubation was not associated with any difference in reintubation, mortality, or composite morbidity-mortality. On subanalysis, those extubated between 24:00 and 06:00 exhibited increased composite morbidity-mortality (odds ratio, 1.18; P = .001) but no difference in reintubation or mortality.Conclusions
Extubation overnight was not associated with increased mortality or reintubation. These results suggest that in the appropriate clinical setting, it is safe to routinely extubate cardiac surgery patients overnight. 相似文献2.
Dr. Arni Raghavendrarao Raghuram M.Ch. Subbiah Kumar MD Kathamuthu Balamurugan DA Arulmurugan DA Ramiah Krishnan M.Ch. Perichiappan Sivakami BS Eluvathingal Varghese John M.Ch. 《Indian Journal of Thoracic and Cardiovascular Surgery》2006,22(3):178-181
Background Beating heart surgery has now become the commonest technique of doing Coronary Artery Bypass Graft Surgery (CABG) in our country.
It is being used even in such high risk situations like diffuse coronary disease and Critical Left Main stem Stenosis (LMCS)
with good results. The aim of this study is to retrospectively review our results in Off-Pump Coronary Artery Bypass Surgery
(OPCAB) in patients with critical left main stem stenosis.
Methods This study is a retrospective analysis of the data of patients who underwent primary coronary artery bypass surgery. During
the period from April 2003 to September 2005 a total of 64 patients underwent OPCAB procedure for critical LMCS. During the
same period 10 patients underwent CABG on Cardio Pulmonary Bypass (CPB). The age range was 36–77yrs. The sex distribution
was M: F 53∶10. Ten patients were done as emergency. 2 of them were on Intra Aortic Balloon Pump (IABP) support preoperatively.
10 patients were high risk with a Euro score of ≥5.
Results Left Internal Mammary Artery (LIMA) was used in 78% of cases. Average grafts per patient was 2.96. The median ventilation
time was 5.91 hrs. New IABP insertion in postoperative period was required in 1 patient. One patient was reexplored for bleeding.
There was one perioperative myocardial infarction. 57% of patients did not need any blood transfusion. There was no conversion
to CPB. There was no operative mortality. Inotropes were used in ten cases.
Conclusions OPCAB is a safe method of revascularization in patients with critical LMCS. Preoperative IABP is useful in patients with cardiogenic
shock. However, there is a place for CPB in patients needing additional procedures like Mitral Valve repair (MV repair) or
Dor's procedure or when the vessels are very diffusely diseased. Those patients who are unstable despite IABP support may
be managed by Beating heart On Pump (BHOP) technique. 相似文献
3.
4.
目的 总结冠状动脉旁路移植术治疗冠心病的体会。 方法 回顾性分析 3 0 6例冠状动脉旁路移植术。男 2 49例 ,女 5 7例。应用体外循环 2 3 4例 ,非体外循环 72例。搭桥数 1~ 6支 人 ,平均 (3 .45± 1.2 5 )支 人。对手术方法、主要并发症和术后处理进行分析总结。结果 二次开胸 5例 (1.6% ) ,低心排综合征 10例 (3 .3 % ) ,应用IABP4例 (1.3 % ) ,肝功能不全 6例 (2 .0 % )。肾功能不全 7例 (2 .3 % ) ,反复发作房颤 2 3例 (7.5 % ) ,肺功能不全 6例(2 .0 % ) ,脑合并症 3例 (1.0 % ) ,胸腔积液 41例 (13 .4% )。死亡 7例 (2 .3 % ) ,其余病人康复出院。结论 合理的选择病人 ,成熟的手术技术 ,良好的心肌保护及术后处理的加强是提高冠状动脉旁路移植术疗效的重要措施。 相似文献
5.
The influence of intravenous magnesium sulphate on the occurrence of atrial fibrillation after coronary artery by-pass operation 总被引:5,自引:1,他引:4
PARIKKA H.; TOIVONEN L.; PELLINEN T.; VERKKALA K.; JARVINEN A.; NIEMINEN M. S. 《European heart journal》1993,14(2):251-258
To examine the influence of (Mg) on hypomagnesaemia and atrialfibrillation (AF) following coronary artery by-pass surgery,140 consecutive patients were randomized to receive 70 mmolof magnesium sulphate intravenously (n = 69) or placebo (n =71). Serum magnesium concentrations fell to 0.77 ± 0.10mmol. l1 in the control group but rose to 1.09 ±0.17 mmol. l1 in the Mg group (P <0.001). The incidenceof AF was 29% in the Mg group and 26% in the placebo group (NS).The AF patients were older, more of them had had prior AF episodes,their sinus rates (SR) were slower (78 ± 10 vs 86 ±12 beats. Min1; P <0.01) and serum Mg concentrationshigher (0.89 ± 0.21 vs 0.11 mmol. l1; P <0.05)The incidence of AF was 43% in the highest quartile of serumMg and 23% among the rest (P = 0.056). In patients experiencingAF during the first three post-operative days, serum Mg concentrationswere higher and SR slower on each day compared with non-AF patients.SR increased post-operatively less with high Mg levels (P =0.044). In the Mg group, serum Mg and SR were the only independentpredictors of AF. In conclusion, the incidence of post-operativeAF is not decreased with magnesium. High Mg levels are likelyto provoke AF probably by mechanisms that modify SR. 相似文献
6.
Ujiie T 《Computers in biology and medicine》2003,33(3):227-237
Partial left ventriculectomy (PLV) was originally introduced as a new surgical approach by patients with an end stage of cardiac disease. Coronary artery bypass grafting (CABG) is a standard procedures used in cardiac surgery. Multichannel ECG (MECG) measurements and body surface mapping (BSM) were used to analyse the normalised beat amplitude power maps (BAM) that reflect an overall cardiac activity. The resulting BAMs show that the amplitude of cardiac signals decrease for approximately 30% after the PLV and stay in the same level during the postoperative monitoring interval while after CABG no significant changes in BAM have been observed. In addition the electrodes from the body surface area above the left ventricle, where surgery was performed, show significant changes in beat amplitudes. 相似文献
7.
8.
Weman SM Salminen US Penttilä A Männikkö A Karhunen PJ 《International journal of legal medicine》1999,112(2):107-114
The advantages and limitations of a novel post-mortem angiographic method using solidifying silicone rubber and lead oxide
as a contrast medium in detecting coronary artery graft complications on a routine basis were evaluated in a series of 223
consecutive patients with fatal outcome within 30 days following coronary artery bypass grafting (CABG). Of these patients,
166 (74.4%) were male and 57 (25.6%) female (mean age 61.9 ± 9). Coronary grafts totalled 660 (3.0 per patient) with 517 aortic
and 838 coronary anastomoses. At autopsy, the rubber cast model of the grafts and coronary arterial tree was exposed by a
bend scalpel and sites of possible complications were examined. Post-mortem angiographs were re-evaluated and compared with
preoperative angiographs and dissection findings. By combining the findings of angiography and heart dissection, 122 (54.7%)
of the 223 patients were found to have some type of complication of the graft or the anastomosis. The diagnostic sensitivity
and specificity of postmortem angiography was 100% in assessing narrowing or twisting of the graft as well as narrowing of
the aortal anastomosis, whereas these findings were revealed with difficulty by autopsy dissection only. In cases with correct
x-ray projection, narrowing and occlusion of the proximal aortal and distal coronary anastomosis were also reliably revealed
by angiography. In contrast, graft thrombosis was clearly overdiagnosed by angiography, leading to a lower specificity (84%)
but high sensitivity (100%) in detecting this complication. Post-mortem angiography also failed to detect dissection of the
wall of the graft or anastomosis. Technical problems with this angiographic method were due to too low perfusion pressure,
too rapid polymerizing of the silicone rubber, leakage of contrast medium into the ventricles, or faulty x-ray projections.
These results suggest that our post-mortem angiographic technique, yielding a permanent rubber- cast model of the graft and
anastomosis site, improves the accuracy of diagnostics of postoperative CABG complications and eases postoperative autopsy
dissection, which can now be directed to confirm suspected complications.
Received: 27 October 1997 / Received in revised form: 2 July 1998 相似文献
9.
【摘要】 目的 研究右美托咪定靶控输注在冠状动脉搭桥术 (CABG) 中的作用。方法 纳入2015年1 月~2017年10月于我院行CABG治疗的94例冠心病患者,数字法随机分为观察组与对照组,每组各47例。两组均采用常规气管插管全麻,观察组在此基础上进行右美托咪定靶控输注,对照组输注等量生理盐水。将麻醉诱导前、麻醉后、插管前、插管后及插管后5min设为T0、T1、T2、T3、T4,比较各时间点两组动脉舒张压(DBP)、收缩压(SBP)、平均动脉压(MAP)、心率(HR)、HR与SBP乘积(RPP)以及手术时间、拔管时间、苏醒时间。结果 两组T0、T1、T2 HR、RPP比较差异均无统计学意义(P>005),T3、T4观察组HR低于对照组,差异具有统计学意义(P<005); 两组T0、T1、T2DBP、SBP、MAP比较差异均无统计学意义(P>005),T3、T4观察组DBP、SBP、MAP均低于对照组,差异具有统计学意义(P<005);两组手术时间比较差异无统计学意义(P>005);观察组苏醒时间、拔管时间低于对照组,差异具有统计学意义(P<005)。结论 冠心病冠状动脉搭桥术治疗运用右美托咪定靶控输注能够降低插管后血压与心率,即减轻气管插管时心血管反应及心肌耗氧。 相似文献
10.
目的 研究冠脉搭桥手术中 ,开放升主动脉时注入 1 0 0mg利多卡因是否有利于避免再灌注室颤。方法 将 30例CAD患者随机分成 2组 :利多卡因组 (L组 )和对照组 (C组 )。L组 1 5名患者于升主动脉开放前 1分钟给予 1 0 0mg利多卡因 ,对照组给予 5ml的生理盐水 ,通过swan—ganz导管监测全组病人麻醉诱导后以及脱离体外循环后的血流动力学指标。结果 ①L组的再灌注室颤的发生率 (1 7% )明显低于对照组 (5 8% )。 (P〈0 .0 5 )。②两组患者应用血管活性药物 ,没有明显差异。③与对照组比较利多卡因在脱离体外循环后心排量明显增加。 (P〈0 .0 1 )。结论 在开放升主动脉时注入利多卡因有利于防止再灌注室颤的发生 相似文献