[Investigations of influential factors of acute renal injury after coronary artery bypass grafting].

OBJECTIVE: To investigate the incidence, correlate factors and effect on convalescent of acute kidney injury (AKI) after coronary artery bypass grafting (CABG). METHODS: Sixty-eight consecutive patients who underwent scheduled CABG were included. AKI was diagnosed according to the diagnostic criteria from expert group of AKI. The patients were divided into AKI group with AKI and control group without AKI. Difference of clinic features was contrasted between the two groups. And multivariable logistic regression modeling was used to identify the risk factors of AKI. RESULTS: AKI occurred in 27.94% patients (19/68). There was significant difference between the two groups in gender, hypertension, hyperlipemia, number of grafts, the duration of mechanic ventilation, the time of ICU and the length of stay post operation. Hypertension(Wald 3.27, P=0.07, 95% CI 0.85-53.59), number of grafts(Wald 7.67, P=0.01, 95%CI 1.48-9.73), the duration of mechanic ventilation(Wald 4.94, P=0.03, 95%CI 1.00-1.18) were risk factors of AKI in multivariable logistic regression modeling. CONCLUSION: The incidence of AKI was high (27.94%). Female, hypertension, hyperlipemia, number of grafts, the duration of mechanic ventilation were risk factors in monovariance analysis, and AKI may increase the time of ICU and the length of stay post operation. Hypertension, number of grafts, duration of mechanic ventilation were independent risk factors of AKI in multivariable logistic regression model.

[Treatment of a case of Kawasaki's disease complicated with myocardial infarction].

Coronary artery by-pass graft (CABG) and ventricular aneurysmectomy were done for a 2.5 years old girl with Kawasaki's disease complicated by myocardial ischemia and old myocardial infarction, left ventricular aneurysm formation and heart failure. Post-operatively, the cardiac out-put of the patient increased, the heart failure syndrome disappeared, and cardiac function improved to class I(NYHA) one month later. In the 6-year follow-up, the patient kept her heart function at class I, and had normal growth and development. Coronary artery by-pass graft is an effective therapeutic strategy for childhood myocardial ischemia, and attention should be paid to some special considerations.

[Impact of intraoperative autotransfusion on RBC's in vivo half-life].

OBJECTIVE: To explore the changes of in vivo half-life of processed erythrocytes following intraoperative autotransfusion(IAT) in off-pump coronary artery bypass grafting(CABG). METHODS: From November 2003 to January 2004,20 consecutive patients undergoing scheduled off-pump CABG were randomly divided into experimental group and control group. Intra-operative autotransfusion was used in the experimental group. The samples were drawn immediately after the saving procedure in the experimental group and immediately after anesthesia introduction through central venous catheter in the control group. A single isotope technique ((51)Cr) was used to determine in vivo half-life of the RBCs in the two groups. RESULTS: There was no significant difference in in vivo half-life between the two groups. CONCLUSION: The in vivo half life of processed erythrocytes following intraoperative autotransfusion ZITI-3000 Cell saving system has not changed significantly in off-pump CABG.

[Clinical application of intro-aortic balloon pump and centrifugal pump in low cardiac output syndrome after coronary artery bypass grafting].

OBJECTIVE: To explore the clinical application of Intra-aortic balloon pump (IABP) and centrifugal pump in low cardiac output syndrome (LCOS) after coronary artery bypass grafting (CABG). METHODS: From April 2000 to January 2004, 5 patients suffered serious LCOS after CABG in our department. Because maximum vasoactive agent had no significant effect, we supported these 5 patients with IABP and centrifugal pumps. The centrifugal pumps were connected with cannulas of right superior pulmonary vein and ascending aorta. The flow rate of the centrifugal pumps were increased to 3-4 L/min gradually. The dosage of vasoactive agent and flow rate of the centrifugal pumps were decreased gradually after hemodynamics stabilized. RESULTS: All 5 patients' hemodynamics were improved significantly after the left ventricular assist by IABP and centrifugal pumps. Five patients were weaned from the centrifugal pumps after 4 to 7 days successfully. But some degree damage to blood cells and renal function were detected. Renal function of 3 patients were recovered gradually after centrifugal pumps removed and discharged successfully, One patient died of acute renal failure, 1 patient died of multiple organ failure, 5 patients need transfusion of whole blood or concentrated erythrocytes and 4 patients need transfusion of platelets. CONCLUSIONS: There were significant improvements in hemodynamics after support with IABP and centrifugal pumps in the patients who suffered serious LCOS with less effect of maximum vasoactive agent after CABG. Some complications on blood cells and renal function should be paid more attention.