RESUMO
BACKGROUND: This study aimed to evaluate the short-term and long-term outcomes of dialysis and non-dialysis patients after On-pump beating-heart coronary artery bypass grafting (OPBH-CABG). METHODS: We retrospectively reviewed medical records of 659 patients underwent OPBH-CABG at our hospital from 2009 to 2019, including 549 non-dialysis patients and 110 dialysis patients. Outcomes were in-hospital mortality, length of stay, surgical complications, post-CABG reintervention, and late mortality. The median follow-up was 3.88 years in non-dialysis patients and 2.24 years in dialysis patients. Propensity matching analysis was performed. RESULTS: After 1:1 matching, dialysis patients had significantly longer length of stay (14 (11-18) vs. 12 (10-15), p = 0.016), higher rates of myocardial infarction (16.85% vs. 6.74%, p = 0.037) and late mortality (25.93% vs. 9.4%, p = 0.005) after CABG compared to non-dialysis patients. No significant differences were observed in in-hospital mortality, complications, or post-CABG reintervention rate between dialysis and non-dialysis groups. CONCLUSIONS: OPBH-CABG could achieve comparable surgical mortality, surgical complication rates, and long-term revascularization in dialysis patients as those in non-dialysis patients. The results show that OPBH-CABG is a safe and effective surgical option for dialysis patients.
Assuntos
Ponte de Artéria Coronária , Doença da Artéria Coronariana , Mortalidade Hospitalar , Complicações Pós-Operatórias , Diálise Renal , Humanos , Masculino , Feminino , Estudos Retrospectivos , Pessoa de Meia-Idade , Ponte de Artéria Coronária/métodos , Ponte de Artéria Coronária/mortalidade , Idoso , Doença da Artéria Coronariana/cirurgia , Doença da Artéria Coronariana/mortalidade , Doença da Artéria Coronariana/complicações , Complicações Pós-Operatórias/epidemiologia , Resultado do Tratamento , Tempo de Internação/estatística & dados numéricos , Fatores de TempoRESUMO
BACKGROUND: Modified Nutrition Risk in the Critically Ill (m-NUTRIC) score is used to evaluate the nutritional risk of patients in intensive care units (ICUs). This study aimed to investigate whether m-NUTRIC can be used as a predictive factor related to the outcome of patients in surgical ICU (SICU) and to identify which patients will benefit from aggressive nutritional intervention according to the results of m-NUTRIC score. METHODS: A total of 205 patients who were admitted to surgical ICU (SICU) with ventilator use for more than 24 hours were enrolled. The m-NUTRIC score data were calculated the day when the patients were admitted to SICU. Patients were divided into two groups according to their m-NUTRIC score: the low-risk group (<5 points, 116 patients) and the high risk group (≥5 points, 89 patients). RESULTS: In this study, a total of 205 patients were enrolled for analysis, including patients in the low-risk group (n = 116) and those in the high risk group (n = 89). The mean duration of ventilator use was 3.6 ± 6.5 days, and average SICU stays for all patients was 5.1 ± 7.4 days. The SICU mortality was significantly higher in the high-risk group (10.3% vs 1.7%). Comparison between survivals and nonsurvivals was carried out, and the data showed that the AKI, Vasopressors, SOFA, APACHE-II, m-NUTRIC score, and shock patient were all significantly associated with higher mortality. The multivariate analysis revealed that acute kidney injury (OR = 13.16; 95% confidence intervals = 3.69-46.92; p < 0.0001) and m-NUTRIC score were independent factors of ICU mortality in these patients. A receiver operating characteristic curve was used to calculate the area under the curve, which was 0.801. The data indicated that high m-NUTRIC score were significantly associated with SICU mortality with the cutoff score > 4 (sensitivity = 90.5%, specificity = 62.3%, p < 0.001). CONCLUSION: We found in this study that the high m-NUTRIC score is an independent factor of ICU mortality, and m-NUTRIC score can be used as an initial screening tool for nutritional assessment in patients admitted to surgical ICU. Further investigations to evaluate whether the aggressive nutritional intervention would be beneficial in the SICU patients with higher m-NUTRIC score is mandatory.
Assuntos
Cirurgia Geral , Unidades de Terapia Intensiva , Desnutrição/prevenção & controle , Avaliação Nutricional , Medição de Risco/métodos , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Complications associated with upper gastrointestinal (UGI) endoscopy are uncommon, and rarely involve those of cardiovascular nature. We report herein a unique case of spontaneous superior mesenteric artery dissection (SMAD) after UGI pandenoscopy. CASE SUMMARY: A 45-year-old man who had previously undergone UGI panendoscopy and colonoscopy during a voluntary health check-up at our facility was admitted to the emergency room (ER) at the same facility due to persistent epigastric pain with radiation to the back. At the ER, the patient did not present notable abnormalities upon physical, conscious, or laboratory examinations apart from mild tenderness in the epigastric abdomen. Acute abdominal aortic dissection was suspected, and abdominal contrast-enhanced computed tomography confirmed SMAD. He was then transferred to the cardiovascular ward and treated conservatively with fasting, prostaglandin E1, and aspirin. The patient recovered and returned home soon after, and was symptom-free 6 months after discharge from the facility. CONCLUSION: SMAD after UGI panendoscopic procedure is a previously unreported complication. Awareness of this complication and associated sequela is warranted.
RESUMO
Gastroduodenal artery (GDA) aneurysms are rare but lethal conditions when ruptures develop. Most common clinical presentation are gastrointestinal hemorrhage and abdominal pain. Obstructive jaundice is unusual. Computed tomography and angiography are useful tools for diagnosis and treatment plan. Any GDA aneurysm should be considered for definitive treatment. Recently, endovascular intervention has gained popularity for its safety and efficacy. Here, we described a patient of GDA pseudoaneurysm presented with generalized jaundice and was treated successfully with endovascular intervention.