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Background@#The aortic arch replacement and cardiopulmonary bypass (CPB) are both associated with the early mortality after cardiothoracic surgery. This study aimed to investigate the relationship between CPB time and 90-day post-operative mortality in patients undergoing aortic arch surgery using the frozen elephant trunk (FET) technique with selective ante-grade cerebral perfusion (SACP).@*Methods@#We retrospectively reviewed data of 377 adult patients undergoing aortic arch surgery via FET with SACP from July 1, 2017 to December 31, 2018 at Beijing Anzhen Hospital. The baseline characteristics, intra-operative data, and post-operative data were collected. Univariate and multivariate Cox regression analyses were used to determine independent predictors of 90-day postoperative mortality.@*Results@#The 90-day post-operative mortality was 13.53%. The 78.51% of patients were men. There were 318 (84.35%) type A aortic dissections and 28 (7.43%) aortic aneurysms. Among those, 264 (70.03%) were emergency operations. Median CPB time was 202.0 (176.0, 227.0) min. Multivariate Cox regression analysis revealed that CPB time was independently associated with 90-day post-operative mortality after adjusting confounding factors (hazard ratio: 1.21/10 min increase in CPB time, 95% confidence interval: 1.15–1.27, P < 0.001). Kaplan-Meier analysis based on CPB time tertiles revealed that the top tertile (median 236.0 min) was associated with reduced survival rate compared with middle and bottom tertiles (P < 0.001). Each sub-group analysis based on the complexity of the underlying disease process showed similar associations between CPB time and 90-day post-operative mortality.@*Conclusions@#CPB time remains a significant factor in determining 90-day post-operative mortality in patients undergoing aortic arch surgery using FET with SACP. Surgeons should be aware of the relationship between CPB time and 90-day post-operative mortality during operative procedures and avoid extended CPB time as far as possible.
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Objective To evaluate the feasibility and safety of Sun's procedure for Stanford A type aortic dissection through single upperhemisternotomy approach ( from the Strernal Notch to the level of fourth intercostal space ) .Methods 58 patients(39 male and 19 female) with Stanford A type aortic dissection were retrospective for this study, who were(46.3 ±9. 5) years old.Sun's prcedure were carried out through single upperhemisternotomy approach and the perioperative characteris-tics were recorded.Results All patients were finished Sun's procedure through single upperhemisternotomy approach, with 5.2％ of mortality(3 patients died postoperation).The time of cardiopulmonary bypass, aortic cross clamp and circulation ar-rest were respectively(181.6 ±25.5)min,(114.2 ±19.8)min and(29.0 ±5.8)min.Non serious adverse event were found after 2 to 15 months follow-up.Conclusion Sun's procedure through single upperhemisternotomy approach was one of the safe and feasible treatment for Stanford A type aortic dissection , which can reduce the operative wound and improve the patients ' satisfactory.
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Objective To explore the curative effect of optimized selective arterial perfusion approach in the total aortic arch replacement of the Stanford type A aortic dissection. Methods From Sep. 2016 to Oct. 2017, 31 Stanford A aortic dissection patients received total aortic arch replacement with cardiopulmonary bypass of optimized selective arterial perfusion approach (O-CPB group, 25 males and 6 females, aged [50.87±9.08] years old) in our hospital. And 60 Stanford A aortic dissection patients, who underwent total aortic arch replacement with cardiopulmonary bypass of traditional approach in our hospital from Jan. 2015 to Oct. 2017, were included as control (T-CPB group, 52 males and 8 females, aged [48.38±12.46] years old). The perioperative blood biochemistry parameters and clinical data were compared between the two groups. Multivariate logistic regression was used to analyze the risk factors for postoperative 30-day mortality. Results Compared with the T-CPB group, the O-CPB group had significantly shorter extracorporeal circulation time, circulatory arrest time and operation time ([206.90±39.92] min vs [276.37±29.92] min, [5.03±1.54] min vs [21.73±6.67] min and [396.68±58.57] min vs [469.28±69.77] min, all P0.01). The blood consumption volume and ICU detention time were significantly less in the O-CPB group versus the T-CPB group ([1 401±738] mL vs [1 705±580] mL and [5.94±2.45] d vs [7.42±3.53] d, both P0.05). The postoperative blood lactate and C-reactive protein concentrations in the O-CPB group were significantly lower than those in the T-CPB group ([6.10±3.80] mmol/L vs [8.11±4.51] mmol/L and [72.13±22.86] mg/L vs [84.78±17.07] mg/L; P0.05, P0.01). The patients in the O-CPB group were awake earlier than those in the T-CPB group ([3.32±1.11] h vs [4.14±1.59] h, P0.05). The absolute value of postoperative Richmond agitation-sedation scale (RASS) score of the O-CPB and T-CPB groups were 1.23±1.06 and 2.15±1.30, respectively, and the difference was statistically significant (P0.01). In O-CPB group, the oxygenation index was significantly higher and mechanical ventilation time was significantly shorter versus the T-CPB group ([234.42±79.51] mmHg vs [183.10±77.26] mmHg and [50.19±37.63] h vs [70.12±40.84] h; P0.01, P0.05; 1 mmHg＝0.133 kPa). There was no significant difference in the postoperative 30-day mortality rate between the O-CPB and T-CPB groups (6.45% [2/31] vs 11.67% [7/60], P0.05). Multivariate logistic regression showed that circulatory arrest time≥31 min and blood consumption volume≥1 390 mL were independent risk factors of postoperative 30-day mortality of Stanford A aortic dissection patients undergoing total aortic arch replacement, with OR (95% CI) being 1.517 (1.153-1.995) and 1.006 (1.002-1.010), respectively. Conclusion With bilateral antegrade selective cerebral perfusion and moderate hypothermia perfusion in lower body, the optimized selective arterial perfusion approach needs shorter circulatory arrest time, and less blood consumption compared with cardiopulmonary bypass of traditional approach. Moreover, it has a good protective effect on the brain and lung during total aortic arch replacement of Stanford type A aortic dissection.
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OBJECTIVE:To investigate the clinical efficacy and safety of amoxicillin sodium and clavulanate potassium com-bined with cranial mild-moderate hypothermia in the treatment of neonatal hypoxic-ischemic encephalopathy (HIE) complicating with pulmonary infection. METHODS:80 children with HIE complicating with pulmonary infection were randomly divided into ob-servation group(42 cases)and control group(38 cases). Control group received routine treatment under normal body temperature as lowering intracranial pressure,correcting acid-base balance,giving nutritional support and anticonvulsive treatment,and then was given amoxicillin sodium and clavulanate potassium 30 mg/kg intravenously,tid,more than 30 min each time,for consecutive 3 d. On the basis of control group,observation group was additionally given cranial mild-moderate hypothermia therapy:wearing cooling cap,at 10 ℃;keeping pharynx nasalis temperature at 34 ℃;keeping rectal temperature at 33-37 ℃;decreasing at rate of 1 ℃/h. They continued treatment for 3 d till body temperature decreased to 34.5 ℃;and then cooling cap was taken off to recover normal body temperature. Therapeutic efficacy of HIE and pulmonary infection were observed in 2 groups. NBNA score of 2 groups were recorded 1st,2nd and 4th week after birth,and the occurrence of ADR was observed. RESULTS:Total effective rate of HIE therapy (95.24% vs. 78.95%),cure rate of pulmonary infection (52.38% vs. 26.32%) and total effective rate (85.71% vs. 65.79%) in observation group were significantly higher than control group,with statistical significance (P0.05). Compared to 1st week after birth,NBNA score were significantly improved 2nd and 4th week after birth,and the observation group were significantly higher than the control group,with statistical significance(P0.05). CONCLUSIONS:Amoxicillin sodium and clavulanate potassium combined with cranial mild-moderate hypothermia is effec-tive for HIE complicating with pulmonary infection,and can effectively improve the prognosis of children with good safety.
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Objective To explore the effect of moderate hypothermia (MH) in liver ischemiareperfusion (IR) injury.Methods Male BALB/c mice (8 weeks old,n =15) were randomly divided into three groups:IR group:five mice subjected to 70％ hepatic IR (hepatic vascular triad above the bifurcation occlusion for 35 min before 24 h reperfusion) in normal temperature condition (37 ±0.5 ℃);MH + IR group:five mice were treated with MH (32 ±0.5 ℃) for 2 h before 70％ hepatic IR was performed;sham group:the other five mice were subjected to laparotomy and liver manipulations without vascular occlusion.AST and ALT in plasma were detected in all mice,and the morphological changes,cell apoptosis and the cold-inducible RNA-binding protein (CIRP) expression after MH in liver tissues were detected.Results Compared with IR group,the ALT and AST levels in MH + IR group were significantly decreased.In IR group,the liver morphology deteriorated with more severe hydropic degeneration and more cell apoptosis.In MH + IR group,the expression of CIRP began to increase after MH preconditioning.Conclusion MH preconditioning could protect against the liver ischemia-reperfusion injury.
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New guideline for the acute medical management of severe traumatic brain injury in infants,children,and adolescents was published in Pediatric Critical Care Medicine in 2012.This guideline made relevant recommendations and suggestions on intracranial pressure monitoring,threshold for treatment of intracranial hypertension,cerebral perfusion pressure thresholds,advanced neuromonitoring,neuroimaging and therapy for intracranial hypertension in pediatric patients with severe traumatic brain injury.This guideline was simply interpretated in order to improve the treatment of severe traumatic brain injury.
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Objective To study clinical effect of moderate hypothennia treatment in patients with cardiac arrest survivors and search a practical monitoring way during moderate hypothennia treatment. Method A total of 40 patients of CPR following the restoration of spontaneous circulation were randomly divided into the hypothermia therapy group ( n= 20) and the routine therapy group ( n= 20), the clinical effect on patient followed for three months is evaluated. At the same time regional cerebral oxygen saturation (rSO2) was detected at different times after moderate hypothennia treatment in two groups. Results The recovery rate were higher and the mutilation rate was lower in hypothermia therapy group than that of the routine therapy group. rSO2 obviously increased after 12 hours of hypothermic treatment, and continuing kept stable level after 24 hours of hypothermic treatment, but it was also higher than routine therapy group (P＜0.01). Conclusions Moderate hypothermia can alleviate the metabolic disorder of the brain tissue and improve the prognosis in patients with cardiac arrest survivors. Noninvasire continuously monitoring of rSO2 has important significance for instructing moderate hypothermia treatment in clinic.
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Objective To study the effect of hypothemah on the early inflammatory reaction in acute lung injury induced by intestinal ischemia-repeffusion(IlR)in rabbits.Method Seventy-two healthy rabbits provided by Peking Union Medical Colege Hospital Anhnal center were randomly divided into four groups(n=18 pergroup):(1)normothermia control group (rectal temperature 37-38 C;sham group);(2)normothermia IlR group(rectal temperature 37-38 C);(3)mild hypothermia HR group(rectal temperature 32-35℃);and (4)moderate hypothermia IIR group(rectal temperature 28-31.9C).Acute lung injury was induced by claIllp.ithe superiornteric artery(SMA)for 1 hour and declamping the SMA for 6 hours.Hypothermia WaS induced by surface cooling.Before and 2.4 and 6 hours after IIR,the Olasmlevels o,IL-,IL-6 and IL10 were measured.All rabbits were killed 6 hours after IIR and water content in lung tissue Wttk'assessed.Iaght mieropic examination was performed tbr morphological assessment of the hmg.The data were analyzed by AN()VA.Statistical significance wag dned as a P of<0.05.Results In the IIR groups,the plasma levels ofTHE-a.IL-l,IL-6 and IL-10 and lung water were increased.There Was evidence of acute lung injury from morphologi-cal assessment of the lung.The acute lung injury induced by IIR was improved by hypethennia.Mild hypothermia Was similar to moderate hypothermia for the treatment of acute lung injury induced by IIR.ConclusiotMild hy-pothermia and moderate hypothermia Can significantly improve acute lung injury induced by IIR in rabbits.Mild hypothea had similar efficacy to moderate hypothermia for the treatment of acute lung injury induced by IIR.
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@#ObjectiveTo demonstrate the effect of moderate hypothermia and doule carotid ice applied to acute intracerebral hemorrhage (ICH) and the best opportunity of treatment.Methods174 cases with ICH were randomly divided into treated group and control group, 87 cases for each group. Each case of both groups was treated by routine therapy, moreover, all cases in treated group were treated by moderate hypothermia (MHT).The clinical effect and prognosis between treated group and control group were contrasted,so to do between the cases in the treated group who were treated no more than 3 hours and more than 3 hours after attack.ResultsCompared with the control group, the neurological function improved in the treated group(P<0.05), as well as survival rate and recovery(P<0.05).Cases who treated no more than 3 hours after attack was better than that of more than 3 hours(P<0.05).ConclusionModerate hypothermia can effectively ease the neurologic deficits after ICH, decrease mortality and disable rate.The best therapy time is within 3 hours after ICH.
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Objective:To investigate the effect of moderatehy pothermia on tumor necrosis factor alpha(TNF-?),interleukin-6(IL-6) and intedeukin-8(IL-8)in cerebrospinal fluid(CSF)of patients with severe traumatic brain injury(STBI)and its clinical significance.Methods:Forty patients with severe traumatic brain injury were randomly divided into hypothermic group and control group.Inclusion criteria included Glasgow Coma Scale(GCS)score ≤8 and time of after injury to on admission must be within 6 hours.TNF-?,IL-6,IL-8concentrations of CSF were tested before and after hypothermic therapy by radioimmunoassay.Results:Levels of serum TNF-?,IL-6 and IL-8 were decreased more significantly in the moderate hypothermia group than the control group(P
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Objective To demonstrate the moderate hypothermia's effect to acute cerebrovascular disease.Methods 82 prospective patients with acute cerebrovascular disease treated by moderate hypothermia were evaluated.According to the standard of clinical neurologic deficiency ,we contrasted the clinical and laboratory effect of control before moderate hypothermia and after moderate hypothermia. Results The neurologic function and SOD improved obviously; NO,ICAM-1,IL-1 and temperature decreased after moderate hypothermic therapy;patients'survival rate and recovery rate improved obviously too.The best therapy time was within 2h after acute cerebrevascular disease happened. Conclusions Moderate hypothermia can improve heal rate of brain damage and decrease mortality and disable rate.
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Objective To study the correlation between the expression of intercellular adhesion molecule 1(ICAM 1) and leukocyte infiltration, and explore the effects of mild hypothermia.Methods ICAM 1 positive expression and leukocyte infiltration in the ischemic regions were determined using immunohistochemitry and histological HE staining techniques at different reperfusion time(2 h,8 h,24 h,48 h and 72 h) after middle cerebral artery occlusion (MCAO) for 3h in rats, and mild hypothermia was given after MCAO followed by 24h reperfusion.Results (1)The expression of ICAM 1 raised obviously 2h after cerebral ischemia reperfusion, and peaked at 24h ( P