[Rational control on postoperative blood glucose levels in infants with congenital heart disease].

OBJECTIVE: To investigate optimal level of post-operation blood glucose control in infants with congenital heart disease (CHD). METHODS: One hundred and two infants ≤1 year old undergoing open-heart surgery were randomly divided into three groups: intensive blood glucose control group (group A, n = 35), active blood glucose control group (group B, n = 38), and common glucose control group (group C, n = 29). Insulin injection would be intravenously administrated when blood glucose levels up to 8.3, 15.0, and 18.0 mmol/L in group A, B, and C, respectively. Blood white blood count (WBC), C-reactive protein (CRP), lactic acid, alanine aminotransferase (ALT), creatinine (Cr), incidence of pulmonary infection, the length of intensive care unit (ICU) stay, incidence of hypoglycemia and mortality were compared at 72 hours after operation among three groups. RESULTS: WBC [×10(9)/L], CRP (mg/L) and incidence of pulmonary infection in group C were significantly higher than those in group A and group B (WBC: 18.2 ± 8.7 vs. 13.2 ± 5.1, 14.5 ± 5.7; CRP: 32.9 ± 10.9 vs. 20.8 ± 9.8, 18.6 ± 8.5; incidence of pulmonary infection: 27.6% vs. 8.6%, 10.5%, all P < 0.05), but there were no statistical differences between group A and group B. ALT (U/L) in group B was significantly lower than that in group A and group C (49.0 ± 17.8 vs. 68.4 ± 16.9, 69.9 ± 13.8, both P < 0.05), but there was no statistical difference between group A and group C. Incidence of hypoglycemia in group A was significantly higher than that in group B and group C (20.0% vs. 2.6%, 3.4%, both P < 0.05), but there was no statistical difference between group B and group C. There were no statistical differences in lactic acid (mmol/L), Cr (µmol/L) and the length of ICU stay (days) among group A, B, and C (lactic acid: 2.1 ± 0.8, 2.3 ± 0.5, 2.2 ± 0.7; Cr: 55.1 ± 13.4, 49.4 ± 15.7, 57.3 ± 11.6; the length of ICU stay: 3.5 ± 1.8, 3.2 ± 1.1, 3.6 ± 1.6, all P>0.05). There was no infant death in three groups. CONCLUSIONS: Severe hyperglycemia after open heart operation was associated with increasing WBC count, CRP level and incidence of pulmonary infection during the post operative period. However, it also demonstrated that intensive blood glucose control be link to increase risks of hypoglycemia and liver dysfunction.

[Clinical study on value of severity of patient with coronary artery disease evaluated with the thrombosis in myocardial infarction risk score].

OBJECTIVE: To explore the value of severity evaluating and outcome predicting on coronary artery disease (CAD) patients scored with the thrombosis in myocardial infarction (TIMI) risk score. METHODS: All of 126 patients with CAD were enrolled in study. TIMI risk score and coronary artery angiographic in them were performed respectively. Correlativity between TIMI risk score and clinical type of CAD, narrow severity, pathological changes limits and character of coronary artery were analyzed. Difference of scores of TIMI, narrow severity, pathological changes limits and character of coronary artery were compared among stable angina (SA), unstable angina (UA), un-ST-segment elevation myocardial infarction (NSTEMI) and ST-segment elevation myocardial infarction (STEMI) respectively. RESULTS: TIMI risk score significantly correlated with clinical type of CAD score, narrow severity score, pathological changes limits and character scores of coronary artery respectively (r=0.607 for narrow severity score, 0.569 for pathological changes limits score, 0.367 for pathological changes character score, all P<0.05). TIMI risk score increased company with severity of coronary artery pathological changes advancing. Significantly differences were found when TIMI risk scores were compared between SA and UA, NSTEMI and STEMI respectively as well as narrow severity scores (all P<0.05). Same RESULTS: were found between UA and NSTEMI, STEMI respectively (all P<0.05). There had no significantly difference among pathological changes limits scores of SA, UA, NSTEMI, STEMI (all P>0.05). Significantly difference was found when pathological changes character scores were compared between SA and UA, NSTEMI, STEMI respectively as well as narrow severity scores (P<0.05), but contrary RESULTS: were found between UA and NSTEMI, STEMI respectively (P>0.05). CONCLUSION: TIMI risk score not only could be used to predict the possibility of heart accident, but also could be used to evaluate clinical type of CAD, narrow severity, pathological changes limits and character of coronary artery in CAD patient.

[Study of acute physiology and chronic health evaluation III and multiple organ dysfunction syndrome score in evaluating severity of intensive care units patient].

OBJECTIVE: To evaluate the value of acute physiology and chronic health evaluation(APACHE)III and multiple organ dysfunction syndrome(MODS) score introduced to evaluate the severity of intensive care unit(ICU) patient. METHODS: Seventy of ICU patients were scored by APACHE III and MODS scoring system respectively after admission for 24 hours. Area under of the receiver operating characteristic curve(ROC) was used to scale the ability of APACHE III and MODS scoring systems evaluating severity and predicting outcomes of ICU patient. The areas were compared among APACHE III, MODS and the score of APACHE III adding MODS. Discriminant was built between the scores and outcomes of patient, and coefficients were compared among the three scoring systems. RESULTS: The areas under of the ROC of APACHE III, MODS and the score of APACHE III adding MODS were 0.765, 0.643 and 0.753 respectively; coefficients of discriminant of them were 0.998, 0.892 and 0.568 respectively. CONCLUSION: APACHE III is superior to MODS scoring system in evaluating severity of ICU patient, and APACHE III add MODS score can't increase the evaluating effectiveness compared to APACHE III and MODS score respectively in evaluating severity of ICU patient.