Objective To study effects of mitral valve replacement(MVR) on the old with mitral valve diseases(MVD). Methods The documents of 265 cases undergoing MVR were reviewed, who aged 60 years old or over between June 1991 and June 2003. Demographices, clinical preoperative conditions, indications to surgery, early postoperative course and long-term outcome were collected via hospital documents and outpatient follow-up. Many risk factors were analysed. Results Follow-up rate amounted to 93.7%(236/252). The mortality was 4.9% (13/265) within 30 days. Heart failure and renal failure were the main cause of death. Compared with younger patients(lt;60 years old), long-term survival rate was lower in the old, 5-year 87.52% vs 96.84%, 10-year 81.23% vs 94.87%. There were 15 late deaths(0.17% case/M), most of whom died of heart failure, cancers and lung infections. Risk factors for MVR in the old included New York Heart Association class Ⅳ, diabetes, and lung incompetence. Conclusions The patients with MVD over 60 years old tended to present high postoperatively mortality and morbidity.
Objective To investigate the cognitive functions in people at high risk for schizophrenia.Methods Two hundred and twenty-two people at high risk for schizophrenia and 331 normal controls were assessed with 14 neuropsychological tests. Results The results of some neuropsychological tests in people at high risk for schizophrenia were worse than those in the normal controls. These tests included information, arithmetic, digital symbol, block design, logical memory, visual memory, Stroop test, verbal fluency, tower of Hanoi, WCST and CPT (Plt;0.01). The time for trail making test A in was longer in the group at high risk for schizophrenia than in the control group (Plt;0.05).Conclusion People at high risk for schizophrenia have general cognitive deficits. Attention and executive function may represent the genetic endophenotype for schizophrenia.
With the development of transcatheter aortic valve replacement, it has become the first-line treatment for elderly patients with aortic valve stenosis. A case of transcatheter aortic valve replacement in a patient at high risk of coronary artery occlusion was reported. The use of intravascular ultrasound to observe the spatial relationship between the coronary ostia and the valve was the characteristic of this case. This patient was an elderly male who was assessed as a high risk of acute coronary artery occlusion before transcatheter aortic valve replacement. After fully evaluation of the patient’s surgical risks\benefits, the strategy was formulated. Percutaneous coronary intervention was the first step. At the same time, intravascular ultrasound was used to observe the spatial relationship between the coronary ostia and the valve, and balloon was embedded for coronary protection. The procedure went smoothly.
【摘要】 目的 比较薤白联合阿司匹林或单用阿司匹林防治心脑血管事件的疗效。 方法 2007年1月〖CD3/5〗2009年9月就诊的188例高危患者纳入研究,随机分为实验组(89例)和对照组(99例)。两组均予口服阿司匹林0.1 g,1次/d。实验组同时给予口服薤白0.9 g,3次/d。观察两组患者血管事件的发生率和不良反应的发生情况。 结果 实验组血管总事件发生率为6.7%,对照组为19.2%,两组间差异有统计学意义(Plt;0.05);实验组脑梗死发生率为1.1%,对照组为9.1%,两组间差异有统计学意义(Plt;0.05)。两组短暂性脑缺血、心绞痛、心肌梗死的发生率比较,差异无统计学意义(Pgt;0.05)。两组皮下出血、血尿、黑便、恶心、腹痛等不良反应的发生率比较,差异无统计学意义(Pgt;0.05)。 结论 服用阿司匹林加薤白可显著降低高危患者心脑血管总事件发生率和脑梗死发生率,增加疗效,而不良反应没有显著增加。【Abstract】 Objective Compare the curative effect of cerebrovascular diseases event prevented with llium macrostemon and aspirin or only with aspirin. Methods Divide the outpatient patients into experimental group (89 patients) and control group (99 patients). Use 0.1 g aspirin for two groups with oral administration once per day. The experimental group is used with 0.9 g allium macrostemon with oral administration three times per day. Observe the generation rate and adverse reaction of vascular events in two groups of patients. Results The Total generation rate of vascular events in the experimental group is 6.7% and the control group is 19.2%,the differences were statistically significant (Plt;0.05); the cerebral infarction generation rate in the experimental group is 1.1% and in the control group is 9.1%,the differences were statistically significant (Plt;0.05). There is no significant difference (Pgt;0.05) in TIA, angina pectoris, myocardial infarction generation rate in two groups. There is no significant difference (Pgt;005) in adverse reaction generation rate of subcutaneous hemorrhage, hematuria, melena, nausea, bellyache. Conclusion Taking aspirin with llium macrostemon can significantly decrease total cardiovascular and cerebrovascular events generation rate and cerebral infarction generation rate in high risk patients, improve the curative effect and the adverse reaction has not been significantly increased.
Abstract： Objective To analyze clinical outcomes of intra-aortic balloon pump （IABP） application for high-risk patients before undergoing off-pump coronary artery bypass grafting （OPCAB）， and summarize our experience and weaning indications of IABP. Methods We retrospectively analyzed clinical data of 102 high-risk patients with coronary artery disease who underwent IABP implantation before OPCAB from January 2008 to July 2011 in Zhongshan Hospital of Fudan University. There were 71 male patients and 31 female patients with their average age of 63.0±8.2 years in this IABP group. We also chose another 100 patients without IABP implantation before undergoing OPCAB as the control group， including 55 male patients and 45 female patients with their average age of 64.1±9.5 years. Postoperative systolic arterial blood pressure （SABP）， mean arterial blood pressure （MABP）， mechanical ventilation time， length of intensive care unit（ICU） stay， morbidity， duration of IABP treatment and in-hospital mortality of two groups were compared. Left ventricular ejection fraction （LVEF） was evaluated with echocardiography 3 months after surgery. Results Postoperative SABP （95.3±12.2 mm Hg vs. 80.1±11.7 mm Hg；t=8.440， P=0.000） and MABP （78.9±13.5 mm Hg vs. 52.3±15.1 mm Hg； t=12.410， P=0.000） of the IABP group were significantly higher than those of the control group. Mechanical ventilation time， length of ICU stay and duration of inotropic support of the IABP group were significantly shorter than those of the control group. The incidence of ventricular arrhythmia， low cardiac output syndrome， perioperative myocardial infarction and dialysis-requiring acute kidney failure of the IABP group were significantly lower than those of the control group. In-hospital mortality of the IABP group was significantly lower than that of the control group ［5.9% （6/102） vs. 17.0% （17/100）， χ 2 =6.180， P=0.020］. Ninety-six patients in the IABP group and 83 patients in the control group were followed up for 3 months. Three months after surgery， echocardiography showed that LVEF of the IABP group was significantly higher than that of the control group（45.3%±12.0% vs. 39.1%±8.2%， t=3.950， P=0.000）. Conclusion Preoperative prophylactic IABP implantation and optimal timing of weaning from IABP support can not only significantly reduce surgical risk and improve surgical outcomes and postoperative recovery of high-risk patients undergoing OPCAB， but also considerably ameliorate patient heart function and reduce perioperative morbidity and mortality.
ObjectiveTo understand the advance in research of high risk factors and diagnosis in primary carci-noma of gallbladder. MethodsThe literatures at home and abroad during recent years were reviewed, and the research progress of high risk factors and inchoate diagnosis about primary gallbladder carcinoma were summarized. ResultsCholecystolithiasis, cholecystitis, and other factors have a certain correlation with primary gallbladder carcinoma.The rate of early diagnosis of primary gallbladder carcinoma can be enhanced through the detailed history taking and physical examination, supplemented by a variety of imaging examination methods, and molecular biological technologies. ConclusionIt can enhance the rate of early diagnosis of primary gallbladder carcinoma that understand the risk factors and master various methods for early diagnosis of carcinoma of gallbladder.
ObjectiveTo investigate the value of noninvasive positive pressure ventilation in patients with high risk of weaning induced pulmonary oedema.MethodsFrom June 2018 to June 2019, 63 patients with mechanical ventilation in the Department of Critical Care Medicine of the First Hospital of Lanzhou University were enrolled. Randomized digital table method was randomly divided into two groups and the resulting random number assignment was hidden in opaque envelopes, the experimental group received non-invasive positive pressure ventilation (n=32), and the control group received mask oxygen therapy ventilation (n=31). The heart rate, respiratory rate, means arterial pressure, hypoxemia, reintubation, blood gas analysis and other indicators were compared between the two groups after 2 hours of weaning. The length of hospital stay, mortality and complications were compared between the two groups.ResultsAfter 2 hours of weaning, the heart rate and respiratory rate were significantly lower in the non-invasive positive pressure ventilation group than in the mask group (P<0.05). There was no difference in mean arterial pressure between the two groups of patients, which was not statistically significant (P>0.05). The incidence of hypoxemia, laryngeal edema and reintubation in the noninvasive positive pressure ventilation group was significantly lower than that in the mask group, which was statistically significant (P<0.05), and the blood gas analysis index was better than the mask group (P<0.05). The non-invasive positive pressure ventilation group was significantly shorter than the mask group in the length of hospital stay and intensive care unit (P<0.05). The hospital mortality rate in 28 days was lower than that in the mask group (P<0.05), but there was no difference in tracheotomy, pneumothorax and subcutaneous emphysema between the two groups (P>0.05).ConclusionsNoninvasive positive pressure ventilation can effectively prevent hypoxemia, laryngeal edema, and re-intubation in patients at high risk of withdrawal related pulmonary edema. It can also shorten the length of hospital stay, which is worth clinical attention and promotion.
ObjectiveTo investigate the diagnosis and classification of chronic obstructive pulmonary disease (COPD) in high risk populations living in metropolitan communities of Beijing. MethodsDuring January 2011 to December 2012,a cross-sectional survey including questionnaires and pulmonary function tests were performed in high risk populations of COPD (aged≥40 years with a history of smoking or chronic bronchitis) at 6 communities in Dongcheng District of Beijing. For those confirmed to have COPD,the dyspnea was rated by the modified Medical Research Council Dyspnea Scale (mMRC),and the frequency of acute exacerbations in the last year was recorded. The patients were classified by the Global Initiative for Chronic Obstructive Lung Disease (GOLD 2011) classification criteria. ResultsA total of 932 individuals,including 689 males (73.9%,aged 60.8±12.5 years) and 243 females(26.1%,aged 59.8±12.1 years),who had risk factors of COPD were included in the screening. COPD was confirmed in 203 patients,with the prevalence of 21.8%,and among whom only 31 cases (15.3%) had been diagnosed as COPD in the past. According to the revised GOLD classification in 2011,96(47.2%),38(18.7%),56(27.5%),and 13(6.4%) patients were classified into group A,B,C and D,respectively. The proportion of subgroup C1 (FEV1%pred <50% and the number of exacerbation in the last year <2) in group C was 71.4% (40/56). ConclusionIn the metropolitan communities of Beijing,screening the population with predisposing factors can increase the early diagnosis of COPD,which is often delayed by the lack of significant symptoms. The high proportion of patients in group C in this population implies that disease screening in high risk populations may be helpful for the prevention and treatment of COPD.
Objective To identify the high risk factors related to postpartum suicide. Methods A total of 40 women with postpartum depression who had suicidal act or ideation were included in the study. They were evaluated by the Edinburgh Postpartum Depression Scale (EPDS), the Life Events Scale (LES) and the Social Support Rate Scale (SSRS), and compared with healthy postpartum women. The multi-element gradual regression analysis was performed to identify the high risk factors. Results Such factors as prior history of depression, negative life events within the previous half year, absence of social support, disease of mothers or infants, and conjugal relationship were significantly correlated with postpartum suicide. Conclusion It might be helpful to reduce the incidence of postpartum suicide by prenatal mental intervention and postpartum crisis intervention.
ObjectivesTo classify the high risk population for primary liver cancer (PLC) in rural China.MethodsBetween June 2011 and June 2013, hepatitis B surface antigen (HBsAg) carriers were identified in clinical laboratory of Qidong People’s Hospital and surveyed by questionnaires. Cox proportional hazard regression model was introduced to demonstrate independent risk factors associated with PLC occurrence. Moreover, receiver characteristic operating (ROC) curve was utilized to evaluate discrimination power of risk factor panel for PLC risk classification.ResultsA total of 1 296 HBsAg carriers were enrolled, among which 686 participants were male with an average age of 45.73±11.58 years, and 610 participants were female with an average age of 45.67±12.33 years. After a mean follow up period of 5.5 years, 43 incident PLC cases were confirmed, which generated a PLC incidence of 60.5 millions person years. Multi-univariate Cox model showed that increase of age (HR=1.055, 95%CI 1.029 to 1.083, P<0.000 1), male (HR=3.263, 95%CI 1.567 to 6.796,P=0.001 6), having family history of PLC (HR=2.315, 95%CI 1.260 to 4.252, P=0.006 8), HBeAg positivity (HR=2.367, 95%CI 1.267 to 4.419, P=0.006 9) and GGT abnormality (HR=2.721, 95%CI 1.457 to 5.083, P=0.001 7) were the independent risk factors of PLC.ConclusionRoutine host, viral and liver biochemical parameters which are readily accessible in daily clinical practice can be utilized in identification of the targeted population for prevention of PLC in rural China.