Dissertation
Dissertation > Medicine, health > Surgery > Of surgery > Cardiovascular and lymphatic system surgery > Heart

The Investigation of Perioperative Myocardial Protection in Elderly Patients with Coronary Heart Disease

Author LiZuo
Tutor ZhengHong
School Xinjiang Medical University
Course Anesthesiology
Keywords Coronary artery bypass grafting Biochemical injury markers MBfraction of creatine kinase Troponin ICoronary heart disease Heme oxygenase-1 Perioperative cardiovascularevent Non-cardiac surgery
CLC R654.2
Type Master's thesis
Year 2012
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Objective: It is uncertain of the association between cardiac biomarker release andprognosis of mortality after coronary artery bypass grafting (CABG)in elder patients.We performed a systematic search to find articles regarding these markers and death afterCABG, and evaluated the results with meta-analysis. Methods: We electronicallysearched CBM-disc、Ovid、Pubmed、Ovid、EMBase、Medline.CD Ram、CNKI.Thissearch was published before Augest2011.Manual searching were also performed. Studyselection and meta-analysis were conducted which according to the Cochrane Handbookfor systematic reviews. Date were extracted from these trials by2reviewersindependently and analyzed by RevMan5.0software. Results:10observational studiesconcerning with that reported the MB fraction of creatine kinase (CK-MB) and troponin I(cTnI) for meta analysis. The increasing release of CK-MB is associated with anincreased risk of the short-term mortality(RR=3.22,95%CI=1.99-5.21,P<0.1) andlong-term mortality (RR=2.90,95%CI=2.07-4.08,P<0.1);Troponin I might serve asbetter predictors as CK-MB in short-term mortality(RR=6.45,95%CI=2.50-16.66,P<0.1) and long-term mortality(RR=4.18,95%CI=2.78-6.28,P<0.1).Conclusion:The data of the CK-MB studies suggest that after coronary artery bypass grafting,theincreasing release of CK-MB is associated with an increased risk of the short-termmortality and long-term mortality;Troponin I might serve as a better predictor inshort-term mortality and long-term mortality. Limited to studies, therefore,it is needed tocarry out more randomized controlled trials in large sample,long-term follow-up with high quality to prvide more reliable evidence. Objective: To investigation the correlation between HO-1levels and Perioperativecardiovascular event of non-cardiac surgery in elder patients with coronary heart disease,and to find Protect factors about decreasing perioperative cardiovascular event.Methods: A total of60cases who is aged60to80years old, ASA class Ⅲ or Ⅳ, withcoronary artery disease admitted to our hospital for major elective non-cardiac surgeryunder general anesthesia were enrolled during May2010to May2011. The medicalrecords were collected, followed up patients in the30days after surgery and then recordwhether adverse events were happened including myocardial ischemia, arrhythmia, angina,acute myocardial infarction,cardiac pulmonary edema and primary cardiovascular death. Thepreoperative venous blood samples were taken within2days before the operation andpreserved for detection. Revised cardiac risk index was performed to assess the risk ofperioperative cardiovascular events in the patients. ELISA assays were used to detectserum HO-1levels of the patients. RCRI, and HO-1levels were statistically analyzed incases with intraoperative and postoperative cardiovascular events and cases withoutcardiovascular events. Results: comparing the group of appearing perioperativecardiovascular event and the group of disappearing perioperative cardiovascular event,elder ages and longer operation time are hazards of perioperative cardiovascular event(P<0.05); There were statistically significant difference between the increased HO-1levels and incidence of perioperative cardiovascular event(P<0.01); There werestatistically significant difference between the increased RCRI index and the incidenceof perioperative cardiovascular events(P<0.01). Conclusion: As for elderly patientswith coronary artery disease who’s undergoing non-cardiac surgery, elder ages and longer operation time are dangers factors of perioperative cardiovascular event;RCRIindex and the HO-1levels were positively correlated with the perioperativecardiovascular complications; HO-1levels is functioned as predictors of perioperativecardiovascular events in non-cardiac surgery of patients with coronary heart disease

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