检索结果-南通市图书馆

Impact of Perioperative Management for Intracranial Arterial Stenosis on Postoperative Stroke Incidence in Coronary Artery Bypass Surgery: A Propensity Matching and Multivariate Analyses

引用

Surgical Science 2018年第9期9卷 311-324页

作者： Hajime Imura Yuji Maruyama Makoto Shirakawa takashi nitta Department of Cardiovascular Surgery Nippon Medical School Musashikosugi Hospital Kawasaki Japan Nippon Medical School Hospital Tokyo Japan

Background: Intracranial arterial steno-occlusive lesion (IAS) is the most common cause of stroke. We hypothesized that adequate perioperative management for IAS is useful to prevent stroke in coronary artery bypass grafting (CABG). Methods: IAS was evaluated using magnetic resonance imaging/angiography (MRI/A, n = 216) in patients without a history of stroke or carotid stenosis (≥50%) in CABG between May 2005 and June 2018 (n = 424). Off-pump CABG was performed in most patients. Different perioperative managements of systolic arterial pressure (SAP) were applied for patients with and without MRI/A. SAP was strictly maintained at ≥80 mmHg in patients with significant IAS (≥50%, n = 28) and ≥90 mmHg for severe IAS (≥70%, n = 44) while SAP less than 80 mmHg (usually ≥70 mmHg) was allowed for patients without MRI/A. Intra-aortic balloon pumping was used for patients with multiple severe IAS and/or occlusion. Clinical outcomes were compared between patients with and without MRI/A. Propensity matching was performed (n = 181 each). Results: Complete revascularization was achieved in all patients. Nine patients (2.12%) had postoperative strokes;the incidence of stroke was signifi-cantly less in patients with preoperative MRI/A (n = 1, p = 0.016). There was no significant difference in the incidence of in-hospital mortality between patients with and without preoperative MRI/A (0.5% and 1.0%, respectively;p = 0.529). Multivariate analysis revealed that no preoperative MRI/A was the only significant predictors of postoperative stroke (p = 0.045). The incidence of stroke was not higher in patients with IAS who underwent MRI/A (p = 0.332). Conclusions: Preoperative evaluation of IAS using MRI/A and following our perioperative management significantly reduced perioperative stroke in patients undergoing CABG.

关键词： CABG Intracranial Arterial Stenosis Stroke Magnetic Resonance Imaging Off-Pump

来源：

维普期刊数据库评论

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

Coronary Artery Bypass Grafting with Complete Revascularization Can Provide Equivalent Long-Term Prevention of Ischemic Cardiac Events in Patients on and Not on Hemodialysis: A Graft-Matched and Baseline-Adjusted Analysis

引用

Surgical Science 2018年第10期9卷 367-380页

作者： Hajime Imura Makoto Shirakawa Motohiro Maeda Kenichiro Takahashi Takahide Yosio Yuji Maruyama takashi nitta Department of Cardiovascular Surgery Nippon Medical School Musashikosugi Hospital Kanagawa Japan Nippon Medical School Hospital Kawasaki Japan

Background: Patients on hemodialysis are at high risk of adverse cardiac events after coronary artery bypass grafting (CABG). The aim of this study is to know whether CABG with complete revascularization and similar graft selection can provide equivalent long-term benefits for patients on and not on hemodialysis. Methods: Between 2004 and 2018, 746 patients underwent isolated CABG, of which 106 were on hemodialysis. Propensity matching on baseline characteristics, graft types and on/off-pump CABG was performed to compare clinical outcomes between patients on (n = 102) and not on (n = 102) hemodialysis. Results: Complete revascularization was achieved in all patients. The mean follow-up was 112.5 ± 46.6 months. Off-pump rates (hemodialysis vs non-hemodialysis, 93/102 vs 94/102, p > 0.999) and graft selections (distal anastomoses: 3.7 ± 1.4 vs 3.8 ± 1.5, p = 0.377, ITA grafts: 1.4 ± 0.6 vs 1.5 ± 0.6, p = 0.560, arterial grafts: 1.9 ± 0.9 vs 2.0 ± 0.8, p = 0.658, vein grafts: 0.69 ± 0.63 vs 0.65 ± 0.70, p = 0.513) were well balanced between the groups. Hospital mortality was higher in patients on hemodialysis than in those not on hemodialysis (5/102 vs 1/102, p = 0.212). The Kaplan-Meier analysis revealed that cardiac death (without non-cardiac causes) was significantly more common in patients on hemodialysis than in those not on hemodialysis (p = 0.018). However, there were no significant differences in deaths due to ischemic heart disease (p = 0.327), repeated revascularization (p = 0.542), myocardial infarction (p = 0.783), and heart failure requiring admission (p = 0.371). Conclusion: CABG with complete revascularization and similar graft selection provides equivalent long-term benefits with regard to the prevention of adverse cardiac events due to ischemic heart disease in patients on and not on hemodialysis.

关键词： Coronary Artery Bypass Grafting Hemodialysis Complete Revasculariza-tion Gastroepiploic Artery

来源：

维普期刊数据库评论

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

Serum Alkaline Phosphatase Levels and Mortality of Chronic Hemodialysis Patients

引用

International Journal of Clinical Medicine 2011年第4期2卷 388-393页

作者： Tetsuri Yamashita Junichi Shizuku takashi Ohba takashi Kabaya Kosaku nitta 不详

Objective: Alkaline phosphatase (ALP) is considered a biomarker of high bone turnover in hemodialysis (HD) patients with secondary hyperparathyroidism. This study was conducted to determine whether high serum ALP levels are associated with increased all-cause mortality of HD patients. Patients and Methods: This was a retrospective cohort study conducted at a single center. The subjects were 195 patients on chronic HD therapy who were followed up for a 5 years, and relationships between their baseline data and outcomes were assessed statistically. The serum ALP level was used as the predictor, and the primary end point was all-cause mortality. Results: Based on the median serum ALP of 236 IU/L, the subjects were divided into a low-ALP group (Conclusion: High baseline serum ALP levels are associated with increased mortality of HD patients, independent of bone metabolism parameters and serum liver enzyme levels. ALP is a potential target for the treatment of HD patients.

关键词： Alkaline Phosphatase Hemodialysis Mortality Secondary Hyperparathyroidism

来源：

维普期刊数据库评论

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

Serum Alkaline Phosphatase Levels and Mortality of Chronic Hemodialysis Patients

引用

International Journal of Clinical Medicine（临床医学国际期刊） 2011年第4期

作者： Tetsuri Yamashita Junichi Shizuku takashi Ohba takashi Kabaya Kosaku nitta

来源：评论

学校读者我要写书评

暂无评论

欢迎您,

建议与咨询留下您的常用邮箱和电话号码，以便我们向您反馈解决方案和替代方法

时间限定

文献类型

馆藏选择

核心期刊

语言

文献类型

帮助

文字说明：

检索规则说明：

检索范例：

分类表

所选分类

限定检索结果

文献类型

馆藏范围

日期分布

学科分类号

主题

机构

作者

语言

在线全文

在线全文

在线全文

请选择保存的检索档案：

请选择收藏分类：

通借通还

欢迎您,

建议与咨询 留下您的常用邮箱和电话号码，以便我们向您反馈解决方案和替代方法

时间限定

文献类型

馆藏选择

核心期刊

语言

文献类型

帮助

文字说明：

检索规则说明：

检索范例：

分类表

所选分类

限定检索结果

文献类型

馆藏范围

日期分布

学科分类号

主题

机构

作者

语言

在线全文

在线全文

在线全文

请选择保存的检索档案： 新增检索档案 确定 取消

请选择收藏分类： 新增自定义分类 确定 取消

通借通还

建议与咨询留下您的常用邮箱和电话号码，以便我们向您反馈解决方案和替代方法

请选择保存的检索档案：

请选择收藏分类：