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The Effect of Cycling and Arm Ergometer Exercises on Physical and Psychosocial Functions: Application in Patients Undergoing Coronary Artery Bypass Surgery

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Open Journal of Therapy and Rehabilitation 2022年第2期10卷 39-53页

作者： Özkan Yükselmiş Dağ kapı State Hospital Department of Physical Therapy and Rehabilitation Diyarbak&#305 r Turkey

Aim: The aim of this study was to compare the effects of bicycle and arm ergometer exercises on physical and psychosocial functions in patients who underwent Coronary Artery Bypass Surgery. Methods: A total of 39 cases (35 males, 4 females) were included in the study, with 23 participants aged between 52 and 65 using bicycle ergometers and a group of 16 people who performed arm ergometers opposite. After the demographic data were recorded, physical functions of all individuals participating in the study were evaluated with a 6-minute walk test, bioimpedance analysis, HDL, LDL, Triglyceride and Total cholesterol values, and psychosocial functions were evaluated with the Beck depression scale, modified borg scale and SF 36 questionnaires before and after the training. All participants were given bicycle or arm ergometer exercises for 6 weeks, 5 sessions per week, for a total of 30 sessions. Result: When the results were examined, it was observed that there was a statistically significant increase in walking distance of the people in the bicycle ergometer group compared to the arm ergometer group (p < 0.05). In addition, it was revealed that there was a statistically significant difference in the general health parameter, which is one of the sub-parameters of SF 36, in the arm ergometer group compared to the bicycle ergometer group (p Conclusion: When we look at the results of this study, it is important in terms of revealing that bicycle and arm ergometer exercises similarly improve the physical and psychosocial functions of patients who have undergone Coronary Artery Bypass Surgery. However, it has been shown that cycling exercises are much more advantageous in improving functional capacity. Summary Statement: What is already known about this topic? 1) Walking and arm exercises are good for heart diseases. What this paper adds? 2) Demonstrated that cycling and arm ergometer exercises have curative aspects for patients undergoing Coronary Artery Bypass Surgery. The implications of this paper: 3) As a result, it has

关键词： cabg Bicycle Ergometer Arm Ergometer Physical Function Psychoso-cial Function Quality of Life

Coronary Artery Bypass with Myxedema

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Case Reports in Clinical Medicine 2023年第2期12卷 44-51页

作者： Yasemin Tekdöş Şeker Halil Cebeci Tuğba Yücel Saygin Türkyilmaz Hasan Toz Yusuf Kuserli Department of Anaesthesiology Univercity of Health Science Bakirkoy Dr. Sadi Konuk Training and Searching Hospital Istanbul Turkey Department of Cardiovascular Surgery Univercity of Health Science Bakirkoy Dr. Sadi Konuk Training and Searching Hospital Istanbul Turkey

Introduction Hypothyroidism increases the risk of cardiovascular complications in patients scheduled for coronary artery bypass grafting. Atrial fibrillation is one of its cardiac complications. Case Report Our 45-year-old male patient was admitted to the Emergency Medicine Clinic of our hospital with chest pain that started in the left arm and extended to the chin 2 days ago. It was noted that the patient had hypothyroidism, but did not have any medication for the disease. On physical examination, dry and pale skin, sparse coarse hair, non-pitting edema were diagnosed with acute coronary artery disease. No signs of ischemia were observed on the ECG at the time of admission, but bradycardic sinus rhythm was recorded. The patient was started to be followed up with the diagnosis of NON-ST myocardial infarction. Nitroglycerin 0.25 - 2 mcgr/h and morphine 2 mg were administered intravenously to the patient whose anginal complaints continued after admission. Anginal complaint continued was operated in 1:1 mode by attaching an intraaortic balloon pump (Maquet Sensation 7Fr 40 cc, Datascope CS300 console) via the left femoral artery. Surgery procedure: The patient was performed with median sternotomi (aortic, two-stage cannulation). While the patient was cooled to 32 degrees and given blood cardioplegia (St. Thomas II) and applied topical cold. After distal anastomoses were performed with saphenous vein graft. Total cross-clamp time was 60 min. Epinephrine was given for bradycardia sinus rhythm. No cardiovascular complications were encountered while being followed in the intensive care unit. The patient was discharged on the 6th postoperative day. Conlucion: Our case, who was taken to emergency cabg operation with myxedema, was discharged without any cardiovascular, respiratory or metabolic complications both in the perioperative and postoperative periods. In this case, the major stress caused by cardiovascular surgery was successfully overcome by both the cardiovascular surgery team and the anesthesiology team.

关键词： Hypothyroidism cabg Myxedema Atrial Fibrillation

Achieving Zero Coronary Artery Bypass Graft Surgical Site Infections for over Four Years: Our Experience Utilizing Bundle Elements, Education, and Audits

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Open Journal of Epidemiology 2022年第2期12卷 102-106页

作者： Mohamed Adawee Ara Pridjian Linnea Eifert Chaney Manarin Viviana Snyder Infection Prevention and Epidemiology Department Sparrow Health System Lansing USA

Background: Surgical site infections (SSI) are expensive and potentially deadly infections;however, with evidence-based infection prevention techniques many can be prevented. The purpose of this quality improvement project is to describe our hospital’s experience achieving zero coronary artery bypass graft (cabg) deep incisional and organ/space SSI incidences from October 2016-July 2021. Methods: To prevent cabg deep incisional and organ/space SSI incidences our Infection Prevention and Epidemiology Department along with the Cardiothoracic and Vascular Surgery Department established SSI prevention bundle elements, continuous education, and monthly audits. Results: From quarter one of 2015 through quarter three of 2016 there were three deep incisional or organ/space SSI cases out of 317 cabg procedures. From quarter four of 2016 through quarter two of 2021 there have been 625 cabg procedures, zero of which developed into deep incisional or organ/space SSI incidences. cabg SSI prevention bundle element compliance ranged from 88.2% to 99.6% and operating room environment of care compliance was 94%. Conclusion: Our results show overall improvements in our quarterly cabg SSI SIR from quarter one of 2015 to quarter two of 2021. This experience demonstrates the importance of complying with SSI prevention bundle elements, education, and auditing in reducing and maintaining zero cabg deep incisional and organ/space incidences for over four years.

关键词： SSI cabg Infection

MR IMAGING OF CORONARY ARTERY BYPASS GRAFT:A PRELIMINARY STUDY

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Chinese Medical Sciences Journal 2000年第2期15卷 67-72页

作者：朱杰敏张竹花刘玉清 DepartmentofRadiology PekingUnionMedicalCollogeHospitalCAMS＆PUMCBeiiing100730 vDepartmentofRadiology CardiovascularInstituteandFuWaiHospitalCAMS＆PUMCBeijing100037

Objective. To make a preliminary investigation of the patency and function of coronary artery bypass grafts(cabg) by magnetic resonance(MR) images and to establish a suitable method for followup study after cabg operation among Chinese. Methods. MR imaging was performed with a Toshiba 15T unit in 27 patients with 74 grafts. All patients were examined with a breathhold ECGgated twodimensional fast field echo (FFE) sequence to evaluate the patency of bypass grafts, among them 16 patients with 42 grafts were further examined with a phase shift magnetic resonance angiography flow (PSMRAflow) sequence to evaluate the grafts patency as well as the flow velocity and flow volume vs. time. Results. The results showed that 66 of the 74 grafts in the patients of the present series studied with FFE were patent with a patency rate of 892% The results evaluated both with FFE and PSMRAflow remained the same except that two grafts were patent with FFE and the results with PSMRAflow were uncertain. Diastolic perfusion pattern curves were found in 25 of the 32 grafts in patients of the present series. Comparing the flow curves of the grafted left internal mammary artery with those of the native right internal mammary artery in 7 patients, the systolic peak velocity value(SPV) of the grafted arteries was significantly lower than that of the ungrafted ones, whereas the diastolic peak velocity value(DPV) and the ratio of DPV to SPV were significantly greater than that of the ungrafed ones. Conclusion. The FFE and PSMRAflow sequences were efficient in evaluating patency and obtaining the curves of flow velocity and volume of the bypass grafts. Therefore, they may offer a noninvasive screening method for followup study in patients after cabg surgery, although its accuracy should be further evaluated in more patients and comparatively studied with other methods.

关键词：冠状动脉旁路移植磁共振成像诊断 cabg 手术疗法

Efficacy of Exercise-based Rehabilitation after Coronary Artery Bypass Graft and Stroke

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Efficacy of Exercise-based Rehabilitation after Coronary Art...

作者： MD. MONERUZZAMAN 山东大学

学位级别：硕士

背景:现有大量报道指出基于运动的康复治疗(exercise-based rehabilitation,ER)对心血管和脑血管疾病的恢复有益。疾病特异性或个性化的康复计划是促进康复和减少患者痛苦的关键。研究发现,在冠状动脉旁路移植术(coronary arterybypassg... 详细信息

背景:现有大量报道指出基于运动的康复治疗(exercise-based rehabilitation,ER)对心血管和脑血管疾病的恢复有益。疾病特异性或个性化的康复计划是促进康复和减少患者痛苦的关键。研究发现,在冠状动脉旁路移植术(coronary arterybypassgraft,cabg)和脑卒中后进行个性化的运动康复治疗,能够有效提高患者的运动功能,改善躯体功能。但是确定心血管疾病康复计划方案所需的血流动力学参数,即心脏健康的重要前提的评价指标仍然不明确;此外,关于cabg的患者和中风患者的运动康复对患者整体生活质量(quality of life,QoL)和心脏健康的影响和改进方法还需要进一步的探讨。目的:本研究旨在通过系统性回顾及meta分析评定运动康复对cabg和脑卒中患者的心脏健康、运动功能和QoL的疗效,并进一步给出指南建议。方法:我们进行了两项系统综述。在第一项研究中,遵循无元分析的综合指南(Synthesis without meta-analysis,SWiM),我们检索了从 2000 年 1 月 1 日到 2022 年 9 月15日的四个在线数据库(EBSCOhost,Scopus,PubMed和Webof Science)中与cabg有关的数据,明确目前cabg的康复方案。在第二项研究中,我们检索了从2012年1月至2022年1月在Web of Science,PubMed Central和Scopus上发表的关于脑卒中后康复治疗的文章,并进行meta分析。我们在两项综述中都使用PICOS(population,intervention,comparison,outcome,and study design)方法进行数据检索。检索到的数据按照2020年系统综述和荟萃分析优先报告的条目(preferred reporting items for systematic reviews and meta-analyses,PRISMA)声明进行呈现。两项研究的系统综述方案均已在线注册和发布。结果:在第一项研究中,我们纳入了共包括599名cabg患者的9项基于运动的康复治疗的随机对照试验(randomized control trials,RCT)。患者出院后随访及入院过程中进行心脏康复(cardiac rehabilitation,CR),其中采用多联运动疗法(包括吸气肌训练、运动、上肢和下肢活动以及有氧运动)的患者,与使用单联运动疗法(呼吸训练)的患者相比,其在6分钟步行实验中,功能(6-minute walking distance,6MWD)取得了显著改善(中等质量的证据)。与单联运动疗法组患者相比,多联运动疗法组患者在出院时的最高摄氧量(volume of oxygen peak,VO2peak)无显著升高,但在随访期间VO2peak发现了显著的改善(证据质量中等)。另外,进行门诊康复治疗(包括高强度吸气肌训练、上下肢力量训练和有氧运动的患者,其出院时的6MWD和VO2peak也显著改善高质量证据)在使用不同健康相关的QoL问卷评估的多项运动组患者中,QOL的改善并不明显。第二项研究共纳入1 1项RCT。其中的康复治疗计划包括有氧运动、平衡训练、柔韧性训练、力量训练、上下肢伸展、游戏式运动,以及心血管疾病风险因素的咨询。其中4项RCT的分析结果表明,脑卒中后进行康复治疗的患者的6分钟步行实验中(six-minute walking test,6MWT)和 VO2peak 均数差(mean difference,MD)为-57.61m 有显著改善;(95%置信区间[confidence interval,CI],-72.34m,-42.89m;Pcabg患者的健康相关的QoL没有明显的影响。在脑卒中患者中,运动康复后的血流动力学(心率、血压和心排出量)改善不显著,但运动功能,特别是6MWT和VO2peak显著提高。本研究提示我们,为了改善患者血流动力学和提高脑卒中后康复的效果,康复从业人员在对患者的康复计划中应该优先考虑心血管运动康复训练,足够的运动强度,以及脑卒中后患者的心脏健康教育。

关键词：运动康复心脏康复脑卒中 cabg 血流动力学

Influence of Junction Angle Changed Models on Hemodynamic of Coronary Artery Bypass Graft

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Chinese Journal of Biomedical Engineering(English Edition) 2016年第4期25卷 162-167页

作者： LIU Zhao-miao GAO Li-dan SHI Yi College of Mechanical Engineering and Applied Electronics Technology Beijing University of Technology Department of Cardiac Surgery Fu Wai HospitalChinese Academy of Medical Sciences

The restenosis after coronary artery bypass graft(cabg) is attributed to the formation of intimal hyperplasia(IH) at the anastomosis,which is closely related to hemodynamic depend on the geometric model. In order to give a reasonable assessment of the surgery effect and judge the long-term patency rate,the hemodynamic of cabg surgery program is compared with that of surgery design of the junction angle changed.Based on in-vivo CT coronary angiography datasets,the individual geometric model of cabg reconstructed instead of idealized geometric models are applied to simulate the real physiological blood flow utilizing pulsatile flow boundary waveforms in the present study. The simulation results show that the maximum wall shear rate(WSS) value is at the bottom of anastomosis. Moreover,the stagnation zone growing gradually with the greater angle downstream the anastomosis is prone to form the IH,which is consistent with clinical observation. It is proved that the surgery being better suited to maintain graft patency is successful.

关键词： cabg hemodynamic three-dimensional reconstruction junction angle long-term patency rate

Percutaneous coronary intervention in the elderly:a growing need for a growing population

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老年心脏病学杂志：英文版 2005年第1期2卷 3-9页

作者： Samuel J.Shubrooks Cardiac Catheterization Laboratory Cardiovascular Division Beth Israel Deaconess Medical CenterBoston 02215USA Jr.

Persons aged 80 and above are the fastest growing age group in the United States population, having increased 50% since 1990 and predicted to grow another 25% by 2020.

关键词： PCI Percutaneous coronary intervention in the elderly cabg than

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中国冠心病二级预防研究

中华心血管病杂志 2005年第2期33卷 109-115页

作者：血脂康调整血脂对冠心病二级预防研究协作组中国医学科学院中国协和医科大学北京阜外心血管病医院 100037

目的判定在与西方人群相比血清胆固醇水平相对较低的中国冠心病患者中,通过血脂康调整血脂能否降低各种冠心病相关事件的危险性,并判定对各种原因死亡的影响.方法本研究为多中心、随机、双盲、安慰剂对照的长期随访临床试验,研究时间从1... 详细信息

目的判定在与西方人群相比血清胆固醇水平相对较低的中国冠心病患者中,通过血脂康调整血脂能否降低各种冠心病相关事件的危险性,并判定对各种原因死亡的影响.方法本研究为多中心、随机、双盲、安慰剂对照的长期随访临床试验,研究时间从1996年5月至2003年12月,在中国19个省市自治区的65家临床协作医疗中心,对4870例血清总胆固醇水平在4.40～6.47 mmol/L(170～250 mg/dl)之间、年龄在18～75岁,有明确心肌梗死史的中国冠心病患者进行了平均4年的随访观察,以比较血脂康胶囊0.6 g,2次/d与安慰剂的作用.主要终点为冠心病事件,包括非致死性心肌梗死及冠心病死亡,次要目标为能否减少非心血管病事件如肿瘤、脑卒中、自杀、经皮冠状动脉介入术(PCI)和(或)冠状动脉旁路移植术(cabg)需求以及总死亡.结果主要终点在血脂康治疗组的发生率为5.72%,安慰剂对照组为10.41%,治疗组相对危险降低45.1%(P=0.0000),其中冠心病死亡治疗组为3.79%,对照组为5.49%,治疗组相对危险降低31.0%(P=0.0048),非致死性心肌梗死治疗组为1.93%,对照组为4.92%,治疗组相对危险降低60.8%(P=0.0000).次要终点(脑卒中、肿瘤、PCI/cabg的需求)的发生率治疗组为69.2例次/1000人,对照组为100.4例次/1000人,治疗组相对危险降低31.1%(P=0.0004),其中PCI和(或)cabg的需求,治疗组为30.1例次/1000人,对照组为45.1例次/1000人,治疗组相对危险降低33.3%(P=0.0097).各种原因的死亡在治疗组为5.19%,对照组为7.74%,治疗组相对危险降低33.0%(P=0.0003),其中肿瘤死亡在治疗组降低54.7%(P=0.0138).在临床不良反应和实验室指标异常方面,治疗组和对照组之间差异无统计学意义.结论与安慰剂比较,血脂康胶囊治疗能显著降低冠心病患者非致死性心肌梗死及冠心病死亡的发生率.能显著减少对PCI和(或)cabg的需求,能显著减少肿瘤死亡和各种原因的总死亡.表明中国冠心病患者服用血脂康胶囊调整血脂可获得明显益处.

关键词：治疗组对照组肿瘤冠心病死亡安慰剂 cabg 人群水平血清胆固醇

中高危非ST段抬高急性冠状动脉综合征早期侵入与早期保守策略的评价

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中华心血管病杂志 2005年第4期33卷 307-311页

作者：聂绍平马长生吕强张崟杜昕康俊平郝鹏刘彤王苏董建增刘晓惠吴学思首都医科大学附属北京安贞医院心内科北京100029

目的了解早期侵入与早期保守策略对中高危非ST段抬高急性冠状动脉综合征(ACS)患者住院主要不良心脏事件(MACE)发生情况的影响.方法根据入院后冠状动脉造影(CAG)与否和时间(≤48 h与＞48 h)对910例中高危非ST段抬高ACS患者分为早期侵入... 详细信息

目的了解早期侵入与早期保守策略对中高危非ST段抬高急性冠状动脉综合征(ACS)患者住院主要不良心脏事件(MACE)发生情况的影响.方法根据入院后冠状动脉造影(CAG)与否和时间(≤48 h与＞48 h)对910例中高危非ST段抬高ACS患者分为早期侵入策略组(n=237)和早期保守策略(n=673)两组,分析早期策略与血管重建方式对住院MACE(包括死亡、新发心肌梗死和靶血管再次血管重建)的关系.结果早期侵入与早期保守组的住院病死率和靶血管血管重建率相当,早期侵入组的住院时间较短,住院MACE(6.3%比2.5%,OR 0.384,95% CI 0.188～0.781,P＝0.006)与新发心肌梗死(4.6%比0.9%,OR 0.185,95% CI 0.068～0.505,P＝0.001)的发生率更高.早期侵入组MACE与新发心肌梗死的增加可能与其血管重建操作较多(86.9%比67.5%,Pcabg)的患者新发心肌梗死的发生率高于早期保守组中接受cabg的患者(7.5%比1.8%,P＝0.027).结论中高危非ST段抬高ACS患者采取早期侵入策略不增加住院病死率,但有可能增加住院心肌梗死.早期PCI安全可行,不增加住院主要不良心脏事件.早期cabg与住院不良事件的关系还有待进一步探讨.

关键词：非ST段抬高急性冠状动脉综合征早期侵入保守高危经皮冠状动脉介入治疗冠状动脉旁路移植术不良心脏事件心肌梗死住院病死率血管重建冠状动脉造影 MACE cabg 靶血管发生率发生情况重建方式住院时间 ACS 患者