| "Twelve-five" period, under the national science and technology support project- "The research surgical key techniques of curing severe ischemic heart disease" and "cardiovascular disease clinical multi-center study key treatment technology information platform(cardiovascular surgical project)" support, the National Center for Cardiovascular Disease Fuwai Hospital(NCC) and other 96 hospitals who has the advantages of cardiovascular surgery, built Chinese cardiovascular surgical registration collaboration and registration system. As a collaborative hospital, all patients who underwent cardiovascular operations in our hospital are enclosed the research. We collected the patients with long-term follow-up, selected their clinical data, risk factors, the methods of medicine treatment and so on.Objective: Coronary artery bypass grafting(CABG) is a more effective treatment for coronary heart disease(CHD) and has become a routine cardiac surgery. At the same time, the valve replacement is also widely accepted in valve disease. Valvular surgical techniques have also been gradually improved. In order to get more informations and statistics’ data and other relationship of these data in CHD and valve disease patient’s medical record information and long-term follow-up information, We registered all patients who underwent CABG or cardiac valvular surgery or both. We collected patients medical history information, summarize the reality of clinical practice patterns and recent results and analysis the selected patients with regular follow-up, collecting clinical events, risk factors and the methods of medicine treatment, etc, to explore the clinical treatment and the factors that affect the prognosis of patients.Method: We registered all patients who underwent CABG or cardiac valvular surgery or both. Collected patients’ basic information, preoperative risk factors, previous history of cardiovascular disease, lab test, operation information, postoperative complications, preoperative medication, medicine treatment etc. Before the work started, we explained the objects of the the research to the patients and signed the informed consent. Give their follow-up after discharge, collected patients basic information, preoperative risk factors, operation information, postoperative complications, Major Adverse Cardiac Events(MACE) and the methods of medicine treatment, etc. We collect the information for statistical analysis and conclusion.Results: From April 2013 to July 2014 in the Second Hospital of Hebei Medical University 181 patients were selected to enclosed the research. 118 patients underwent CABG and 58 patients underwent heart valve surgery and 5 patients underwent CABG and cardiac valvular surgery. All patients accepted one month follow-up. 2 cases had MACE, they both had myocardial infarction. Due to the requirement of the database, meet the criteria for the patients after the first cardiovascular surgery within three days of registration of the basic information and within 15 days after discharge to review medical records, fill in the medical record information extraction table, no patient seriously ill or die. Within 3 days after automatically discharged patients was seriously ill or death, did not register into the database. Registered patients, the time from in the hospital to follow-up, do not rehospitalized.1 14 cases had pulmonary complications including hypoxemia, lung infection after CABG. Pulmonary complications is associated with age, preoperative pulmonary infection and(or) COPD, obesity, the degree of preoperative heart function, auxiliary ventilation time. It had statistical significance(P<0.05). Those patients who are ages, BMI on the high side,and had preoperative lung disease, bad heart function, long auxiliary ventilation time are leaned to suffer pulmonary complications. Pulmonary complications is not associated with sex, preoperative hypertension, diabetes, hyperlipidemia, preoperative smoking history. There is no statistical significance(P > 0.05)(see Table 2, 4).2 10 cases had limb or chest incision infection after CABG(all are superficial incision infection). The infection of incision is associated with preoperative diabetes. It had statistical significance(P < 0.05). Those patients who had preoperative diabetes is leaned to suffer incision infection. Incision infection is not associated with age, sex, BMI, preoperative hypertension, hyperlipidemia, preoperative smoking history, preoperative pulmonary infection and(or) COPD, preoperative heart function and auxiliary ventilation time. The results were no statistical difference(P > 0.05)(see Table 2, 4).3 4 cases had new atrial fibrillation after CABG. New atrial fibrillation is associated with stop using beta blockers after surgery. It had statistical significance(P < 0.05). 4 cases of postoperative atrial fibrillation in new occur with 3 cases of preoperative application of beta blockers and regularity and stop using beta blockers after surgery. New atrial fibrillation is not associated with age, sex, preoperative hypertension, diabetes, hyperlipidemia, preoperative smoking history, preoperative heart function, history of myocardial infarction and auxiliary ventilation time. There is no statistical significance(P > 0.05)(see Table 3, 4).4 The occurrence of MACE events, follow-up of patients with CABG, 2 cases of myocardial infarction and no cardiac tamponade, cardiac insufficiency, heart failure. Postoperative myocardial infarction patients were both aged older than 65 years old, preoperative had a history of myocardial infarction before 21 days ago. They both had the history of hyperlipidemia, hypertension, and diabetes. 1 case of preoperative heart function is Ⅲ class, the other is Ⅳ class. 2 cases with preoperative coronary stenosis were left main and 3 lesions, and coronary artery bypass were four. One patient, left anterior descending artery, the right coronary artery, the circumflex artery and blunt edge were replaced. Another example of the patient, left anterior descending artery, right coronary artery, the diagonal branch and blunt edge were replaced. The patients control postoperative blood glucose, postoperative blood fat and regular use of anticoagulant drugs. They appeared chest pain respectively postoperative 14 and 17 days. The electrocardiogram inspection showed ST segment elevation and T wave inversion and serum enzyme elevated. After gave vascular active drug promptly, cardiac systolic function improved and didn’t appear any sorts of complications such as cardiac arrhythmias. Postoperative myocardial infarction maybe associate with older age, poor heart function, preoperative diabetes, hyperlipidemia, hypertension, the counts of coronary artery lesion, the counts of coronary artery bypass, different anastomosis of target blood vessels, the calibre of the target vascular anastomosis site, postoperative blood glucose, postoperative blood fat and postoperative anticoagulation situation. Relevant data is not specific account in the database and need to be further researched(see Table 3, 4).5 5 cases had lung infection after Cardiac valvular surgery. In addition to ages, preoperative pulmonary infection and(or) COPD, obesity, the degree of preoperative heart function, auxiliary ventilation time, lung infection is also associated with extracorporeal circulation time and aorta blocking time. There is statistical significance(P<0.05). Those patients who had long extracorporeal circulation time and long aortic cross-clamp time are leaned to suffer lung infection(see Table5).Conclusion:Compared to using a database system to collect, sort out medical record information refer to paper records, improving work efficiency, for clinical treatment and scientific research work to provide data support, at the same time advantage resource sharing is realized.This study used the database information research and analysis, draw the conclusion: 1 Pulmonary complications after CABG with older age, preoperative pulmonary infection and(or) COPD, obesity, poor preoperative heart function and long postoperative auxiliary ventilation time. Pulmonary complications after CABG Postoperative is not associated with the history of smoke in this research but in other literature reports smoking is one of risk factors. The study needs to be further research. Limb or chest incision infection(all are superficial incision infection) is associated with preoperative diabetes. In addition, it also has a certain relationship with ages, operation time. Many literature thought chest incision infection is associated with internal mammary artery as bridge vascular impact blood to the sternum. In this study we are not collected relevant data. Further study is needed to pay attention to. Postoperative new atrial fibrillation is associated with stop using beta blockers after surgery and it also has a certain relationship with older age myocardial ischemia and right coronary artery lesions. Postoperative myocardial infarction maybe associate with older age, poor heart function, preoperative diabetes, hyperlipidemia, hypertension, the counts of coronary artery lesion, the counts of coronary artery bypass, different anastomosis of target blood vessels, the calibre of the target vascular anastomosis site, postoperative blood glucose, postoperative blood fat and postoperative anticoagulation situation. 2 Postoperative pulmonary infection after heart valve surgery in addition to older age, preoperative pulmonary infection and(or) COPD, obesity, poor preoperative heart function and postoperative auxiliary ventilation time, also with intraoperative extracorporeal circulation time and aortic cross-clamp time. In other literature reports smoking is one of risk factors of postoperative pulmonary infection.The study needs to be further research.In order to reduce the occurrence of postoperative complications, preoperative diagnosis is clear, active control of risk factors, guarantee in the preoperative stage would be likely to affect the operation of factor control in the normal range. As much as possible to shorten operation time, operation to minimize the influence of the will. Use the vasoactive drugs timely after the surgery. The patients with postoperative recovery, still should actively control risk factors, so as to greatly improve the quality of life.The current database is still in its infancy and still need further long-term follow-up. The patients were observed with the improvement of cardiac function and the quality of life. In the process of database application, also has some problems, for medical record collection time, the specific data collection should be further perfected. |
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