Objective To explore the predictors of perioperative ischemic stroke following percutaneous transluminal angioplasty and stenting.Methods We retrospectively evaluated data on 416 percutaneous transluminal angioplasty and stenting (PTAS) procedures at (334 males,82 females,aged 40-85 years,falling into ASA Ⅰ-Ⅲ) a single institution.Logistic regression was used to analyze the role of clinical,angiographic and hemodynamic variables on periprocedural ischemic strokes.Results Among 328 patients underwent PTAS for the treatment of extracranial stenosis,10 patients (3.0％) had perioperative ischemic stroke.Among the 88 stenting for intracranial stenosis,6 patients (6.8 ％) had perioperative ischemic stroke.Multivariable predictors of perioperative ischemic stroke for stenting for extracranial stenosis were the presence of untreated intracranial artery stenosis (OR =9.44,95％CI 2.36-37.71,P=0.001) and intraoperative absolute minimal SBP＜90 mm Hg (OR=9.13,95％CI 1.35-61.76,P =0.023).The independent predictors of perioperative ischemic stroke following PTAS for intracranial stenosis included the patients' increasing age (OR =1.25,95 ％ CI 1.04-1.51,P=0.021),presence of calcific plaques (OR=11.02,95％CI 1.11-109.25,P=0.040) and untreated intracranial artery stenosis (OR =44.81,95％ CI 1.99-1 011.84,P =0.017).Conclusion For patients with extracranial stenosis,suffering from the presence of untreated intracranial artery stenosis and intraoperative absolute minimal SBP＜90 mm Hg are the independent risk factors for perioperative ischemic stroke.The patients' increasing age,presence of calcific plaques and untreated intracranial artery stenosis were the independent risk factors for this complication in patients with intracranial stenosis.

Objective:To identify the risk factors for myocardial injury after non-cardiac surgery.Methods:The medical records of adult patients admitted to the intensive care unit of Peking University First Hospital after non-cardiac surgery from June 2017 to June 2018 were retrospectively collected.Myocardial injury was defined as serum cardiac troponin I concentration>0.06 μg/L within 3 days after operation, and the patients were divided into myocardial injury group and non-myocardial injury group.The perioperative data of patients were obtained through searching the electronic medical record system.The variables of which P values were less than 0.05 would enter the logistic regression analysis to stratify the risk factors for myocardial injury after non-cardiac surgery. Results:A total of 752 patients were included in the study, and the incidence of myocardial injury occurred after non-cardiac surgery was 15.7%.Emergency operation and highest lactic acid concentration during operation were the independent risk factors for myocardial injury after non-cardiac surgery.Conclusion:Emergency operation and highest lactic acid concentration during operation are the independent risk factors for myocardial injury after non-cardiac surgery.

Objective:To evaluate the relationship between preoperative long-term sleep disorder and postoperative hyperalgesia in the patients undergoing cardiac surgery.Methods:One hundred and eighty-one adult patients of both sexes, aged 18 yr, undergoing elective cardiac valve surgery under cardiopulmonary bypass with general anesthesia, were enrolled in this study.On 1st day before surgery, the Pittsburgh Sleep Quality Index questionnaire was used to assess the patient′s sleep quality in the last month.When Pittsburgh Sleep Quality Index score was more than 5, the patient was considered to have long-term sleep disorder.Postoperative analgesia was performed with sufentanil.Patients were divided into 2 groups according to the numeric rating scale (NRS) score: non-hyperalgesia group (NHA group, NRS score <4) and hyperalgesia group (HA group, NRS score ≥4). A multivariate logistic regression was used to identify the risk factors associated with postoperative hyperalgesia.Results:The results of logistic regression analysis found that smoking and preoperative long-term sleep disorder were independent risk factors for postoperative hyperalgesia.Conclusion:Preoperative long-term sleep disorder may induce hyperalgesia after cardiac surgery in patients.

Objective:To evaluate the effect of autologous platelet plasmapheresis (APP) and reinfusion on acute kidney injury (AKI) after total aortic arch replacement.Methods:Sixty American Society of Anesthesiologists physical status Ⅲ or Ⅳ patients of both sexes, aged 18-64 yr, with body mass index of 19-34 kg/m 2, scheduled for total aortic arch replacement under general anesthesia, were divided into 3 groups( n=20 each)using a random number table method: APP-reinfusion group (group A), acute normovolemic hemodilution (ANH) group (group N) and autologous blood withdrawal-reinfusion group (group C). In group A, APP was completed before the operation, concentrated red blood cells were transfused timely according to the intraoperative conditions, and platelet-poor and platelet-rich plasma were transfused after protamine neutralization.In group N, ANH was completed before the operation, and the whole blood released was transfused after protamine neutralization.Autologous blood withdrawal and washed red blood cell (RBC) transfusion were only performed in group C, and autologous blood withdrawal was performed in group A and group N. Cervical venous blood and urine samples were collected at 10 min after anesthesia induction (T 1), at 5min after cardiopulmonary bypass (T 2), immediately after the end of surgery (T 3), at 24h and 48h after surgery (T 4、5) for determination of the concentrations of hematocrit (Hct), plasma free hemoglobin (fHb), urinary neutrophil gelatinase-associated lipocalin (NGAL), tissue metalloproteinase-inhibitor -2 (TIMP-2) and insulin-like growth factor binding protein-7 (IGFBP-7) and for calculation of [TIMP-2]×[IGFBP-7]. Glomerular filtration rate (GFR) and concentrations of reatinine (Scr), urea, uric acid and cystatin C were measured before surgery, on the right postoperative day, and at 1, 2 and 3 days after surgery.The intraoperative requirements for allogeneic blood product transfusion, postoperative mechanical ventilation time, duration of intensive care unit (ICU) stay and hemodialysis were recorded. Results:Compared with group C, the postoperative requirement for allogeneic RBC transfusion in group A and group N and the allogeneic platelet transfusion in group A were significantly reduced, Hct at T 2 in group N was decreased, fHb at T 3 and T 4 in groups N and group A was decreased, Scr concentration on the right postoperative day and at 1 day after operation in group A was decreased, and cystatin C concentration on the right postoperative day and at 2 and 3 days after operation in group A was decreased ( P<0.05). Compared with group N, the postoperative requirement for the allogeneic platelet transfusion, concentrations of NGAL and TIMP-2 at T 3-5, IGFBP-7 concentration and [TIMP-2]×[IGFBP-7] at T 3 and T 4, Scr concentration on the right postoperative day and at 1 day after operation and cystatin C concentration on the right postoperative day and at 2 and 3 days after operation were significantly decreased in group A ( P<0.05). Conclusion:APP-reinfusion provides better efficacy in alleviating postoperative AKI than ANH in the patients undergoing total aortic arch replacement.

Objective: To explore the impact of metabolic syndrome (MS) on post-operative bleeding and in-hospital prognosis in patients with coronary artery bypass grafting (CABG). Methods: A total of 542 patients received CABG in Fuwai hospital from 2012-06 to 2012-09 were enrolled. Based on existing MS, the patients were divided into 2 groups: MS group, n=223 and Non-MS group, n=319. The amounts of 24 h post-operative bleeding and total bleeding were compared between 2 groups; the impact of MS for in-hospital prognosis was studied. Results: Compared with Non-MS group, MS group had the higher ratio of female patients (17.9％ vs 29.1％), P=0.002; the lower ratio of patients with plasma transfusion during operation and post-operation (20.7％ vs 12.6％), P=0.015 and the higher ratio of patients with zero plasma transfusion during operation and post-operation (79.3％ vs 87.5％), P=0.015. The median of 24h post-operative bleeding amount in MS group was lower [710.00(530.00, 950.00)ml vs 580.00(430.00, 790.00)ml, P<0.001]. The ratio of patients with total post-operative bleeding amount from (0-500)ml and (501-1000)ml was higher in MS group(4.4％ vs 10.8％, P=0.006;41.1％ vs 53.4％, P=0.005,respectively). MS group had the lower ratios of patients with 24 h post-operative bleeding amount>1000 ml, P=0.004, with total post-operative bleeding amount from (1001-2000) ml, P=0.001 and with total post-operative bleeding amount>2001 ml,P=0.044. Conclusion: MS patients had the lower amounts of peri-operative plasma transfusion and post-operative bleeding in CABG;while it had no impact on in-hospital prognosis.

Objective:To evaluate the accuracy of pRIFLE criterion and KDIGO criterion for the diagnosis of acute kidney injury (AKI) after radical operations for tetralogy of Fallot in children from the perspective of postoperative outcomes.Methods:A total of 375 children, aged<8 yr, undergoing radical operations for tetralogy of Fallot, were selected continuously and retrospectively. According to the pRIFLE and KDIGO diagnostic criteria, postoperative AKI was diagnosed, and the children were classified into different AKI grades. The prognostic parameters (postoperative mechanical ventilation time, duration of intensive care unit (ICU) stay, postoperative length of hospital stay, total costs of hospitalization, and in-hospital mortality, etc.) were collected, and the differences among different AKI grades were compared. Logistic regression method was used to analyze the risk factors for prolonged postoperative length of hospital stay (≥14 days) when two different criteria were used to diagnose AKI. The children diagnosed as non-AKI by KDIGO criterion were further confirmed using pRIFLE criterion, and the prognostic parameters in the children who were diagnosed as AKI and non-AKI were compared.Results:When two different criteria were used to diagnose AKI after radical resection for tetralogy of Fallot, the incidence was 56.8% (pRIFLE criterion) and 40.0% (KDIGO criterion). AKI diagnosed according to the two criteria was the independent risk factor for prolonged postoperative length of hospital stay, and the levels of all the prognostic parameters (postoperative mechanical ventilation time, duration of ICU stay, postoperative length of hospital stay, total costs of hospitalization, and in-hospital mortality) were significantly higher in AKI children than in non-AKI (AKI grade 0) children ( P<0.01). Among the 225 children diagnosed as non-AKI according to the KDIGO criterion, 63 cases were diagnosed as AKI and 162 cases as non-AKI according to the pRIFLE criterion, however, there was no significant difference in each prognostic parameter between children with AKI and non-AKI ( P>0.05). Conclusion:The pRIFLE criterion has a higher sensitivity, while the KDIGO criterion produces better accuracy when used to evaluate the diagnosis of AKI after radical operation for tetralogy of Fallot in children from the perspective of postoperative outcomes.