Objective To investigate the dynamic changes in the fibrinolytic system during and after open heart surgery performed with cardiopulmonary bypass (CPB) and the effect of epsilon-aminocaproic acid (EACA) on fibrinolysis, postoperative blood loss and transfusion requirements.Methods Forty patients (24 males, 16 females) aged 17-43 yr undergoing valve replacement with CPB were randomized to receive EACA 200 mg?kg-1 (group A) or normal saline (group B) added to the priming solution. The patients were premedicated with intramuscular morphine 0.2 mg?kg-1 and scopolamine 0.3 mg. Anesthesia was induced with midazolam 0.2 mg ? kg, fentanyl 10 ?g?kg-1 and vecuronium 0.1 mg?kg-1 and maintained with isoflurane inhalation and intermittent i.v. boluses of fentanyl and vecuronium. The patients were mechanically ventilated (VT = 10 ml?kg-1 , RR = 10-12 bpm, I:E = 1:2) after tracheal intubation. Blood samples were taken before skin incision (baseline) , 8 and 30 min on CPB, 10 min after protamine administration and 2 h after operation for determination of tissue type plasminogen activator (t-PA) activity, plasminogen activator inhibitor (PAI) activity, plasmin (Plm) activity and D-dimer. The amount of blood drained from chest and bank blood infused within 24 h after operation were recorded.Results (1) Group B (control group): PAI activity was maintained stable perioperatively. The t-PA activity and t-PA/PAI ratio increased significantly during operation but returned to the baseline value 2 h after operation. D-dimer level also significantly increased during and after operation. The Plm activity increased significantly at 8h on CPB and 10 min after protamine administration compared to the baseline value. (2) The t-PA activity and t-PA /PAI ratio were significantly lower in group A than in group B. The D-dimer level and Plm activity were also significantly lower in group A than in group B during and after operation. The amount of blood loss and bank blood infused within 24 h after operation was 40% and 37% less than that in group B.Conclusion Fibrinolytic system is activated during CPB as shown by the increase in plasminogen and t-PA/PAI ratio. EACA is effective in reducing postoperative blood loss and blood transfusion through inhibition of the activation of fibrinolytic system.

Objective To explore the operative indication operation time and post-operative care for infants with large ventricular septal defects (VSD).Methods Eighty-eight infants who suffered from large VSD were selected,male 53 cases,female 35 cases,aged from 3 to 18 months[average (7.5-±2.9) months],weight from 5 to 13 kg [average (7.9 ± 1.9) kg].All patients underwent VSD repair and other accompanied anomaly corrections under cardiopulmonary bypass.Fifty-eight cases were operated through right atrium,14 cases through pulmonary artery and 16 cases through right ventricle.Patch repairs were done in all patients,78 cases given bovine pericardium patches,10 cases given self pericardium patches treated by Glutaral.Patients were sent to the intensive care unit after surgery,vasoactive drugs were used as a routine method.Antibotics were selected based on their sputum cultures postoperatively.Nutritional support was given in the earlier stage.Results There were no hospital death,average hospitalization days were (15.2 ± 5.9) days (from 11 to 32 days).The main complication were pneumonia (5 cases),bad coalesce of incision (4 cases),atelectasis (3 cases),minimal residual shunt of VSD (3 cases).All patients were discharged from hospital,76 cases were followed up from 1 to 12 months,2 cases had residual shunt of VSD,the residual shunt of the other case disappeared;76 patients had no clinical symptom,28 patients body weight returned to normal after 6 months of operation.There was no other complication and death.Conclusion Early surgical treatment for infants with large VSD is a safe and effective way with a better prognosis.

Objective To analyze the etiology of fever of unknown origin (FUO).Methods A total of 372 patients with FUO who hospitalized in Capital Medical University Affiliated Beijing Friendship Hospital were retrospectively analyzed from January 2003 to August 2013.All the patients were divided into two groups:group A (January 2003-December 2007) and group B (January 2008-August 2013).Diagnosis rate,duration of hospitalization (days) and time to diagnosis between the two groups were artificially compared.Results Of the 372 FUO cases,336 were positively diagnosed with a diagnosis rate of 90.3％.Infectious diseases were still the primary causes of FUO (60.2％),including 72 cases (32.1％) of tuberculosis.Connective tissue diseases accounted for 12.9％ of the FUO cases,malignancies were 8.3％,and miscellaneous diseases were 8.9％.Yet thirty six patients (9.7％) could not be confirmed until they were discharged from hospital.The duration of fever in patients with malignancies was longer than that with infectious diseases [60.0 (30.0,90.0) days vs 30.0 (20.0,60.0) days,P =0.003].Time to diagnosis of connective tissue disease and malignancies was longer than infectious diseases [(12.0 (7.3,18.8) days and 11.0 (7.0,18.0) vs 5.0 (3.0,8.0) days,both P values =0.000].The duration of hospitalization in group A was longer than that of group B [17.0(12.0,30.0) days vs 14.0(10.0,20.0) days,P =0.000].The diagnosis rate and time to diagnosis of group A were similar with those of group B.The proportion of connective tissue diseases in group A was higher than group B(18.1％ vs 9.2％,x2 =6.201,P =0.013).The proportion of infectious disease,malignancies and miscellaneous diseases was not significantly different between the two groups.Conclusions Infectious diseases are the major causes of FUO,and the most common cause is tuberculosis.Connective tissue diseases and malignancies are the second and third causes of FUO.The duration of fever and time to diagnosis are significantly different between the different origins.

Objective:To investigate the safety and effect of the operation of the upper sternum small incision assisted by normothermic cardiopulmonary bypass in the treatment of aortic valve disease.Methods:From March 2014 to June 2016, the clinical data of 25 patients who underwent single incision minimally invasive aortic valve replacement assisted by normothermic cardiopulmonary bypass in The Second Hospital of Hebei Medical University and 25 patients who underwent aortic valve replacement under hypothermia cardiopulmonary bypass were analyzed retrospectively.The former was used as minimally invasive surgery group, and the sternum was sawn in " J" shape through a small incision on the upper sternum.In the latter group, aortic valve replacement was performed under cardiopulmonary bypass.The operation effect and complications of the two groups were compared.Results:There was no death in the two groups.There was no significant difference in operation time between minimally invasive surgery group and routine operation group ( P>0.05). The time of aortic occlusion and cardiopulmonary bypass in minimally invasive surgery group ((50.0±6.8), (69.5±9.7) min) was longer than those in routine operation group ((45.8±7.2), (65.0±8.8) min), the difference was statistically significant ( t=2.120, 2.052, all P<0.05). In the minimally invasive operation group, red cell volume, plasma volume, intraoperative bleeding volume, incision length, postoperative 24-h drainage volume, postoperative 24-h leukocyte count, postoperative 24-h C-reactive protein concentration, postoperative 24-h total blood transfusion volume, ventilator-assisted time, ICU stay time and drainage tube retention time(85.1(42.3, 181.3) ml, 108.5(79.4, 173.8) ml, 186.4(132.6, 307.6) ml, (4.2±0.8) cm, 130.0(88.1, 224.3) ml, 14.2(9.8, 17.1)×10 9/L, 14.0(9.9, 23.2) mg/L, 186.6(135.3, 302.1) ml, 3.7(2.3, 6.8) h, 25.2(20.6, 35.6) h, 31.2(26.4, 41.9) h) were lower than those in the routine operation group (354.2(150.2, 507.2) ml, 211.9(119.2, 281.5) ml, 378.4(220.9, 496.5) ml, (13.8±6.5) cm, 365.8(171.8, 511.3) ml, 20.4(13.6, 24.7)×10 9/L, 28.6(14.4, 39.3) mg/L, 405.1(185.3, 570.1) ml, 7.7(4.2, 10.2) h, 52.8(30.8, 69.3) h, 57.2(37.6, 71.9) h), the difference between the two groups was statistically significant ((the statistical values were Z=3.393, 2.696, 2.781, t=7.329, Z=3.151, 2.638, 2.493, 2.597, 2.472, 3.254, 3.338, respectively; all P<0.05). There was no significant difference between the minimally invasive operation group and the routine operation group( P>0.05). The total incidence of postoperative complications in the minimally invasive operation group and the routine operation group was (12% (3/25) and 44% (11/25)), the difference was statistically significant ( P=0.025). Conclusion:CPB with normal temperature has the advantages of less trauma, fewer complications and faster recovery in the operation of single incision in the upper part of sternum.

Objective To analyze the short-term clinical efficacy and prognosis of one-stop transcatheter aortic valve replacement (TAVR)+percutaneous coronary intervention (PCI) in the treatment of aortic valve disease with coronary heart disease. Methods The clinical data of patients with aortic valve disease complicated with coronary heart disease who underwent one-stop TAVR+PCI treatment at the Department of Cardiovascular Surgery, the Second Hospital of Hebei Medical University from January 2018 to June 2023 were retrospective analyzed. The preoperative and postoperative clinical data were compared, and 1-month follow-up results were recorded. Results A total of 37 patients were enrolled, including 22 males and 15 females, with an average age of 69.14±6.47 years. Thirty-six patients recovered and were discharged after the surgery, and 1 (2.7%) patient died during the surgery. Self-expanding TAVR valves were implanted through the femoral artery in all patients. One coronary artery was opened by PCI in 35 (94.6%) patients, and two coronary arteries were opened by PCI in 2 (5.4%) patients. All PCI opened arteries had a stenosis>70%. During the postoperative hospitalization, the complications included pulmonary infection in 11 (30.6%) patients, severe pneumonia in 10 (27.8%) patients, liver function injury in 14 (38.9%) patients, renal function injury in 5 (13.9%) patients, cerebral infarction in 1 (2.8%) patient, atrial fibrillation in 1 (2.8%) patient, ventricular premature beats in 2 (5.6%) patients, atrioventricular block in 2 (5.6%) patients, and complete left bundle branch block in 5 (13.9%) patients. The median postoperative ventilation assistance time was 12.0 (0.0, 17.0) h, the ICU monitoring time was 1.0 (0.0, 2.0) d, and the postoperative hospitalization time was 5.0 (4.0, 7.0) d. There was a significant improvement in the New York Heart Association cardiac function grading after surgery (P<0.001). After surgery, there were 21 (58.3%) patients had minor perivalve leakage, 6 (16.7%) patients had minor to moderate perivalve leakage, and no moderate or above degree of perivalve leakage. After one month of postoperative follow-up, 36 patients showed significant improvement in heart function. There were no patients with recurrent acute coronary syndrome, re-PCI, or cardiovascular system disease related re-hospitalization. Conclusion The one-stop TAVR+PCI treatment for patients with aortic valve disease and coronary heart disease can obtain satisfactory short-term clinical efficacy, which is worth further trying and studying.