OBJECTIVETo define the determinants of perioperative death and complications after cardiac valve replacement in 702 patients.

METHODSClinical data of the patients after cardiac valve replacement were analyzed retrospectively.

RESULTSPerioperative mortality and morbidity correlated significantly with some of the perioperative variables, such as higher NYHA functional class (III or IV), large left ventricular end-diastolic diameter (>/= 70 mm), C/T >/= 0.70, prolonged aortic cross-clamping time and cardiopulmonary bypass time, unsatisfactory myocardial protection.

CONCLUSIONSPerioperative mortality and morbidity correlate significantly with some of perioperative variables, such as higher NYHA functional class, unsatisfactory myocardial protection, inappropriate surgical procedure, improper therapy of some complications after cardiac valve replacement. To avoid the occurrence of these independent predictors or to correct them timely might effectively decrease the perioperative mortality and morbidity after cardiac valve replacement.

Adolescent ; Adult ; Aged ; Cause of Death ; Child ; Female ; Heart Valve Diseases ; mortality ; surgery ; Heart Valve Prosthesis ; adverse effects ; Humans ; Intraoperative Complications ; mortality ; Male ; Middle Aged ; Mortality ; Postoperative Complications ; mortality

Objective:To compare the application value of ultrasound-guided lumbar plexus block (LPB) and continuous adductor canal nerve block (ACNB) in total hip arthroplasty (THA), and to explore the anesthesia scheme of THA.Methods:A prospective randomized controlled trial was used. Ninety patients who received THA admitted to in Lishui People′s Hospital from March 2019 to February 2022 were selected as the study subjects. According to the random number table method, 90 patients were divided into the test group and the control group, with 45 patients in each. The control group received LPB + general anesthesia, and the test group received ACNB + general anesthesia. By evaluating the hemodynamic parameters heart rate (HR) and mean arterial pressure (MAP) at the time of entry (T 1), osteotomy (T 2), prosthesis implantation (T 3) and immediately after surgery (T 4); the pain degree visual analogue score (VAS) at 6 h (S 1), 12 h (S 2), 24 h (S 3), 48 h (S 4) after awakening; the dosage of anesthetic drugs, the anesthetic effects of LPB and ACNB in THA were compared. Results:From T 2 to T 4, HR of patients in the two groups had a trend of increase: (85.24 ± 4.26) times/min vs. (86.13 ± 4.86) times/min, (83.82 ± 5.11) times/min vs. (85.16 ± 3.56) times/min and (81.64 ± 4.32) times/min vs. (82.24 ± 4.62) times/min, while MAP was in a downward trend: (86.54 ± 4.25) mmHg (1 mmHg = 0.133 kPa) vs. (85.35 ± 4.66) mmHg, (86.15 ± 3.92) mmHg vs. (84.86 ± 4.13) mmHg and (90.65 ± 5.25) mmHg vs. (92.12 ± 4.62) mmHg. The difference at different time points was statistically significant ( P<0.05). There was no statistically significant difference in HR, MAP and change trend between the two groups at different time ( P>0.05). The VAS score of the two groups increased from S 2 time point, and the difference between different time points was statistically significant ( P<0.05). The rising trend of VAS score in the test group was lower than that in the control group, and the VAS score at different time points was lower than that in the control group ( P<0.05). The dosage of sufentanil used in the test group was less than that in the control group: (114.37 ± 16.61) μg vs. (131.36 ± 18.31) μg, and the number of press of analgesia pump was less than that in the control group: 6.00 (5.00, 6.50) times vs. 8.00 (7.00, 9.00) times ( P<0.05). Conclusions:Ultrasound-guided LPB and ACNB could maintain hemodynamic stability in THA. Especially, ACNB could play an analgesic role within 48 h after THA and reduce the dosage of analgesic drugs.