Objective:To summarize acute type A aortic dissection(ATAAD) is relatively uncommon in dialysis patients, and repair outcomes are not fully understood.Methods:Between January 2014 and March 2020, 20 patients with ATAAD required dialysis for preoperative end-stage renal disease(ESRD) were treated by our group. There were 11 male and 9 female patients at mean age of(47.8±11.3) years. The mean duration of dialysis therapy in the total 20 patients before the onset of ATAAD was(4.5±3.9 )years, with 90%(18 cases) of these patients undergoing hemodialysis(rather than peritoneal dialysis). 17 patients were treated emergency surgically, surgical operation were performed under deep hypothermic circulatory arrest and perfused the cerebral selective cerebral perfusion, 5 cases with ascending aorta + arch fenestrated stent, 5 cases with ascending aorta+ hemi-arch replacement(2 cases with stent elephant trunk), 4 cases with ascending aorta+ arch replacement+ stent elephant trunk(1 case with coronary artery bypass grafting for left anterior descending coronary artery), 2 cases with aortic valvuloplasty + ascending aorta+ hemi-arch replacement, 1 case with Bentall+ arch fenestrated stent.Results:2 patients were died from aortic ruptured before operation, 1 patient treated medically was alive three months after admission. Cross-clamp, cardiopulmonary bypass, and circulatory arrest times of all the surgical patients were(233.8±84.4) min, (155.5±63.6)min and(28.2±10.8)min, respectively. The following complications occurred postoperative: 3 cases died in the hospital, 1 case of tracheotomy, 2 cases of cerebral infarction, 1 case of cerebral hemorrhage, 1 case of transient paraplegia, and 1 case of surgical site infection. After a mean follow-up of(11.6±14.5) months(rang, 3-61 months). the overall survival rate at 1 year and 5 years was 53% and 27% respectively.Conclusion:Dialysis patients with ATAAD should be operated on urgently and medical treatment carries high risks of aortic rupture, although in-hospital mortality is acceptable, long-term mortality is poor.

Objective:To analyze the application effect of three-fourths prone position drainage method in patients with pulmonary infection and consciousness disorders after tracheotomy.Methods:A total of 84 patients with consciousness disorders who were admitted to the First Affiliated Hospital of Wenzhou Medical University from January 2018 to October 2020 with pulmonary infection after tracheotomy were selected. They were divided into the control group and the observation group, there were 42 cases in each group according to random number table method. The control group received routine prone position drainage for pulmonary infection after tracheotomy and the observation group was given three-fourths prone position drainage method. The arterial partial pressure of oxygen(PaO 2), arterial partial pressure of carbon dioxide(PaCO 2) before and after intervention, the drainage effect after the intervention, the absorption of pulmonary infection foci, and the time of antibiotic treatment for pulmonary infection during the patients′ hospitalization were compared between the two groups. Results:After the intervention, PaO 2 and PaCO 2 were (91.87 ± 7.21), (35.34 ± 3.28) mmHg(1 mmHg=0.133 kPa) in the observation group, and (85.23 ± 7.90), (43.41 ± 3.39) mmHg in the control group, the differences between the two groups were statistically significant ( t=-4.02, 11.09, both P<0.05). After the intervention, the apparent rate, effective rate, and ineffective rate were 78.57%(33/42), 19.05% (8/42), 2.38% (1/42) in the observation group,and 33.33% (14/42), 45.24% (19/42), 21.43% (9/42) in the control group. The drainage effect of the observation group was better than that of the control group, and the difference was statistically significant ( Z=-4.28, P<0.05). After the intervention, the complete absorption rate of the pulmonary infection foci and the time taken to treat pulmonary infection with antibiotics during hospitalization were 59.52% (25/42), (10.67 ± 2.70) d in the observation group, and 35.71%(15/42), (13.51 ± 3.46) d in the control group, the differences were statistically significant ( χ2=4.77, t=4.19, both P<0.05). Conclusions:The three-fourths prone position drainage method has significant application effect in patients with pulmonary infection and consciousness disorder after tracheotomy. It can effectively improve the drainage effect, improve oxygenation, promote the absorption of lung infections, and shorten the antibiotic treatment time.

Objective:To identify the risk factors for and outcomes of preoperative hepatic dysfunction (HD) in patients who underwent surgery for the treatment of acute DeBakey type I aortic dissection (ADIAD).Methods:A retrospective study including 810 consecutive patients between January 2014 and December 2019 in Nanjing Drum Tower Hospital was performed with emergency surgical repair. All patients were divided into non-HD and HD groups according to the Model of End-Stage Liver Disease (MELD) score before surgery and their clinical parameters and clinical outcomes were collected and compared. To determine independent predictors of preoperative HD, multivariate logistic regression analyses were performed using variables with P<0.5 in the univariate analyses. Kaplan-Meier survival analyses were conducted to analyze the association between preoperative HD and postoperative long-term survival. Results:The mean age of the patients was (52.4±12.5) years. 215 patients (26.5%) were identified as the preoperative HD group. In univariate analysis, significant difference was found with respect to the postoperative complications (98.6% vs. 94.5%, P=0.011) and 30-day mortality (20.0% vs. 8.4%, P<0.001) between the two groups. Multivariate logistic analysis showed that elevated serum troponin T levels upon admission( OR=1.921, P<0.001) and preoperative cardiac tamponade ( OR=2.158, P=0.002) were independent risk factors for preoperative HD. The long-term mortality rate was not significantly affected by preoperative HD. Conclusion:Early HD before surgery was commonly observed in patients with ADIAD and was associated with increased postoperative complications and 30-Day mortality. Elevated serum troponin T levels upon admission and preoperative cardiac tamponade were identified as risk factors for preoperative HD.

Objective:To evaluate the clinical effect of the pulmonary rehabilitation system based on the concept of prehabilitation for patients after cardiac surgery to wean tube and avoid related complications.Methods:From January 2018 to December 2019 in a single-center(third-class hospital in cardiac surgery intensive care unit), all adult patients hospitalized for 7 days before open-heart surgery were included. They were randomly divided into pulmonary rehabilitation group(198 cases) and control group(234 cases). To compare and analyze the clinical effects, the main observations were observed including overall outcome indicators(such as early extubation rate, ICU stay, hospitalization costs, advanced oxygen therapy support after extubation) and lung outcome related indicators(such as the occurrence of pulmonary complications, chest drainage, secondary intubation, tracheotomy, lung infection and chest tube drainage).Results:There was no statistical difference between groups in basic conditions and surgical conditions. The lung rehabilitation group significantly increased the rate of early extubation, reduced the number of advanced oxygen therapy after weaning, shortened the length of ICU stay, saved hospitalization cost, significantly reduced the occurrence of postoperative respiratory complications and improved postoperative respiratory function( P<0.05). Conclusion:During cardiac perioperation, pulmonary rehabilitation significantly can increase the rate of early extubation , shorten the length of mechanical ventilation, reduce the occurrence of secondary tracheal intubation and pulmonary complications. And it can also effectively promote the recovery of lung function and the overall recovery.

Objective    To identify the predictors for readmission in the ICU among cardiac surgery patients. Methods    We conducted a retrospective cohort study of 2 799 consecutive patients under cardiac surgery, who were divided into two groups including a readmission group (47 patients, 27 males and 20 females at age of 62.0±14.4 years) and a non readmission group (2 752 patients, 1 478 males and 1 274 females at age of 55.0±13.9 years) in our hospital between January 2014 and October 2016. Results    The incidence of ICU readmission was 1.68% (47/2 799). Respiratory disorders were the main reason for readmission (38.3%).Readmitted patients had a significantly higher in-hospital mortality compared to those requiring no readmission (23.4% vs. 4.6%，P<0.001). Logistic regression analysis revealed that pre-operative renal dysfunction (OR=5.243, 95%CI 1.190 to 23.093, P=0.029), the length of stay in the ICU (OR=1.002, 95%CI 1.001 to 1.004, P=0.049), B-type natriuretic peptide (BNP) in the first postoperative day (OR=1.000, 95%CI 1.000 to 1.001, P=0.038), acute physiology and chronic health evaluationⅡ (APACHEⅡ) score in the first 24 hours of admission to the ICU (OR=1.171, 95%CI 1.088 to1.259, P<0.001), and the drainage on the day of surgery (OR=1.001, 95%CI1.001 to 1.002, P<0.001) were the independent risk factors for readmission to the cardiac surgery ICU. Conclusion    The early identification of high risk patients for readmission in the cardiac surgery ICU could encourage both more efficient healthcare planning and resources allocation.