Amiodarone ; administration & dosage ; Anti-Arrhythmia Agents ; administration & dosage ; Atrial Fibrillation ; drug therapy ; Heart Valve Diseases ; drug therapy ; Humans ; Quality of Life ; Rheumatic Heart Disease ; drug therapy

OBJECTIVETo observe the protection effect of Ligustrazine Hydrochloride (LH) on coagulation reaction and inflammation reaction in single valve replacement patients with rheumatic heart disease undergoing cardiopulmonary bypass (CPB).

METHODSTotally 40 patients undergoing single valve replacement were recruited in the study and randomly assigned to the two groups, the treatment group and the control group, 20 in each group. In treatment group LH (3 mg/kg) was intravenously infused from the jugular vein. LH (3 mg/kg) was also added in the CPB priming. In the control group LH was replaced by equal amount of normal saline. Endothelial micro-particles (EMP) count was detected before CPB, 30 min after CPB, 1 h and 24 h after CPB finished. The coagulation reaction time (R), coagulation time (K), clotting formation velocity (alpha angle), maximum amplitude (MA), coagulation index (CI), platelet (PLT), hypersensitive C reactive protein (hs-CRP), IL-6, and IL-10 were detected before CPB, 1 h and 24 h after CPB finished.

RESULTSThere was no statistical difference in aorta arresting time, period of CPB, post-operative drainage volume, plasma transfusion volume, post-operative respirator assistant time, and hospitalization time between the two groups (P >0.05). Compared with pre-CPB in the same group, the count of EMP was much higher at 30 min after CPB and 1 h after CPB finished (P < 0.01). R and K, hs-CRP, IL-6, and IL-10 increased at 1 h and 24 h after CPB finished (P <0.01,P < 0.05). The alpha angle,.MA, CI, and PLT decreased 1 h after CPB finished (P <0.01). The a angle increased, while CI and PLT decreased 24 h after CPB finished (P <0.05). Compared with the control group in the same period, the count of EMP was lower in the treatment group 30 min after CPB and 1 h after CPB finished (P <0. 05, P <0. 01). R and K values obviously decreased in treatment group 1 hour after CPB finished (P <0. 05), while a angle, MA, CI, and PLT increased (P <0. 05, P <0. 01). hs-CRP and IL-6 decreased in the treatment group 1 h and 24 h after CPB finished (P <0.05), while IL-10 increased (P <0.05). The count of PLT increased 24 h after CPB finished in the treatment group (P <0. 05).

CONCLUSIONLH had certain protection effect on the vascular endothelium undergoing CPB, and lower excessive activation of coagulation reaction and inflammation reaction in patients undergoing CPB.

Blood Coagulation ; drug effects ; C-Reactive Protein ; metabolism ; Cardiopulmonary Bypass ; methods ; Humans ; Inflammation ; Interleukin-10 ; blood ; Interleukin-6 ; blood ; Pyrazines ; pharmacology ; therapeutic use ; Rheumatic Heart Disease ; drug therapy

The present study analyzed the efficacy evaluation indexes of the randomized controlled trials(RCTs) of Chinese medi-cine in the treatment of rheumatic heart disease to lay the foundation for the construction of the corresponding core outcome index set. Clinical RCTs with a definite diagnosis of rheumatic heart disease were retrieved from CNKI, Wanfang, VIP, Sino Med, Pub Med, EMbase, and Cochrane Library from January 1, 2010, to December 31, 2020. Thirty-five RCTs were included, involving 3 314 patients and 41 efficacy evaluation indexes, which covered seven domains [traditional Chinese medicine(TCM) symptoms/syndromes, symp-toms/signs, physical and chemical examination, quality of life, long-term prognosis, economic evaluation, and safety events]. Physi-cal and chemical examination(56. 91%) and symptoms/signs(29. 27%) were the more frequently applied. The number of indexes used in a single trial ranged from 1 to 15, with an average of 4. The measurement time points of the top five indexes in the frequency of use were as follows: total response rate was reported at five measurement time points, ranging from 14 days to 6 months; left ventri-cular ejection fraction was measured at eight time points ranging from 5 days to 6 months; left ventricular end systolic diameter was measured at six time points, ranging from 5 days to 6 months; interleukin-2(IL-2) and tumor necrosis factor-α(TNF-α) were repor-ted 28 days after treatment. At present, there are many problems in the efficacy outcome indexes of RCTs in the treatment of rheumatic heart disease with TCM, such as large difference in quantity, unclear primary and secondary indexes, unreasonable selection of " surro-gate indexes", insufficient attention to long-term prognostic indexes and safety event indexes, non-standard application of composite in-dexes, long measurement period, and lack of TCM characteristics. It is urgent to establish the core outcome set for TCM treatment of rheumatic heart disease.
Drugs, Chinese Herbal/therapeutic use* ; Humans ; Medicine, Chinese Traditional ; Quality of Life ; Randomized Controlled Trials as Topic ; Rheumatic Heart Disease/drug therapy* ; Treatment Outcome

OBJECTIVE: To evaluate the effect of different control levels of glucose on the serum lactic acid during operation, and to investigate the relation between glucose and lactic acid to find a new way of myocardial protection. METHODS: Volunteers were divided into an experiment group(n=38) and a control group(n=33) by random sampling and double blind method. The experiment group received intensive insulin therapy and the control group received traditional therapy. The arterial blood gas samples of all the patients at different time points after the operation were harvested in the intensive care unit for blood gas analysis. The related data were collected and analyzed. RESULTS: The serum glucose level in the 2 groups decreased firstly, then increased, and recovered finally. The serum lactic acid level in the 2 groups increased firstly, decreased later, then reincreased, and recovered finally. The highest level of the serum lactic acid was found 2 hours after the operation. There were significant differences in serum glucose and lactic acid levels at 2, 12, and 24 h after the operation in the two groups (P<0.01). The other data were not significant (P>0.05). CONCLUSION The variation of serum glucose and lactic acid level at 2, 12, 24 h after the valve replacement is consistent and significant. The serum lactic acid in the serum may be decreased by controlling the blood glucose, which provides experiment basis for myocardial protection.
Adult ; Cardiopulmonary Bypass ; adverse effects ; Double-Blind Method ; Female ; Heart Valve Prosthesis Implantation ; Humans ; Hyperglycemia ; blood ; drug therapy ; prevention & control ; Insulin ; therapeutic use ; Lactic Acid ; blood ; Male ; Middle Aged ; Postoperative Complications ; drug therapy ; prevention & control ; Rheumatic Heart Disease ; blood ; surgery

OBJECTIVETo compare the efficacy of combined amiodarone and irbesartan use versus amiodarone alone on maintaining sinus rhythm in rheumatic heart disease patients with persistent atrial fibrillation (AF) post valve replacement and cardioversion.

METHODSPatients were randomly divided into amiodarone group (A, n = 31) and amiodarone plus irbesartan group (AI, n = 32) and all patients received Warfarin (INR 2.0 - 3.0). For patients in group A, intravenous amiodarone (600 mg/d) was applied for 10 days and oral amiodarone (200 mg, b.i.d.) was given on the 7th day for 3 days. For patients in group AI, irbesartan (150 mg/d) was added on top of amiodarone at the study begin. Electric cardioversion was performed for patients still with AF on day 10. Amiodarone (200 mg, b.i.d. for 1 week, then 200 mg, q.d. till study end) with or without irbesartan (150 mg/d) was continued thereafter. Patients were followed up for 12 months after sinus rhythm recovery. The primary end points are first recurrence of symptomatic and asymptomatic AF.

RESULTSTwelve months post therapy, number of patients on sinus rhythm was significantly higher (68.7% vs. 41.9%, P<0.05) and left atrium diameter (LAD) was significantly smaller [(48.6 +/- 4.6) mm vs. (51.5 +/- 4.2) mm, P<0.05] in group AI than those in group A. LAD (OR 1.242) and use of irbesartan (OR 0.226) are associated with the AF recurrence.

CONCLUSIONCombined amiodarone and irbesartan use is superior to amiodarone alone for maintaining sinus rhythm in rheumatic heart disease patients with persistent AF post valve replacement and cardioversion.

Adult ; Amiodarone ; therapeutic use ; Anti-Arrhythmia Agents ; therapeutic use ; Atrial Fibrillation ; drug therapy ; Biphenyl Compounds ; therapeutic use ; Female ; Humans ; Male ; Middle Aged ; Rheumatic Heart Disease ; drug therapy ; Tetrazoles ; therapeutic use ; Treatment Outcome

Adolescent ; Anti-Arrhythmia Agents ; therapeutic use ; Atrial Fibrillation ; drug therapy ; Child ; Female ; Follow-Up Studies ; Heart Valve Diseases ; complications ; Humans ; Male ; Quinidine ; adverse effects ; therapeutic use ; Rheumatic Heart Disease ; complications

OBJECTIVETo investigate the protective effect of Shenfu injection (SFI) on cardiac function of patients undergoing valve replacement operation under cardio-pulmonary bypass.

METHODSOne hundred and twenty patients undergoing valve replacement operation under cardio-pulmonary bypass were randomly divided into the SFI group and the control group, 60 in each group. Intravenous infusion of 1 ml/kg SFI was given to the SFI group, 30 min before anesthesia, and to the control group, equal volume of normal saline was given instead. The following indices were observed: (1) the hemodynamic changes occurred in the operational period; (2) the dosage of vaso-active drugs used during and after operation; (3) the post-operational recovery time of patients.

RESULTSThe mean arterial pressure and heart rate in the SFI group during operation were higher, while the central venous pressure was lower than those in the control group (P < 0.05). The dosage of vaso-active drugs, such as dopamine, dobutamine, sodium nitroprusside and lidocaine, used during and after operation was lower, and the extubation time and the intensive care unit (ICU) staying time were shorter in the SFI group when compared with those in the control group (P < 0.05).

CONCLUSIONSFI has certain protective effects on the cardiac function of patients undergoing valve replacement operation under cardio-pulmonary bypass.

Adolescent ; Adult ; Aortic Valve Insufficiency ; drug therapy ; physiopathology ; surgery ; Cardiopulmonary Bypass ; Dopamine ; therapeutic use ; Drug Therapy, Combination ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Heart Valve Prosthesis Implantation ; Humans ; Infusions, Intravenous ; Male ; Middle Aged ; Mitral Valve Insufficiency ; drug therapy ; physiopathology ; surgery ; Nitroprusside ; therapeutic use ; Phytotherapy ; Postoperative Period ; Rheumatic Heart Disease ; drug therapy ; physiopathology ; surgery