Background: The incidence of hyperbilirubinemia after off-pump coronary artery bypass grafting (OPCAB) is unclear. This study aimed at retrospectively analyzing the incidence and character of perioperative hyperbilirubinemia in patients undergoing OPCAB, to analyze the independent risk factors, to identify the correlation with adverse events and mortality, and to explore the management strategy of perioperative hyperbilirubinemia.Methods: Clinical data for 416 patients (314 males and 102 female), who had been subjected to off-pump coronary artery bypass grafting in the Department of Cardiac Surgery, Beijing Chaoyang Hospital from December, 2016 to March, 2019 were recorded. Hyperbilirubinemia was defined as serum total bilirubin ≥ 34.2 μmol/L within 5 days after surgery. Based on the occurrence of hyperbilirubinemia, patients were divided into the normal serum total bilirubin group and the hyperbilirubinemia group. Perioperative variables between the two groups were compared by univariate logistic regression analysis. Multivariate logistic regression analysis was used to analyze variables with statistical significance. Then, we determined the independent risk factors for hyperbilirubinemia after OPCAB. Moreover, incidences of adverse events, length of ICU stay, time of mechanical ventilation and mortality rates between the two groups were compared. Results: Thirty two of 416 patients were found to exhibit postoperative hyperbilirubinemia. The incidence rate was 7.7%. Based on univariate regresssion analysis, differences in gender, preoperative total bilirubin levels, perioperative IABP implantation, perioperative blood transfusion between the two groups were significant. Multivariate logistic regression analysis revealed that elevated preoperative serum total bilirubin levels (OR=1.241, p<0.001), perioperative blood transfusion (OR=0.237, p=0.002) and perioperative IABP implantation (OR=0.238, p=0.003) were independent risk factors for hyperbilirubinemia after OPCAB. Compared to the normal bilirubin group, incidences of new acute renal failure, continuous renal replacement therapy, perioperative myocardial infarction, pulmonary infection, multiple organ dysfunction syndrome and in-hospital mortality in the hyperbilirubinemia group were significantly increased.Conclusions: Perioperative hyperbilirubinemia is associated with adverse events and mortality. In clinical practice, changes in serum total bilirubin levels among patients undergoing OPCAB should be routinely monitored, and active as well as early interventions in patients with risk factors performed. In this manner, postoperative complications can be reduced, thereby improving patient prognosis.
To observe the incidence of adverse reactions of amlodipine combined with atorvastatin in patients with coronary heart disease complicated with carotid atherosclerosis and the effect on the levels of high-mobility group box protein 1 and human cartilage glycoprotein 39. Retrospective analyses of patients with coronary heart disease combined with carotid atherosclerosis in our hospital are divided into two groups according to different treatment methods. The control group was given atorvastatin and the observation group was given amlodipine on this basis. The differences in blood lipid levels, myocardial enzyme levels, intima-media thickness levels, high-mobility group box protein 1 and human cartilage glycoprotein 39 changes before and after treatment were compared between the two groups. During the treatment period, there was no difference in the incidence of complications between the two groups. There was no difference in blood lipid levels between the two groups before treatment. After treatment, the levels of low-density lipoprotein cholesterol, triglycerides and total cholesterol in the observation group were lower than those in the control group and the levels of high-density lipoprotein cholesterol were higher than those in the control group. There was no difference in intima-media thickness before treatment between the two groups. At 4 and 8 w after treatment, the intima-media thickness value of the observation group was lower than that of the control group (p<0.05). There was no difference in the levels of high-mobility group box protein 1 and human cartilage glycoprotein 39 between the two groups before treatment. After treatment, the levels of high-mobility group box protein 1 and human cartilage glycoprotein 39 in the observation group were lower than those in the control group (p<0.001). There was no difference in myocardial enzyme indexes between the two groups before treatment. After treatment, the levels of lactate dehydrogenase and creatine kinase myocardial band of the two groups were lower than before treatment and the observation group was lower than the control group, the difference was statistically significant (p<0.001). Amlodipine combined with atorvastatin has a good therapeutic effect on patients with coronary heart disease complicated with carotid atherosclerosis and has good application value.
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