فهرست مطالب رسول آذرفرین

The aim of the present study was to examine the effect of early mobilization protocol on the strength of diaphragmatic muscle and other inspiratory muscles after open heart surgery.

Early mobilization is recommended as a safe protocol after open heart surgery to decrease hospital stay and post-op respiratory complications; however, our knowledge about its effect on improving respiratory muscles strength is limited.

  This is a randomized single-blinded clinical trial conducted on 80 consecutive patients who underwent coronary artery bypass surgery and/or valvular surgery that were randomly assigned to experimental group (postoperative early mobilization) and control group (routine physiotherapy). On the day before surgery and the day before leaving intensive care unit (ICU), two scores were measured for assessing diaphragmatic muscle strength: maximum inspiratory pressure (PI max) and Strength index (S index). Hemodynamic parameters were also measured and compared.

According to both PI max and S index, diaphragmatic muscle strength decreased from 77.28 to 59.53 cmH2O in patients after surgery, but the changes in the experimental group was less than the control group, which indicates a significant improvement in the strength of the diaphragm muscle in the experimental group (p≤0.0001). Hemodynamic changes after surgery (lower blood pressure and increased heart rate) occurred in both groups without any significant clinical effect.

  Early mobilization after cardiac surgery has positive effect on the strength of diaphragmatic muscle and is also safe as shown to have no adverse effect on hemodynamic parameters.

Aim:

 This study was conducted to examine the relationship between magnesium blood levels and postoperative bleeding in patients undergoing elective Coronary Artery Bypass Grafting (CABG) Surgery.

Background:

 Decline in Serum magnesium following cardiac surgery is an important issue and postoperative bleeding is among concerns associated with postoperative care in open heart surgery. It seems that coagulation disorders related to magnesium are dose-related.

Method:

In this descriptive correlational study, 120 patients undergoing CABG surgery using cardiopulmonary bypass machine were enrolled. All the patients were similar regarding the process of anesthesia and surgery. After surgery, when transferring to the intensive care unit, a blood sample was obtained from patient and sent to the laboratory to measure the magnesium blood levels. The amount of blood drainage in chest bottle of patient was recorded. The data were analyzed in SPSS version 20 using descriptive and inferential statistics.

Findings:

 There was a statistically significant inverse correlation between magnesium blood levels and postoperative blood drainage (r=-0.17, P=0.046). There was also a statistically significant correlation of Prothrombin Time (PT) and Partial Thromboplastin Time (PTT).

Conclusion:

 Magnesium blood level is influential on blood drainage in postoperative period as well as antiarrhythmic effect. It seems there is no concern about increasing blood drainage following infusing magnesium for patients under CABG surgery.

It is assumed that left atrial (LA) volume provides more accurate prognostic information about patients with acute myocardial information (AMI), because it presents severity of diastolic function impairment by the time. The aim of this study was to evaluate the effect of left atrium size on patient's outcome after acute myocardial infarction.

In this cohort study 100 patients with AMI during admission were entered into the study. The patients were followed up for 9 months. Their one month survival rate was evaluated. Demographic, atherosclerotic risk factors, arrhythmic and mechanical side effects of MI were recorded. Moreover, echocardiographic indices such as systolic and diastolic function and left atrial volume were evaluated.

In our study patients with higher LA volume index (>32 mL/m2) had more mortality rate (6/22, 27.3%) compared to patients with lower LA index (1/78, 1.3%) (P= 0.001). There was no statistically significant difference in mortality rate considering gender and age of the patients (P>0.05). In univariate analysis, there was no statistically significant difference in mortality rate with regard to hypertension, diabetes mellitus, cigarette smoking and dyslipidemia. However mortality rate was significantly higher in ST segment elevation MI, diastolic dysfunction, restrictive pattern, left ventricular ejection fraction less than 40% and LA volume index ≥32 mL/m2. In multivariate analysis (logistic regression), only LA volume index ≥32 mL/m2 was an independent predictor of increased mortality rate after AMI (P= 0.008).

LA volume index is an independent predictor of poor prognosis in patients with AMI, even after adjustment with clinical predictors and conventional indices of echocardiography.