فهرست مطالب محمد عباسی تشنیزی

Coronary artery bypass graft (CABG) is a very good option for the treatment of coronary artery occlusion. One of the risks is bleeding from anastomotic site because of suturing disruption which is dangerous for patient. Fibrin glue (FG) is an effective tissue sealant in tissue repair. In the present time, FG has been not used routinely in CABG surgery. The aim of this review article is to evaluate the preventive effect of FG from bleeding in anastomotic site in CABG.

A systematic search in PubMed database was done from February 1999 to February 2019 with these key words: Fibrin glue, surgery and coronary artery bypass. All clinical and experimental studies, which are written in English language and about preventive effect of FG from bleeding in CABG surgery were considered.

The seventy articles were found. Seventeen articles have been used. In Clinical studies, commercial allogenic FG in eleven studies , allogenic FG from single donor in one study, autologous FG in three studies and commercial allogenic & autologous FG in one experimental study were used. Fourteen studies showed that FG is very effective to decrease the bleeding. One study reported that autologous FG can decrease the bleeding better than commercial allogenic FG. One study reported no beneficial effect of FG in decreasing of bleeding. One study reported very adverse effect of FG which caused the mortality in patients.

The use of allogenic and autologous FG is very effective in reducing of bleeding in anastamotic site in CABG.

Despite the improvement in postoperative outcomes, delirium is a common neurological complication after cardiac surgery. Therefore, the present study was conducted to investigate the relationship between STS risk score and postoperative delirium in ICU in coronary artery bypass graft surgery.

150 patients between the ages of 18 and 75 who underwent elective off-pump CABG surgery were evaluated for STS risk score during the operation, the anesthesia protocol was the same, the patient's blood pressure was kept in the optimal range (map: 60-80). Delirium in the patient was assessed with a CAM ICU checklist by a trained nurse after extubation. After the operation, the care protocol was the same in the ICU and in the ICU after extubation, the rate of delirium was assessed by the trained nurse.

Frequency male and female was 57 and 93 respectively.  STS, was no significant difference between the two groups .The number of grafts and the length of hospital stay  in the group  was significantly . No significant differences were observed between the two groups.There was a significant correlation between age and weight and STS  . Weight,  height  and body mass index had a significant correlation with STS. The number of pixels received during operation with STS has a significant  correlation. The number of platelets received during operation with EF before surgery and  duration of operation had a significant negative and positive correlation, respectively.

The presence or absence of Delirium did not show a significant difference with STS score. The presence or absence of Delirium did not show a significant difference with STS score.

Sleep disorders after heart surgery lead to increased heart rate, increased myocardial oxygen demand, and cause dysrhythmia that worsen heart ischemia. The purpose of this study was to compare the effect of acupressure and reflexology on sleep condition following coronary artery bypass graft surgery.

A randomized controlled trial was performed in 60 patients. They were randomly assigned into three groups. Two intervention groups; reflexology (n=20) and acupressure (n=20), and a control group (n=20). For three to six days after the surgery, foot reflexology and acupressure were done for 30 min and 21 min, respectively. St. Mary's Hospital Sleep Questionnaire was administered for five consecutive days for each group. Data was analyzed in SPSS V25.

The General Estimated Equation (GEE) showed that, compared to acupressure, reflexology significantly improved duration of the last day sleep (P<0.001). The depth of sleep and last night's sleep satisfaction were significantly higher in acupressure group than reflexology group (P<0.001).

In this study, reflexology and acupressure led to higher last night's sleep satisfaction. Compared to reflexology, acupressure is performed in less time and is more effective. Therefore, it can be an appropriate non pharmacological treatment following open heart surgery.
 
(Clinical Trials Registry Number: IRCT20110906007494N29)

Infective endocarditis refers to an infectious disease that often affects the heart valves (whether natural or artificial). Unfortunately, there are few studies on the epidemiology of infective endocarditis in Iran. The aim of this study was to evaluate the incidence of infective endocarditis in terms of demographic characteristics of clinical symptoms, underlying diseases and outcomes. Methods & Materials This study was a retrospective-prospective cohort study, which was done descriptively on patients with endocarditis. Accordingly, the information of patients in two hospitals of Imam Reza and Ghaem was followed and recorded in the checklist. The information was included in the field information as well as information about the patients' illness was entered in the statistical software and was evaluated descriptively. Results In our study we observed that of 19 patients evaluated in this study, 17 cases (89.5%) were males and 2 patients (10.5%) were females. We also observed that only 2 patients (10.5%) had heart attack after surgery, 4 (21.1%) patients had recurrent endocarditis after surgery, and 3 patients (15.8%) needed re-surgery due to other diseases and total mobility rates were positive in 9 patients. Conclusion Based on the results observed in this study, the high mortality rate of patients after endocarditis indicates the importance of attention to these patients. Accordingly, consideration of the clinical features of these patients can lead to better management of patients and promote their prognosis.

Background and Following coronary artery bypass grafting (CABG) respiratory failure is inevitable, therefore, invasive ventilation is used in patients. This study was conducted to investigate the effect of airway pressure release ventilation (APRV) on arterial blood gas (ABG) of patients after CABG.
This study was conducted in 32 patients in Mashhad Imam Reza Hospital, 2014. The patients were randomly divided into two groups (n= 16 per group). The two groups received synchronized intermittent mandatory ventilation (SIMV). Then the patients in group I were switched to APRV while in group II SIMV continued for another half an hour. Afterwards, group I received SIMV and group II received APRV for half an hour. In all three stages the values for ABG were recorded. Data was then analyzed in SPSS.
The mean values of PaCO2 showed no significant changes in three stages between the two groups (P>0.05) but the mean values of PaO2 in APRV stage in first group (P APRV led to improvement of oxygenation.

Suturing, is the most common way to close wounds and non-absorable sutures must be removed. Suture removal is a painful process. The purpose of this study was to evaluate the application of ice bag on pain intensity from pulling sutures of the leg vein removal among patients undergoing cardiac surgery. This single-blinded clinical trial, three groups before and after intervention, was conducted on 90 post cardiac surgery patients who had at least 20 cm incision in surgical site (leg vein removal) and hospitalysed in Imam Reza Hospital of Mashhad, Iran. In group 1, Ice bags were applied on surgical site for 10 minutes and in group 2 for 20 minutes before sutures removal. Participants in the control group did not receive any intervention. Pain intensity was measured by visual analog scale before and immediately after sutures removed. Data analysis was done by ANOVA, Paired T test, Chi-square and Fisher exact tests. There was no significant difference in pain intensity scores between three groups before sutures removal. Immediately after sutures removal, pain intensity score in group1 (2/53±0/93) and group2 (1/60±0/85) were significantly less than the control group (4/13±1/40). Applying ice bag can be considerd as an effective, cheap and low risk intervention for decreasing pain associated with sutures removal.

Inserting at least one chest tube is necessary in cardiac and thoracic surgery patients. Chest tube removal (CTR) has been described as one of the worst experiences by patients in intensive care unit. The purpose of this study was to evaluate the application of ice bag on pain intensity of chest tube removal in adult patients undergo cardiothoracic surgery. This single-blinded crossover clinical trial was done on 51 post cardiac surgery patients in Imam Reza Hospital of Mashhad، Iran، who had at least two chest tubes in situ. Patients assigned to 3 groups of Ice bag، placebo and control. Ice and placebo bags were applied to the area surrounding the chest tubes for 20 minutes before CTR. Pain intensity was measured by visual analog scale before، immediately after and 15 minutes after CTR. Data analysis was done by ANOVA، Kruskal-Wallis and Chi-square tests. There were no significant difference in pain intensity and quality scores of three groups before CTR. Immediately after CTR، pain intensity score in ice bag group (2. 5±2. 3) was significantly less than placebo (4. 2±3. 2) and control groups [4. 0±2. 7). After 15 minutes of CTR، there was significant difference in pain intensity scores of ice bag (0. 6±0. 7) versus placebo (2. 0±2. 6) and control (1. 9±1. 9) groups. Applying ice bag is an effective، cheap and low risk intervention for decreasing pain associated with CTR.

Application of off-pump technique for reoperative coronary artery bypass grafting (Redo CABG) has been limited by technical difficulties, potentiation for embolism of athermanous debris from the involved grafts, resulting in myocardial infarction, and rapid hemodynamic deterioration. In this descriptive study from 2002, at Cardiac surgery Department of Emam Reza Hospital, a total of 77 consecutive patients underwent redo CABG (64 ONCAB and 13 OPCAB) The outcomes of off-pump (OPCAB) and on-pump (ONCAB) redo CABG were compared. Surgical technique in 2 patients (%11) was converted from OPCAB to ONCAB due to hemodynamic instability, severe adhesion or graft injury; and in one patient (%7) the conversion from ONCAB to OPCAB was for severe aorta calcification. Propensity matched comparison of the outcome of OPCAB with ONCAB for redo CABG showed that OPCAB was associated with significant reduction in postoperative complications, volume of blood transfusion and hospitalization length. OPCAB can be safely and effectively applied for reoperative CABG, in selected cases.

Nowadays coronary surgery is done by means of cardiopulmonary pump (on-pump) or without using it (off-pump). Patients who undergo off-pump coronary artery bypass graft surgery (OPCAB) may be potentially hypercoagulable with an increased risk of graft thrombosis in their transplanted vessels. To counteract this complication and reduce ischemic events, antiplatelet drugs including ticlopedin is used in most therapeutic centres of the world. The purpose of this study was to determine the side effects of early ticlopedin administration after OPCAB. This clinical trial study was done on 300 patients admitted to cardiosurgical ward of Imam Reza hospital affiliated to Mashhad University of Medical Sciences between 2005 and 2007. Those clients whose postoperative drainage was less than 100cc/h were divided into two groups with 150 cases in each. The first group took ticlopedin for four weeks, but the second group (control) was not administered the drug. Aspirin was administered preoperatively and postoperatively to all patients. Telephone follow-up was made 6 to 12 months after being discharged. The obtained data was statistically analysed by means of 2 at the significant level P≤0.05. None of the patients in the first group required re-operation for mediastinal hemorrhage. Mean chest tube drainage was 1005±423 in ticlopedin group and 950±400 mL in patients who had not received ticlopedin. The total number of blood units transfused and the number of patients receiving blood transfusions was almost similar in the two groups. In-hospital mortality was 1.2% in ticlopedin group and 3.2% in the control group (P=0.314). No group difference in mortality or adverse cardiac events were observed during 6 months. Gastrointestinal bleeding occurred in 2.5% of ticlopedin patients but in 0.9% of the controls. The study showed that ticlopedin administration does not increase postoperative mediastinal hemorrhage.