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Changes in Expression of Membrane Molecules CD200R, CD95, CD95L, and Soluble CD200R Regulating inflammatory Responses in Patients Undergoing Cardiac Surgery
Holmannová, Drahomíra ; Krejsek, Jan (advisor) ; Brát, Radim (referee) ; Turánek, Jaroslav (referee)
Cardiac surgery is known to initiate a complex physiological response with the immune system activation (SIRS), neurohormonal response, metabolic changes, coagulopathies etc. SIRS is triggered by tissue injury, myocardial ischemia, reperfusion, use of anaesthesia, cardioplegia, extracorporeal circuit etc. Excessive immune system activation is associated with progression of SIRS, life-threatening multi-organ dysfunction (MOD), and increased morbidity/mortality in the postoperative period. The immune system response is regulated and terminated by both cellular and humoral regulatory and inhibitory mechanisms including changes in expression of in our study monitored molecules: CD200/CD200R, sCD200R and CD95/CD95L. Methods: The study included the measurement the expression of CD95, CD95L, CD200R, and sCD200R molecules in granulocyte and monocyte populations in blood samples of 30 patients who underwent heart surgery using CPB. Samples collected before surgery, after surgery, and in the postoperative period (1st , 3rd , 7th day) were analysed by flow cytometry and sCD200R by ELISA. Results: We discovered a significant increase in the percentage of granulocytes expressing inhibitory molecule CD200R (from 5% to 17.8%) instantly after surgery. It might be presumed that these cells are less susceptible to...
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The specifics of nursing in the treatment of pain in patients after cardiosurgical operations
ZAJÍČKOVÁ, Tereza
Pain is a phenomenon perceived as an undesirable experience of physical and mental suffering that we want to avoid at any cost. It is common and expected though that during surgeries patients experience pain due to interrupting the integrity of skin and hypodermis by originating a surgical incision. Complex cardiac surgeries, which usually take several hours and create large cuts, require effective analgesic treatment during postoperative recovery ensuring proper pain relief. This bachelor thesis aims to examine the specifics of nursing within analgesic treatment of patients´pain after cardiac surgeries. A theoretical part focuses on general findings about pain, the ways of pain evaluation, the specifics of postoperative pain. This part also introduces the most common cardiac surgeries and pharmacologic and nonpharmacologic pain treatments. A practical part of the thesis consists of a quantitative research applying semi-structured interviews with ten nurses and ten patients of a cardiac surgical ward. Results show that nurses discover certain specifics in providing pain relief while nursing patients after cardiac surgeries. The research concerns not only with treatment of the pain from a surgical incision, but with treatment of secondary types of pain as well: back pain, painful cough, pain caused with a chest tube. In the interviews, nurses and patients identified a postoperative pain similarly, they identically described pain evaluation executed by nurses, and agreed on high standards of analgesic treatment on this specific ward. The bachelor thesis aspires to be a source of information for nursing students and a proper guide for incoming nurses who are about to be employed at a cardiac surgical ward.
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Healing of the surgical wound after cardiac surgery
Mrkvičková, Petra ; Gigalová, Veronika (advisor) ; Votroubková, Michaela (referee)
ANOTATION Autor: Petra Mrkvičková Institution: Charles University, Faculty of Medicine in Hradec Kralove, Department of Social Medicine, Division of Nursing Title: Healing of the surgical wound after cardiac surgery Supervisor: Mgr. Veronika Gigalová Number of pages: 136 Number of attachments: 8 Year of defense: 2019 Keywords: patient, cardiac surgery, sternotomy, healing of the surgical wound, nursing care The bachelor thesis deals with healing of surgical wound after cardiac surgery. Theoretical part of the thesis deals with facts from the area of cardiac surgery, the most common cardiac diseases, which are indicated for cardiac surgery and appropriate surgical approaches. It points out to risk groups of patients who may have complications within the healing wound. This thesis focuses mainly on nursing care of sternotomy with sternotomy healing and potential complications. It points out to the importance of regular inspection of sternotomy, regular changing of wound dressing under aseptic conditions, education and care of patients' mental health. In the empirical part, the thesis focuses on quantitative and qualitative research. Quantitative research was conducted by a non-standardized questionnaire and qualitative research by a semi-structured interview. The aim of the research was to find out some...
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Biomarkers of early renal injury
Fořtová, Magdaléna ; Průša, Richard (advisor) ; Kalousová, Marta (referee) ; Ryšavá, Romana (referee)
Aims: The thesis deals with the biomarkers of early renal injury, namely albuminuria and neutrophil gelatinase-associated lipocalin (NGAL). The aims in the case of albuminuria were the implementation of HPLC method, comparing HPLC with immunoturbidimetric (IT) method and monitoring the relationship to the diagnosis of diabetes mellitus. The aim of urinary NGAL (and eventually other markers) examination was to verify its reliability in the prediction of acute kidney injury (AKI). Methods: We investigated albuminuria in fresh urine samples in the groups of 636 diabetics and 456 nondiabetics using the HPLC method (Agilent 1200, Agilent Technologies, USA) and immunoturbidimetrically (Cobas Integra 400, Roche Diagnostics); we studied the correlations and relationships between albuminuria and glycated hemoglobin HbA1c. We investigated urinary NGAL by chemiluminescent microparticle immunoassay (Architect i4000, Abbott) in children's groups: 1) after renal transplantation (N = 15), 2) with acute or chronic kidney disease (N = 28); and in adult patient's groups: 1) after cardiac surgery (N = 10) and 2) post angiography (N = 41). Results: Albuminuria determined by HPLC was statistically significantly higher than albuminuria determined by IT. We excluded nonspecificity of the HPLC method. Results indicate...
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Assessment of information knowledge for patients after cardiac surgery
Lomozová, Lenka ; Burišková, Klára (advisor) ; Pucholtová, Romana (referee)
Creating conditions for the effective healthcare provision in cooperation with the patient is one of the main missions of today's healthcare. A cardiac surgery is a difficult life situation for patients. Being informed, as the basic premise for the patient to become an active part of the entire healing process. The main aim of my thesis was to evaluate the awareness of patients who underwent a cardiac surgery, to map the problematic areas and to propose solutions. A combination of qualitative and quantitative method was used for the research. The qualitative part was carried out by means of semi-structured interviews with three interviewees. The quantitative part had the form of the questionnaire presented to 52 respondents. The results of both researches have been analyzed. The results show that the patients seem to have been provided with adequate information at the clinic. Impact of patients' awareness on their cooperation with healthcare professionals was proven, in particular in rehabilitation. A medical doctor remains the main source of information for patients, but they often seek to obtain additional information from other sources. The use of multiple sources and different forms of information seems to be advisable. I identified the groups of patients requiring a specific approach when...
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Changes in Expression of Membrane Molecules CD200R, CD95, CD95L, and Soluble CD200R Regulating inflammatory Responses in Patients Undergoing Cardiac Surgery
Holmannová, Drahomíra ; Krejsek, Jan (advisor) ; Brát, Radim (referee) ; Turánek, Jaroslav (referee)
Cardiac surgery is known to initiate a complex physiological response with the immune system activation (SIRS), neurohormonal response, metabolic changes, coagulopathies etc. SIRS is triggered by tissue injury, myocardial ischemia, reperfusion, use of anaesthesia, cardioplegia, extracorporeal circuit etc. Excessive immune system activation is associated with progression of SIRS, life-threatening multi-organ dysfunction (MOD), and increased morbidity/mortality in the postoperative period. The immune system response is regulated and terminated by both cellular and humoral regulatory and inhibitory mechanisms including changes in expression of in our study monitored molecules: CD200/CD200R, sCD200R and CD95/CD95L. Methods: The study included the measurement the expression of CD95, CD95L, CD200R, and sCD200R molecules in granulocyte and monocyte populations in blood samples of 30 patients who underwent heart surgery using CPB. Samples collected before surgery, after surgery, and in the postoperative period (1st , 3rd , 7th day) were analysed by flow cytometry and sCD200R by ELISA. Results: We discovered a significant increase in the percentage of granulocytes expressing inhibitory molecule CD200R (from 5% to 17.8%) instantly after surgery. It might be presumed that these cells are less susceptible to...
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Factors affecting glucose metabolism and inflammatory response in critically ill patients
Kotulák, Tomáš ; Haluzík, Martin (advisor) ; Maruna, Pavel (referee) ; Šenolt, Ladislav (referee)
Hyperglycemia in critically ill patients was considered for many years an adaptive response to stress conditions being present in both patients with and without previous history of diabetes. Hyperglycemia is caused mainly by peripheral insulin resistance induced by the factors acting counteracting insulin signalling at the postreceptor level. Furthermore, hyperglycemia itself can then increase serum levels of pro-inflammatory cytokines such as tumor necrosis factor alpha (TNF-α), interleukin-6 (Il-6) and interleukin-8 (Il- 8) and others. On the contrary, peripheral insulin resistance induced by pro- inflammatory cytokines may further potentiate hyperglycemia. White adipose tissue represents in addition to its energy storage function also a very active endocrine active organ. In addition to regulation of a number of metabolic processes it also significantly modulates the inflammatory response. In critically ill patients, adipose tissue changes its morphology, i.e. the adipocytes are shrinking and adipose tissue is abundantly infiltrated by macrophages. Paradoxically, overweight and obese critically ill patients have lower mortality than underweight, lean and morbidly obese subjects. In our studies, we selected population of the patients undergoing elective major cardiac surgery with extracorporeal...
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Nursing Care for Patient after Surgery of Valvular Defects
Beranová, Veronika ; Burišková, Klára (advisor) ; Hocková, Jana (referee)
This thesis is focused on the nursing care for patient after valvular defects surgery. The aim of this final paper is to ascertain the principles of specialized nursing care for patient after valvular defects surgery, analyse the condition of written standards for providing aftercare to patients who underwent valvular defects surgery, or the state of the nursing protocols in specialized nursing care. The purpose of qualitative - observational research in providing specialized nursing care is to find an answer to the question of whether the specifics of nursing care in Prague cardiac centres are significantly different. The theoretical section contains chapters describing cardiac centres, the history of surgical treatment of heart valves, and the most common valvular heart defects in adulthood. In the theoretical section of this study, I focus in detail on the nursing care for patients following cardiac procedure, ensuring not to forget the monitoring of physiological functions, artificial pulmonary ventilation, and immediate position after elective cardiac surgery. The empirical section is divided into quantitative and qualitative research. The quantitative empirical investigation is focused on an anonymous questionary survey that has been applied in three Prague cardiac centres. Approximately 150...
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Oxygen consumption in awake cardiac surgical patients
Pořízka, Michal ; Stříteský, Martin (advisor) ; Szárszoi, Ondrej (referee) ; Šetina, Marek (referee)
OBJECTIVES: Standard blood flow rates for cardiopulmonary bypass have been assumed to be the same for awake cardiac surgery with thoracic epidural anesthesia as for general anesthesia. However, compared to general anesthesia, awake cardiac surgery with epidural anesthesia may be associated with higher oxygen consumption due to missing effect of general anesthetics. This may result in insufficient oxygen delivery and lactic acidosis when standard blood flow rates were used. The primary aim of our study was to investigate if standard blood flow rates are adequate in awake cardiac surgery. The secondary aim was to evaluate postoperative clinical outcomes of patients undergoing awake cardiac surgery. METHODS: Forty-seven patients undergoing elective on-pump cardiac surgery were assigned to receive either epidural (Group TEA, n=17), combined (Group TEA-GA, n=15) or general (Group GA, n=15) anesthesia. To monitor adequacy of standard blood flow rates, arterial lactate, acid base parameters, central venous and jugular bulb saturation were measured at six time points during in all groups. Blood flow rates were adjusted when needed. Subsequently, early and late postoperative outcome data including hospital and 3-year mortality was recorded and compared among the study groups RESULTS: No lactic acidosis has...
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Haemolysis and other biochemical evaluations of vacuum-assisted venous drainage in cardiac surgery
Škorpil, Jiří ; Tošovský, Jan (advisor) ; Lonský, Vladimír (referee) ; Semrád, Michal (referee)
Haemolysis and other biochemical evaluations of vacuum-assisted venous drainage in cardiac surgery Aims of the study: Vacuum-assisted venous drainage (VAVD) improves the quality of venous return in procedures using extracorporeal circulation systems (ECC). Nevertheless, there is not an evidence that such high negative pressure applied to ECC in combination with selective bicaval cannulation due to open heart surgery cause a trauma to blood elements and deteriorates organ function. A prospective randomised study was designed to demonstrate that negative pressure of -20 mm Hg to -80 mm Hg does not cause a significant haemolysis and organ deterioration in such procedures. Materials and methods: 85 consecutive patients undergoing combined cardiac surgery procedure with two separate venous cannulas were randomised in three groups A, B and C. VAVD with negative pressure of -20 to -45 mm Hg was applied to 28 patients in group A and negative pressure of -45 mm Hg to -80 mmHg was applied to 28 patients in group B. There was zero negative pressure applied to 29 patients in group C. Six blood samples were taken from each patient and examinated for haemolysis and other indicators of organ deterioration such as hemoblobin, platelet count, free hemoglobin, aptoglobin, lactate-dehydrogenase, aspartate-amino-transferase,...
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