Association of hypoalbuminemia with acute kidney injury in children after cardiac surgery / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study whether hypoalbuminemia after pediatric cardiopulmonary bypass (CPB) for cardiac surgery is a risk factor for postoperative acute kidney injury (AKI).</p><p><b>METHODS</b>A retrospective analysis was performed on the clinical data of 1 110 children who underwent CPB surgery between 2012 and 2016. According to the minimum serum albumin within 48 hours postoperatively, these patients were divided into hypoalbuminemia group (≤35 g/L) and normal albumin group (>35 g/L). The two groups were compared in terms of perioperative data and the incidence of AKI. Furthermore, the incidence of AKI was compared again after propensity score matching for the unbalanced factors during the perioperative period. The perioperative risk factors for postoperative AKI were analyzed by logistic regression.</p><p><b>RESULTS</b>The overall incidence rate of postoperative AKI was 13.78% (153/1 110), and the mortality rate was 2.52% (28/1 110). The mortality rate of children with AKI was 13.1% (20/153). The patients with hypoalbuminemia after surgery (≤35 g/L) accounted for 44.50% (494/1 110). Before and after propensity score matching, the hypoalbuminemia group had a significantly higher incidence of AKI than the normal albumin group (P<0.05). The children with AKI had a significantly lower serum albumin level after surgery than those without AKI (P<0.05). The multivariate logistic regression analysis showed albumin ≤35 g/L was one of the independent risk factors for postoperative AKI.</p><p><b>CONCLUSIONS</b>Albumin ≤35 g/L within 48 hours postoperatively is an independent risk factor for postoperative AKI in children after CPB surgery.</p>

Clinical characteristics and prognostic analysis of children with congenital heart disease complicated by postoperative acute kidney injury / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To analyze the perioperative clinical data of children with congenital heart disease complicated by acute kidney injury (AKI) after cardiopulmonary bypass (CPB) surgery, and to explore potential factors influencing the prognosis.</p><p><b>METHODS</b>A retrospective analysis was performed among 118 children with congenital heart disease who developed AKI within 48 hours after CPB surgery.</p><p><b>RESULTS</b>In the 118 patients, 18 died after 48 hours of surgery. Compared with the survivors, the dead children had significantly higher incidence of cyanotic disease and Risk Adjustment for Congenital Heart Surgery-1 (RACHS-1) scores before surgery; during surgery, the dead children had significantly longer CPB time and aortic cross-clamping time, a significantly higher proportion of patients receiving crystalloid solution for myocardial protection, and a significantly higher mean blood glucose level. Within 48 hours after surgery, the dead children had significantly higher positive inotropic drug scores, significantly higher creatinine values, a significantly higher incidence of stage 3 AKI, a significantly higher proportion of patients receiving renal replacement the, and significantly higher usage of blood products (P<0.05). The mortality rate of the patients increased with increased intraoperative blood glucose levels (P<0.05). Patients with intraoperative blood glucose levels >8.3 mmol/L had a significantly lower postoperative cumulative survival rate and a significantly shorter mean survival time than those with blood glucose levels ≤ 8.3 mmol/L (P<0.05).</p><p><b>CONCLUSIONS</b>Intraoperative blood glucose levels are associated with the prognosis in children with congenital heart disease complicated by AKI after CPB surgery. Maintaining good intraoperative blood glucose control can improve the prognosis of the children.</p>

Debridement and drainage of infected necrosis for severe acute pancreatitis via lumbo-retroperitoneal route / 中南大学学报(医学版)

OBJECTIVE@#To determine the route and ways of debridement and drainage of infected necrosis for severe acute pancreatitis (SAP) combined with pancreatic infection.@*METHODS@#Clinical data of 28 patients with SAP accompanied with secondary pancreatic infection, who underwent lumbo-retroperitoneal debridement, drainage and lavage after the operation were retrospectively investigated.@*RESULTS@#Four patients underwent one operation, 21 underwent 2 operations, and 3 underwent 3 operations. All patients recovered or improved and were discharged by postoperative lavage. Four patients had complications, including 1 gastrointestinal bleeding,1 intestinal fistula and 2 pancreatic fistula.@*CONCLUSION@#Debridement and drainage of infected necrosis for SAP combined with pancreatic infection via lumbo-retroperitoneal route is direct, safe and effective.

Surgical treatment of 2465 primary hepatolithiasis cases / 中华外科杂志

<p><b>OBJECTIVE</b>To summarize the experience of surgical treatment of primary hepatolithiasis.</p><p><b>METHODS</b>To analyze the clinical data, operation choice, postoperative complications of 2465 cases of primary hepatolithiasis retrospectively.</p><p><b>RESULTS</b>Of the patients, 2034 received external drainage (82.5%) and 431 received internal drainage (17.5%) and 586 were performed adjunctive partial hepatectomy (23.8%). The postoperative complications were found in 211 cases (8.6%) and 17 cases (0.7%) died after the operation. One thousand seven hundred and sixty-seven cases (71.7%) have been followed up for 2 to 25 years, among them therapeutic effect of 1518 cases (85.9%) was excellent or good, 315 cases (17.8%) had residual stone and 115 cases (6.5%) recurred.</p><p><b>CONCLUSIONS</b>It could decrease the incidence rate of complications, residual stone and recurrence in the patients with hepatolithiasis after surgical therapy to pinpoint the situs of the lithiasis and biliary stricture and managed properly before the surgery.</p>