Analysis of risk factors of death after cardiopulmonary bypass in children with congenital heart disease less than 5 kg / 中国综合临床

Objective:To investigate the risk factors for surgical death in children with congenital heart disease (CHD) less than 5 kg undergoing cardiopulmonary bypass.Methods:The clinical data of 225 children with CHD who underwent open cardiopulmonary bypass in the First Affiliated Hospital of Air Force Military Medical University from February 2017 to February 2020 were collected for a retrospective case-control study. The independent sample T test was used for inter-group comparison of measurement data, Chi square test or chi squre correction test was used for the comparision between count data. Mann-Whitney rank-sum test was used for rank distribution data and multiple Logistic regression analysis was performed for factors affecting surgical death of children with CHD.Results:Among the 225 cases, 204 (90.67%, 204/225) survived surgery and 21 (9.33%, 21/225) died. Univariate analysis showed that age (2.48±0.68) months and body weight (2.28±0.56) kg in the death group were significantly lower than that in the survival group (4.92±0.65) months ( t=16.33, P<0.001) and body weight (4.26±0.52) kg ( t=16.38, P<0.001), while the proportion of female (66.67% (14/21)), malnutrition (none: 14.28% (3/21); Mild: 42.86% (9/21). Severity: 42.86%(9/21)), palliative surgery proportion (28.57%(6/21)), emergency surgery proportion (71.43%(15/21)), congenital heart surgery risk assessment (RACHS-1) grading ratio (<grade 3: 23.81%(5/21), ≥grade 3: 76.19% (16/21)), CPB time (135.24±11.19) min, aorta blocking time (78.24±8.20) min, operation time (178.43±13.82) min, heart malformation complex ratio (complex: 47.62% (10/21), simple: 52.38% (11/21)), ICU treatment days (4.76±0.77) d, postoperative mechanical ventilation time (121.33±12.66) h were significantly higher than the female survival group (41.67% (85/204), χ2=4.83, P=0.028), malnutrition rate (none: 38.24%(78/204); Mild: 42.15% (86/204)); Severe: 19.61% (40/204) ( z=2.72, P=0.007), palliative surgery proportion 8.82% (18/204), proportion of radicalsurgery91.18% (186/204) ( χ2=5.86, P=0.016), RACHS-1 grading ratio (<grade 3:77.45% (158/204); ≥grade 3: 22.55% (46/204), χ2=27.44, P<0.001), CPB time (106.87±11.12) min ( t=11.12, P<0.001), aorta occlusion time (58.68±9.26) min ( t=9.32, P<0.001), operation time (167.24±13.75) min ( t=3.55, P<0.001), heart malformation complex ratio (complex: 78.92%(161/204), simple: 21.08%(43/204) ( χ2=10.23, P<0.001)), ICU treatment time (3.67±0.87) d ( t=5.52, P<0.001), postoperative mechanical ventilation time (109.74±13.75) h ( t=3.70, P<0.001). Logistic regression analysis showed that operation time ( OR=1.064, 95% CI: 1.019-1.110, P=0.004), postoperative mechanical ventilation time ( OR=1.083, 95% CI: 1.031~1.138, P=0.002), ICU treatment time ( OR=5.317, 95% CI: 2.410-11.730, P<0.001) and malnutrition ( OR=2.974, 95% CI: 1.291-6.850, P=0.010) were independent risk factors for surgical death after cardiopulmonary bypass in children with CHD less than 5 kg. Conclusions:The mortality rate of CHD patients with low body weight less than 5 kg was relatively high. The increase of operation time, ICU treatment time, degree of malnutrition and postoperative mechanical ventilation time will increase the probability of death. Targeted measures should be taken to reduce the surgical mortality of children.

The Risk Factors Influencing Postoperative Mortality in the Patients with Ruptured Abdominal Aortic Aneurysm

PURPOSE: The mortality rate for elective repair of abdominal aortic aneurysm (AAA) has gradually decreased to approximately 5%. However the mortality rate for ruptured AAA (RAAA) has not changed significantly and continues to be 45% to 50%, and the mortality rate exceeds 90% if deaths occurring before patients reach the hospital are included in the statistics. The aim of this study was to determine what factors are associated with operative death in patients with RAAA. METHOD: For January 1997 and December 2003, 35 patients underwent surgery for RAAA. The factors of the preoperative status included age, gender, history of loss of consciousness, mental change, hemodynamics, the serum creatinine level and the patients' comorbidities were analyzed. As for the aneurysmal factors, the site, etiology, maximal diameter and rupture status of the aneurysms were evaluated. Finally operative factors including the operation time and status, surgeon, type of grafting, renal dysfunction during operation and the amount of blood transfusion were also analyzed. As the statistical method, Fischer's exact test and multi-step logistic regression method were used. RESULT: The 30-day mortality rate was 17.1% (6/35). By univariate analysis, mental change, increased preoperative serum creatinine level (>2 mg/dl), intraoperative renal dysfunction, prolonged intraoperative hypotension over 30 minutes, the amount of transfusion, diameter of aneurysms and surgeon's experience were statistically significant. On multivariate analysis, the amount of transfusion and intraoperative renal dysfunction were defined as the significant risk factors. CONCLUSION: To reduce the operative mortality of RAAA, preventing massive bleeding and the subsequent acute renal failure by early operative control of bleeding, fluid resuscitation and maintenance of blood pressure are important.