Clinical Study On The Effect Of Crystal Prefilling Fluid And Colloid Prefilling Fluid In Cardiopulmonary Bypass On Renal Function After Aortic Dissection

Background and Purpose:Aortic dissection(AD)is caused by tearing of the intima of Aortic wall,in which blood directly penetrates the Aortic middle layer,resulting in the separation of the middle layer of Aortic wall.AD is the most common lesion type in aortic disease,which can be divided into type A and TYPE B according to Stanford classification.Aortic dissection involving the ascending aorta is type A,and descending aorta involving the distal opening of the left subclavian artery is type B.Type A aotic dissection TAAD is one of the most critical complex diseases in cardiovascular surgery,with rapid progression,more severe disease,higher mortality,and A serious threat to patients’ lives.Timely diagnosis and prompt operation are the main ways to save lives.However,the surgical trauma is large,the operation time is longer than other operations,and the operation process is complex and there are many links.During the operation,extracorporeal circulation or even deep hypothermia circulation arrest are needed,resulting in many postoperative complications.In recent years,with the rapid development of surgical technology and the continuous improvement of anesthesia and extracorporeal circulation technology,although the postoperative mortality of patients is significantly lower than before,the incidence of postoperative complications is still very high.Kidney complication is one of the most common and harmful complications in AD patients after surgery,which increases the mortality rate,disability rate and seriously affects the quality of life of patients.In adult extracorporeal surgery,the ideal prefilling fluid of extracorporeal circulation is still a problem worth discussing.There are few studies on the use of crystal prefilling fluid in CPB pipeline at home and abroad.In this study,the effects of crystal prefilling fluid and colloid prefilling fluid in CPB pipeline on postoperative renal function of patients with aortic dissection were retrospectively analyzed to provide theoretical basis for reducing postoperative renal complications in patients with aortic dissection and to guide clinical treatment.Materials and Methods:A total of 51 patients who underwent surgical treatment for aortic dissection in Fu Wai Central China Cardiovascular Hospital from January 2020 to December 2020 were retrospectively analyzed.All patients were diagnosed with aortic dissection by preoperative aortic CTA.Crystal prefilling and colloid prefilling are used in the CPB pipeline according to the order of the patient’s surgery.According to the type of prefilling fluid used in the extracorporeal circulation pipeline during surgery time,it can be divided into Crystal Prefilled group(CP group,n = 27)and Colloid Prefilled group(CL group,n = 24).The preoperative general data,extracorporeal circulation data,intraoperative data and postoperative physiological indicators of the two groups were compared in order to find the effect of using crystal prefilling fluid and colloid prefilling fluid in cardiopulmonary bypass on postoperative renal function.SPSS 21.0 software was used for statistical analysis of the data.Normal distribution continuous variables were represented by mean ± standard deviation((?)± S),and non-normal discrete data were represented by median and quartile spacing.χ2 test or Fisher’s exact test was used for rate comparison between the two groups.T test was used for continuous variable comparison between the two groups,and Mann-Whitney U test was used for non-parametric comparison.P < 0.05 was considered statistically significant.Results:Preoperative general data such as age and gender of patients in the two groups were not statistically significant(P>0.05),there was no significant difference in preoperative blood routine,renal function and coagulation function(P>0.05).There were no significant differences in extracorporeal circulation time,aorta blocking time,circulation cessation time,intraoperative red blood cell transfusion,plasma transfusion,platelet transfusion,cryoprecipitate transfusion and autotransfusion between the two groups(P >0.05).There were no significant differences in postoperative blood routine,renal function and coagulation function between the two groups(P>0.05).Conclusion:There are many factors affecting postoperative renal function of patients with aortic dissection.The use of crystal prefilling fluid during cardiopulmonary bypass has no adverse effect on postoperative renal function of patients with aortic dissection.Crystal prefilling fluid is readily available and inexpensive,and the use of crystal prefilling fluid during CPB can reduce the cost of prefilling fluid and prevent the transmission of blood-borne diseases.It is worthy of clinical application.