| Part one Effect of allogeneic blood transfusion on prognosis after cardiac valve replacement with cardiopulmonary bypassObjective: To analyze the effect of allogeneic blood transfusion on prognosis after cardiac valve replacement with cardiopulmonary bypass(CPB)in the patients.Methods:For this retrospective study,a total of 1283 adult patients were enrolled at the department of Cardiac Surgery in Guizhou People's Hospital from January 2014 to November 2016.747 patients of both sexes,aged 18~72 year,undergoing cardiac valve replacement surgery with CPB,were divided into two groups based on whether or not allogeneic blood was used in perioperative(intraoperative and postoperatve): nonblood transfusion group(n=249)and allogeneic blood transfusion group(n=498).A total of 208 matched pairs were selected from the patients with propensity score matching.The effect of allogeneic blood transfusion on prognosis was analyzed by univariate analysis.Results: Compared with non-blood transfusion group,the length of hospital stay(24±9 vs 27±9)(d)and mechanical ventilation(7 ± 7 vs 10 ± 8)(h)were significantly prolonged(P<0.05)in the blood transfusion group;and the incidences of re-intubation(0.0% vs 3.8%)and pulmonary infection after operation(1.0% vs 5.3%)were significantly increased(P<0.05)in the blood transfusion group;the incidences of inhospital mortality,hypohepatie,acute kidney injury,cerebral vascular adverse incident,malignant arrhythmia,install pacemaker,mediastinal infection,poor healing of incision wound,reoperation and readmission ICU and the duration of ICU were no significant between the group(P>0.05).Conclusion: In this study we found that perioperative allogeneic blood transfusionincrease the risk of re-intubation and pulmonary infection after operation and significantly prolong the length of mechanical ventilation and hospital stay in adult patients under CPB with cardiac valve replacement.Part two Study on the risk factors of blood transfusion in cardiac vave replacement patients with cardiopulmonary bypass Objective: To observes the risk factors associated with intraoperative blood transfusion and to screen the indicators for evaluating the risk of blood transfusion in preoperative period of patients with cardiac valve replacement under cardiopulmonary bypass(CPB).Methods: For this retrospective study,a total of 1283 adult patients were enrolled at the department of Cardiac Surgery in Guizhou People's Hospital from January 2014 to November 2016.721 patients of both gender,aged 18~72 year,undergoing cardiac valve replacement surgery with CPB,were divided into two groups depending on whether or not allogeneic blood was used during or after the end of CPB.Univariate and multivariate logistic regression analysis were used to investigate the risk factors for preoperative period blood transfusion.Results 480(66.57%)patients received blood transfusion in perioperative period.185(25.66%)patients received blood transfusion during CPB;422(58.53%)patients received blood transfusion during the CPB ending to discharge.Multivariate logistic regression analysis indicated that the risk factors of during CPB receiving blood transfusion were female(P=0.000,OR=5.199,95%CI(3.107~8.107)),old age(60~74yr)(P=0.003,OR=2.562,95%CI(1.386~4.735)),BMI(18.5~23Kg/m2)(P=0.000,OR=0.388,95%CI(0.209~0.547)),BMI(24~27Kg/m2)(P=0.000,OR=0.319,95%CI(0.174~0.584)),BMI(>28Kg/m2)(P=0.001,OR=0.023,95%CI(0.003~0.198)),preoperative fibrillation(P=0.003,OR=0.541,95%CI(0.359~0.814)),two valve replacement(P=0.000,OR=2.295,95%CI(1.512~3.483)),three valve replacement(P=0.036,OR=7.702,95%CI(1.146~51.744)),NYHA ?(P=0.004,OR=3.629,95%CI(1.521~8.658)),preoperative anemia(P=0.000,OR=14.858,95%CI(7.401~29.829))and diabetes(P=0.029,OR=5.263,95%CI(1.184~23.397));and that the risk of after CPB receiving blood transfusion were age(year)(P=0.002,OR=1.027,95%CI(1.010~1.043)),BMI(Kg/m2)(P=0.007,OR=0.938,95%CI(0.896~0.983)),preoperative anemia(P=0.006,OR=2.458,95%CI(1.302~4.643)),operative time(min)(P=0.005,OR=1.005,95%CI(1.002~1.009)),bloodloss(m L)(P=0.000,OR=1.003,95%CI(1.002~1.004)).Conclusion 1.The risk factors of receiving blood transfusion were female,older,low BMI,none preoperative fibrillation,two or more valve replacement,NYHA ?,preoperative anemia and diabetes during CPB;2.The risk factors of receiving blood transfusion were older,low BMI,preoperative anemia,prolonged operations and massive blood loss during the CPB ending to discharge. |
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