ObjectiveTo research the influence of anticoagulation to blood clotting function in patients who experienced cardiopulmonary bypass surgery under continuous renal replacement therapy (CRRT) with regional citrate anticoagulation (RCA), low molecular weight heparin (LMWH) anticoagulation and non-anticoagulation.MethodsWe retrospectively analyzed the clinical data of 146 patients who underwent CRRT after cardiopulmonary bypass surgery between January 2014 and December 2016. There were 98 males and 48 females at age of 60.51±14.29 years. All CRRT patients were allocated into three groups including a RCA group, a LMWH group, and a non-anticoagulation group, which were compared in terms of convention coagulation tests, platelet counts, thromboelastography, circuit lifespan and transfusion.ResultsThree hundred and fifty four CRRT patients were selected from patients above, including 152 patients in the LMWH group, 160 in the RCA group, and 42 in the non-anticoagulation group. The difference of CRRT circuits time among three groups was statistically different (P=0.023). And multiple comparison showed that the circuit lifespan of the RCA group was significantly longer than that of the non-anticoagulation group (34.50 h ranged 14.00 h to 86.00 h vs.15.00 h ranged 12.00 h to 50.88 h, P=0.033). One hundred and fifty-five CRRT patients last beyond 24 hours with same anticoagulation were selected, the results of coagulation tests, and the difference between CRRT starting and after 24 hours were compared. The difference of Angle and maximum amplitude(MA) of pre- and post-CRRT were significantly different among three groups by one-way ANOVA (P=0.004, 0.000), as well as between the RCA group and the LMWH group by multiple comparison (P=0.004, 0.000). There was no statistical difference in frequencies and doses of the transfusion of fresh frozen plasma and platelet among three groups.ConclusionRCA is an effective anticoagulation which may prolong circuit lifespan and has small impact on the coagulation function of patients who undergo CRRT after cardiopulmonary bypass surgery.
Objective To identify the predictors for readmission in the ICU among cardiac surgery patients. Methods We conducted a retrospective cohort study of 2 799 consecutive patients under cardiac surgery, who were divided into two groups including a readmission group (47 patients, 27 males and 20 females at age of 62.0±14.4 years) and a non readmission group (2 752 patients, 1 478 males and 1 274 females at age of 55.0±13.9 years) in our hospital between January 2014 and October 2016. Results The incidence of ICU readmission was 1.68% (47/2 799). Respiratory disorders were the main reason for readmission (38.3%).Readmitted patients had a significantly higher in-hospital mortality compared to those requiring no readmission (23.4% vs. 4.6%, P<0.001). Logistic regression analysis revealed that pre-operative renal dysfunction (OR=5.243, 95%CI 1.190 to 23.093, P=0.029), the length of stay in the ICU (OR=1.002, 95%CI 1.001 to 1.004, P=0.049), B-type natriuretic peptide (BNP) in the first postoperative day (OR=1.000, 95%CI 1.000 to 1.001, P=0.038), acute physiology and chronic health evaluationⅡ (APACHEⅡ) score in the first 24 hours of admission to the ICU (OR=1.171, 95%CI 1.088 to1.259, P<0.001), and the drainage on the day of surgery (OR=1.001, 95%CI1.001 to 1.002, P<0.001) were the independent risk factors for readmission to the cardiac surgery ICU. Conclusion The early identification of high risk patients for readmission in the cardiac surgery ICU could encourage both more efficient healthcare planning and resources allocation.