Objective To investigate clinical features and risk factors of prolonged postoperative recovery of pediatric patients in ICU after total cavopulmonary connection（TCPC），provide evidence for risk stratification management strategy， and enhance their postoperative recovery. Methods We conducted a retrospective analysis of clinical data of 81 patients undergoing TCPC in Fu Wai Hospital from January 2010 to July 2012. Three patients who died postoperatively were excluded from analysis. Prolonged postoperative recovery was defined as patients whose postoperative mechanical ventilation time was longer than that of 75% of all the patients. A total of 78 patients were divided into normal recovery group and prolonged recovery group. There were 59 patients in the normal recovery group including 34 male and 25 female patients with their age of 62.5±20.7 months，and 19 patients in the prolonged recovery group including 11 male and 8 female patients with their age of 64.8±29.8 months. Perioperative variables were compared between the two groups. Results The average cardiopulmonary bypass time of all the 81 patients was 107.6±54.1 （33-350） minutes. The average aortic cross-clamping time of 17 patients was 46.4±31.5 （22-143） minutes. Three patients （3.7%） died postoperatively because of severe low cardiac output syndrome and thrombosis in the extracardiac conduit. The mechanical ventilation time and ICU stay were 7.5 hours and 1.6 days respectively in the normal recovery group，which were both significantly prolonged in the prolonged recovery group. Preoperative high hemoglobin level，coexistence of intracardiac anomalies，longer cardiopulmonary bypass time，and non-fenestrated procedure were the main risk factors of prolonged postoperative recovery. Conclusion Early extubation and fast track recovery can be achieved in most of TCPC patients. Risk stratification management strategies may contribute to successful postoperative recovery of critical patients after TCPC.
Abstract: Objectives To evaluate the accuracy of four existing risk stratification models including the Society of Thoracic Surgeons(STS) 2008 Cardiac Surgery Risk Models for Coronary Artery Bypass Grafting (CABG), the European System for Cardiac Operative Risk Evaluation (EuroSCORE), the American College of Cardiology/American Heart Association (ACC/AHA) model, and the initial Parsonnet’s score in predicting early deaths of Chinese patients after CABG procedure. Methods We collected clinical records of 1 559 consecutive patients who had undergone isolated CABG in the Fu WaiHospital from November 2006 to December 2007. There were 264 females (16.93%) and 1 295 males (83.06%) with an average age of 60.87±9.06 years. Early death was defined as death inhospital or within 30 days after CABG. Calibration was assessed by the Hosmer-Lemeshow (H-L) test, and discrimination was assessed by the receiveroperatingcharacteristic (ROC) curve. The endpoint was early death. Results Sixteen patients(1.03%) died early after the operation. STS and ACC/AHA models had a good calibration in predicting the number of early deaths for the whole group(STS: 12.06 deaths, 95% confidence interval(CI) 5.28 to 18.85; ACC/[CM(159mm]AHA:20.67deaths, 95%CI 11.82 to 29.52 ), While EuroSCORE and Parsonnet models overestimated the number of early deaths for the whole group(EuroSCORE：36.44 deaths，95%CI 24.75 to 48.14；Parsonnet：43.87 deaths，95%CI 31.07 to 56.67). For the divided groups, STS model had a good calibration of prediction(χ2=11.46, Pgt;0.1)，while the other 3 models showed poor calibration（EuroSCORE：χ2=22.07，Plt;0.005；ACC/AHA：χ2=28.85，Plt;0.005；Parsonnet：χ2=26.74，Plt;0.005）.All the four models showed poor discrimination with area under the ROC curve lower than 0.8. Conclusion The STS model may be a potential appropriate choice for Chinese patients undergoing isolated CABG procedure.
ObjectiveTo investigate diagnostic and prognostic value of pulmonary embolism severity index (PESI), troponin I (cTnI) and brain natriuretic peptide (BNP) in patients with acute pulmonary embolism (APE). MethodsA total of 96 patients confirmed with APE were collected from January 2010 to January 2013, and 50 cases of non-APE controls were also selected in the same period. According to the PESI scores, patients were divided into low-risk, mid-risk, and highrisk group. According to the results of cTnI and BNP, patients were divided into positive group and negative group. Then, we evaluated the diagnostic and prognostic value of the PESI score, cTnI and BNP for patients with APE. ResultsFor the APE patients, the higher the risk was, the higher the constituent ratio of massive and sub-massive APE was (P<0.01). In the cTnI positive group, massive and sub-massive APE accounted for 82.9%, and in the cTnI negative group, non-massive APE was up to 81.9%; in the BNP positive group, massive and sub-massive APE accounted for 73.3%, and in the BNP negative group, non-massive APE was up to 86.3%. The patients with positive cTnI and BNP had a higher rate of right ventricular dysfunction, cardiogenic shock and mortality than the negative group (P<0.01). ConclusionThe combined detection of cTnI, BNP and PESI score is important in the diagnosis and risk stratification in APE patients.
ObjectiveTo explore the clinical application value of antithrombin Ⅲ (ATⅢ) in pulmonary thromboembolism (PTE).MethodsA retrospective study included 204 patients with confirmed PTE who were admitted to Fujian Provincial Hospital from May 2012 to June 2019. The clinical data of the study included basic conditions, morbilities, laboratory examinations and scoring system within 24 hours after admission. The relationship between ATⅢ and PTE in-hospital death was analyzed, and the value of ATⅢ to optimize risk stratification was explored.ResultsFor ATⅢ, the area under receiver operating characteristic curve (AUC) of predicting in-hospital mortality was 0.719, with a cut-off value of 77.7% (sensitivity 64.71%, specificity 80.21%). The patients were divided into ATⅢ≤77.7% group (n=48) and ATⅢ>77.7% group (n=156) according to the cut-off value, and significant statistically differences were found in chronic heart failure, white blood cells count, platelets count, alanine aminotransferase (ALT), albumin and troponin I (P<0.05). According to the in-hospital mortality, patients were divided into a death group (n=17) and a survival group (n=187), and the differences in count of white blood cells, ATⅢ, D-dimer, ALT, albumin, estimated glomerular filtration rate and APACHEⅡ were statistically significant. Logistic regression analysis revealed that ATⅢ≤77.7% and white blood cells count were independent risk factors for in-hospital death. The risk stratification and the risk stratification combined ATⅢ to predict in-hospital death were evaluated by receiver operating characteristic curve, and the AUC was 0.705 and 0.813, respectively (P<0.05). A new scoring model of risk stratification combined with ATⅢ was showed by nomogram.ConclusionsATⅢ≤77.7% is an independent risk factor for in-hospital death, and is beneficial to optimize risk stratification. The mechanism may be related to thrombosis, right ventricular dysfunction and inflammatory response.