Analysis Of Related Factors Of Low Cardiac Output After Cardiopulmonary Bypass

Objective: To analyze the risk factors associated with low cardiac output syndrome(LCOS)after open-heart coronary artery bypass transplantation(CABG)and valve replacement in adults undergoing cardiopulmonary bypass(CPB)and their effects on the clinical prognosis,so as to provide a basic evaluation of the surgical risk of patients and reducing the incidence of complications.Methods: Retrospective collection of cardiovascular surgery between January 2018 and January 2020 in affiliated hospital of Zunyi Medical University vascular surgery and CABG,(coronary artery bypass grafting less because of the number of cases,extended to June 2016 to November 2020)the clinical data of patients with postoperative appear LCOS,according to the clinical diagnosis standard,patients divided into two groups: group with or without LCOS after valve replacement,group with or without LCOS after CABG,screening those differences between two groups of patients with risk factors,then compare the differences between groups were statistically significant variables,using the binary Logistic regression to relevant variables for multiple factors analysis.To identify statistically significant risk factors for LCOS in patients after cardiopulmonary bypass.Analyze and compare the research results,discuss and summarize.Results: A total of 59 patients meeting the inclusion criteria were collected,including 40 males and 19 females,aged 25-77 years,in the coronary artery bypass grafting group.In the valve replacement group,there were 242 cases,including 90 males and 152 females,aged25-75 years.Single factor analysis results show that the line on-pump CABG surgery patients,preoperative smoking history,recent myocardial infarction,cerebral infarction intervention treatment history,history of hypertension,resting heart rate is more than 100times/min,admission NYHA heart function class III or higher,laboratory tests showed serum albumin below 35 g/L,Scr more than 100 μmol/L,echocardiography revealed a heart valve lesion,cardiothoracic ratio on chest radiograph > 0.5,electrocardiogram(ecg)showed atrial fibrillation,preoperative patients with renal insufficiency accounted for a higher proportion than the group without postoperative LCOS,and the postoperative ICU residence time and mechanical ventilation time of the LCOS group were longer.The mortality within28 days after surgery was higher in the LCOS group,and there were statistically significant differences in the cardiothoracic ratio on chest radiograph > 0.5,serum albumin,Scr,extracorporeal circulation time and aortic occlusion time between the two groups(P<0.05);LCOS group after cardiopulmonary bypass valve replacement,the proportion of patients older than 55 years of age,heart function NYHA class III or higher,preoperative smoking history,history of hypertension,diabetes,pulmonary hypertension,cardiothoracic ratio >0.5,intraoperative surgical time,extracorporeal circulation time,aorta blocked time,intraoperative blood loss volume,red blood cells and plasma infusion volumes was higher than that of the group without LCOS.The postoperative ICU stay time and mechanical ventilation time of the LCOS group were longer,the LCOS group had a higher mortality within 28 days.There were statistically significant differences in age,history of hypertension,smoking history,atrial fibrillation,pulmonary hypertension,operative time,extracorporeal circulation time,aortic occlusion time,intraoperative red blood cell and plasma infusion between the two groups(P<0.05).Logistic regression analysis showed that for patients undergoing CABG surgery,operative time and extracorporal circulation time were independent risk factors for LCOS after CABG surgery,high preoperative ALB number was a protective factor.For those patients undergoing valve replacement surgery,preoperative history of hypertension,atrial fibrillation,operative time,extracorporal circulation time,aortic occlusion time and large amount of intraoperative plasma infusion(especially > 600ml)were independent risk factors for LCOS after valve replacement.Conclusion: For patients undergoing CABG surgery,operative time,extracorporal circulation time were independent risk factors for LCOS,high preoperative ALB number was a protective factor.For those patients undergoing valve replacement surgery,preoperative history of hypertension,atrial fibrillation,operative time,extracorporeal circulation time,aortic occlusion time,intraoperative infusion of large amounts of plasma(especially > 600ml)were independent risk factors for LCOS after valve replacement surgery.