| Penetrating Cardiac Trauma(PCT) was considered to be "unabled medical" lethal damage because of its heavy state,fast development,high mortality and difficulty treatment.Until 19 century's ends(in 1896),Germany surgeon Ludwing Rhen successed to suture patching on a patient whose right ventricle was punctured by knife.In the development about 100 years after that,the PCT's prognosis had gradually improved.However,the PCT still is the critical illness in the range of chest trauma,according to the late-1990s overseas related report,the PCT total mortality rate was 25%-65%.Along with the science of medicine technology,the communication and the trasportation development,the more state seriously injured patients may deliver the hospital to obtain the rescue.Although the heart penetration wound's rescue success ratio improves,but the mortality rate was quite still high.Surgery is the main treatment for PCT,the outcomes of the PCT operations are greatly diferent due to the injury mechanism,operation spot,and the other clinic conditions.Some preoperative or operative variables related to the diseases or the operations may influence the early mortality after operations significantly.But the effects of these factors on the early mortality after PCT operations aren't consensus. At present there is no systematic review of the quantitative analysis for such clinic studies aimed at such clinic problem in China and abroad.On the basis of the retrospective review of the clinic data of patients who underwent PCT operations in our hospital and analysis of the risk factors influencing early outcomes after PCT operations,we applied a new pattern,reliable method of synthesis and appraisal of the literatures(meta-analysis) to analyses the risk factors that may affect the early mortality after PCT operations,identify the effects of these factors on early postoperative mortality,and expect to guide the treatment for PCT in the future. Objective:Records of the 27 patients suffering penetrating cardiac trauma over a twenty-year period were retrospective reviewed.To identity the risk factors for early mortality after PCT operations.Then,the experimnt applies the Meta-analysis to quantitative study the variables which affects the early mortality after PCT operation, by merger and synthesis of the results in many small sample studies.It will be proposed more reliable conclusion to prevent the early death after PCT,and established more powerful evidence about evidence-based medicine,to further direct the clinic work.Methods:In the first part of the study,the clinic data of the PCT patients who underwent opewration in our hospital during the 20 years was collected,concomitant procedure were selected to identify the risk factors for early mortality after PCT operation by univariate analysis.In the second part of the study,all literatures related to analysis of the risk factors for early mortality after PCT operations in MEDLINE database,EMBASE database and CBMdisc were searched for and appraised critically to undertake meta-analysis of risk factors for early mortality mortality after PCT operations and identify the effects of these variables on early after PCT operations.The variables which were used to undertake meta-analysis included injury mechanism,operation spot,number of chambers to be injuryed,pericardial tamponade,combined injury,Revise Trauma Score,blood pressure on admisson, physiology index.Results:1.Results of the first part:Overall early postoperative mortality was 41%(11 deaths).Injury severity score (ISS)＞25(p=0.03),The Revised trauma score(RTS) at presentation≤2(p=0.002),the combination with aortic injury(p=0.004),the quantity of metachysis at the first 24 hours≥12 unit(p=0.0203),exploration at the emergency room(p=0.0002) were significant univariate risk factors for early mortality after PCT operation.2.Results of the second part:2.1 Results of the effect of injury mechanismThe results of meta-analysis of 11 retrospective studies and 1 prospective study indicated that the gun shoot group and the stab group comparsion of early mortality in PCT patients after operation with the pooled OR was 4.56(P＜0.00001,95%CI, 3.54-5.88).There was no statistical heterogeneity among studies included in the meta-analysis(P=0.50).2.2 Results of the effect of operation spotThe results of meta-analysis of 3 retrospective studies and 1 prospective study indicated that the emergency room group and the operation room group comparsion of early mortality in PCT patients after operation with the pooled OR was 22.26 (P＜0.00001,95%CI,13.87-35.73).There was no statistical heterogeneity among studies included in the meta-analysis(P=0.17).2.3 Results of the effect of the number of chambers to be injuryedThe results of meta-analysis of 3 retrospective studies and 1 prospective study indicated that the one chamber to be injuryed group and the more than two chambers to be injuryed group comparsion of early mortality in PCT patients after operation with the pooled OR was 0.19(P＜0.00001,95%CI,0.11-0.32).There was no statistical heterogeneity among studies included in the meta-analysis(P=0.32).2.4 Results of the effect of pericardial tamponadeThe results of meta-analysis of 4 retrospective studies indicated that the pericardial tamponade group and the no pericardial tamponade group comparsion of early mortality in PCT patients after operation with the pooled OR was 0.68(P=0.93, 95%CI,0.47-0.97).The test of heterogeneity showed that there was statistical heterogeneity among studies included in the meta-analysis(P=0.005).The synthesis was completed by random effect model.2.5 Results of the effect of the combined injuryThe results of meta-analysis of 4 retrospective studies indicated that the with the combined injury group and the no combined injury group comparsion of early mortality in PCT patients after operation with the pooled OR was 3.31(P=0.02,95% CI,1.17-9.35).The test of heterogeneity showed that there was statistical heterogeneity among studies included in the meta-analysis(P=0.02).The synthesis was completed by random effect model.2.6 Results of the effect of Revise Trauma Score(RTS)The results of meta-analysis of 2 retrospective studies and 1 prospective study indicated that the RTS=0 group and the RTS=1+ group comparsion of early mortality in PCT patients after operation with the pooled OR was 5.26(P=0.0008,95%CI, 2.00-13.83).There was no statistical heterogeneity among studies included in the meta-analysis(P=0.51).2.7 Results of the effect of the blood pressure on admissonThe results of meta-analysis of 4 retrospective studies and 1 prospective study indicated that the blood pressure on admisson＜90 mmHg group and the blood pressure on admisson＜90 mmHg group comparsion of early mortality in PCT patients after operation with the pooled OR was 6.52(P＜0.00001,95%CI, 3.39-12.52).There was no statistical heterogeneity among studies included in the meta-analysis(P=0.27).2.8 Results of the effect of the physiology index(PI)The results of meta-analysis of 4 retrospective studies indicated that the(PI≤10) group and the(PI＞10) group comparison of early mortality in PCT patients after operation with the pooled OR was 0.10(P＜0.00001,95%CI,0.06-0.17).There was no statistical heterogeneity among studies included in the meta-analysis(P=0.07).Conclusions:1.From the experience of surgical treatment for PCT in our hospital,Injury severity score(ISS)＞25(p=0.03),The Revised trauma score(RTS) at presentation≤2 (p=0.002),the combination with aortic injury(p=0.004),the quantity of metachysis at the first 24 hours≥12 unit(p=0.0203),exploration at the emergency room (p=0.0002)may affect early postoperative mortality significantly.2.The results of the meta-analyses indicated that variables related to the gun shoot,emergency room operation,with combined injury,RTS=0 and the blood pressure on admission＜90 mmHg are the risk factors for the early death after PCT operation,while the number of chambers to be injuryed(n=1),pericardial tamponade and the physiology index(PI≤10) are the protective factors for the early death after PCT operation.3.By merger and synthesis of the results of the same kind studies, meta-analysis can increase the sample size,enhance the statistic efficiency.In particular,when the results of diferent studies aren't consensus or there aren't statistic significance in results,meta-analysis could obtain statistic analytic result that approachs the real situation.4.The results of this study would advantage the systematic evaluation of the operative risk of the patient with Penetrating Cardiac Trauma in the future clinic work,take reasonable measures to relieve risk factors to improve surgical outcome. They would also benefit the prediction of the prognosis of the patient undergoing operation.Therefore,this study is helpful for the clinic work in the future.
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