Risk Factors Analysis Of Postoperative Pulmonary Complications Of Cardiac Surgery

Objective Among the various complications after cardiac surgery,postoperative pulmonary complications（PPCs）are one of the common complications,mainly including pneumonia,atelectasis,pneumothorax,pleural effusion,pulmonary edema,respiratory failure,acute respiratory distress syndrome and so on.PPCs is closely related to the mortality and prognosis after cardiac surgery.Its occurrence can be affected by multiple variables.Analyzing its risk factors may help to identify patients with high risk of postoperative pulmonary complications.This study mainly discusses the risk factors of pulmonary complications after cardiac surgery,in order to reduce its incidence and improve the prognosis.Methods The medical records of patients undergoing cardiac surgery from January2017 to December 2020 were collected.According to whether PPCs occurred,the patients were divided into two groups: complication group（n = 271）and no complication group（n = 331）,including 300 males and 302 females,ASA Ⅱ ～ Ⅳ.Gender,age,history of hypertension,history of diabetes,history of chronic obstructive pulmonary disease（COPD）,history of cerebrovascular disease,history of operation,cardiac function,coagulation function,liver and kidney function,blood sugar,lactate dehydrogenase,operation time,cardiopulmonary bypass（CPB）time,intraoperative drug use,intraoperative blood transfusion,intraoperative fluid load,intraoperative urine volume,and so on were extracted.The correlation between the above indexes and PPCs was evaluated by univariate analysis.The single factor with statistically significant difference between groups was included in the logistic regression model for screening.Results1.Preoperative basic data of patients in the two groups: compared with patients in the non complication group,the age and left atrial diameter of patients in the complication group were significantly increased,ASA grade,preoperative atrial fibrillation ratio,pulmonary hypertension grade,lymphocyte content,AST,urea nitrogen,globulin,total protein and lactate dehydrogenase concentration were significantly increased（P < 0.05）.There was no significant difference in gender,BMI,hypertension,chronic obstructive pulmonary disease,cerebral infarction,proportion of operation history,left ventricular diameter,preoperative leukocytes,neutrophils,prothrombin time（PT）,activated partial thromboplastin time（APTT）,alt,creatinine,albumin,blood sugar and Hb concentration between the two groups.2.Intraoperative conditions of the two groups: compared with the non complication group,the operation time and CPB time of the complication group were significantly prolonged,the proportion of platelet transfusion and the amount of crystal fluid were more in the complication group（P < 0.05）.There was no significant difference in the amount of heparin,protamine,red blood cells,colloid,liquid and urine between the two groups.3.Postoperative conditions of the two groups: compared with the non complication group,the postoperative urea nitrogen,creatinine and drainage volume in the complication group were significantly increased（P < 0.05）.There was no significant difference in atrial fibrillation and hemoglobin between the two groups.Conclusion Preoperative atrial fibrillation,ASA grade IV and CPB time ≥ 2h were independent risk factors for PPCs in cardiac surgery.