Mierdl S, Meininger D, Dogan S, Aybek T, Wimmer-Greinecker G, Lischke V, Kessler P
Department of Anesthesiology, Intensive Care Medicine and Pain Control, J.W. Goethe-University Hospital Center, Theodor-Stern-Kai 7, D-60590 Frankfurt, Germany.
Ann Acad Med Singap. 2001 May;30(3):245-9.
Abdominal complications after cardiac surgery are associated with a high mortality rate. Due to the absence of early specific clinical signs, diagnosis is often delayed. The present study seeks to determine predictive risk factors for subsequent gastrointestinal complications after cardiosurgical procedures.
Within 12 months, all patients (n = 1,116) who had undergone open heart surgery with cardiopulmonary bypass at our institution were studied for abdominal complications. To determine predictive factors, all case histories of the patients were analysed.
Abdominal complications occurred in 23 (2.1%) patients during the postoperative intensive care unit (ICU) stay, ten of whom had to undergo subsequent abdominal surgery. Of these 23 patients, 20 died. Early complications occurred most likely on postoperative days 6 and 7, consisting of bowel ischaemia or hepatic failure. Late complications consisted of gastrointestinal bleeding, pseudomembraneous colitis, cholecystitis and septic rupture of a spleen. The relative risk for abdominal complications after cardiopulmonary bypass was highly increased in association with a cardiac index less than 2.0 l/min-1/(m2)-1 (22.1-fold), postoperative onset of atrial fibrillation (16.6-fold), emergency surgery (10.7-fold), need for vasopressors (10.1-fold), need for intra-aortic balloon counterpulsation (8.6-fold), and the need for re-exploration within the first 24 hours (8.4-fold). All patients with necrotic bowel disease had elevated serum lactate levels. Furthermore, both cardiopulmonary bypass and aortic clamping times were significantly prolonged in patients who developed gastrointestinal complications.
A number of predictive factors has been described to contribute to the development of abdominal complications subsequently after cardiac surgery on cardiopulmonary bypass. Knowledge of these factors may lead to earlier identification of patients at increased risk and may allow for more efficient and earlier interventions.
心脏手术后的腹部并发症与高死亡率相关。由于缺乏早期特异性临床体征，诊断往往延迟。本研究旨在确定心脏外科手术后后续胃肠道并发症的预测风险因素。
在12个月内，对我院所有接受体外循环心脏直视手术的患者（n = 1116）进行腹部并发症研究。为确定预测因素，分析了所有患者的病历。
23例（2.1%）患者在术后重症监护病房（ICU）住院期间发生腹部并发症，其中10例患者随后接受了腹部手术。这23例患者中，20例死亡。早期并发症最可能发生在术后第6天和第7天，包括肠缺血或肝功能衰竭。晚期并发症包括胃肠道出血、伪膜性结肠炎、胆囊炎和脾脓毒症破裂。体外循环后腹部并发症的相对风险与心脏指数低于2.0 l/min-1/(m2)-1（22.1倍）、术后房颤发作（16.6倍）、急诊手术（10.7倍）、需要血管升压药（10.1倍）、需要主动脉内球囊反搏（8.6倍）以及在最初24小时内需要再次探查（8.4倍）高度相关。所有坏死性肠病患者血清乳酸水平升高。此外，发生胃肠道并发症的患者体外循环和主动脉阻断时间均显著延长。
已描述了一些预测因素，这些因素有助于心脏体外循环手术后腹部并发症的发生。了解这些因素可能有助于更早识别风险增加的患者，并可能实现更有效和更早的干预。
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