非冠状动脉心脏手术患者的快速康复

Fast-track recovery in noncoronary cardiac surgery patients.

作者信息

Toraman Fevzi, Evrenkaya Serdar, Yuce Murat, Göksel Onur, Karabulut Hasan, Alhan Cem

机构信息

Department of Anesthesiology, Acibadem Kadiköy Hospital, Istanbul, Turkey.

出版信息

Heart Surg Forum. 2005;8(1):E61-4. doi: 10.1532/HSF98.20041138.

DOI:10.1532/HSF98.20041138

PMID:15769719

Abstract

OBJECTIVE

Fast-track recovery protocols result in shorter hospital stays and decreased costs in coronary artery bypass grafting (CABG) surgery. However, data based on an objective scoring system are lacking for the impact of these protocols on patients undergoing cardiac surgery other than isolated CABG.

METHODS

Between March 1999 and March 2003, 299 consecutive patients who underwent open cardiac surgery other than isolated CABG were analyzed to evaluate the safety and efficacy of fast-track recovery. The parameters evaluated as predictors of mortality, ie, delayed extubation (>360 minutes), intensive care unit (ICU) discharge (>24 hours), increased length of hospital stay (>5 days), and red blood cell transfusion, were determined by regression analysis. Standard perioperative data were collected prospectively for every patient.

RESULTS

Seventy-two percent of the patients were extubated within 6 hours, 87% were discharged from the ICU within 24 hours, and 60% were discharged from the hospital within 5 days. No red blood cells were transfused in 67% of the patients. There were no predictors of mortality. The predictors of delayed extubation were preoperative congestive heart failure (P = .005; odds ratio [OR], 4.5; 95% confidence interval [CI], 1.6-12.6) and peripheral vascular disease (P = .02; OR, 6; 95% CI, 1.9-19.4). Factors leading to increased ICU stay were diabetes (P = .05; OR, 3.6; 95% CI, 1-12.6), emergent operation (P = .04; OR, 6.1; 95% CI, 1.1-33.2), red blood cell transfusion (P = .03; OR, 2.9; 95% CI, 1.1-7.8), chest tube drainage >1000 mL (P = .03; OR, 3.4; 95% CI, 1.1-10.2). The predictors of increased length of hospital stay were ICU stay >24 hours (P = .001; OR, 5.9; 95% CI, 2-17), EuroSCORE >5 (P = .05; OR, 1.8; 95% CI, 1-3.2), and chronic obstructive pulmonary disease (P = .003; OR, 3.7; 95% CI, 1.5-8.7). Predictive factors for transfusion of red blood cells were diabetes (P = .04; OR, 2.9; 95% CI, 1.1-8.1), delayed extubation (P = .02; OR, 2.7; 95% CI, 1.4-5.1), increased ICU stay (P = .04; OR, 2.6; 95% CI, 1-6.4), and chest tube drainage >1000 mL (P = .001; OR, 4.3; 95% CI, 2-9.3).

CONCLUSIONS

This study confirms the safety and efficacy of the fast-track recovery protocol in patients undergoing open cardiac surgery other than isolated CABG.

摘要

目的

快速康复方案可缩短冠状动脉旁路移植术（CABG）患者的住院时间并降低费用。然而，对于这些方案对除单纯CABG之外的心脏手术患者的影响，缺乏基于客观评分系统的数据。

方法

在1999年3月至2003年3月期间，对299例连续接受除单纯CABG之外的心脏直视手术的患者进行分析，以评估快速康复的安全性和有效性。通过回归分析确定作为死亡率预测指标的参数，即拔管延迟（>360分钟）、重症监护病房（ICU）出院延迟（>24小时）、住院时间延长（>5天）和红细胞输血情况。前瞻性收集每位患者的标准围手术期数据。

结果

72%的患者在6小时内拔管，87%的患者在24小时内从ICU出院，60%的患者在5天内出院。67%的患者未输注红细胞。没有死亡率的预测指标。拔管延迟的预测因素为术前充血性心力衰竭（P = .005；比值比[OR]，4.5；95%置信区间[CI]，1.6 - 12.6）和外周血管疾病（P = .02；OR，6；95% CI，1.9 - 19.4）。导致ICU住院时间延长的因素为糖尿病（P = .05；OR，3.6；95% CI，1 - 12.6）、急诊手术（P = .04；OR，6.1；95% CI，1.1 - 33.2）、红细胞输血（P = .03；OR，2.9；95% CI，1.1 - 7.8）、胸腔闭式引流量>1000 mL（P = .03；OR，3.4；95% CI，1.1 - 10.2）。住院时间延长的预测因素为ICU住院时间>24小时（P = .001；OR，5.9；95% CI，2 - 17）、欧洲心脏手术风险评估系统（EuroSCORE）>5（P = .05；OR，1.8；95% CI，1 - 3.2）和慢性阻塞性肺疾病（P = .003；OR，3.7；95% CI，1.5 - 8.7）。红细胞输血的预测因素为糖尿病（P = .04；OR，2.9；95% CI，1.1 - 8.1）、拔管延迟（P = .02；OR，2.7；95% CI，1.4 - 5.1）、ICU住院时间延长（P = .04；OR，2.6；95% CI，1 - 6.4）和胸腔闭式引流量>1000 mL（P = .001；OR，4.3；95% CI，2 - 9.3）。