Yoshida Kazunori, Matsumoto Masahiko, Sugita Takaaki, Nishizawa Junichiro, Matsuyama Katsuhiko, Tokuda Yoshiyuki, Matsuo Takehiko
Department of Cardiovascular Surgery, Tenri Hospital, Nara, Japan.
Ann Thorac Cardiovasc Surg. 2005 Feb;11(1):25-8.
Gastrointestinal complications (GICs) such as gastroduodenal ulcer, enterocolitis, and ischemic colitis after coronary artery bypass grafting (CABG) are rare, but are associated with high mortality and morbidity. The present study was performed to detect risk factors and to investigate outcomes following GICs after CABG.
Between January 1992 and December 2001, 17 of 549 patients (3.1%) developed GICs after CABG with cardiopulmonary bypass, presenting with gastrointestinal bleeding due to gastroduodenal ulcer, enterocolitis, or ischemic colitis. We conducted a retrospective analysis of these patients.
All patients required emergent treatment for hemorrhage by means of blood transfusion and endoscopic ablation and/or clipping. The following possible predictors of GICs were identified by logistic multivariate analysis: age over 70, diabetes mellitus (particularly insulin-dependent diabetes), history of cerebrovascular disease or history of renal failure and postoperative low output syndrome (LOS).
Our results suggested that GICs after CABG with cardiopulmonary bypass are rare but can be lethal. Early diagnosis and prompt intervention can be difficult but are potentially life saving for patients in whom GICs develop.
冠状动脉搭桥术（CABG）后出现的胃肠道并发症（GICs），如胃十二指肠溃疡、小肠结肠炎和缺血性结肠炎虽较为罕见，但却与高死亡率和高发病率相关。本研究旨在检测冠状动脉搭桥术后胃肠道并发症的危险因素并调查其预后情况。
在1992年1月至2001年12月期间，549例行体外循环冠状动脉搭桥术的患者中有17例（3.1%）出现了胃肠道并发症，表现为胃十二指肠溃疡、小肠结肠炎或缺血性结肠炎所致的胃肠道出血。我们对这些患者进行了回顾性分析。
所有患者均需通过输血以及内镜下切除和/或钳夹术对出血进行紧急治疗。通过逻辑多变量分析确定了以下可能的胃肠道并发症预测因素：年龄超过70岁、糖尿病（尤其是胰岛素依赖型糖尿病）、脑血管疾病史或肾衰竭病史以及术后低心排血量综合征（LOS）。
我们的研究结果表明，体外循环冠状动脉搭桥术后的胃肠道并发症虽罕见，但可能致命。早期诊断和及时干预可能具有难度，但对于发生胃肠道并发症的患者而言却有可能挽救生命。
