Chaudhuri Nilanjan, James Justin, Sheikh Adnan, Grayson Antony D, Fabri Brian M
Department of Cardiothoracic Surgery, The Cardiothoracic Centre-Liverpool, The Cardiothoracic Centre NHS Trust, Thomas Drive, Liverpool L14 3PE, United Kingdom.
Eur J Cardiothorac Surg. 2006 Jun;29(6):971-7. doi: 10.1016/j.ejcts.2006.03.014. Epub 2006 May 3.
Intestinal ischaemia following cardiac surgery is a serious complication, which carries a high mortality rate. Several studies have examined pre-operative and intra-operative risk factors. We aimed to develop a multivariate risk model to identify those patients at highest risk of intestinal ischaemia.
Data was prospectively collected for 10,976 consecutive cardiac surgery patients from our institution between April 1997 and March 2004. Fifty (0.5%) patients developed post-operative intestinal ischaemia. A forward stepwise multivariate logistic regression analysis was undertaken to identify predictors of developing intestinal ischaemia. Intra-operative and post-operative variables were censored at the time of onset of intestinal ischaemia.
The predictors of post-operative intestinal ischaemia were: post-op inotrope and dialysis support (OR 6.7; p < 0.001), post-op ventilation >48 h (OR 5.1; p < 0.001), age at operation (OR 1.06 [for each additional year]; p < 0.001), post-op atrial fibrillation (OR 2.3; p = 0.014) and blood loss in intensive care unit (ICU) >700 ml (OR 2.0; p = 0.037). The predictive ability of this model was very good with an area under the receiver operating characteristic curve of 0.93. In-hospital mortality for the patients who developed intestinal ischaemia was 94% (47/50) compared to 3.6% (390/10,926) for the other patients (p < 0.001).
Although the incidence of intestinal ischaemia following cardiac surgery is low, the prognosis for these patients is very poor. We have identified several risk factors, and developed a multivariate prediction tool, which may be useful in identifying patients at high-risk of developing intestinal ischaemia.
心脏手术后肠道缺血是一种严重的并发症，死亡率很高。多项研究已对术前和术中的风险因素进行了检查。我们旨在建立一个多变量风险模型，以识别肠道缺血风险最高的患者。
前瞻性收集了1997年4月至2004年3月期间我院连续10976例心脏手术患者的数据。50例（0.5%）患者发生术后肠道缺血。进行向前逐步多变量逻辑回归分析，以确定发生肠道缺血的预测因素。术中及术后变量在肠道缺血发作时进行审查。
术后肠道缺血的预测因素为：术后使用血管活性药物和透析支持（比值比6.7；p<0.001）、术后通气>48小时（比值比5.1；p<0.001）、手术年龄（比值比1.06[每增加一岁]；p<0.001）、术后房颤（比值比2.3；p=0.014）和重症监护病房（ICU）失血>700 ml（比值比2.0；p=0.037）。该模型的预测能力非常好，受试者操作特征曲线下面积为0.93。发生肠道缺血的患者院内死亡率为94%（47/50），而其他患者为3.6%（390/10926）（p<0.001）。
虽然心脏手术后肠道缺血的发生率较低，但这些患者的预后非常差。我们已经确定了几个风险因素，并开发了一种多变量预测工具，这可能有助于识别发生肠道缺血高风险的患者。
