Choong Cliff K, Gerrard Caroline, Goldsmith Kimberley A, Dunningham Helen, Vuylsteke Alain
Papworth Hospital NHS Trust, Cambridge, United Kingdom.
Eur J Cardiothorac Surg. 2007 May;31(5):834-8. doi: 10.1016/j.ejcts.2007.02.001. Epub 2007 Mar 13.
We aimed to identify the impact of re-exploration for bleeding after coronary artery bypass grafting (CABG) and the effect of time delay, re-exploration within 12h (<12h) versus 12h or later (>or=12h).
Analyses of prospective clinical data on 3220 consecutive patients who underwent CABG between 2003 and 2005 were performed. Pearson chi(2) tests, Fisher's exact tests, Student's t-tests, Mann-Whitney U tests, or univariate logistic regression analysis were used to assess the effects of pre-operative and operative characteristics on re-exploration, and the effects of re-exploration and time delay on adverse outcomes. Predictors of re-exploration and its effect on adverse outcomes were further evaluated using multiple logistic regression analysis.
One hundred ninety-one patients (5.9%) underwent re-exploration for bleeding. Re-explored patients as a group in comparison to the non-re-explored group had increased postoperative blood loss, transfusion requirements, duration of mechanical ventilation, ICU stay, intra-aortic balloon pump (IABP) and haemofiltration support, and mortality (all p<0.001). One hundred fifty-seven (82%) of the 191 patients were re-explored <12h. The group of patients who were re-explored <12h in comparison to >or=12h group had shorter ICU stay (median 3 vs 8.5 days; p<0.001), less IABP support (22.3 vs 44.1%; p=0.009) and a lower mortality (7 vs 29.4%; p=0.001). There was no significant difference in blood loss or transfusion requirements between the two groups. The predicted EuroSCORE risks of the <12h group was 6.66% and the observed mortality was 7% (p=0.865). The observed mortality of 29.4% in the >or=12h group was significantly higher than the predicted EuroSCORE risks of 7.59% (p<0.001).
Patients requiring re-exploration for bleeding are at higher risk of adverse outcomes and this risk is increased if time to re-exploration is prolonged for 12h or longer.
我们旨在确定冠状动脉旁路移植术（CABG）后再次手术探查出血的影响以及延迟时间的影响，即12小时内（<12小时）与12小时或更晚（≥12小时）进行再次手术探查的情况。
对2003年至2005年间连续3220例行CABG患者的前瞻性临床数据进行分析。采用Pearson卡方检验、Fisher精确检验、Student t检验、Mann-Whitney U检验或单因素逻辑回归分析来评估术前和手术特征对再次手术探查的影响，以及再次手术探查和延迟时间对不良结局的影响。使用多因素逻辑回归分析进一步评估再次手术探查的预测因素及其对不良结局的影响。
191例患者（5.9%）因出血接受了再次手术探查。与未接受再次手术探查的组相比，接受再次手术探查的患者组术后失血量增加、输血需求增加、机械通气时间延长、重症监护病房（ICU）停留时间延长、主动脉内球囊反搏（IABP）和血液滤过支持增加以及死亡率增加（所有p<0.001）。191例患者中有157例（82%）在12小时内接受了再次手术探查。与≥12小时组相比，在12小时内接受再次手术探查的患者组ICU停留时间更短（中位数3天对8.5天；p<0.001），IABP支持更少（22.3%对44.1%；p=0.009）且死亡率更低（7%对29.4%；p=0.001）。两组之间的失血量或输血需求无显著差异。<12小时组预测的欧洲心脏手术风险评估系统（EuroSCORE）风险为6.66%，观察到的死亡率为7%（p=0.865）。≥12小时组观察到的死亡率29.4%显著高于预测的EuroSCORE风险7.59%（p<0.001）。
因出血需要再次手术探查的患者出现不良结局的风险更高，如果再次手术探查的时间延长至12小时或更长时间，这种风险会增加。
