Salis Stefano, Mazzanti Valeria V, Merli Guido, Salvi Luca, Tedesco Calogero C, Veglia Fabrizio, Sisillo Erminio
Anesthesia and Intensive Care Unit, Centro Cardiologico Monzino IRCCS, Milan, Italy.
J Cardiothorac Vasc Anesth. 2008 Dec;22(6):814-22. doi: 10.1053/j.jvca.2008.08.004. Epub 2008 Oct 22.
The aim of this study was to determine if there is a direct relationship between the duration of cardiopulmonary bypass (CPB time [CPBT]) and postoperative morbidity and mortality in patients undergoing cardiac surgery.
Retrospective study.
Cardiac surgery unit, university hospital.
Five thousand six patients, New York Heart Association classes 1 through 4, who underwent cardiac surgery between January 2002 and March 2008.
All patients were subjected to CPB.
The mean CPBT was 115 minutes (median 106). One hundred thirty-one patients (2.6%) died during the same hospitalization. The postoperative median blood loss was 600 mL. Reoperations for bleeding occurred in 193 patients (3.9%), and 1,001 patients received 3 or more units of red blood cells. There were 108 patients (2.2%) with neurologic sequelae, 391 patients (7.8%) with renal complications, 37 patients (0.7%) with abdominal complications, and 184 patients (3.7%) with respiratory complications. Seventy-two patients (1.4%) had an infective complication, and 80 patients (1.6%) had a postoperative multiorgan failure. The multivariate analysis confirmed the role of CPBT, considered in 30-minute increments, as an independent risk factor for postoperative death (odds ratio [OR] = 1.57, p < 0.0001), pulmonary (OR = 1.17, p < 0.0001), renal (OR 1.31, p < 0.0001), and neurologic complications (OR = 1.28, p < 0.0001), multiorgan failure (OR = 1.21, p < 0.0001), reoperation for bleeding (OR = 1.1, p = 0.0165), and multiple blood transfusions (OR = 1.58, p < 0.0001).
Prolonged CPB duration independently predicts postoperative morbidity and mortality after cardiac surgery.
本研究旨在确定心脏手术患者体外循环时间（CPB时间[CPBT]）与术后发病率和死亡率之间是否存在直接关系。
回顾性研究。
大学医院心脏外科病房。
2002年1月至2008年3月期间接受心脏手术的5600例纽约心脏协会心功能分级为1至4级的患者。
所有患者均接受体外循环。
平均CPBT为115分钟（中位数为106分钟）。131例患者（2.6%）在同一住院期间死亡。术后中位数失血量为600毫升。193例患者（3.9%）因出血接受再次手术，1001例患者输注了3个或更多单位的红细胞。108例患者（2.2%）出现神经后遗症，391例患者（7.8%）出现肾脏并发症，37例患者（0.7%）出现腹部并发症，184例患者（3.7%）出现呼吸并发症。72例患者（1.4%）发生感染性并发症，80例患者（1.6%）出现术后多器官功能衰竭。多变量分析证实，以30分钟为增量考虑的CPBT是术后死亡（比值比[OR]=1.57，p<0.0001）、肺部（OR=1.17，p<0.0001）、肾脏（OR 1.31，p<0.0001）和神经并发症（OR=1.28，p<0.0001）、多器官功能衰竭（OR=1.21，p<0.0001）、因出血再次手术（OR=1.1，p=0.0165）和多次输血（OR=1.58，p<0.0001）的独立危险因素。
体外循环时间延长可独立预测心脏手术后的术后发病率和死亡率。
