Bignami Elena, Landoni Giovanni, Crescenzi Giuseppe, Gonfalini Massimiliano, Bruno Giovanna, Pappalardo Federico, Marino Giovanni, Zangrillo Alberto, Alfieri Ottavio
Department of Cardiothoracic Anesthesia and Intensive Care, Università Vita-Salute San Raffaele, Milano, Italy.
Ann Card Anaesth. 2009 Jan-Jun;12(1):22-6. doi: 10.4103/0971-9784.45009.
Perioperative and postoperative morbidity and mortality associated with cardiac surgery affect both the outcome and quality of life. Markers such as troponin effectively predict short-term outcome. In a prospective cohort study in a University Hospital we assessed the role of cardiac biomarkers, also as predictors of long-term outcome and life quality after cardiac surgery with a three-year follow-up after conventional heart surgery. Patients were interviewed via phone calls with a structured questionnaire examining general health, functional status, activities of daily living, perception of life quality and need for hospital readmission. Descriptive statistics and multivariate analysis were performed. Out of 252 consecutive patients, 8 (3.2%) died at the three years follow up: 7 for cardiac complications and 1 for cancer. Thirty-six patients (13.5%) had hospital readmission for cardiac causes (mostly for atrial fibrillation or other arrhythmias (9.3%), but none needed cardiac surgical reintervention; 21 patients (7.9%) were hospitalised for non-cardiac causes. No limitation in function activities of daily living was reported by most patients (94%), 92% perceived their general health as excellent, very good or good and none considered it insufficient; 80% were NYHA I, 17% NYHA II, 3% NYHA III and none NYHA IV. Multivariate analysis indicated preoperative treatment with digitalis or nitrates, and postoperative cardiac biomarkers release was independently associated to death. Elevated cardiac biomarker release and length of hospital stay were the only postoperative independent predictors of death in this study.
心脏手术相关的围手术期和术后发病率及死亡率会影响手术结果和生活质量。肌钙蛋白等标志物能有效预测短期结果。在一家大学医院进行的一项前瞻性队列研究中，我们评估了心脏生物标志物的作用，这些标志物也是常规心脏手术后三年随访期内心脏手术长期结果和生活质量的预测指标。通过电话访谈患者，使用结构化问卷来调查总体健康状况、功能状态、日常生活活动、生活质量感知以及再次入院需求。进行了描述性统计和多变量分析。在连续的252例患者中，8例（3.2%）在三年随访期死亡：7例死于心脏并发症，1例死于癌症。36例患者（13.5%）因心脏原因再次入院（主要是心房颤动或其他心律失常（9.3%）），但无人需要再次进行心脏手术干预；21例患者（7.9%）因非心脏原因住院。大多数患者（94%）报告日常生活活动无受限，92%认为其总体健康状况为优秀、非常好或良好，无人认为不足；80%为纽约心脏协会（NYHA）I级，17%为NYHA II级，3%为NYHA III级，无人为NYHA IV级。多变量分析表明，术前使用洋地黄或硝酸盐治疗以及术后心脏生物标志物释放与死亡独立相关。在本研究中，心脏生物标志物释放升高和住院时间是术后仅有的死亡独立预测因素。
