Albacker Turki B, Chaturvedi Rakesh, Al Kindi Adil H, Al-Habib Hamad, Al-Atassi Talal, de Varennes Benoit, Lachapelle Kevin
Division of Cardiothoracic Surgery, Department of Surgery, McGill University Health Centre, McGill University, Montreal, Canada.
Interact Cardiovasc Thorac Surg. 2009 Jul;9(1):56-60. doi: 10.1510/icvts.2009.204990. Epub 2009 Apr 7.
Old age is a significant risk factor for perioperative morbidity and mortality following cardiac surgery and optimal myocardial protection strategy should be sought in this group of patients. We, therefore, reviewed the data on 295 consecutive patients older than 75 years who underwent any cardiac surgical procedure. Microplegia was used in 144 patients compared to 151 patients who had the standard 4:1 blood cardioplegia. Logistic regression analysis was used for propensity matching to balance the differences between the two groups. The microplegia group included more females and sicker patients as indicated by higher Parsonnet scores. There were differences in the pump time, aortic cross-clamp time, procedure type and surgeons between the two groups. These differences were balanced using the propensity matching. In-hospital mortality, acute renal injury and confusion were higher in the microplegia group (17%, 34%, 35%, respectively) compared to the standard 4:1 cardioplegia group (9%, 23%, 24%, respectively) (P=0.04, 0.04, 0.04, respectively). These differences were not statistically significant after propensity matching. These results demonstrate that the use of microplegia is safe in patients older than 75 years who are undergoing cardiac surgery and results in similar in-hospital morbidity and mortality to the standard 4:1 blood cardioplegia.
老年是心脏手术后围手术期发病和死亡的重要危险因素，应在这类患者中寻求最佳的心肌保护策略。因此，我们回顾了295例连续接受任何心脏手术的75岁以上患者的数据。144例患者使用了微停搏液，而151例患者使用了标准的4:1血液停搏液。采用逻辑回归分析进行倾向匹配，以平衡两组之间的差异。微停搏液组女性更多，且根据较高的Parsonnet评分显示病情更重。两组之间在体外循环时间、主动脉阻断时间、手术类型和外科医生方面存在差异。使用倾向匹配平衡了这些差异。与标准4:1停搏液组（分别为9%、23%、24%）相比，微停搏液组的院内死亡率、急性肾损伤和精神错乱发生率更高（分别为17%、34%、35%）（P值分别为0.04、0.04、0.04）。倾向匹配后这些差异无统计学意义。这些结果表明，对于接受心脏手术的75岁以上患者，使用微停搏液是安全的，且院内发病率和死亡率与标准4:1血液停搏液相似。
