Mataraci Ilker, Polat Adil, Toker Mehmet Erdem, Tezcan Orhan, Erkin Alper, Kirali Kaan
Cardiovascular Surgery Clinic, Kartal Kosuyolu Heart and Research Hospital, Istanbul, Turkey.
Asian Cardiovasc Thorac Ann. 2010 Jun;18(3):266-71. doi: 10.1177/0218492310369030.
We analyzed cases of re-exploration for bleeding after 19,680 open heart operations performed between January 1995 and January 2009 to determine the risk factors for mortality and morbidity. Half of the 282 patients reexplored had nonsurgical causes of bleeding. The patients were grouped according to the timing of reoperation, early re-exploration being on the day of the operation. Mortality, total morbidity, and the need for transfusion of any blood product were compared between the early and late re-exploration groups. Most patients (77.7%) were reexplored early. Overall mortality was 8.5% (24 patients). Mortality, total morbidity, renal, gastrointestinal, neurologic and infectious complications, and low cardiac output differed significantly between the 2 groups. Significant predictors of mortality were old age, female sex, left ventricular dysfunction, noncoronary operations, and delayed reoperation. Predictors of morbidity were old age, preoperative dialysis, tobacco use, chronic lung disease, and delayed reoperation. No factors were found to be associated with the need for transfusion.
我们分析了1995年1月至2009年1月期间进行的19680例心脏直视手术后因出血而再次手术探查的病例，以确定死亡率和发病率的危险因素。在接受再次手术探查的282例患者中，一半患者的出血原因是非手术性的。患者根据再次手术的时间分组，早期再次探查是在手术当天进行。对早期和晚期再次探查组之间的死亡率、总发病率以及任何血液制品的输血需求进行了比较。大多数患者（77.7%）进行了早期再次探查。总体死亡率为8.5%（24例患者）。两组之间的死亡率、总发病率、肾脏、胃肠道、神经和感染并发症以及低心排血量存在显著差异。死亡率的显著预测因素为高龄、女性、左心室功能障碍、非冠状动脉手术和延迟再次手术。发病率的预测因素为高龄、术前透析、吸烟、慢性肺病和延迟再次手术。未发现与输血需求相关的因素。
