Sun Xiumei, Boyce Steven W, Herr Daniel L, Hill Peter C, Zhang Li, Corso Paul J, Haile Elizabeth, Lee Anne T, Molyneaux Robert E
Section of Cardiac Surgery, Department of Surgery, Washington Hospital Center, Washington, DC 20010-2975, USA.
Cardiovasc Revasc Med. 2011 Jul-Aug;12(4):203-9. doi: 10.1016/j.carrev.2010.10.004. Epub 2011 Mar 1.
Postoperative vasoplegic syndrome (PVS) is a frequent complication and can affect the early postoperative course. Our study investigated the incidence and risk factors of PVS after on-pump isolated coronary artery grafting bypass (CABG) and on-pump open-heart surgery. A total of 629 patients underwent on-pump cardiac surgery from November 21, 2005, to June 9, 2006, at our institution. Of those, 334 patients underwent on-pump isolated CABG and 295 patients had open-heart surgery. PVS was defined based on the recognized criteria. Multivariate logistic regression analysis was used to identify the risk factors for PVS. The overall incidence of PVS was 11.7%. The incidence in isolated on-pump CABG surgery was 6.9% and 17.0% in open-heart surgery (P<.01). In multivariate analysis, isolated CABG reduced by half the incidence of PVS [odds ratio (OR)=0.45, P=.02]; preoperative left ventricular ejection fraction (EF) <35% was identified as an independent predictor of PVS (OR=2.1, P=.01), and a protective effect of female gender for PVS was observed (OR=0.4, P=.01). The association between angiotensin-converting enzyme inhibitors and other preoperative medical treatments was not confirmed by our study. In conclusion, PVS occurred less often after isolated CABG surgery than after open-heart surgery. Advanced age and low preoperative EF strongly predicted PVS.
术后血管麻痹综合征（PVS）是一种常见并发症，可影响术后早期病程。我们的研究调查了体外循环下单纯冠状动脉旁路移植术（CABG）和体外循环下心内直视手术后PVS的发生率及危险因素。2005年11月21日至2006年6月9日，共有629例患者在我院接受了体外循环心脏手术。其中，334例患者接受了体外循环下单纯CABG，295例患者接受了心内直视手术。PVS根据公认标准进行定义。采用多因素logistic回归分析确定PVS的危险因素。PVS的总体发生率为11.7%。单纯体外循环CABG手术的发生率为6.9%，心内直视手术的发生率为17.0%（P<0.01）。多因素分析显示，单纯CABG使PVS的发生率降低一半[比值比（OR）=0.45，P=0.02]；术前左心室射血分数（EF）<35%被确定为PVS的独立预测因素（OR=2.1，P=0.01），并且观察到女性性别对PVS有保护作用（OR=0.4，P=0.01）。我们的研究未证实血管紧张素转换酶抑制剂与其他术前药物治疗之间的关联。总之，单纯CABG手术后PVS的发生率低于心内直视手术后。高龄和术前低EF是PVS的强烈预测因素。
