Anderson Alexander John Pessoa Grant, Barros Neto Francisco Xavier do Rêgo, Costa Marcelo de Almeida, Dantas Luciano Domingues, Hueb Alexandre Ciappina, Prata Marcelo Fernandes
Cardiovascular Surgery Department, Hospital Santa Casa de Misericordia de Limeira.
Rev Bras Cir Cardiovasc. 2011 Jan-Mar;26(1):69-75. doi: 10.1590/s0102-76382011000100014.
To identify risk factors in septuagenarians and octogenarians submitted to cardiovascular surgery with cardiopulmonary bypass (CPB).
Per-operative variables of 265 patients over 70 years of age were analyzed. 248 (93.6%) were septuagenarians and 17 (6.4%) octogenarians.
Overall mortality did not differ between the groups, nor did the type of procedure (CABG or valvular) (P=0.545). Pre-operative variables did not increase the death risk, nor did the use of arterial or venous grafts (P=0.261), or the number of grafts per patient (P=0.131). CPB and cross-clamp time are associated with higher mortality. The survivors' group had an average CPB time of 70 ± 27 minutes while the non-survivors group 88.8 ± 25.4 minutes (P<0.001). Cross-clamp time in the survivors was 55.5 ± 20 minutes, while 64.9 ± 16 minutes in the non-survivors (P=0.014). Using multivariate logistic regression, CPB time is associated with death (Pearson's chi square= 0.0056). CPB time over 75 minutes presents an increased risk of death of 3.2 times (CI 95%: 1.3-7.9) over those with CPB time < 75 minutes. Post-operative variables associated with increased death rates: mechanical ventilation > 12 hours (P<0.001); ICU stay (P=0.033); re-exploration (P=0.001); inotropic support > 48 hours (P<0.001); use of blood components (P<0.001).
Overall mortality justifies the interventions. CPB time greater than 75 minutes, mechanical ventilation over 12 hours, length of ICU stay, need for reoperation, inotropic drug support over 48 hours, and use of blood components are associated with a higher mortality rate.
确定接受体外循环（CPB）心血管手术的七旬和八旬老人的风险因素。
分析了265例70岁以上患者的术中变量。248例（93.6%）为七旬老人，17例（6.4%）为八旬老人。
两组的总体死亡率无差异，手术类型（冠状动脉旁路移植术或瓣膜手术）也无差异（P=0.545）。术前变量未增加死亡风险，动脉或静脉移植物的使用（P=0.261）或每位患者的移植物数量（P=0.131）也未增加死亡风险。CPB和主动脉阻断时间与较高的死亡率相关。存活组的平均CPB时间为70±27分钟，而非存活组为88.8±25.4分钟（P<0.001）。存活组的主动脉阻断时间为55.5±20分钟，而非存活组为64.9±16分钟（P=0.014）。使用多因素逻辑回归分析，CPB时间与死亡相关（Pearson卡方检验=0.0056）。CPB时间超过75分钟的患者死亡风险比CPB时间<75分钟的患者增加3.2倍（95%CI：1.3-7.9）。与死亡率增加相关的术后变量：机械通气>12小时（P<0.001）；入住重症监护病房（P=0.033）；再次手术探查（P=0.001）；使用血管活性药物支持>48小时（P<0.001）；使用血液成分（P<0.001）。
总体死亡率证明了这些干预措施的合理性。CPB时间大于75分钟、机械通气超过12小时、重症监护病房住院时间、再次手术需求、血管活性药物支持超过48小时以及使用血液成分与较高的死亡率相关。
