Bhat Mamatha, Larocque Martin, Amorim Marcos, Herba Karl, Martel Myriam, De Varennes Benoît, Barkun Alan
McGill University, Montreal, Quebec.
Can J Gastroenterol. 2012 Jun;26(6):340-4. doi: 10.1155/2012/121836.
Gastrointestinal (GI) complications of cardiovascular surgery, particularly bleeding, occur frequently.
To determine factors that predict upper GI bleeding (UGIB) after cardiac surgery to improve prognostication and, thus, outcomes.
The present case-control study reviewed institutional records spanning 2002 to 2005 for consecutive patients who developed in-hospital UGIB following cardiovascular surgery. Each case was matched to two to three controls for age, sex and date of hospital admission. Demographics, pharmacotherapy (including use of in-hospital acid suppression), endoscopic findings and outcomes were recorded. After adjustment for possible confounders, including Parsonnet score and demographic parameters, conditional logistic regression analysis identified independent significant predictors of the subsequent development of UGIB.
The study population consisted of 131 cases (mean [± SD] age 68.8±10.2 years, 69.5% male, mean Parsonnet score 24.6±14.2) and 387 matched controls (mean age 68.8±10.8 years, 70.0% male, mean Parsonnet score 20.9±14.2). UGIB events occurred a mean of 10.3±7.7 days after cardiac surgery. Duration of mechanical ventilation (OR 3.01 [95% CI 1.44 to 6.28]), elevation of international normalized ratio (OR 1.91 [95% CI 1.31 to 2.78]) and occurrence of Clostridium difficile colitis before bleeding (OR 3.15 [95% CI 1.19 to 8.36]) were independent risk factors. Use of histamine type 2 receptor antagonists (H2RAs) (OR 0.65 [95% CI 0.38 to 1.12]) or proton pump inhibitors (PPIs) (OR 0.60 [95% CI 0.27 to 1.32]) demonstrated trends toward protecting against UGIB after cardiac surgery.
GI bleeding events occurred approximately 10 days after cardiac surgery in patients with a complicated postoperative course. Significant predictors of subsequent bleeding included increased duration of mechanical ventilation and elevation of international normalized ratio; routine acid suppression with PPIs should be considered in such patients. C difficile colitis also significantly predicted UGIB, and H2RAs should be considered for acid suppression. Neither H2RAs nor PPIs were effective in preventing UGIB, although the small number of patients limits definitive conclusions regarding the role of acid suppression.
心血管手术的胃肠道（GI）并发症，尤其是出血，很常见。
确定预测心脏手术后上消化道出血（UGIB）的因素，以改善预后，从而改善治疗结果。
本病例对照研究回顾了2002年至2005年机构记录中连续发生心血管手术后院内UGIB的患者。每个病例与两到三个年龄、性别和入院日期匹配的对照进行配对。记录人口统计学、药物治疗（包括院内使用抑酸剂）、内镜检查结果和治疗结果。在对可能的混杂因素进行调整后，包括Parsonnet评分和人口统计学参数，条件逻辑回归分析确定了UGIB后续发生的独立显著预测因素。
研究人群包括131例病例（平均[±标准差]年龄68.8±10.2岁，69.5%为男性，平均Parsonnet评分为24.6±14.2）和387例匹配对照（平均年龄68.8±10.8岁，70.0%为男性，平均Parsonnet评分为20.9±14.2）。UGIB事件平均发生在心脏手术后10.3±7.7天。机械通气时间（比值比[OR]3.01[95%置信区间（CI）1.44至6.28]）、国际标准化比值升高（OR 1.91[95%CI 1.31至2.78]）以及出血前艰难梭菌结肠炎的发生（OR 3.15[95%CI 1.19至8.36]）是独立危险因素。使用组胺2型受体拮抗剂（H2RAs）（OR 0.65[95%CI 0.38至1.12]）或质子泵抑制剂（PPIs）（OR 0.60[95%CI 0.27至1.32]）显示出预防心脏手术后UGIB的趋势。
术后病程复杂的患者心脏手术后约10天发生胃肠道出血事件。后续出血的显著预测因素包括机械通气时间延长和国际标准化比值升高；此类患者应考虑常规使用PPIs进行抑酸。艰难梭菌结肠炎也显著预测UGIB，应考虑使用H2RAs进行抑酸。H2RAs和PPIs均未能有效预防UGIB，尽管患者数量较少限制了关于抑酸作用的确切结论。
