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开胸心脏手术后的胃肠道并发症:发生率和危险因素的决定因素。

Gastrointestinal complications after open heart surgery: incidence and determinants of risk factors.

机构信息

1Cardiovascular Surgery Clinic, Gaziosmanpasa Hospital, Istanbul, Turkey.

出版信息

Angiology. 2014 May;65(5):425-9. doi: 10.1177/0003319713482357. Epub 2013 Apr 9.

Abstract

Acute mesenteric ischemia is a rare but serious complication of open heart surgery. Between January 2009 and January 2012, 1360 adult patients underwent open heart surgery with cardiopulmonary bypass at our institution; 29 patients presented gastrointestinal complications. Eight patients developed acute mesenteric ischemia and all of them died. Significant predictors of the complication were New York Heart Association functional class III/IV, history of extensive atherosclerosis and chronic renal failure, acute renal failure following surgery, low cardiac output, use of 2 or more vasoconstrictor drugs, prolonged mechanical ventilation, and multiorgan failure. Atherosclerosis is a multisystemic disease that affects several organs. Radiologic evaluation of mesenteric arterial system should be performed in high-risk patient populations. Perioperative percutaneous and open vascular procedures will reduce the risk of acute mesenteric ischemia that may develop after cardiac surgery and consequent morbidity and mortality rates.

摘要

急性肠系膜缺血是心脏直视手术的一种罕见但严重的并发症。2009 年 1 月至 2012 年 1 月,我院对 1360 例成人患者进行了体外循环下心内直视手术,其中 29 例出现胃肠道并发症。8 例发生急性肠系膜缺血,均死亡。该并发症的显著预测因素为纽约心脏协会心功能分级 III/IV 级、广泛动脉粥样硬化和慢性肾衰竭病史、术后急性肾衰竭、心输出量低、使用 2 种或更多血管收缩药物、长时间机械通气和多器官衰竭。动脉粥样硬化是一种多系统疾病,可影响多个器官。高危患者人群应进行肠系膜动脉系统的放射学评估。心脏手术后可能发生的急性肠系膜缺血及其随后的发病率和死亡率可通过围手术期经皮和开放血管手术来降低。

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