Chen Shao-Wei, Chang Chih-Hsiang, Chu Pao-Hsien, Chen Tien-Hsing, Wu Victor Chien-Chia, Huang Yao-Kuang, Liao Chien-Hung, Wang Shang-Yu, Lin Pyng-Jing, Tsai Feng-Chun
Department of Cardiothoracic and Vascular Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan; Graduate Institute of Clinical Medical Sciences, College of medicine, Chang Gung University, Taoyuan City, Taiwan.
Graduate Institute of Clinical Medical Sciences, College of medicine, Chang Gung University, Taoyuan City, Taiwan; Kidney research center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan.
J Crit Care. 2016 Feb;31(1):139-43. doi: 10.1016/j.jcrc.2015.11.002. Epub 2015 Nov 6.
The aim of this study is to investigate the incidence, severity, and outcome of postoperative acute respiratory distress syndrome (ARDS), according to the Berlin definition, in isolated valvular heart surgery. The preoperative and perioperative predisposing factors of this complication were also identified.
A retrospective chart review was conducted on 457 patients who underwent isolated valvular heart surgery between January 2010 and December 2012. Clinical characteristics and outcomes were collected. The primary outcome was postoperative ARDS, according to the 2012 Berlin definition for ARDS.
A total of 37 patients (8.1%) developed postoperative ARDS, with a mortality rate of 29.7%. The multivariate analysis identified that age (odds ratios [ORs], 1.067, P ≤ .001), liver cirrhosis (OR, 7.159; P = .001), massive blood transfusion (OR, 2.980; P = .005), and tricuspid valve replacement (OR, 5.197; P = .012) were independent risk factors of postoperative ARDS. Furthermore, we have determined that the increased severity stages of ARDS were associated with decreased postoperative survival.
In conclusion, postoperative ARDS, according to Berlin definition, in valvular surgery, was associated with high in-hospital mortality. The severity of ARDS was associated with patient midterm mortality. In multivariate analysis, age, liver cirrhosis, massive blood transfusion, and tricuspid valve replacement were identified as independent risk factors of ARDS.
本研究旨在根据柏林定义调查单纯瓣膜心脏手术术后急性呼吸窘迫综合征（ARDS）的发生率、严重程度及转归。同时确定该并发症的术前及围手术期诱发因素。
对2010年1月至2012年12月期间接受单纯瓣膜心脏手术的457例患者进行回顾性病历审查。收集临床特征及转归情况。主要结局为根据2012年柏林ARDS定义确定的术后ARDS。
共有37例患者（8.1%）发生术后ARDS，死亡率为29.7%。多因素分析确定年龄（比值比[OR]，1.067，P≤0.001）、肝硬化（OR，7.159；P = 0.001）、大量输血（OR，2.980；P = 0.005）及三尖瓣置换术（OR，5.197；P = 0.012）是术后ARDS的独立危险因素。此外，我们还确定ARDS严重程度增加与术后生存率降低相关。
总之，根据柏林定义，瓣膜手术术后ARDS与较高的院内死亡率相关。ARDS的严重程度与患者中期死亡率相关。多因素分析确定年龄、肝硬化、大量输血及三尖瓣置换术为ARDS的独立危险因素。
