Department of General, Visceral and Vascular Surgery, University Hospital, Friedrich-Schiller-University Jena, Erlanger Allee 101, D-07740 Jena, Germany.
Department of Anesthesiology and Intensive Care, University Hospital, Friedrich-Schiller-University Jena, Erlanger Allee 101, D-07740 Jena, Germany.
Int J Surg. 2016 Feb;26:79-85. doi: 10.1016/j.ijsu.2015.12.066. Epub 2016 Jan 12.
Acute mesenteric ischemia is a rare but often fatal complication following cardiovascular surgery. Early suspicion may reduce overall mortality. This retrospective study aims to identify predictors and risk factors that may determine the onset and evolution of acute mesenteric ischemia.
In a retrospective case-control study, we compared co-morbidities and peri-operative risk factors of patients with or without mesenteric ischemia following cardiac surgery using univariate and logistic regression analyses.
Of 9385 patients, 108 (1.15%) were diagnosed with acute mesenteric ischemia within two weeks after cardiac surgery. In-hospital mortality was 68% for this group. Patients with ischemia and controls were matched in regard to patient's age and type of surgical intervention and showed similar pre-operative parameters. Only liver cirrhosis (OR 13.3, CI95% 3.6-49.3), and emergency operation (OR 2.6, CI95% 1.3-5.2) remained independent pre-operative predictors for acute mesenteric ischemia in multivariate analysis. In contrast, early postoperative parameters revealed a higher correlation with the occurrence of mesenteric ischemia including the use of norepinephrine (OR 3.5 CI95% 1.6-7.8), epinephrine (OR 2.0, CI95% 1.1-3.7), and serum lactate levels >3 mmol/L (OR 2.9, CI95% 1.5-5.6). A set of key markers of regression analysis was evaluated in a ROC curve analysis. The area under curve was 0.835, which indicates moderate to good prognostic accuracy.
Early identification of pre- and post-operative predictors including liver cirrhosis, emergency operation, serum lactate >3 mmol/L, and the use of norepinephrine and epinephrine may help facilitate early diagnosis of acute mesenteric ischemia following cardiac surgery, and thus may allow immediate adequate treatment, leading to a reduction in mortality rates.
急性肠系膜缺血是心血管手术后罕见但常致命的并发症。早期怀疑可能降低整体死亡率。本回顾性研究旨在确定可能决定急性肠系膜缺血发病和演变的预测因子和危险因素。
在回顾性病例对照研究中，我们使用单变量和逻辑回归分析比较了心脏手术后发生或未发生肠系膜缺血患者的合并症和围手术期危险因素。
在 9385 例患者中，有 108 例（1.15%）在心脏手术后两周内被诊断为急性肠系膜缺血。该组的院内死亡率为 68%。缺血患者和对照组在患者年龄和手术干预类型方面相匹配，且术前参数相似。只有肝硬化（OR 13.3，95%CI95% 3.6-49.3）和急诊手术（OR 2.6，95%CI95% 1.3-5.2）在多变量分析中仍然是急性肠系膜缺血的独立术前预测因子。相比之下，早期术后参数与肠系膜缺血的发生相关性更高，包括去甲肾上腺素（OR 3.5，95%CI95% 1.6-7.8）、肾上腺素（OR 2.0，95%CI95% 1.1-3.7）和血清乳酸水平>3mmol/L（OR 2.9，95%CI95% 1.5-5.6）。在 ROC 曲线分析中评估了一组回归分析的关键标志物。曲线下面积为 0.835，表明具有中等至良好的预后准确性。
早期识别包括肝硬化、急诊手术、血清乳酸>3mmol/L 以及去甲肾上腺素和肾上腺素的使用等术前和术后预测因子，可能有助于早期诊断心脏手术后的急性肠系膜缺血，从而可以立即进行充分的治疗，降低死亡率。
