Heringlake Matthias, Schön Julika, Pliet Teresa, Haake Nils, Reinecke Alexander, Habicher Marit, Sander Michael, Markewitz Andreas, Reuter Daniel A, Groesdonk Heinrich Volker, Trummer Georg, Pilarzyk Kevin, von der Brelie Michael, Bein Berthold, Schirmer Uwe
Department of Anesthesiology and Intensive Care, University of Lübeck, Lübeck, Germany.
Department of Cardiovascular Surgery, Christian-Albrechts University, Kiel, Germany.
Thorac Cardiovasc Surg. 2017 Dec;65(8):593-600. doi: 10.1055/s-0036-1572511. Epub 2016 Feb 24.
Sparse data are available on the prevalence of right ventricular dysfunction and/or pulmonary arterial hypertension in patients scheduled for cardiac surgery in Germany as well as on the intensity and modalities used for diagnosis, perioperative monitoring, and treatment of these comorbidities. A postal survey including questions on the prevalence of preoperative right ventricular dysfunction and/or pulmonary arterial hypertension in patients undergoing cardiac surgery in 2009 was sent to 81 German heart centers. Total 47 of 81 (58%) heart centers returned the questionnaires. The centers reported data on 51,095 patients, and 49.8% of the procedures were isolated coronary artery bypass grafting. Data on the prevalence of preoperative pulmonary hypertension and/or right ventricular dysfunction were not available in 54% and 64.6% of centers. In the remaining hospitals, 19.5% of patients presented right heart dysfunction and 10% pulmonary arterial hypertension. Preoperative echocardiography was performed in only 45.3% of the coronary artery bypass grafting cases. Preoperative pharmacologic treatment of pulmonary hypertension or right ventricular dysfunction with oral sildenafil, inhaled prostanoids, or nitric oxide was initiated in 71% and 95.7% of the centers, respectively. Intra- and postoperative treatment was most frequently accomplished with phosphodiesterase-III inhibitors. The prevalence of preoperative right heart dysfunction and pulmonary arterial hypertension in cardiac surgical patients in Germany seems to be substantial. However, in more than 50% of the patients, no preoperative data on right ventricular function and pulmonary arterial pressure are available. This may lead to underestimation of perioperative risk and inappropriate management of this high-risk population.
关于德国心脏手术患者右心室功能障碍和/或肺动脉高压的患病率，以及用于这些合并症诊断、围手术期监测和治疗的强度和方式，现有数据稀少。一项邮政调查被发送至81家德国心脏中心，调查问题包括2009年接受心脏手术患者术前右心室功能障碍和/或肺动脉高压的患病率。81家中心中有47家（58%）回复了问卷。这些中心报告了51,095例患者的数据，其中49.8%的手术为单纯冠状动脉搭桥术。54%和64.6%的中心没有提供术前肺动脉高压和/或右心室功能障碍患病率的数据。在其余医院中，19.5%的患者存在右心功能障碍，10%存在肺动脉高压。仅45.3%的冠状动脉搭桥术病例进行了术前超声心动图检查。分别有71%和95.7%的中心对肺动脉高压或右心室功能障碍进行了术前药物治疗，药物包括口服西地那非、吸入性前列腺素或一氧化氮。术中和术后治疗最常用的药物是磷酸二酯酶-III抑制剂。德国心脏手术患者术前右心功能障碍和肺动脉高压的患病率似乎相当高。然而，超过50%的患者没有术前右心室功能和肺动脉压的数据。这可能导致对围手术期风险的低估以及对这一高危人群的管理不当。
