Libin Cardiovascular Institute of Alberta, Division of Cardiac Surgery, Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada.
Statistical Support Unit, Centre for Advancement of Health, University of Calgary, Calgary, Alberta, Canada.
J Thorac Cardiovasc Surg. 2017 Jul;154(1):181-188. doi: 10.1016/j.jtcvs.2017.02.012. Epub 2017 Feb 14.
To determine the incidence of gastrointestinal (GI) bleeding in patients after cardiac surgery, assess the perioperative risk factors, and determine the type of GI tract pathology associated with bleeding events.
At a tertiary referral hospital, all cardiac surgery patients having a postoperative GI bleed from April 2002 to March 2012 were identified. To determine bleeding etiology, only patients requiring endoscopy were included in the analysis. By retrospective review of 3 prospectively maintained databases, the incidence and independent predictors of GI bleeding, as well as endoscopic findings, were determined.
Ninety-one GI bleeding events that required endoscopy were identified in 9017 patients. Those that bled were aged 71 ± 12 years, and 76% were men. Sixty-three percent of these patients had valve surgery and 37% had an isolated coronary artery bypass grafting. The overall incidence of GI bleeding was 1.01%, with an upper GI source accounting for 78%. Endoscopy data found a duodenal ulcer as the bleeding source in 71%, whereas stress gastritis accounted for 8%. Preoperative risk factors for bleeding included age ≥70 years, ejection fraction <35%, congestive heart failure, cerebrovascular disease, chronic kidney disease, and gastrointestinal disease. A preoperative history of atrial fibrillation and anticoagulation with Coumadin also was associated with bleeding. Patients that bled had a 30-day mortality rate of 8.8%, which was significantly greater than patients who did not bleed (4.3%; P = .03).
Clinical variables can be used to identify patients at high risk for GI bleeding after cardiac surgery. When GI bleeding occurs, the most common cause is duodenal ulceration, which has an association with Helicobacter pylori infection. These findings may provide an opportunity to initiate preoperative preventative strategies.
确定心脏手术后患者胃肠道（GI）出血的发生率，评估围手术期危险因素，并确定与出血事件相关的胃肠道病理类型。
在一家三级转诊医院，确定了 2002 年 4 月至 2012 年 3 月期间所有术后出现胃肠道出血的心脏手术患者。为了确定出血病因，仅将需要内镜检查的患者纳入分析。通过对 3 个前瞻性维护数据库的回顾性审查，确定了 GI 出血的发生率和独立预测因素，以及内镜检查结果。
在 9017 例患者中，确定了 91 例需要内镜检查的胃肠道出血事件。出血患者的年龄为 71±12 岁，其中 76%为男性。这些患者中有 63%接受了瓣膜手术，37%接受了单纯冠状动脉旁路移植术。GI 出血的总体发生率为 1.01%，上胃肠道出血占 78%。内镜检查数据发现，71%的出血源为十二指肠溃疡，而应激性胃炎占 8%。出血的术前危险因素包括年龄≥70 岁、射血分数<35%、充血性心力衰竭、脑血管疾病、慢性肾脏病和胃肠道疾病。房颤病史和华法林抗凝治疗也与出血相关。出血患者的 30 天死亡率为 8.8%，明显高于未出血患者（4.3%；P=0.03）。
临床变量可用于识别心脏手术后发生胃肠道出血的高危患者。当发生胃肠道出血时，最常见的原因是十二指肠溃疡，其与幽门螺杆菌感染有关。这些发现可能为术前预防策略提供机会。
