Pérez Vela J L, Jiménez Rivera J J, Alcalá Llorente M Á, González de Marcos B, Torrado H, García Laborda C, Fernández Zamora M D, González Fernández F J, Martín Benítez J C
Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España.
Servicio de Medicina Intensiva, Complejo Hospitalario Universitario de Canarias, Tenerife, España.
Med Intensiva (Engl Ed). 2018 Apr;42(3):159-167. doi: 10.1016/j.medin.2017.05.009. Epub 2017 Jul 21.
An analysis is made of the clinical profile, evolution and differences in morbidity and mortality of low cardiac output syndrome (LCOS) in the postoperative period of cardiac surgery, according to the 3 diagnostic subgroups defined by the SEMICYUC Consensus 2012.
A multicenter, prospective cohort study was carried out.
ICUs of Spanish hospitals with cardiac surgery.
A consecutive sample of 2,070 cardiac surgery patients was included, with the analysis of 137 patients with LCOS.
No intervention was carried out.
The mean patient age was 68.3±9.3 years (65.2% males), with a EuroSCORE II of 9.99±13. NYHA functional class III-IV (52.9%), left ventricular ejection fraction<35% (33.6%), AMI (31.9%), severe PHT (21.7%), critical preoperative condition (18.8%), prior cardiac surgery (18.1%), PTCA/stent placement (16.7%). According to subgroups, 46 patients fulfilled hemodynamic criteria of LCOS (group A), 50 clinical criteria (group B), and the rest (n=41) presented cardiogenic shock (group C). Significant differences were observed over the evolutive course between the subgroups in terms of time subjected to mechanical ventilation (114.4, 135.4 and 180.3min in groups A, B and C, respectively; P<.001), renal replacement requirements (11.4, 14.6 and 36.6%; P=.007), multiorgan failure (16.7, 13 and 47.5%), and mortality (13.6, 12.5 and 35.9%; P=.01). The mean maximum lactate concentration was higher in cardiogenic shock patients (P=.002).
The clinical evolution of these patients leads to high morbidity and mortality. We found differences between the subgroups in terms of the postoperative clinical course and mortality.
根据2012年SEMICYUC共识定义的3个诊断亚组，分析心脏手术后低心排血量综合征（LCOS）的临床特征、病情演变以及发病率和死亡率的差异。
开展一项多中心前瞻性队列研究。
西班牙开展心脏手术医院的重症监护病房。
纳入2070例心脏手术患者的连续样本，对137例LCOS患者进行分析。
未实施干预。
患者平均年龄为68.3±9.3岁（男性占65.2%），欧洲心脏手术风险评估系统（EuroSCORE）II评分为9.99±13。纽约心脏协会（NYHA）心功能分级III-IV级（52.9%），左心室射血分数<35%（33.6%），急性心肌梗死（AMI，31.9%），重度肺动脉高压（PHT，21.7%），术前病情危急（18.8%），既往心脏手术史（18.1%），经皮冠状动脉腔内血管成形术（PTCA）/支架置入术（16.7%）。根据亚组划分，46例患者符合LCOS的血流动力学标准（A组），50例符合临床标准（B组），其余41例出现心源性休克（C组）。各亚组在机械通气时间（A、B、C组分别为114.4、135.4和180.3分钟；P<0.001）、肾脏替代治疗需求（11.4%、14.6%和36.6%；P=0.007）、多器官功能衰竭（16.7%、13%和47.5%）以及死亡率（13.6%、12.5%和35.9%；P=0.01）方面的病情演变存在显著差异。心源性休克患者的平均最大乳酸浓度更高（P=0.002）。
这些患者的临床病情演变导致高发病率和高死亡率。我们发现各亚组在术后临床病程和死亡率方面存在差异。
