微创二尖瓣手术后单侧肺水肿：单中心经验。

Unilateral pulmonary oedema after minimally invasive mitral valve surgery: a single-centre experience.

机构信息

Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany.

Institute of Medical Informatics and Statistics, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany.

出版信息

Eur J Cardiothorac Surg. 2018 Apr 1;53(4):764-770. doi: 10.1093/ejcts/ezx399.

DOI:10.1093/ejcts/ezx399

PMID:29186375

Abstract

OBJECTIVES

Unilateral pulmonary oedema (UPE) is a rare but potentially life-threatening complication that has been described after minimally invasive mitral valve surgery (MICS). Over the last 8 years, we have witnessed, in our institution, several cases of severe UPE requiring immediate postoperative extracorporeal life support after MICS. Reviewing the available literature, data regarding this complication after MICS are rare. Consequently, we decided to retrospectively analyse patients scheduled for MICS in our institution.

METHODS

After approval by our institutional review board, 256 MICS patients were analysed. As a primary end-point, we defined a newly developed UPE, radiographically evident within the first 24 h postoperatively. Secondary end-points were length of stay in the intensive care unit, length of stay in the hospital and in-hospital mortality. Chest radiographs were analysed by an independent consultant of radiology.

RESULTS

Fifty-one (19.9%) patients showed increased right-sided pulmonary vascular congestion in the 1st postoperative chest radiography performed in the intensive care unit. Five (1.95%) patients immediately required extracorporeal life support after admission to the intensive care unit. Cardiopulmonary bypass time was significantly longer in the UPE group [UPE vs non-UPE 213 (49) vs 196 (43) min; P = 0.013]. More patients with UPE showed a preoperative increase of C-reactive protein >0.4265 mg/dl (P = 0.05). Logistic regression analysis identified a preoperative increase in C-reactive protein >0.4265 mg/dl as well as a prolonged cardiopulmonary bypass time (odds ratio 1.009, 95% confidence level 1.002-1.016; P = 0.014) independent risk factors, significantly associated with the development of UPE (odds ratio 2.583, 95% confidence interval 1.275-5.233; P = 0.008), a prolonged cardiopulmonary bypass time (odds ratio 1.009, 95% confidence interval 1.002-1.016; P = 0.014). The presence of pulmonary hypertension (odds ratio 0.273, 95% confidence interval 0.08-0.84; P = 0.02) seemed to be a protective factor regarding the genesis of UPE.

CONCLUSIONS

In accordance with the rarely available literature regarding UPE after MICS, our analysis led us to hypothesize the possibility of an inflammatory disposition for UPE. The role of pulmonary hypertension remains unclear in our patient population.

CLINICAL TRIALS NUMBER

NCT02655094.

摘要

目的

单侧肺水肿（UPE）是一种罕见但潜在危及生命的并发症，在微创二尖瓣手术（MICS）后已有描述。在过去的 8 年中，我们在本机构观察到几例在 MICS 后出现严重 UPE 的病例，这些病例在手术后立即需要进行体外生命支持。查阅现有文献，关于 MICS 后发生这种并发症的数据很少。因此，我们决定回顾性分析本机构接受 MICS 的患者。

方法

在获得我们机构审查委员会的批准后，分析了 256 例 MICS 患者。我们将新出现的 UPE 定义为术后 24 小时内放射学上出现的 UPE，作为主要终点。次要终点为重症监护病房的住院时间、住院时间和院内死亡率。胸部 X 光片由放射学顾问进行独立分析。

结果

51 名（19.9%）患者在术后第一时间接受重症监护病房进行的胸部 X 光检查中显示右侧肺部血管充血增加。5 名（1.95%）患者在入住重症监护病房后立即需要体外生命支持。UPE 组的体外循环时间明显更长[UPE 组与非 UPE 组分别为 213（49）和 196（43）分钟；P=0.013]。更多 UPE 患者术前 C-反应蛋白升高>0.4265mg/dl（P=0.05）。Logistic 回归分析确定术前 C-反应蛋白升高>0.4265mg/dl以及体外循环时间延长（比值比 1.009，95%置信区间 1.002-1.016；P=0.014）是与 UPE 发展显著相关的独立危险因素（比值比 2.583，95%置信区间 1.275-5.233；P=0.008），体外循环时间延长（比值比 1.009，95%置信区间 1.002-1.016；P=0.014）。肺高血压（比值比 0.273，95%置信区间 0.08-0.84；P=0.02）的存在似乎是 UPE 发生的保护因素。