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心脏手术后呼吸困难的原因。

Causes of Dyspnea after Cardiac Surgery.

作者信息

Bolukçu Ahmet, İlhan Sami, Topçu Ahmet Can, Günay Rafet, Kayacıoğlu İlyas

机构信息

Clinic of Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey.

Clinic of Pulmonology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey.

出版信息

Turk Thorac J. 2018 Sep 13;19(4):165-169. doi: 10.5152/TurkThoracJ.2018.17084. Print 2018 Oct.

Abstract

OBJECTIVES

Postoperative dyspnea is common after cardiac surgery, even in low-risk patients. Cardiac surgeons and anesthesiologists are familiar with patients suffering from dyspnea in the early postoperative period, but in some cases, conventional treatment strategies may be ineffective, and a consultation with a pulmonologist may be required. The aim of this study is to investigate the causes of dyspnea after cardiac surgery in this particular patient group.

MATERIALS AND METHODS

The hospital database was searched for non-emergency cardiac surgery for the period January 2014-October 2015. Individuals with an impaired spirometry result and a history of any pulmonic disease were excluded. Only patients for whom a pulmonary consultation was needed because of dyspnea in the postoperative course were enrolled in the study. Causes of dyspnea were analyzed according to consultation reports and computed tomography findings.

RESULTS

One hundred and three patients were enrolled in the study. Of those, 67 (65%) were male, and the mean age was 61.50±9.43. The most common procedure was the coronary artery bypass grafting. Atelectasis (n=57, 42%) was the most common cause of dyspnea. The length of the intensive care unit (ICU) stay was significantly longer in the pneumonia group (p=0.012). Hospital mortality in the pneumonia group was significantly higher compared with other subgroups (p<0.001).

CONCLUSION

After cardiac surgery, atelectasis was the most common cause of dyspnea, followed by pleural effusion and pneumonia. Patients who experienced dyspnea due to pneumonia had a longer ICU stay. Developing the treatment strategies with consideration of these causes may help reduce the length of stay, morbidity, and mortality in this patient group.

摘要

目的

心脏手术后术后呼吸困难很常见,即使在低风险患者中也是如此。心脏外科医生和麻醉医生熟悉术后早期出现呼吸困难的患者,但在某些情况下,传统治疗策略可能无效,可能需要咨询肺科医生。本研究的目的是调查这一特定患者群体心脏手术后呼吸困难的原因。

材料与方法

检索医院数据库中2014年1月至2015年10月期间的非急诊心脏手术病例。排除肺功能测定结果受损及有任何肺部疾病史的个体。仅纳入因术后过程中出现呼吸困难而需要进行肺部会诊的患者。根据会诊报告和计算机断层扫描结果分析呼吸困难的原因。

结果

103例患者纳入本研究。其中,67例(65%)为男性,平均年龄为61.50±9.43岁。最常见的手术是冠状动脉旁路移植术。肺不张(n = 57,42%)是呼吸困难最常见的原因。肺炎组重症监护病房(ICU)住院时间显著更长(p = 0.012)。与其他亚组相比,肺炎组的医院死亡率显著更高(p < 0.001)。

结论

心脏手术后,肺不张是呼吸困难最常见的原因,其次是胸腔积液和肺炎。因肺炎出现呼吸困难的患者ICU住院时间更长。考虑这些原因制定治疗策略可能有助于缩短该患者群体的住院时间、降低发病率和死亡率。

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