Sato Hiroshi, Nakamura Masanori, Uzuka Takeshi, Kondo Mayo
Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, S1W16, Chuo-ku, Sapporo, 060-8543, Japan.
Department of Cardiovascular Surgery, Sapporo City General Hospital, N11W13, Chuo-ku, Sapporo, 060-8604, Japan.
J Cardiothorac Surg. 2018 Nov 16;13(1):115. doi: 10.1186/s13019-018-0807-5.
Nonocclusive mesenteric ischemia (NOMI) is a rare but life-threatening complication after cardiovascular surgery. Early diagnosis and treatment is essential for a chance to cure. The aim of this study is to identify the independent risk factors for NOMI based on the evaluation of 12 cases of NOMI after cardiovascular surgery.
We retrospectively analyzed 12 patients with NOMI and 674 other patients without NOMI who underwent cardiovascular surgery in our hospital. We reviewed the clinical data on NOMI patients, including their characteristics and the clinical course. In addition, we performed a statistical comparison of each factor from both NOMI and non-NOMI groups to identify the independent risk factors for NOMI.
The median duration between the cardiac surgery and the diagnosis of NOMI was 14.0 (10.3-20.3) days. The in-hospital mortality of NOMI patients was 75.0%. Age (p < 0.05), peripheral arterial disease (p < 0.001), postoperative hemodialysis (p < 0.001), intraaortic balloon pump (p < 0.05), norepinephrine (NOE) > 0.10γ (p < 0.0001), percutaneous cardiopulmonary support (p < 0.001), sepsis (p < 0.05), loss of sinus rhythm (p < 0.05), prolonged ventilation (p < 0.0001), and resternotomy for bleeding (p < 0.05) showed significant differences between NOMI and non-NOMI groups. In the multivariate logistic regression model, prolonged ventilation [odds ratio (OR) = 18.1, p < 0.001] and NOE > 0.10 μg/kg/min (OR = 130.0, p < 0.0001) were detected as independent risk factors for NOMI.
We have identified the risk factors for NOMI based on the evaluation of the 12 cases of NOMI after cardiovascular surgery. This result may be useful in predicting NOMI, which is considered difficult in clinical practice. For the patient with suspected of NOMI who has these risk factors, early CT scan and surgical exploration should be performed without delay.
非闭塞性肠系膜缺血（NOMI）是心血管手术后一种罕见但危及生命的并发症。早期诊断和治疗对于治愈的机会至关重要。本研究的目的是基于对12例心血管手术后NOMI病例的评估，确定NOMI的独立危险因素。
我们回顾性分析了我院12例NOMI患者和674例其他未发生NOMI的心血管手术患者。我们回顾了NOMI患者的临床资料，包括其特征和临床病程。此外，我们对NOMI组和非NOMI组的每个因素进行了统计学比较，以确定NOMI的独立危险因素。
心脏手术至NOMI诊断的中位时间为14.0（10.3 - 20.3）天。NOMI患者的院内死亡率为75.0%。年龄（p < 0.05）、外周动脉疾病（p < 0.001）、术后血液透析（p < 0.001）、主动脉内球囊泵（p < 0.05）、去甲肾上腺素（NOE）> 0.10γ（p < 0.0001）、经皮心肺支持（p < 0.001）、脓毒症（p < 0.05）、窦性心律丧失（p < 0.05）、通气时间延长（p < 0.0001）以及因出血行再次胸骨切开术（p < 0.05）在NOMI组和非NOMI组之间存在显著差异。在多因素逻辑回归模型中，通气时间延长[比值比（OR）= 18.1，p < 0.001]和NOE > 0.10μg/kg/min（OR = 130.0，p < 0.0001）被检测为NOMI的独立危险因素。
我们基于对12例心血管手术后NOMI病例的评估确定了NOMI的危险因素。这一结果可能有助于预测NOMI，而NOMI在临床实践中被认为难以预测。对于有这些危险因素的疑似NOMI患者，应立即进行早期CT扫描和手术探查。
