Moh'd Ashraf Fadel, Al-Odwan Hayel Talal, Altarabsheh Salah, Makahleh Zeid Mohammad, Khasawneh Mohammad Abdallah
Queen Alia Heart Institute/Jordanian Royal Medical Services, Amman, Jordan.
Cardiac Surgery Department, Queen Alia Heart Institute/Jordanian Royal Medical Services, Amman, Jordan.
Egypt Heart J. 2021 Oct 22;73(1):92. doi: 10.1186/s43044-021-00195-0.
Aortic cross-clamp utilized during cardiac surgery facilitates motionless and bloodless surgical field. However, the duration of clamp time has an inverse effect on early post-operative recovery period. In this study, we sought to examine the predictors of aortic clamp duration and intensive care unit length of stay.
Six hundred and nine adult patients presented for elective cardiac surgery between December 2019 and December 2020 were enrolled. The age of patients ranged from 18 to 82 years (mean 55.62 years, SD ± 12.3 years). Male/female ratio is 4.6:1. Most patients (87.2%) were planned for coronary artery bypass grafting (CABG) and 78 patients (12.8%) for single heart valve procedure. Operative time (OT) ranged from 120 to 402 min and averaged 259.4 min (SD ± 45.9 min). ACC time ranged from 15 to 159 min and averaged 50.56 min (SD ± 19.4 min). Factors associated with significantly longer ACCT were: smoking (OR = 1.89 (95% CI 1.3-2.74), p value = 0.01), respiratory disease (OR = 0.48 (95% CI 0.24-0.96), p value = 0.039), obesity (OR = 1.76 (95% CI 1.18-2.63), p value = 0.005) and AVR (OR = 2.11 (95% CI 1.17-3.83), p value = 0.013). Low cardiac output syndrome (LCOS) was observed in 19.2% of patients. Longer than average ACCT was associated with increased use of inotropes (p value < 0.001), intra-aortic balloon pump (p value < 0.001) and first 24 h post-operative blood loss (p value < 0.001). The average intensive care unit length of stay (ICULOS) was 1.64 days (SD ± 1.1 days). Patients' ACCT converged positively and significantly on ICULOS (Beta coefficient = 1.013 (95% CI 1.01-1.015), p value < 0.001).
Aortic cross-clamping is a crucial method in cardiac surgery to achieve motionless field; however, prolongation of this method had an incremental risks for the development of low cardiac output syndrome, increased first 24 h post-operative blood loss and longer stay in the intensive care unit.
心脏手术中使用主动脉夹闭可创造静止且无血的手术视野。然而，夹闭时间长短对术后早期恢复时间有相反影响。在本研究中，我们试图探究主动脉夹闭时间及重症监护病房住院时长的预测因素。
纳入了2019年12月至2020年12月期间接受择期心脏手术的609例成年患者。患者年龄在18至82岁之间（平均55.62岁，标准差±12.3岁）。男女比例为4.6:1。大多数患者（87.2%）计划进行冠状动脉旁路移植术（CABG），78例患者（12.8%）进行单心瓣膜手术。手术时间（OT）在120至402分钟之间，平均为259.4分钟（标准差±45.9分钟）。主动脉夹闭时间（ACC时间）在15至159分钟之间，平均为50.56分钟（标准差±19.4分钟）。与显著更长的主动脉夹闭时间相关的因素有：吸烟（比值比=1.89（95%置信区间1.3 - 2.74），p值=0.01）、呼吸系统疾病（比值比=0.48（95%置信区间0.24 - 0.96），p值=0.039）、肥胖（比值比=1.76（95%置信区间1.18 - 2.63），p值=0.005）和主动脉瓣置换术（比值比=2.11（95%置信区间1.17 - 3.83），p值=0.013）。19.2%的患者出现低心排血量综合征（LCOS）。主动脉夹闭时间长于平均水平与增加使用血管活性药物（p值<0.001）、主动脉内球囊反搏（p值<0.001）以及术后24小时内出血量增加（p值<0.001）相关。重症监护病房平均住院时长（ICULOS）为1.64天（标准差±1.1天）。患者的主动脉夹闭时间与重症监护病房住院时长呈显著正相关（β系数=1.013（95%置信区间1.01 - 1.015），p值<0.001）。
主动脉夹闭是心脏手术中实现静止视野的关键方法；然而，延长此方法会增加发生低心排血量综合征、术后24小时内出血量增加以及在重症监护病房停留时间延长的风险。
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