心脏手术后重症监护病房胸部再次探查止血的结果：一项回顾性分析。

Outcome of chest re-exploration for haemostasis in intensive care unit post-cardiac surgery: A retrospective analysis.

作者信息

Mahazir N Q A, Md Taib M E, Yunus A M

机构信息

National Heart Institute, Department of Cardiothoracic Surgery, Kuala Lumpur, Malaysia.

出版信息

Med J Malaysia. 2022 Mar;77(2):150-155.

PMID:35338620

Abstract

INTRODUCTION

Chest re-exploration is potentially life-saving in the treatment of early post-operative complications of open-heart surgery such as for surgical haemostasis, hemodynamic instability, and cardiac arrest. The procedure is often performed in the intensive care unit (ICU) rather than in the operating theatre (OT). The incidence of chest reexploration may range from 2 to 12%. To analyse the complications of patients who underwent chest reexploration in the ICU for haemostasis after heart surgery vs in those who were operated in an OT. Secondary outcome measured is all-cause mortality in the patients involved.

MATERIALS AND METHODS

This is a retrospective analysis of patients' medical records who underwent chest reexploration in the ICU for haemostasis over a 2-year period (2019 to 2020). The cases which needed re-exploration for haemostasis were divided into two groups: cases conducted in those ICU and those conducted in the OT. Complications post-chest re-exploration were measured and categorized into renal failure needing dialysis, pulmonary complication, gastrointestinal complication, heart failure, pericardial effusion, fever, and surgical site infection.

RESULTS

4406 cases of open-heart surgeries were analysed. 351 of the patients underwent chest re-exploration, and majority of the cases were re-explored for haemostasis (88.9%). 64.2% of the chest re-exploration were conducted in the ICU. 21.9% patients who underwent post-chest reexploration in the ICU died, while 13.1% of the patients died post- chest re-exploration in the OT. From the total number of cases of chest re-exploration, 75.9% of patients who had chest re-exploration in the ICU developed complication, whereas patients who developed complication post-chest re-exploration in the OT were 35.1% (p-value < 0.001).

CONCLUSION

Chest re-exploration in the ICU for post-cardiacsurgery patients showed a higher percentage of complications, which contributes to mortality.

摘要

引言

心脏直视手术后早期术后并发症的治疗中，如外科止血、血流动力学不稳定和心脏骤停，再次开胸探查可能挽救生命。该手术通常在重症监护病房（ICU）而非手术室（OT）进行。再次开胸探查的发生率可能在2%至12%之间。分析在ICU进行心脏手术后止血再次开胸探查的患者与在手术室进行手术的患者的并发症情况。次要观察指标是所涉及患者的全因死亡率。

材料与方法

这是一项对在2年期间（2019年至2020年）在ICU进行止血再次开胸探查的患者病历的回顾性分析。因止血需要再次探查的病例分为两组：在ICU进行的病例和在手术室进行的病例。测量再次开胸探查后的并发症，并分为需要透析的肾衰竭、肺部并发症、胃肠道并发症、心力衰竭、心包积液、发热和手术部位感染。

结果

分析了4406例心脏直视手术病例。351例患者接受了再次开胸探查，大多数病例是为了止血而进行再次探查（88.9%）。64.2%的再次开胸探查在ICU进行。在ICU进行再次开胸探查后21.9%的患者死亡，而在手术室进行再次开胸探查后13.1%的患者死亡。在所有再次开胸探查病例中，75.9%在ICU进行再次开胸探查的患者出现并发症，而在手术室进行再次开胸探查后出现并发症的患者为35.1%（p值<0.001）。