UCLan Medical School, University of Central Lancashire, Preston, UK.
Department of Critical Care Medicine, Barts Health NHS Trust, London, UK.
J Card Surg. 2022 Jul;37(7):2025-2039. doi: 10.1111/jocs.16516. Epub 2022 Apr 30.
This systematic review aims to identify predictors of outcomes of mesenteric ischemia in patients following cardiac surgery.
A comprehensive literature search was done on EMBASE, PubMed, Ovid MEDLINE, and SCOPUS using keywords relating to bowel ischemia and cardiac surgery. Database search results were screened by at least two authors and 32 articles were selected for inclusion in this review.
Data on 1907 patients were analyzed. The mean age was 70.0 ± 2.99 years and the prevalence of bowel ischemia was 1.74%. Advanced age was a significant risk factor. 63.16% of patients reported were men, and 58.4% of patients died in hospital. There was heterogeneity in the reported significance of the following preoperative risk factors: hypertension, smoking status, type 2 diabetes mellitus, end-stage renal disease, preoperative left ventricular ejection fraction <35%. Cardiopulmonary bypass (CPB) time, preoperative/operative intra-aortic balloon pump (IABP) support, and inotrope usage were significantly associated with the development of mesenteric ischemia; however, other intraoperative factors including the type of cardiac surgery and duration of aortic cross-clamping had varying levels of reported significance. There were discrepancies in the reported significance of leukocytosis and metabolic acidosis (pH <7.3) as postoperative markers. Postoperative vasopressor use, prolonged ventilation time, and elevation in lactate, transaminases, creatinine, and intestinal fatty acid-binding protein (IFABP) levels were found to be strongly associated with bowel ischemia.
This systematic review found the strongest associations of mesenteric ischemia postcardiac surgery to be advanced age, CPB time, rise in lactate, transaminases, creatinine, and IFABP. IABP support, vasopressor, and inotrope use as well as prolonged ventilation were strongly linked too.
本系统评价旨在确定心脏手术后肠系膜缺血患者结局的预测因素。
使用与肠缺血和心脏手术相关的关键词，在 EMBASE、PubMed、Ovid MEDLINE 和 SCOPUS 上进行全面文献检索。至少由两位作者筛选数据库搜索结果，并选择 32 篇文章纳入本综述。
分析了 1907 名患者的数据。平均年龄为 70.0±2.99 岁，肠缺血的患病率为 1.74%。高龄是一个显著的危险因素。报告的患者中 63.16%为男性，58.4%的患者在医院死亡。以下术前危险因素的报告意义存在异质性：高血压、吸烟状况、2 型糖尿病、终末期肾病、术前左心室射血分数<35%。体外循环（CPB）时间、术前/术中主动脉内球囊泵（IABP）支持以及儿茶酚胺类药物的使用与肠系膜缺血的发生显著相关；然而，包括心脏手术类型和主动脉阻断时间在内的其他术中因素报告的意义程度不一。白细胞增多和代谢性酸中毒（pH<7.3）作为术后标志物的报告意义存在差异。术后血管升压药物的使用、通气时间延长以及乳酸、转氨酶、肌酐和肠型脂肪酸结合蛋白（IFABP）水平升高与肠缺血密切相关。
本系统评价发现，心脏手术后肠系膜缺血的最强关联因素是高龄、CPB 时间、乳酸、转氨酶、肌酐和 IFABP 的升高。IABP 支持、血管升压药物和儿茶酚胺类药物的使用以及通气时间延长也与之密切相关。
