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心血管手术相关弥散性血管内凝血的发生率、结局及危险因素:一项单中心回顾性研究

Incidence, Outcome, and Risk Factors of Cardiovascular Surgery-Associated Disseminated Intravascular Coagulation: A Single-Center Retrospective Study.

作者信息

Yasuda Norihisa, Goto Koji, Kuribayashi Yoshihide, Ohchi Yoshifumi, Kitano Takaaki

机构信息

Department of Anesthesiology and Intensive Care, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasamamachi, Yufu City 879-5593, Japan.

Department of Anesthesiology, Oita Urological Hospital, 2-1-32 Nagahamamachi, Oita City 870-0023, Japan.

出版信息

J Clin Med. 2022 Jun 23;11(13):3633. doi: 10.3390/jcm11133633.

Abstract

Cardiovascular surgery is highly invasive, with a risk of postoperative coagulopathy due to various factors such as bleeding. Coagulopathy can progress to disseminated intravascular coagulation (DIC), which complicates various clinical conditions. However, no study to date has reported on DIC associated with cardiovascular surgery. Therefore, we investigated retrospectively the incidence, outcome, and risk factors of cardiovascular surgery-associated DIC in our institute. All patients who underwent cardiovascular surgery and were admitted to our intensive care unit between January 2016 and December 2017 were included in this study. The Japanese Association for Acute Medicine (JAAM) DIC score was calculated using our institute's database at the following time points: preoperatively, postoperative day 1 (POD1), POD3, and POD7. Data regarding surgery, 90-day mortality, and risk factors of DIC were also collected and analyzed by multiple regression. In total, 553 patients were considered eligible for analysis. Median age of eligible patients was 72 years, with a 90-day mortality rate of 1.4%. Patients with DIC at POD7 had higher Sequential Organ Failure Assessment (SOFA) score, preoperative JAAM DIC scores, and a longer anesthesia time than those without DIC. Female sex, preoperative DIC score, and anesthesia time were found to be risk factors for DIC.

摘要

心血管手术具有高度侵入性,因出血等多种因素存在术后凝血病风险。凝血病可进展为弥散性血管内凝血(DIC),这会使各种临床情况变得复杂。然而,迄今为止尚无关于与心血管手术相关的DIC的研究报道。因此,我们对我院心血管手术相关DIC的发生率、转归及危险因素进行了回顾性调查。本研究纳入了2016年1月至2017年12月期间在我院重症监护病房接受心血管手术的所有患者。使用我院数据库在以下时间点计算日本急性医学协会(JAAM)DIC评分:术前、术后第1天(POD1)、POD3和POD7。还收集了有关手术、90天死亡率及DIC危险因素的数据,并通过多元回归进行分析。总计553例患者被认为符合分析条件。符合条件患者的中位年龄为72岁,90天死亡率为1.4%。与无DIC的患者相比,POD7时发生DIC的患者序贯器官衰竭评估(SOFA)评分、术前JAAM DIC评分更高,麻醉时间更长。女性、术前DIC评分及麻醉时间被发现是DIC的危险因素。

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