Department of Intensive Care, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
Department of Clinical Pharmacy and Pharmacology, Medical Center Leeuwarden, Leeuwarden, The Netherlands.
BMJ Open. 2023 Feb 24;13(2):e068598. doi: 10.1136/bmjopen-2022-068598.
Impaired right ventricular (RV) function after cardiac surgery is associated with morbidity and long-term mortality. The purpose of this study was to identify factors that play a role in the development of RV dysfunction in the perioperative cardiac surgery setting.
We performed a prospective, observational, single centre study. Over a 2-year period, baseline and perioperative characteristics were recorded. For analysis, subjects were divided into three groups: patients with a ≥3% absolute increase in postoperative RV ejection fraction (RVEF) in comparison to baseline (RVEF+), patients with a ≥3% absolute decrease in RVEF (RVEF-) and patients with a <3% absolute change in RVEF (RVEF=).
Tertiary care hospital in the Netherlands.
We included all cardiac surgery patients ≥18 years of age equipped with a pulmonary artery catheter and admitted to the ICU in 2015-2016. There were no exclusion criteria. A total number of 267 patients were included (65.5% men).
Risk factors for a perioperative decline in RV function.
A reduction in RVEF was observed in 40% of patients. In multivariate analysis, patients with RVEF- were compared with patients with RVEF= (first-mentioned OR) and RVEF+ (second-mentioned OR). Preoperative use of calcium channel blocker (CCB) (OR 3.06, 95% CI 1.24 to 7.54/OR 2.73, 95% CI 1.21 to 6.16 (both p=0.015)), intraoperative fluid balance (FB) (OR 1.45, 95% CI 1.02 to 2.06 (p=0.039)/OR 1.09, 95% CI 0.80 to 1.49 (p=0.575)) and baseline RVEF (OR 1.22; 95% CI 1.14 to 1.30/OR 1.27, 95% CI 1.19 to 1.35 (both p<0.001)) were identified as independent risk factors for a decline in RVEF during surgery.
Apart from the impact of the perioperative FB, preoperative use of a CCB as a risk factor for perioperative reduction in RVEF is the most prominent new finding of this study.
心脏手术后右心室（RV）功能受损与发病率和长期死亡率有关。本研究的目的是确定围手术期心脏手术中导致 RV 功能障碍的因素。
我们进行了一项前瞻性、观察性、单中心研究。在 2 年期间，记录了基线和围手术期特征。为了进行分析，将受试者分为三组：与基线相比，术后 RV 射血分数（RVEF）绝对增加≥3%的患者（RVEF+）、RVEF 绝对降低≥3%的患者（RVEF-）和 RVEF 绝对变化<3%的患者（RVEF=）。
荷兰的一家三级护理医院。
我们纳入了所有年龄≥18 岁、配备肺动脉导管并于 2015-2016 年入住 ICU 的心脏手术患者。无排除标准。共纳入 267 例患者（65.5%为男性）。
围手术期 RV 功能下降的危险因素。
40%的患者出现 RVEF 降低。多变量分析中，将 RVEF-患者与 RVEF=（首先提到的 OR）和 RVEF+（其次提到的 OR）患者进行比较。术前使用钙通道阻滞剂（CCB）（OR 3.06，95%CI 1.24 至 7.54/OR 2.73，95%CI 1.21 至 6.16（均 p=0.015））、术中液体平衡（FB）（OR 1.45，95%CI 1.02 至 2.06（p=0.039）/OR 1.09，95%CI 0.80 至 1.49（p=0.575））和基线 RVEF（OR 1.22；95%CI 1.14 至 1.30/OR 1.27，95%CI 1.19 至 1.35（均 p<0.001））被确定为术中 RVEF 下降的独立危险因素。
除了围手术期 FB 的影响外，术前使用 CCB 作为围手术期 RVEF 降低的危险因素是本研究的最显著新发现。
