心脏手术后胃肠道并发症的特征、发生率和结局：一项回顾性研究。

Characteristics, incidence, and outcomes of gastrointestinal complications post cardiac surgery in a quaternary referral centre: A retrospective study.

机构信息

Intensive Care Unit, Royal Prince Alfred Hospital, Sydney, Australia.

Intensive Care Unit, Royal Adelaide Hospital, Adelaide, Australia; Discipline of Acute Care Medicine, University of Adelaide, Adelaide, Australia; Centre for Research Excellence in Nutritional Physiology, University of Adelaide, Adelaide, Australia.

出版信息

Aust Crit Care. 2024 Jul;37(4):571-576. doi: 10.1016/j.aucc.2023.10.009. Epub 2023 Dec 7.

DOI:10.1016/j.aucc.2023.10.009

PMID:38061921

Abstract

BACKGROUND

Gastrointestinal (GI) complications after cardiac surgery are associated with high morbidity and mortality. Early identification and treatment of GI complications could improve patient outcomes.

OBJECTIVES

The objective of this study was to ascertain the incidence, risk factors, and clinical outcomes of GI complications following cardiac surgery.

METHODS

A retrospective single-centre cohort study of adult patients undergoing cardiac surgery in an Australian quaternary cardiothoracic surgical referral centre was conducted from November 2012 to March 2020. Preoperative, intraoperative, and postoperative characteristics were compared between patients who did and did not develop GI complications. Data are presented as n (%). Between-group comparisons were analysed using Chi-square and Fisher's exact tests (where n < 6) for categorical variables and Wilcoxon rank-sum test for continuous variables.

RESULTS

Of the 4417 patients who underwent cardiac surgery, 95 (2.2%) patients developed a total of 100 GI complications, with the most common being paralytic ileus (n = 22/100, 22%). Baseline characteristics and preoperative factors associated with GI complications included an age of >70 years (GI complication vs no GI complication: 55.8% vs 37.6%; p = 0.000), preexisting diabetes (49.5% vs 34.5%; p = 0.002), and a creatinine level >200 mcg/ml (11.6% vs 3.7%; p = 0.000). Intra-operative factors included a cardiopulmonary bypass time >120 min (28.4% vs 15.5%; p < 0.01). Postoperatively, developing a GI complication was associated with return to theatre (36.8% vs 13.9%; p < 0.01) and new stroke, pneumonia, and acute kidney injury (all p < 0.01). Patients with a GI complication had a higher intensive care unit and hospital mortality (7.4% vs 1.1%, and 13.6% vs 1.4%, respectively), and a longer intensive care unit and hospital stay (5.5 vs 2.3 days, and 24.0 vs 10.3 days).

CONCLUSIONS

Multiple risk factors associated with GI complications in cardiac surgery patients were identified. These provide potential targets to support the early detection and management of GI complications to reduce morbidity and mortality in these patients.

摘要

背景

心脏手术后的胃肠道（GI）并发症与高发病率和死亡率相关。早期识别和治疗胃肠道并发症可改善患者预后。

目的

本研究旨在确定心脏手术后胃肠道并发症的发生率、危险因素和临床结果。

方法

对 2012 年 11 月至 2020 年 3 月在澳大利亚四级心胸外科转诊中心接受心脏手术的成年患者进行回顾性单中心队列研究。比较发生和未发生胃肠道并发症的患者的术前、术中及术后特征。数据以 n（%）表示。对于分类变量，使用卡方检验和 Fisher 确切检验（n<6）进行组间比较，对于连续变量，使用 Wilcoxon 秩和检验。

结果

在 4417 例接受心脏手术的患者中，95 例（2.2%）患者共发生 100 例胃肠道并发症，最常见的是麻痹性肠梗阻（n=22/100，22%）。与胃肠道并发症相关的基线特征和术前因素包括年龄>70 岁（胃肠道并发症组 vs 无胃肠道并发症组：55.8% vs 37.6%；p=0.000）、预先存在的糖尿病（49.5% vs 34.5%；p=0.002）和肌酐水平>200 mcg/ml（11.6% vs 3.7%；p=0.000）。术中因素包括体外循环时间>120 分钟（28.4% vs 15.5%；p<0.01）。术后，发生胃肠道并发症与再次手术（36.8% vs 13.9%；p<0.01）和新发中风、肺炎和急性肾损伤（均 p<0.01）相关。胃肠道并发症患者的 ICU 死亡率和住院死亡率更高（分别为 7.4% vs 1.1%和 13.6% vs 1.4%），且 ICU 住院时间和住院时间更长（分别为 5.5 天 vs 2.3 天和 24.0 天 vs 10.3 天）。