Department of Anesthesiology and Reanimation, Intensive Care, Health Sciences University Kanuni Sultan Süleyman Training and Research Hospital, İstanbul-Türkiye.
Department of Anesthesiology and Reanimation, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research İstanbul-Türkiye.
Ulus Travma Acil Cerrahi Derg. 2024 May;30(5):328-336. doi: 10.14744/tjtes.2024.00569.
This study aims to identify the factors influencing 30-day morbidity and mortality in patients aged 65 and older undergoing cardiovascular surgery.
Data from 360 patients who underwent cardiac surgery between January 2012 and August 2021 in the Cardiovascular Surgery Intensive Care Unit (CVS ICU) were analyzed. Patients were categorized into two groups: "mortality+" (33 patients) and "mortality-" (327 patients). Factors influencing mortality, including preoperative, intraoperative, and postoperative risk factors, complications, and outcomes, were assessed.
Significant differences were observed between the two groups in factors affecting mortality, including extubation time, ICU stay duration, blood transfusion, surgical reexploration, aortic clamp duration, glomerular filtration rate (GFR), blood urea nitrogen (BUN), creatinine, hemoglobin A1c (HbA1c) levels, and the lowest systolic blood pressure during the first 24 hours in the ICU (p<0.05). The "mortality+" group had longer extubation times and ICU stays, required more blood transfusions, and had higher BUN-creatinine ratios, but lower systolic blood pressures, GFR, and HbA1c levels. Mortality was also higher in patients needing noradrenaline infusions and those who underwent reoperation for bleeding (p<0.05).
By optimizing preoperative renal function, minimizing extubation time, shortening ICU stays, and carefully managing blood transfusions, surgical reexplorations, aortic clamp duration, and HbA1c levels, we believe that the mortality rate can be reduced in elderly patients. Key strategies include shortening aortic clamp times, reducing perioperative blood transfusions, and ensuring effective bleeding control.
本研究旨在确定影响 65 岁及以上心血管手术患者 30 天发病率和死亡率的因素。
分析了 2012 年 1 月至 2021 年 8 月在心血管外科重症监护病房（CVS ICU）接受心脏手术的 360 名患者的数据。患者分为两组：“死亡率+”（33 名患者）和“死亡率-”（327 名患者）。评估影响死亡率的因素，包括术前、术中、术后危险因素、并发症和结局。
两组间影响死亡率的因素存在显著差异，包括拔管时间、ICU 停留时间、输血、手术再次探查、主动脉夹闭时间、肾小球滤过率（GFR）、血尿素氮（BUN）、肌酐、血红蛋白 A1c（HbA1c）水平以及 ICU 内前 24 小时的最低收缩压（p<0.05）。“死亡率+”组的拔管时间和 ICU 停留时间更长，需要更多的输血，BUN-肌酐比值更高，但收缩压、GFR 和 HbA1c 水平较低。需要去甲肾上腺素输注和因出血再次手术的患者死亡率也更高（p<0.05）。
通过优化术前肾功能，尽量减少拔管时间，缩短 ICU 停留时间，谨慎管理输血、手术再次探查、主动脉夹闭时间和 HbA1c 水平，我们相信可以降低老年患者的死亡率。关键策略包括缩短主动脉夹闭时间、减少围手术期输血以及确保有效止血。
