Wang Zhigang, Kang Yubei, Wang Zheyun, Xu Jingfang, Han Dandan, Zhang Lifang, Wang Dongjin
Department of Cardio-thoracic Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, 210008 Nanjing, Jiangsu, China.
Department of Nephrology, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, 210023 Nanjing, Jiangsu, China.
Rev Cardiovasc Med. 2023 Mar 8;24(3):87. doi: 10.31083/j.rcm2403087. eCollection 2023 Mar.
Cardiac surgical re-exploration for bleeding is associated with increased morbidity and mortality. Whether to perform these procedures in the operating room (OR) or the Cardiac Intensive Care Unit (CICU) in uncertain. We sought to determine if the location of the reoperation would affect postoperative outcomes when a reoperation for bleeding is required following cardiac surgery.
Patients who underwent planned cardiac re-explorations for bleeding at our center from January 2019 to December 2021 were retrospectively enrolled in this study. Patient outcomes were compared and analyzed.
Due to hemorrhagic shock, 72 patients underwent planned cardiac re-explorations, including 21 operated in the CICU and 51 in the OR. Within 12 h of the primary operation, 65 re-explorations (90.3%) were performed. The peak Vasoactive-Inotropic Score was 47.0 27.4, systolic blood pressure was 89.4 9.6 mmHg, central venous pressure was 12.1 4.4 O, and the serum lactate was 5.5 4.1 mmol/L prior to the reoperation. Multivariate logistic analysis showed that a reoperation performed in the CICU was not an independent risk factor for the occurrence of major complications. There was no significant difference in mortality between the two groups.
Planned re-exploration for bleeding following open cardiac surgery in the CICU is feasible and safe.
因出血进行心脏外科再次手术与发病率和死亡率增加相关。对于这些手术是在手术室（OR）还是心脏重症监护病房（CICU）进行尚不确定。我们试图确定当心脏手术后因出血需要再次手术时，再次手术的地点是否会影响术后结局。
回顾性纳入2019年1月至2021年12月在我们中心因出血进行计划性心脏再次手术的患者。比较并分析患者结局。
由于失血性休克，72例患者接受了计划性心脏再次手术，其中21例在CICU进行，51例在OR进行。在初次手术后12小时内进行了65例再次手术（90.3%）。再次手术前血管活性-正性肌力评分峰值为47.0±27.4，收缩压为89.4±9.6mmHg，中心静脉压为12.1±4.4cmH₂O，血清乳酸为5.5±4.1mmol/L。多因素逻辑分析显示，在CICU进行再次手术不是发生主要并发症的独立危险因素。两组死亡率无显著差异。
在CICU对心脏直视手术后出血进行计划性再次手术是可行且安全的。
