Department of Cardiovascular Anesthesia and Intensive Care, Pauls Stradins Clinical University Hospital, LV-1002 Riga, Latvia.
Department of Anesthesiology, Riga Stradins University, LV-1007 Riga, Latvia.
Medicina (Kaunas). 2024 Aug 26;60(9):1398. doi: 10.3390/medicina60091398.
: Postoperative pulmonary complications (PPCs) are common in patients who undergo cardiac surgery and are widely acknowledged as significant contributors to increased morbidity, mortality rates, prolonged hospital stays, and healthcare costs. Clinical manifestations of PPCs can vary from mild to severe symptoms, with different radiological findings and varying incidence. Detecting early signs and identifying influencing factors of PPCs is essential to prevent patients from further complications. Our study aimed to determine the frequency, types, and risk factors significant for each PPC on the first postoperative day. The main goal of this study was to identify the incidence of pleural effusion (right-sided, left-sided, or bilateral), atelectasis, pulmonary edema, and pneumothorax as well as detect specific factors related to its development. : This study was a retrospective single-center trial. It involved 314 adult patients scheduled for elective open-heart surgery under CPB. : Of the 314 patients reviewed, 42% developed PPCs within 12 h post-surgery. Up to 60.6% experienced one PPC, while 35.6% developed two PPCs. Pleural effusion was the most frequently observed complication in 89 patients. Left-sided effusion was the most common, presenting in 45 cases. Regression analysis showed a significant association between left-sided pleural effusion development and moderate hypoalbuminemia. Valve surgery was associated with reduced risk for left-sided effusion. Independent parameters for bilateral effusion include increased urine output and longer ICU stays. Higher BMI was inversely related to the risk of pulmonary edema. : At least one PPC developed in almost half of the patients. Left-sided pleural effusion was the most common PPC, with hypoalbuminemia as a risk factor for effusion development. Atelectasis was the second most common. Bilateral effusion was the third most common PPC, significantly related to increased urine output. BMI was an independent risk factor for pulmonary edema development.
术后肺部并发症（PPCs）在接受心脏手术的患者中很常见，被广泛认为是导致发病率、死亡率、住院时间延长和医疗成本增加的重要因素。PPC 的临床表现从轻度到重度症状不等，具有不同的放射学发现和不同的发病率。早期发现 PPC 的迹象并确定其影响因素对于预防患者进一步并发症至关重要。我们的研究旨在确定术后第 1 天 PPC 的频率、类型和对每种 PPC 有意义的危险因素。本研究的主要目的是确定胸腔积液（右侧、左侧或双侧）、肺不张、肺水肿和气胸的发生率，并检测与其发展相关的特定因素。
这项研究是一项回顾性单中心试验。它涉及 314 名接受 CPB 下择期心脏直视手术的成年患者。
在回顾的 314 名患者中，有 42%在手术后 12 小时内发生 PPCs。高达 60.6%的患者出现一种 PPC，35.6%的患者出现两种 PPCs。胸腔积液是 89 例患者中最常见的并发症。左侧胸腔积液最常见，有 45 例。回归分析显示，左侧胸腔积液的发生与中度低白蛋白血症之间存在显著关联。瓣膜手术与左侧胸腔积液的发生风险降低有关。双侧胸腔积液的独立参数包括尿量增加和 ICU 停留时间延长。较高的 BMI 与肺水肿的风险呈负相关。
至少有一种 PPC 在近一半的患者中发展。左侧胸腔积液是最常见的 PPC，低白蛋白血症是胸腔积液发展的危险因素。肺不张是第二常见的 PPC。双侧胸腔积液是第三种最常见的 PPC，与尿量增加显著相关。BMI 是肺水肿发展的独立危险因素。
