Tsiotos G G, Mullany C J, Zietlow S, van Heerden J A
Division of General Surgery, Mayo Clinic, Rochester, Minnesota 55905.
Am J Surg. 1994 Jun;167(6):553-7. doi: 10.1016/0002-9610(94)90096-5.
Between 1978 and 1991, 116 of 19,246 patients (0.6%) undergoing cardiac surgery developed abdominal complications (renal/hepatic failure excluded) within 30 days of their cardiac operation. Comparison with a randomly selected control group of 217 patients operated upon over the same period of time was also undertaken. Compared to the control group, the study patients were older (mean age, 63.3 +/- 12.5 years vs 57.5 +/- 21.5 years; P = 0.03), more likely to have a history of alcohol abuse (10% vs 4%; P = 0.03), and more likely to have a previous history of gastrointestinal problems (43% vs 17%; P = 0.0001). There was also a trend towards a greater number of patients having valvular surgery, particularly reoperative surgery, in the study group. Postoperatively, patients with marked low cardiac output, requiring the intra-aortic balloon pump, were more likely to develop abdominal complications. These complications included complicated peptic ulcer disease in 54 (47%), intestinal obstruction and/or perforation in 19 (16%), biliary tract disease in 13 (11%), mesenteric ischemia in 13 (11%), acute pancreatitis in 3 (3%), and miscellaneous complications in the remaining 14 (12%). Forty-three patients were treated medically and 73 patients required operative intervention. The surgical procedures performed were truncal vagotomy and drainage (12), oversewing of a perforation or a bleeding vessel (6), gastrectomy (2), intestinal resection (14), laparotomy only (14), cholecystectomy (14), and other (11). Mortality was 26% (30/116) with the mortality for medical and surgical treatment being 16% vs 32%, respectively (P = 0.112). Intestinal ischemia had the highest mortality, with a rate of 85% (11/13). Despite intensive monitoring and care of cardiac surgical patients, abdominal complications do occur, although rarely. Risk factors include older age, a positive history of gastrointestinal disease, reoperative valve surgery, and severe postoperative low cardiac output.
1978年至1991年间，19246例接受心脏手术的患者中有116例（0.6%）在心脏手术后30天内出现腹部并发症（不包括肾衰竭/肝衰竭）。同时还与同期随机选取的217例接受手术的对照组进行了比较。与对照组相比，研究组患者年龄更大（平均年龄，63.3±12.5岁对57.5±21.5岁；P = 0.03），更有可能有酗酒史（10%对4%；P = 0.03），并且更有可能有胃肠道问题既往史（43%对17%；P = 0.0001）。研究组中进行瓣膜手术的患者数量也有增多的趋势，尤其是再次手术。术后，心脏指数明显降低、需要主动脉内球囊反搏的患者更有可能发生腹部并发症。这些并发症包括复杂性消化性溃疡病54例（47%）、肠梗阻和/或穿孔19例（16%）、胆道疾病13例（11%）、肠系膜缺血13例（11%）、急性胰腺炎3例（3%），其余14例（12%）为其他并发症。43例患者接受内科治疗，73例患者需要手术干预。实施的外科手术包括迷走神经干切断术和引流术（12例）、穿孔或出血血管缝扎术（6例）、胃切除术（2例）、肠切除术（14例）、仅剖腹探查术（14例）、胆囊切除术（14例）以及其他手术（11例）。死亡率为26%（30/116），内科治疗和外科治疗的死亡率分别为16%和32%（P = 0.112）。肠缺血的死亡率最高，为85%（11/13）。尽管对心脏手术患者进行了密切监测和护理，但腹部并发症确实会发生，尽管很少见。危险因素包括年龄较大、胃肠道疾病阳性史、再次瓣膜手术以及术后严重低心输出量。
