Egleston C V, Wood A E, Gorey T F, McGovern E M
National Cardiac Surgical Unit, Mater Misericordiae Hospital, Dublin, Ireland.
Ann R Coll Surg Engl. 1993 Jan;75(1):52-6.
Gastrointestinal complications after cardiac surgery are uncommon, but are associated with a high morbidity and mortality. Over 11 years 8559 procedures requiring cardiopulmonary bypass were performed in this unit and 35 patients were identified who developed gastrointestinal complications after surgery, an incidence of 0.41%. There were nine deaths in this group, a mortality of 25.7% compared with an overall mortality after cardiac surgery in Ireland ranging from 3.24% to 4.81%. These complications required surgery in 21 patients. The most common indication for surgical intervention was upper gastrointestinal bleeding in 10 patients, three patients had acute pancreatitis, two patients had perforated peptic ulcer; two patients had intestinal ischaemia, with five cases of colon pathology. The difficulties of making an early diagnosis are outlined and a low threshold to exploratory laparotomy is recommended.
心脏手术后的胃肠道并发症并不常见,但却与高发病率和高死亡率相关。在本单位11年期间共进行了8559例需要体外循环的手术,其中35例患者术后出现了胃肠道并发症,发生率为0.41%。该组中有9例死亡,死亡率为25.7%,而爱尔兰心脏手术后的总体死亡率在3.24%至4.81%之间。这些并发症中有21例患者需要手术治疗。手术干预最常见的指征是10例上消化道出血,3例患者患有急性胰腺炎,2例患者患有消化性溃疡穿孔;2例患者有肠缺血,还有5例结肠病变。文中概述了早期诊断的困难,并建议对剖腹探查保持较低的阈值。