Michalopoulos A, Stavridis G, Geroulanos S
Cardiac Surgical Intensive Care Unit, Onassis Cardiac Surgery Center, Athens, Greece.
Eur J Surg. 1998 Mar;164(3):217-22. doi: 10.1080/110241598750004670.
To elucidate the incidence, determinants, and consequences of severe sepsis after cardiac surgery.
Prospective study.
Cardiac surgical unit, Greece.
2615 adult patients having cardiac operations.
Microbiological evidence of sepsis, mortality, and duration of stay in the intensive care unit (ICU) and hospital.
Severe sepsis developed in 41/2615 patients (2%), all during their stay in the ICU: there were 30 men and 11 women, mean (SD) age 65 (10) years. It was most common after combined coronary artery bypass grafting and valve-related operations (7/95, 7%), followed by miscellaneous cardiac operations (7/147, 5%), valve replacement (8/359, 2%), and coronary artery bypass grafting (19/2014, 1%). When the 41 patients who developed severe sepsis were compared with those who did not (n = 2574) by univariate analysis, there were significant differences in age (p = 0.004); type of operation (p < 0.0001); duration of operation (p < 0.001); bleeding that necessitating either reoperation or significantly more blood transfused (p < 0.0001); and the incidence of low cardiac output syndrome (p = 0.0001). Of the 41 patients with severe sepsis, 19 (46%) had serious operative complications, 40 (98%) had severe complications in the ICU, and 16 (39%) required reintubation for hypoxaemia. Among the 41 there were 54 bacteraemic episodes of which 37 (69%) were caused by gram positive cocci, 6 (11%) by gram negative bacteria, and 11 (20%) by Candida albicans. Staphylococcus epidermidis was the most common pathogen isolated (n = 26, 48%). Sepsis associated with bacterial infection usually developed during the first two weeks, and that caused by fungal infection was most common after the twentieth postoperative day. Patients with severe sepsis required longer mechanical ventilation (31 (21) days compared with 0.9 (0.1) days); longer stay in the ICU (40 (25) days) compared with 2 (1) days); longer stay in hospital (48 (27) days compared with 10 (2) days); and significantly more of them died (13 (32%) compared with 41 (2%), p < 0.0001 in each case).
We concluded that severe sepsis mainly developed in cardiac surgery patients with serious operative and postoperative complications and was associated with a longer stay in both ICU and hospital, and a higher mortality.
阐明心脏手术后严重脓毒症的发生率、决定因素及后果。
前瞻性研究。
希腊心脏外科病房。
2615例接受心脏手术的成年患者。
脓毒症的微生物学证据、死亡率、重症监护病房（ICU）及住院时间。
2615例患者中有41例（2%）发生严重脓毒症，均发生在ICU住院期间：男性30例，女性11例，平均（标准差）年龄65（10）岁。严重脓毒症最常见于冠状动脉搭桥术和瓣膜相关手术联合进行后（7/95，7%），其次是其他心脏手术（7/147，5%）、瓣膜置换术（8/359，2%）和冠状动脉搭桥术（19/2014，1%）。对发生严重脓毒症的41例患者与未发生严重脓毒症的患者（n = 2574）进行单因素分析，发现年龄（p = 0.004）、手术类型（p < 0.0001）、手术持续时间（p < 0.001）、需要再次手术或大量输血的出血情况（p < 0.0001）以及低心排血量综合征的发生率（p = 0.0001）存在显著差异。41例严重脓毒症患者中，19例（46%）有严重手术并发症，40例（98%）在ICU有严重并发症，16例（39%）因低氧血症需要再次插管。41例患者中有54次菌血症发作，其中37次（69%）由革兰氏阳性球菌引起，6次（11%）由革兰氏阴性菌引起，11次（20%）由白色念珠菌引起。表皮葡萄球菌是最常见的分离病原体（n = 26，48%）。与细菌感染相关的脓毒症通常在头两周内发生，真菌感染引起的脓毒症最常见于术后第20天之后。严重脓毒症患者需要更长时间的机械通气（31（21）天，而未发生严重脓毒症患者为0.9（0.1）天）；在ICU停留时间更长（40（25）天，而未发生严重脓毒症患者为2（1）天）；住院时间更长（48（27）天，而未发生严重脓毒症患者为10（2）天）；且死亡人数显著更多（13例（32%），而未发生严重脓毒症患者为41例（2%），每种情况p < 0.0001）。
我们得出结论，严重脓毒症主要发生在有严重手术和术后并发症的心脏手术患者中，并且与在ICU和医院停留时间延长以及更高的死亡率相关。
