Serna D L, Chen J C, Milliken J C
Division of Cardiothoracic Surgery, University of California, Irvine Medical Center, Orange 92868, USA.
Am Surg. 1998 Oct;64(10):942-6.
The success of "fast-track" accelerated recovery pathways in improving patient outcomes after coronary artery bypass graft surgery (CABG) has prompted expanded application. Although initially used only in routine cases, higher-risk cohorts may also benefit from this collection of management techniques. Twenty-seven consecutive patients with ejection fractions (EFs) less than or equal to 30 per cent (group I) undergoing CABG requiring cardiopulmonary bypass were started on our routine care path. The results of this effort were retrospectively compared with 27 concurrent patients with an EF greater than or equal to 50 per cent (group II) undergoing CABG at our institution. Outcome criteria included postoperative extubation (by 6 hours), transfer from intensive care unit (in < or = 24 hours), and hospital discharge on or before postoperative day 5. As anticipated, group I patients deviated from pathway criteria more frequently than did group II. However, despite severely compromised preoperative cardiac function, 52 per cent of group I patients were extubated within the first 6 hours postoperatively, 51 per cent were discharged from the intensive care unit on the 1st postoperative day, and 52 per cent were discharged from the hospital within the first 5 postoperative days. Group II patients' values for these parameters were 96, 96, and 70 per cent, respectively. No adverse effects could be attributed to pathway expectations. The results of this preliminary study suggest that accelerated care pathways may be safely applied to patients with severely low EFs and deserve further study.
“快速通道”加速康复方案在改善冠状动脉搭桥手术（CABG）后患者预后方面取得的成功促使其应用范围不断扩大。尽管该方案最初仅用于常规病例，但高危患者群体也可能从这一系列管理技术中获益。连续27例射血分数（EF）小于或等于30%的患者（第一组）接受需要体外循环的CABG手术，采用我们的常规护理方案。将这一治疗结果与本院同时期接受CABG手术的27例EF大于或等于50%的患者（第二组）进行回顾性比较。预后标准包括术后拔管（6小时内）、从重症监护病房转出（≤24小时）以及术后第5天或之前出院。正如预期的那样，第一组患者偏离方案标准的频率高于第二组。然而，尽管术前心脏功能严重受损，但第一组52%的患者在术后6小时内拔管，51%的患者在术后第1天从重症监护病房出院，52%的患者在术后前5天内出院。第二组患者这些参数的值分别为96%、96%和70%。未发现有任何不良影响可归因于方案预期。这项初步研究结果表明，加速护理方案可安全应用于EF严重低下的患者，值得进一步研究。
