Cardiopulmonary Bypass Duration Is an Independent Predictor of Morbidity and Mortality After Cardiac Surgery
Cardiopulmonary Bypass Duration Is an Independent Predictor of Morbidity and Mortality After Cardiac Surgery
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DOI：
10.1053/j.jvca.2008.08.004
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发表时间：
2008-12-01
影响因子：
2.8
通讯作者：
Sisillo, Erminio
中科院分区：
文献类型：
--
作者：
Salis, Stefano;Mazzanti, Valeria V.;Sisillo, Erminio
目的：本研究的目的是确定接受心脏手术的患者的体外循环时间（CPB 时间 [CPBT]）与术后发病率和死亡率之间是否存在直接关系。设计：回顾性研究。地点：大学医院心脏外科病房。参与者：纽约心脏协会 1 至 4 级的 5,06 名患者，他们在 2002 年 1 月至 2008 年 3 月期间接受了心脏手术。干预措施：所有患者均接受了心脏手术。 CPB.测量和主要结果：平均 CPBT 为 115 分钟（中位数 106 分钟）。 131 名患者（2.6%）在同一住院期间死亡。术后中位失血量为 600 mL。 193 名患者（3.9%）因出血再次手术，1,001 名患者接受了 3 个或更多单位的红细胞。 108例（2.2%）出现神经系统后遗症，391例（7.8%）出现肾脏并发症，37例（0.7%）出现腹部并发症，184例（3.7%）出现呼吸系统并发症。 72 名患者（1.4%）出现感染并发症，80 名患者（1.6%）出现术后多器官衰竭。多变量分析证实了 CPBT 的作用（以 30 分钟为增量考虑）作为术后死亡（比值比 [OR] = 1.57，p < 0.0001）、肺部并发症（OR = 1.17，p < 0.0001）、肾脏并发症（OR = 1.31，p < 0.0001）和神经系统并发症（OR = 1.28，p < 0.0001）的独立危险因素。 0.0001）、多器官衰竭（OR = 1.21，p < 0.0001）、出血再次手术（OR = 1.1，p = 0.0165）和多次输血（OR = 1.58，p < 0.0001）。结论：延长 CPB 持续时间独立预测心脏手术后的术后发病率和死亡率。 (C) 2008 Elsevier Inc. 保留所有权利
Objective: The aim of this study was to determine if there is a direct relationship between the duration of cardiopulmonary bypass (CPB time [CPBT]) and postoperative morbidity and mortality in patients undergoing cardiac surgery.Design: Retrospective study.Setting: Cardiac surgery unit, university hospital.Participants: Five thousand six patients, New York Heart Association classes 1 through 4, who underwent cardiac surgery between January 2002 and March 2008.Interventions: All patients were subjected to CPB.Measurements and Main Results: The mean CPBT was 115 minutes (median 106). One hundred thirty-one patients (2.6%) died during the same hospitalization. The postoperative median blood loss was 600 mL. Reoperations for bleeding occurred in 193 patients (3.9%), and 1,001 patients received 3 or more units of red blood cells. There were 108 patients (2.2%) with neurologic sequelae, 391 patients (7.8%) with renal complications, 37 patients (0.7%) with abdominal complications, and 184 patients (3.7%) with respiratory complications. Seventy-two patients (1.4%) had an infective complication, and 80 patients (1.6%) had a postoperative multiorgan failure. The multivariate analysis confirmed the role of CPBT, considered in 30-minute increments, as an independent risk factor for postoperative death (odds ratio [OR] = 1.57, p < 0.0001), pulmonary (OR = 1.17, p < 0.0001), renal (OR 1.31, p < 0.0001), and neurologic complications (OR = 1.28, p < 0.0001), multiorgan failure (OR = 1.21, p < 0.0001), reoperation for bleeding (OR = 1.1, p = 0.0165), and multiple blood transfusions (OR = 1.58, p < 0.0001).Conclusions: Prolonged CPB duration independently predicts postoperative morbidity and mortality after cardiac surgery. (C) 2008 Elsevier Inc. All rights reserved