Acute Mesenteric Ischemia Among Postcardiac Surgery Patients Presenting with Multiple Organ Failure
Acute Mesenteric Ischemia Among Postcardiac Surgery Patients Presenting with Multiple Organ Failure
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DOI：
10.1097/shk.0000000000000720
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发表时间：
2017-03-01
期刊：
影响因子：
3.1
通讯作者：
Piton, Gael
中科院分区：
文献类型：
--
作者：
Guillaume, Alexis;Pili-Floury, Sebastien;Piton, Gael
背景：急性肠系膜缺血（AMI）是心脏手术后罕见但严重的并发症。然而，在心脏手术后出现多器官衰竭的患者亚组中，AMI 可能更为常见。本研究的主要目的是确定心脏手术后需要入住重症监护病房 (ICU) 的患者中的 AMI 危险因素。方法：对一所大型大学医院心脏手术后需要入住两个 ICU 的所有患者进行回顾性观察研究。 AMI 确认基于腹部计算机断层扫描、消化内窥镜检查、剖腹手术或尸检。通过单变量和多变量分析来比较患有或不患有 AMI 的患者入住前和入住 ICU 的特征。 结果：2007 年至 2013 年间，4,948 名患者接受了心脏手术，其中 320 名患者 (6%) 因多器官功能衰竭需要入住 ICU。因多器官衰竭入住 ICU 的患者中有 10% 被确诊为 AMI (33/320)。这些患者的预后极差，28天和90天死亡率分别为64%和83%。非闭塞性肠系膜缺血（NOMI）是 83% 患者的主要机制。冠状动脉搭桥术、体外循环期间需要输血、天冬氨酸转氨酶至少100UI/L以及入ICU时简化急性生理学评分II至少50与AMI独立相关。基于这四个风险因素的 AMI 风险评分能够识别三类风险：低风险（
Background:Acute mesenteric ischemia (AMI) is a rare but severe complication after cardiac surgery. However, AMI is likely to be more frequent in the subgroup of patients presenting with multiple organ failure after a cardiac surgery. The primary objective of this study was to identify AMI risk factors among patients requiring intensive care unit (ICU) admission after cardiac surgery.Methods:Retrospective observational study of all the patients requiring admission to two ICUs in a large university hospital after a cardiac surgery procedure. AMI confirmation was based on abdominal computed tomography scan, digestive endoscopy, laparotomy, or postmortem examination. Univariate and multivariate analyses were done to compare pre- and in-ICU characteristics between patients with or without AMI.Results:Between 2007 and 2013, a cardiac surgery was performed in 4,948 patients, of whom 320 patients (6%) required ICU admission for multiple organ failure. AMI was confirmed in 10% of the patients admitted to the ICU for multiple organ failure (33/320). The prognosis of these patients was extremely poor with 28- and 90-day mortality rates of 64% and 83%, respectively. Nonocclusive mesenteric ischemia (NOMI) was the main mechanism involved in 83% of the patients. Coronary artery bypass graft, need for blood transfusion during cardiopulmonary bypass, aspartate aminotransferase at least 100UI/L, and Simplified Acute Physiology Score II at least 50 at ICU admission were independently associated with AMI. An AMI risk score based upon these four risk factors was able to identify three classes of risk: low risk (