心脏手术术后消化道出血的研究进展

Research progress on gastrointestinal hemorrhage after cardiac surgery

心脏手术术后消化道出血发生率虽低,但死亡率较高且早期难于发现及诊断。其发病高危因素包括术前、术中及术后三部分,术前伴有消化道溃疡、高血压、冠心病、慢性肾功能衰竭等;术中体外循环导致的胃肠道血流灌注降低、炎性物质大量释放、凝血机制的改变、各类成分栓子的形成;术后低血压、低心排血量、机械通气时间延长等。本文将着重归纳心脏手术后消化道出血的高危因素及发病机制,回顾性总结心脏手术术后消化道出血的预防、治疗进展及目前存在的问题。

Although the incidence of gastrointestinal hemorrhage after cardiac surgery is low,the mortality rate is high.Early detection and diagnosis of gastrointestinal hemorrhage are difficult.The high risk phases including preoperation,intraoperation and postoperation.Preoperative high risk comorbidities include gastrointestinal ulcer, hypertension,coronary heart disease and chronic renal failure.Intraoperative high risk factors include decreased gastrointestinal blood perfusion due to cardiopulmonary bypass,inflammatory factors releasing,coagulation disorders, and thrombosis.Postoperative high risk factors include hypotension,low cardiac output,prolonged mechanical ventilation,etc.This article retrospectively summarized high-risk factors and pathogenesis of gastrointestinal hemorrhage after cardiac surgery,in order to improve prevention and treatment of gastrointestinal hemorrhage.