146例二次心脏开胸手术后并发症及病死率分析

To investigate the postoperative complications and mortality after reoperative cardiac surgery:an analysis of 146 cases

目的分析二次心脏开胸手术后并发症和在院病死率, 探讨二次开胸手术的可行性及安全性。方法回顾性收集2012年11月至2021年11月期间在南京市第一医院实施心脏手术患者的一般资料和临床信息。根据是否行二次开胸手术分为二次手术组和首次手术组, 行倾向性评分匹配。匹配后对两组患者的术中指标、术后并发症及在院病死率等进行比较。结果倾向性评分匹配后两组各纳入146例患者。术中指标方面, 二次开胸组体外循环时间[(141.48±47.88)min对(105.31±33.56)min]、主动脉阻断时间[87.0(70.5, 113.3)min对71.5(53.0, 92.0)min]、ICU停留时间[2(1, 4)天对2(1, 2)天]、术后胸腔引流量[750.0(460, 1300)ml对610(410, 840)ml]、术后输悬浮红细胞[0(0, 3.5)U对0(0, 2)U]明显增加(P<0.05)。术后并发症方面, 二次开胸组术后低氧血症[15(10.3%)对6(4.1%)]、急性肾损伤[10(6.8%)对0(0)]、术后感染[24(16.4%)对4(2.7%)]、脑部并发症[7(4.8%)对1(0.7%)]发生率显著增高(P<0.05)。两组间在院病死率[7(4.8%)对4(2.8%)]差异无统计学意义(P>0.05)。结论再次心脏开胸手术时间更长, 术后恢复更慢, 术后并发症发生率更高, 但不提高在院病死率。

Objective To investigate the postoperative complications and in-hospital mortality of reoperative cardiac surgery,and to explore the feasibility and safety of reoperative cardiac surgery.Methods The baseline data and clinical information of patients undergoing cardiac surgery in Nanjing First Hospital from November 2012 to November 2021 were retrospectively conducted,and they were divided into the reoperative cardiac surgery group and the primary surgery group according to whether they underwent reoperative cardiac surgery using a propensity score analysis.The intraoperative indicators,postoperative complications and in-hospital mortality were compared between the two groups after matching.Results After propensity score analysis,146 cases were included in each of the group.In terms of intraoperative indicators,the cardiopulmonary bypass time[(141.48±47.88)min vs.(105.31±33.56)min],aortic occlusion time[87.0(70.5,113.3)min vs.71.5(53.0,92.0)min],ICU stay time[2(1,4)days vs.2(1,2)days],postoperative drainage volume[750(460,1300)ml vs.610(410,840)ml],postoperative transfusion of red blood cells[0(0,3.5)U vs.0(0,2)U],the reoperative cardiac surgery group increased with statistically significant differences(P<0.05).Postoperative complications,the two groups had postoperative hypoxemia[15(10.3%)vs.6(4.1%)],acute kidney injury[10(6.8%)vs.0(0)],postoperative infection[24(16.4%)vs.4(2.7%)],cerebral complications[7(4.8%)vs.1(0.7%)],the incidence rate in the reoperative cardiac surgery group was higher with statistically significant differences(P<0.05).There was no significant difference in in-hospital mortality[7(4.8%)vs.4(2.8%)](P>0.05).Conclusion The time of reoperative cardiac surgeryis is longer,postoperative recovery is slower,and postoperative complication rate is higher,but does not increase in-hospital mortality.