在初级联合膜和冠状动脉手术后死亡的风险因素
J K Kirklin1, D C Naftel, E H Blackstone
1Department of Surgery, University of Alabama, Birmingham Medical Center.
Circulation
|June 1, 1989
概括
在联合门和冠状动脉旁路移植手术 (CABG) 后确定死亡的风险因素至关重要. 高龄,不稳定以及特定的门/动脉状况增加了CABG患者的死亡风险.
科学领域:
- 心血管外科心血管外科
- 心脏外科手术的结果
- 膜心脏疾病 膜心脏疾病
- 冠状动脉疾病冠状动脉疾病
背景情况:
- 联合膜和冠状动脉旁路移植手术 (CABG) 提出了独特的挑战.
- 了解死亡风险因素对于患者分层和改善结果至关重要.
- 以前的分析可能使用了任意分层,限制了比较准确度.
研究的目的:
- 为了检查在接受联合心肌 (MV) 或大动脉 (AV) 手术和CABG的患者中死亡的风险因素.
- 识别具有有利或不利预后的患者子集.
- 在比较外科手术结果时倡导多变量分析.
主要方法:
- 对141名接受隔离MV或AV手术并同时进行CABG (1986-1988) 的患者的回顾性分析.
- 进行了精算生存分析.
- 确定并分析了死亡风险因素,包括年龄,血液动力状况和特定的心脏病状况.
主要成果:
- 整体一个月的生存率为92%,一年的生存率为79%.
- 手术后立即死亡风险最高,在大约4个月内下降.
- 死亡的重要风险因素包括年龄较大,手术前血液动力学不稳定,左主冠状动脉疾病,缺血性米特拉病,三管无能,以及较长的缺血时间.
- 血液动力学不稳定的老年患者 (≥70岁) 的30天死亡率为20%.
- 一个有利的风险组 (70岁以下,没有左主狭窄,血液动力稳定,没有缺血性MV疾病) 的30天死亡率为<5%.
结论:
- 高龄,血液动力学不稳定,左主冠状动脉疾病,缺血性米特拉病,三管不称职,以及长时间的缺血时间是联合门和CABG后死亡的重要风险因素.
- 老年人和血液动力学不稳定的患者是高风险的子组.
- 建议使用连续变量进行多变量分析,以准确比较不同患者子组的手术结果.
相关概念视频
Mitral Stenosis III: Medical Management
Mitral stenosis, a condition marked by the narrowing of the mitral valve, necessitates an integrated approach for effective management. This approach includes preventative measures, medical therapy, and surgical interventions to reduce symptoms and prevent complications.PreventionPrevention of mitral stenosis primarily focuses on reducing the incidence of bacterial infections, particularly streptococcal infections, which can lead to rheumatic fever and subsequent valvular damage. Timely...
Mitral Stenosis IV: Nursing Management
A comprehensive nursing assessment is essential for patients with valvular heart disease, which involves any dysfunction of the heart valves that could impact blood flow and overall heart function.Subjective Data Collection:Chief Complaint and Present Illness: Start with the patient's primary concerns, focusing on the onset, duration, and progression of cardiac symptoms such as dyspnea, fatigue, chest pain, and palpitations.Past Medical History: Collect detailed information on any previous...
Aortic Regurgitation III: Medical Management
Aortic regurgitation (AR) is when the aortic valve does not close or seal properly, leading to backward blood circulation from the aorta into the left ventricle during diastole. Common causes of AR include rheumatic heart disease, congenital valve defects, and aortic root dilation. Managing AR requires a multifaceted approach to alleviate symptoms, preserve left ventricular function, and address the underlying cause of the regurgitation. Patients with symptomatic AR or significant left...
Cardiomyopathy VII: Pre and Post Operative Nursing Management
Patients with hypertrophic cardiomyopathy (HCM) and left ventricular outflow tract (LVOT) obstruction who remain symptomatic despite optimal medical therapy may undergo a septal myectomy (Morrow procedure). This procedure involves excising a portion of the hypertrophied septum below the aortic valve using a heart-lung machine to improve blood flow through the LVOT. Effective preoperative and postoperative nursing management ensures successful patient outcomes, minimizes complications, and...
Peripheral Artery Disease V: Postoperative Nursing Management
During the postoperative period, it is crucial to focus on maintaining circulation, identifying and managing potential complications, and planning for discharge.Nursing AssessmentVital signs monitoring: Regularly monitor vital signs, including blood pressure, heart rate, respiratory rate, and temperature, to detect early signs of complications such as bleeding and infection.Circulation assessment: Monitor pulses, perform Doppler assessments, and check capillary refill, color, temperature, and...
Aneurysm IV: Nursing Management
Vigilant monitoring for aneurysm rupture is essential for patients undergoing aortic surgery.Preoperative Nursing ManagementContinuously monitor the patient for manifestations of aneurysm rupture, such as pallor, weakness, tachycardia, hypotension, abdominal, back, groin, or periumbilical pain, changes in consciousness, and a pulsating abdominal mass. Regularly assess the patient's peripheral pulses.Instruct the patient to consume a clear liquid diet the day before surgery and administer...


