目的:探讨术中脑血氧饱和度(CeOx)对成人心脏手术后主要器官发病率和死亡率(MOMM)的影响。
方法:回顾性研究,多中心队列研究。
方法:2011年7月1日至2016年12月31日期间在胸外科医师协会成人心脏外科数据库内的任何医院接受治疗的患者,术后随访30天。
方法:年龄≥18岁的患者接受单纯冠状动脉旁路移植术(CABG)或瓣膜修复或置换,或体外循环手术的任何组合。
方法:术中CeOx。
结果:MOMM包括手术死亡率,中风,肾功能衰竭,长时间机械通气,深部胸骨伤口感染,或在30天内以任何原因重新操作。在1180个设施内符合纳入标准的119万名患者中,~30%(n=361,124)接受CeOx治疗,与未接受CeOx治疗(n=838,675)相比,基线患者特征相似。使用基于倾向得分的1:1贪婪匹配方法,99.7%的CeOx接受者(n=360,285)与非接受者匹配。与不含CeOx相比,MOMM的发生率较低。绝对风险降低转化为治疗227例患者所需的数量(95%CI:166-363,p<0.0001)。在预设亚组的敏感性分析中,在接受主动脉瓣修复术或置换术±CABG的患者中,获益最强(每1,000例MOMM事件减少7例以上,p<0.0001).然而,使用CeOx的重症监护病房住院时间>72小时较高。
结论:术中脑血氧定量与成人心脏手术后较少的主要器官发病率和死亡率相关。大规模的临床试验是必要的,鉴于去饱和是常见且可校正的。
OBJECTIVE: To examine the association/effect of intraoperative cerebral oximetry (CeOx) on major organ morbidity and mortality (MOMM) after adult cardiac surgery.
METHODS: A retrospective, multicenter cohort study.
METHODS: Patients treated at any hospital within the Society of Thoracic Surgeons Adult Cardiac Surgery Database between July 1, 2011, and December 31, 2016, with a 30-day postoperative follow-up.
METHODS: Individuals ≥18 years old undergoing isolated coronary artery bypass graft (CABG) or valve repair or replacement, or any combination of procedures with cardiopulmonary bypass.
METHODS: Intraoperative CeOx.
RESULTS: MOMM includes operative mortality, stroke, renal failure, prolonged mechanical ventilation, deep sternal wound infection, or reoperation for any reason within 30 days. Of 1.19 million patients who met inclusion criteria within 1,180 facilities, ∼30% (n = 361,124) received CeOx versus nonrecipients (n = 838,675) with similar baseline patient characteristics. Using a propensity score-based 1:1 greedy matching method, 99.7% of CeOx recipients (n = 360,285) were matched with nonrecipients. The rates of MOMM were lower with versus without CeOx. The absolute risk reduction translated to a number needed to treat of 227 patients (95% CI: 166-363, p < 0.0001). In sensitivity analyses of prespecified subgroups, the benefit was strongest among patients undergoing aortic valve repair or replacement ± CABG (more than 7 fewer MOMM events per 1,000, p < 0.0001). However, intensive care unit stay >72 hours was higher with CeOx.
CONCLUSIONS: Intraoperative cerebral oximetry is associated with less major organ morbidity and mortality after adult cardiac surgery. A large-scale clinical trial is warranted, given that desaturation is common and correctable.