体外循环术后消化系统功能障碍的临床分析

目的 分析体外循环(CPB)心血管手术后消化系统功能障碍的临床特点。方法 回顾本科1996-01～2002-12间2349例心血管手术患者的临床资料，分析术后消化系统功能功能障碍的特点，总结其高危因素、病变类型、诊断方法、治疗经过及预后。结果 共有33例(1.4％)患者出现术后消化系统功能障碍，以麻痹性肠梗阻(11／33，33.3％)和上消化道出血(9／33，27．3％)最为多见。保守治疗26例(78．8％)，手术探查7例(21．2％)，死亡5例(15．2％)。肝功能不全和缺血性肠病是最主要的致死原因。结论 心脏术后消化系统功能障碍发生率低但死亡率高，高龄、胃肠疾病史及围术期循环不稳定是其高危因素。早期明确诊断和积极干预是决定病情转归的关键。

The Clinical Analysis of Digestive System Dysfunctions after Cardiovascular Surgery with Cardiopulmonary Bypass

Objective To analyze the clinical characteristics of digestive system dysfunctions after cardiovascular surgery with cardiopulmonary bypass (CPB). Methods The clinical data of 2349 consecutive cases undergoing cardiovascular surgery with CPB from Jan 1996 to Dec 2002 were retrospectively reviewed. The risk factors, clinical features, diagnostic methods, treatment and prognosis of digestive system dysfuctions were summarized. Results The incidence of digestive system dysfunctions was 1.4% (n=33), and the most common events were paralytic ileus (33.3%, n=11) and gastrointestinal bleeding (27.3%, n=9). Liver function insufficiency and ischemic bowel disease were the most common causes of deaths. 26(78.8%) patients underwent medicine treatment, 7(21.2%) patients accepted surgical interventions, and 5 patients (15.2%) died. Conclusion Digestive system dysfunctions following cardiovascular surgery were uncommon but had a high mortality. Advanced ages, history of gastrointestinal disease and perioperative hemodynamic unstability may be the clinical risk factors of digestive system dysfuctions. Early diagnosis and prompt treatment are essential for the outcome of the patients.