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CURRENT ISSUETHE JOURNAL OF CARDIOVASCULAR SURGERY

A Journal on Cardiac, Vascular and Thoracic Surgery


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The Journal of Cardiovascular Surgery 2000 April;41(2):221-5

CARDIAC PAPERS 

 ORIGINAL ARTICLES

Postoperative oxygenation following coronary artery bypass grafting. A multivariate analysis of perioperative factors

Yamagishi T., Ishikawa S., Ohtaki A., Takahashi T., Koyano T., Ohki S., Sakata S., Murakami J., Hasegawa Y., Morishita Y.

From the ­Second Depart­ment of Sur­gery Gunma Uni­ver­sity ­School of Med­i­cine, Mae­bashi, ­Japan

Back­ground. Pul­mo­nary oxy­gen­a­tion is gen­er­ally tem­po­rarily ­impaired fol­lowing car­diac sur­gery. We ­studied the fac­tors influ­encing post­op­er­a­tive oxy­gen­a­tion ­using mul­ti­var­iate anal­ysis.
­Methods. ­This ­study was ret­ro­spec­tively per­formed in Uni­ver­sity hos­pital. ­Fifty ­patients under­going sol­i­tary cor­o­nary ­artery ­bypass ­grafting ­were ­included in ­this ­study. ­Patients ­were ­divided ­into two ­groups by ­mean age; ­older ­group (n=25) and ­younger ­group (n=25). ­Alveolar-arte­rial ­oxygen dif­fer­ence (A-aDO2) and res­pir­a­tory ­index (RI) ­were meas­ured at 3 ­hours ­after sur­gery and on post­op­er­a­tive day 1. Sta­tis­tical anal­ysis was per­formed ­using for­ward selec­tion step­wise regres­sion of 12 per­i­op­er­a­tive var­i­ables.
­Results. In all ­patients, A-aDO2 and RI sig­nif­i­cantly (p<0.01) ­increased ­after sur­gery and ­remained ­high on POD1. In step­wise regres­sion anal­ysis, pre­op­er­a­tive A-aDO2 and RI ­were sig­nif­i­cant fac­tors in the equa­tions for post­op­er­a­tive A-aDO2 and RI in gen­eral, ­which was the ­most impor­tant ­factor in the ­older ­group. In the ­older ­group, pre­op­er­a­tive A-aDO2 or RI and ­water bal­ance ­were sig­nif­i­cant (p<0.05) fac­tors ­which ­were respon­sible for ­half the oxy­gen­a­tion impair­ment ­just ­after sur­gery, and ­PCWP ­showed a sig­nif­i­cant (p<0.01) neg­a­tive cor­re­la­tion ­with ­both A-aDO2 and RI on POD1. In the ­younger ­group, ­PCWP was a sig­nif­i­cant (p<0.01) ­factor for A-aDO2 and CVP and CI ­were sig­nif­i­cant for RI on POD1.
Con­clu­sions. Post­op­er­a­tive oxy­gen­a­tion was ­mainly influ­enced by the pre­op­er­a­tive res­pir­a­tory con­di­tion, espe­cially in old ­patients, indi­cating ­that pre­op­er­a­tive man­age­ment by a phys­io­ther­a­pist may be nec­es­sary. Pleu­rotomy ­also had a neg­a­tive influ­ence. ­Careful intra­op­er­a­tive and post­op­er­a­tive ­volume con­trol is impor­tant in old ­patients.

language: English


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