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

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

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


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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.

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