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選択的心臓手術後の横隔膜機能障害。プロスペクティブ観察研究
Diaphragmatic Dysfunction After Elective Cardiac Surgery: A Prospective Observational Study.
PMID: 32653270 DOI: 10.1053/j.jvca.2020.06.038.
抄録
目的:
超音波検査で診断された術後の横隔膜機能障害の発生率を調べる。
OBJECTIVES: To determine the incidence of postoperative diaphragm dysfunction as diagnosed by ultrasonography.
デザイン:
探索的プロスペクティブ観察研究
DESIGN: Explorative prospective observational study.
設定:
大学の集中治療室。
SETTING: University intensive care unit.
参加者:
選択的心臓手術を受けた連続100例。
PARTICIPANTS: One hundred consecutive patients undergoing elective cardiac surgery.
介入:
手術前日の無補助呼吸時（D-1）、最初の自発呼吸試行時（D）、手術後24時間後（D+1）、集中治療室（ICU）退院時（D）に横隔膜超音波検査を行った。横隔膜変位、吸気・呼気厚、肥厚率はすべての時点で測定した。
INTERVENTIONS: Diaphragm ultrasound was performed the day before surgery during unassisted breath (D-1), at the first spontaneous breathing trial attempt (D), 24 hours after surgery (D+1), and at intensive care unit (ICU) discharge (D). Diaphragm displacement, inspiratory and expiratory thickness, and the thickening fraction were measured at all timepoints.
測定および主な結果:
副次的転帰は、離乳困難な患者数、非侵襲的人工呼吸の必要性、再挿管率、ICU滞在期間であった。D時に横隔膜機能障害を示した患者は38例で、時間の経過とともに消失した。術前の特徴および併存疾患には、術後に横隔膜機能障害を発症した患者と術後障害のない患者との間に差は認められなかった。心肺バイパス術の持続時間（103±34分 vs 55±34分；P＜0.001）は、術後横隔膜機能障害の発症と有意に関連していた。術後横隔膜機能障害のない患者と比較すると、横隔膜機能障害を有する患者は、離乳困難率が高い（32％ vs 5％；P < 0.001）、術後24時間での抜糸率が低い（50％ vs 92％；P < 0.001）、およびICU滞在時間が長い（19 [16; 88] vs 16 [15; 18] 時間；P < 0.001）という特徴を有していた。
MEASUREMENTS AND MAIN RESULTS: Primary outcome was assessing the rate of postoperative diaphragm dysfunction, defined as a thickening fraction <20% at D. Secondary outcomes were the number of difficult-to-wean patients, the need for rescue noninvasive ventilation, the reintubation rate, and the ICU length of stay. Thirty-eight patients showed diaphragm dysfunction at D, which resolved over time. No differences in preoperative characteristics and comorbidities were found between patients who developed postoperative diaphragm dysfunction and patients without postoperative disorders. The duration of cardiopulmonary bypass (103 ± 34 v 55 ± 34 min; P < 0.001) was significantly associated with the development of postoperative diaphragm dysfunction. When compared with patients without postoperative diaphragm disorders, patients with diaphragm dysfunction were characterized by a higher rate of difficult weaning (32% v 5%; P < 0.001), lower extubation rate at 24 hours after surgery (50% v 92%; P < 0.001), and longer ICU length of stay (19 [16; 88] v 16 [15; 18] hours; P < 0.001).
結論:
選択的心臓手術後の術後横隔膜機能障害の発生率は高く、ICU滞在期間の延長に寄与している可能性がある。
CONCLUSIONS: The incidence of postoperative diaphragm dysfunction after elective cardiac surgery is high and might contribute to prolonging ICU length of stay.
Copyright © 2020 Elsevier Inc. All rights reserved.