Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Feb 1994
Randomized Controlled Trial Clinical Trial[Abdominal complications following heart surgery].
Intra-abdominal complications occurring after cardiopulmonary bypass operations are rare but often fatal. There are only speculative approaches concerning the pathogenesis and the risk factors of these complications. The aim of our study was therefore to determine the causative factors and to evaluate the diagnostic and therapeutic measures, because early diagnosis and immediate treatment is essential for the outcome of the patients. ⋯ In reviewing both our results and data cited in earlier studies, intra-abdominal complications can generally be attributed to the following: Intraoperative surgical complications with the consequence of prolonged aortic cross clamping and total bypass times can cause low cardiac output and mesenteric hypoperfusion. Predominantly as a result of the low cardiac output, the use of vasopressors increases splanchnic ischaemia, in particular in patients with pre-existing occlusive vascular disease of the mesenteric arteries. Mucosal ischaemia might be aggravated by a concurrent pseudo-obstruction. On the other hand, intraoperative complications and low cardiac output can cause further complications and finally multiple organ failure. Multiple organ failure and ischaemia of the gut can initiate the vicious circle which is responsible for the high mortality from these complications. Early detection by careful physical examination and the combination of the diagnostic procedures and prompt treatment should lead to a reduction of mortality.