| Abstract | Uvod
Kardiovaskularne bolesti su glavni uzrok smrti i u svijetu i u Hrvatskoj, te predstavljaju veliki javnozdravstveni problem. Napredak u procjeni rizika prije operacije, tehnike kirurškog zahvata i tehnološka dostignuća u intenzivnom liječenju smanjili su mortalitet i morbiditet u pacijenata koji trebaju kardiokirurški zahvat. Na području Europe, za procjenu operacijskog rizika kardiokirurških pacijenta se uobičajeno koristi EuroSCORE (engl. The European System for Cardiac Operative Risk Evaluation). Također, EuroSCORE se koristi i za procjenu ishoda u kardijalnoj kirurgiji. Od 2011. godine se koristi inačica EuroSCORE 2 unutar koje postoje tri varijable. Prva varijabla je vezana uz opće stanje pacijenta, druga varijabla se odnosi na čimbenike srčane funkcije, a treća na čimbenike vezane uz potrebnu operaciju.
Cilj istraživanja
Cilj ovog istraživanja bio je analizirati postoji li povezanost između EuroSCORE 2 i vremena provedenog na respiratoru nakon kardiovaskularnog zahvata.
Metode
Retrospektivno istraživanje provedeno je u Klinici za kardiovaskularne bolesti Magdalena. Analizirani su podaci za razdoblje od pet godina, od 2017. do 2021. godine. Analizom baze podataka Klinike Magdalena koja je namijenjena za statističku obradu podataka u domeni kardijalne kirurgije za odrasle, dobiveni su podaci o broju pacijenata podvrgnutim zahvatima u odnosu na spol, vrstama kardiovaskularnih zahvata, broju sati provedenih na respiratoru te o komplikacijama koje su produljile vrijeme intubacije pacijenta.
Rezultati
U analizu je uključeno 1467 pacijenata od kojih je 68,85% bilo muškog spola. Medijan dobi pacijenata iznosio je 68 godina, te su u najvećoj mjeri (44,65%) bili podvrgnuti CABG (engl. Coronary Artery Bypass Graft). Predominantno su provedene elektivne operacije (68,71%) te je najveći udio pacijenata (67,48%) bio s niskim EuroSCORE 2 stupnjem rizika. Smrtni ishod zabilježen je u 1,02% pacijenata. Pronađene su statistički značajne povezanosti između EuroSCORE 2 i vremena provedenog na respiratoru (r=0,33, p<0,05), pri čemu su pacijenti s
većim stupnjem rizika proveli značajno dulje vrijeme na respiratoru (p<0,05) u usporedbi s niže i srednje rizičnim pacijentima.
Također, pronađena je i statistički značajna povezanost između EuroSCORE 2 i postoperativnih komplikacija, nakon kardiovaskularnih zahvata, gdje je vidljivo da je najučestalija komplikacija bila fibrilacija atrija nastala nakon zahvata (20,72%), dok je ukupni udio ostalih komplikacija (ventrikularna tahikardija, ventrikularna fibrilacija, traheotomija, upala pluća povezana sa strojnim ventilatorom, emfizem, atelektaza, akutni respiratorni distresni sindrom) kod zaprimljenih pacijenata iznosio svega 3,35%.
Zaključak
Istraživanjem je utvrđena pozitivna, statistički značajna povezanost između EuroSCORE 2 stupnja rizika i vremena koje pacijenti provedu na respiratoru nakon kardiovaskularnog zahvata, kao i s pojedinim pre- i postoperativnim komplikacijama. |
| Abstract (english) | Background
Cardiovascular diseases, the main cause of death both in the world and in Croatia, represent a major public health problem. Advances in preoperative risk assessment, surgical techniques, and technological achievements in intensive care have reduced mortality and morbidity for patients requiring cardiac surgery. EuroSCORE is commonly used to assess the operative risk of cardiac surgery patients in Europe. EuroSCORE is used to evaluate outcomes in cardiac surgery as well. The EuroSCORE 2 version, within which there are three variables, has been used since 2011. The first variable is related to the general condition of the patient, the second variable refers to factors of cardiac function, and the third to factors related to the necessary surgery.
Aim
The aim of this research is to analyse whether there exists a correlation between EuroSCORE 2, and the time spent on a ventilator after a cardiovascular procedure.
Methods
A retrospective study was conducted at the Clinic for Cardiovascular Diseases Magdalena. Data were analyzed for the period of five years, from 2017. to 2021. By analyzing the clinic's database, which is intended for statistical processing of data in the domain of cardiac surgery for adults, data on the number of patients undergoing procedure in relation to gender, types of cardiovascular procedures, the number oh hours spent on a respirator and complications that prolonged the time of intubation were obtained.
Results
A total of 1467 patients, of which 68,85% are male, were included in the analysis. The median age of patients were 68 years, and the most of them (44,65%) underwent CABG
procedure (Coronary Artery Bypass Graft). Elective operations were mostly performed (68,71%) and the largest proportion of patients (67,48%) had a low EuroSCORE 2 risk level. Fatal outcomes were recorded in 1,02% of patients. Statistically significant correlations were found between EuroSCORE 2 and the time spent on a respirator (r=0,33, p<0,05), whereby patients with a higher degree of risk spent significantly longer time on a respirator (p<0,05) compared to low- and medium-risk patients.
A statistically significant association was also found between EuroSCORE 2 and complications after cardiovascular procedure, where is seen that the most common complication was atrial fibrillation which arose after the procedure (20,72%), while the total share of other complications (ventricular tachycardia, ventricular fibrillation, tracheotomy, ventilator-associated pneumonia, emphysema, atelectasis, acute respiratory distress syndrome) was only 3,35%.
Conclusion
The research results indicate the existence of a positive, statistically significant correlation between the EuroSCORE 2 risk level, and the time patients spend on a ventilator after cardiovascular surgery, as well as with certain pre- and post-operative complications. |
