Research progress on gastrointestinal hemorrhage after cardiac surgery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZENG Ling ¹ , LIAO Yao ² ,  QIAN Yongjun ³

1. Department of Intensive Care Unit, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;
2. Department of Cardiovascular Surgery, Jingzhou Central Hospital, Jingzhou, 434000, Hubei, P.R.China;
3. Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;

Corresponding?author：

QIAN Yongjun, Email: yongjunqian@sina.com

Keywords：

Cardiac surgery; gastrointestinal hemorrhage; research progress

DOI：

10.7507/1007-4848.201805069

Video：

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Although the incidence of gastrointestinal hemorrhage after cardiac surgery is low, the mortality rate is high. Early detection and diagnosis of gastrointestinal hemorrhage are difficult. The high risk phases including preoperation, intraoperation and postoperation. Preoperative high risk comorbidities include gastrointestinal ulcer, hypertension, coronary heart disease and chronic renal failure. Intraoperative high risk factors include decreased gastrointestinal blood perfusion due to cardiopulmonary bypass, inflammatory factors releasing, coagulation disorders, and thrombosis. Postoperative high risk factors include hypotension, low cardiac output, prolonged mechanical ventilation, etc. This article retrospectively summarized high-risk factors and pathogenesis of gastrointestinal hemorrhage after cardiac surgery, in order to improve prevention and treatment of gastrointestinal hemorrhage.

Citation： ZENG Ling, LIAO Yao, QIAN Yongjun. Research progress on gastrointestinal hemorrhage after cardiac surgery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2019, 26(1): 97-100. doi: 10.7507/1007-4848.201805069 Copy

1.	Krawiec F, Maitland A, Duan Q, et al. Duodenal ulcers are a major cause of gastrointestinal bleeding after cardiac surgery. J Thorac Cardiovasc Surg, 2017, 154(1): 181-188.
2.	Bolcal C, Iyem H, Sargin M, et al. Gastrointestinal complications after cardiopulmonary bypass: sixteen years of experience. Can J Gastroenterol, 2005, 19(10): 613-7.
3.	Geissler HJ, Fischer UM, Grunert S, et al. Incidence and outcome of gastrointestinal complications after cardiopulmonary bypass. Interact Cardiovasc Thorac Surg, 2006, 5(3): 239-42.
4.	Hanks JB, Curtis SE, Hanks BB, et al. Gastrointestinal complications after cardiopulmonary bypass. Surgery, 1982, 92(2): 394-400.
5.	Heikkinen LO, Ala-Kulju KV. Abdominal complications following cardiopulmonary bypass in open-heart surgery. Scand J Thorac Cardiovasc Surg, 1987, 21(1): 1-7.
6.	Hashemzadeh K, Hashemzadeh S. Predictors and outcome of gastrointestinal complications after cardiac surgery. Minerva Chir, 2012, 67(4): 327-335.
7.	Lebovics E, Lee SS, Dworkin BM, et al. Upper gastrointestinal bleeding following open heart surgery. Dig Dis Sci, 1991, 36(6): 757-760.
8.	Sicsic JC, Duranteau J, Corbineau H, et al. Gastric mucosal oxygen delivery decreases during cardiopulmonary bypass despite constant systemic oxygen delivery. Anesth Analg, 1998, 86(3): 455-460.
9.	Cassina T, Santambrogio L. Microcirculation after cardiopulmonary bypass: a glance at the mesenteric mucosa. Minerva Anestesiol, 2012, 78(3): 288-290.
10.	Jungwirth B, Eckel B, Blobner M, et al. The impact of cardiopulmonary bypass on systemic interleukin-6 release, cerebral nuclear factor-kappa B expression,and neurocognitive outcome in rats. Anesth Analg, 2010, 110(2): 312-320.
11.	Warren OJ, Smith AJ, Alexiou C, et al. The inflammatory response to cardiopulmonary bypass: part 1-mechanisms of pathogenesis. J Cardiothorac Vasc Anesth, 2009, 23(2): 223-231.
12.	黑飛龍, 龍村, 孫桂民, 等. 體外循環心內直視手術中胃腸激素變化. 中華實驗外科雜志, 2003, 20(4): 375.
13.	De Backer D, Dubois MJ, Schmartz D, et al. Microcirculatory alterations in cardiac surgery: effects of cardiopulmonary bypass and anesthesia. Ann Thorac Surg, 2009, 88(5): 1396-1403.
14.	Martinez A, Seymour C, Nam M. Minute ventilation recovery time: a predictor of extubation outcome. Chest, 2003, 123(4): 1214-1221.
15.	龍小毛, 林輝, 李香偉. 16例心血管病術后消化道出血病因分析. 心肺血管病雜志, 2008, 27(5): 295-296.
16.	石進, 李雅君, 吳素萍. 腸溶阿司匹林與冠心病患者結腸出血:31例臨床分析. 胃腸病學, 2008, 13(4): 244-245.
17.	Mead J, Folk F. Gastrointestinal bleeding after cardiac surgery. N Engl J Med, 1969, 281(14): 799.
18.	中華醫學雜志編委會. 應激性潰瘍防治建議. 現代實用醫學, 2003, 15(4): 260-261.
19.	S?reide K1, Thorsen K, S?reide JA. Strategies to improve the outcome of emergency surgery for perforated peptic ulce. Br J Surg, 2014, 101(1): e51-e64.
20.	周曄, 王建華, 劉冰, 等. 泮托拉唑對體外循環手術患者胃內酸堿度的影響. 心肺血管病雜志, 2010, 29(3): 197-199.
21.	施學進, 沈翠華, 曹坤躍. 老年腦卒中患者醫院內獲得性肺炎及其相關獨立危險因素的分析. 心肺血管病雜志, 2003, 22(1): 33-35.
22.	董力, 石應康, 劉家珍, 等. 體外循環心內直視術后上消化道大出血的處理. 中國胸心血管外科臨床雜志, 1996, 2(4): 229-230.
23.	Chen CH, Lin HC, Lin HL, et al. Proton pump inhibitor usage and the associated risk of pneumonia in patients with chron- ic kidney disease. J Microbiol Immunol Infect, 2015, 48(4): 390-396.
24.	Lazarus B, Chen Y, Wilson FP, et al. Proton pump inhibitor use and the risk of chronic kidney disease. JAMA Intern Med, 2016, 176(2): 238-246.
25.	Xie Y, Bowe B, Li T, et al. Proton pump inhibitors and risk of incident CKD and progression to ESRD. J Am Soc Nephrol, 2016, 27(10): 3153-3163.
26.	Peng Y L, Luo J C. The benefits and risks of proton pump inhibitor therapy. J Chin Med Assoc, 2016, 79(1): 1-2.
27.	Levenstein S, Rosenstock S, J acobsen RK, et al. Psychological stress increases risk for peptic ulcer, regardless of Helicobacter pylori infection or use of nonsteroidal anti-inflammatory drugs. Clin Gastroenterol Hepatol, 2015, 13(3): 498-506.
28.	陳新貴, 許勛良, 段禮興, 等. 生長抑素及凝血酶在上消化道潰瘍出血治療中的應用及安全性分析. 中國普通外科雜志, 2016, 25(2): 307-310.
29.	Cook DJ, Reeve BK, Guyatt GH, et al. Stress ulcer prophylaxis in critically ill patients. JAMA, 1996, 275(4): 308-314.
30.	Kuipers EJ, Thijs JC, Festen HP. The prevalence of helicobacter pylori in peptic ulcer disease. Aliment Pharmacol Ther, 1995, 9(Suppl2): 59-69.
31.	Halm U, Halm F, Thein D, et al. Helicobacter pylori infection:A risk factor for upper gastrointestinal bleeding after cardiac surgery? Crit Care Med, 2000, 28(1): 110-113.
32.	郭靜賢, 景富春, 賀繼東, 等. 急性上消化道出血患者幽門螺桿菌感染分析. 中國公共衛生, 2010, 26(9): 1180-1181.
33.	Shiba M, Higuchi K, Kadouchi K, et al. Risk factors for bleeding after endoscopic mucosal resection. World J Gastroenterol, 2005, 11(46): 7335-7339.
34.	Andersson B, Nilsson J, Brandt J, et al. Gastrointestinal complications after cardiac surgery. Br J Surg, 2005r, 92(3): 326-333.
35.	DiSesa VJ. Gastrointestinal bleeding after cardiac surgery: Does describing the disease prescribe the cure? J Thorac Cardiovasc Surg, 2017, 154(1): 189.

1. Krawiec F, Maitland A, Duan Q, et al. Duodenal ulcers are a major cause of gastrointestinal bleeding after cardiac surgery. J Thorac Cardiovasc Surg, 2017, 154(1): 181-188.
2. Bolcal C, Iyem H, Sargin M, et al. Gastrointestinal complications after cardiopulmonary bypass: sixteen years of experience. Can J Gastroenterol, 2005, 19(10): 613-7.
3. Geissler HJ, Fischer UM, Grunert S, et al. Incidence and outcome of gastrointestinal complications after cardiopulmonary bypass. Interact Cardiovasc Thorac Surg, 2006, 5(3): 239-42.
4. Hanks JB, Curtis SE, Hanks BB, et al. Gastrointestinal complications after cardiopulmonary bypass. Surgery, 1982, 92(2): 394-400.
5. Heikkinen LO, Ala-Kulju KV. Abdominal complications following cardiopulmonary bypass in open-heart surgery. Scand J Thorac Cardiovasc Surg, 1987, 21(1): 1-7.
6. Hashemzadeh K, Hashemzadeh S. Predictors and outcome of gastrointestinal complications after cardiac surgery. Minerva Chir, 2012, 67(4): 327-335.
7. Lebovics E, Lee SS, Dworkin BM, et al. Upper gastrointestinal bleeding following open heart surgery. Dig Dis Sci, 1991, 36(6): 757-760.
8. Sicsic JC, Duranteau J, Corbineau H, et al. Gastric mucosal oxygen delivery decreases during cardiopulmonary bypass despite constant systemic oxygen delivery. Anesth Analg, 1998, 86(3): 455-460.
9. Cassina T, Santambrogio L. Microcirculation after cardiopulmonary bypass: a glance at the mesenteric mucosa. Minerva Anestesiol, 2012, 78(3): 288-290.
10. Jungwirth B, Eckel B, Blobner M, et al. The impact of cardiopulmonary bypass on systemic interleukin-6 release, cerebral nuclear factor-kappa B expression,and neurocognitive outcome in rats. Anesth Analg, 2010, 110(2): 312-320.
11. Warren OJ, Smith AJ, Alexiou C, et al. The inflammatory response to cardiopulmonary bypass: part 1-mechanisms of pathogenesis. J Cardiothorac Vasc Anesth, 2009, 23(2): 223-231.
12. 黑飛龍, 龍村, 孫桂民, 等. 體外循環心內直視手術中胃腸激素變化. 中華實驗外科雜志, 2003, 20(4): 375.
13. De Backer D, Dubois MJ, Schmartz D, et al. Microcirculatory alterations in cardiac surgery: effects of cardiopulmonary bypass and anesthesia. Ann Thorac Surg, 2009, 88(5): 1396-1403.
14. Martinez A, Seymour C, Nam M. Minute ventilation recovery time: a predictor of extubation outcome. Chest, 2003, 123(4): 1214-1221.
15. 龍小毛, 林輝, 李香偉. 16例心血管病術后消化道出血病因分析. 心肺血管病雜志, 2008, 27(5): 295-296.
16. 石進, 李雅君, 吳素萍. 腸溶阿司匹林與冠心病患者結腸出血:31例臨床分析. 胃腸病學, 2008, 13(4): 244-245.
17. Mead J, Folk F. Gastrointestinal bleeding after cardiac surgery. N Engl J Med, 1969, 281(14): 799.
18. 中華醫學雜志編委會. 應激性潰瘍防治建議. 現代實用醫學, 2003, 15(4): 260-261.
19. S?reide K1, Thorsen K, S?reide JA. Strategies to improve the outcome of emergency surgery for perforated peptic ulce. Br J Surg, 2014, 101(1): e51-e64.
20. 周曄, 王建華, 劉冰, 等. 泮托拉唑對體外循環手術患者胃內酸堿度的影響. 心肺血管病雜志, 2010, 29(3): 197-199.
21. 施學進, 沈翠華, 曹坤躍. 老年腦卒中患者醫院內獲得性肺炎及其相關獨立危險因素的分析. 心肺血管病雜志, 2003, 22(1): 33-35.
22. 董力, 石應康, 劉家珍, 等. 體外循環心內直視術后上消化道大出血的處理. 中國胸心血管外科臨床雜志, 1996, 2(4): 229-230.
23. Chen CH, Lin HC, Lin HL, et al. Proton pump inhibitor usage and the associated risk of pneumonia in patients with chron- ic kidney disease. J Microbiol Immunol Infect, 2015, 48(4): 390-396.
24. Lazarus B, Chen Y, Wilson FP, et al. Proton pump inhibitor use and the risk of chronic kidney disease. JAMA Intern Med, 2016, 176(2): 238-246.
25. Xie Y, Bowe B, Li T, et al. Proton pump inhibitors and risk of incident CKD and progression to ESRD. J Am Soc Nephrol, 2016, 27(10): 3153-3163.
26. Peng Y L, Luo J C. The benefits and risks of proton pump inhibitor therapy. J Chin Med Assoc, 2016, 79(1): 1-2.
27. Levenstein S, Rosenstock S, J acobsen RK, et al. Psychological stress increases risk for peptic ulcer, regardless of Helicobacter pylori infection or use of nonsteroidal anti-inflammatory drugs. Clin Gastroenterol Hepatol, 2015, 13(3): 498-506.
28. 陳新貴, 許勛良, 段禮興, 等. 生長抑素及凝血酶在上消化道潰瘍出血治療中的應用及安全性分析. 中國普通外科雜志, 2016, 25(2): 307-310.
29. Cook DJ, Reeve BK, Guyatt GH, et al. Stress ulcer prophylaxis in critically ill patients. JAMA, 1996, 275(4): 308-314.
30. Kuipers EJ, Thijs JC, Festen HP. The prevalence of helicobacter pylori in peptic ulcer disease. Aliment Pharmacol Ther, 1995, 9(Suppl2): 59-69.
31. Halm U, Halm F, Thein D, et al. Helicobacter pylori infection:A risk factor for upper gastrointestinal bleeding after cardiac surgery? Crit Care Med, 2000, 28(1): 110-113.
32. 郭靜賢, 景富春, 賀繼東, 等. 急性上消化道出血患者幽門螺桿菌感染分析. 中國公共衛生, 2010, 26(9): 1180-1181.
33. Shiba M, Higuchi K, Kadouchi K, et al. Risk factors for bleeding after endoscopic mucosal resection. World J Gastroenterol, 2005, 11(46): 7335-7339.
34. Andersson B, Nilsson J, Brandt J, et al. Gastrointestinal complications after cardiac surgery. Br J Surg, 2005r, 92(3): 326-333.
35. DiSesa VJ. Gastrointestinal bleeding after cardiac surgery: Does describing the disease prescribe the cure? J Thorac Cardiovasc Surg, 2017, 154(1): 189.

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