ภาวะแทรกซ้อนในผู้ป่วยหลังได้รับการผ่าตัดหัวใจแบบเปิด ระยะ 72 ชั่วโมงแรก และปัจจัยที่ส่งผล : การศึกษาย้อนหลัง 2 ปี

Teepatad Chintapanyakun; Siwaphan  Yutthasaen; Waranya  Phopasert; Kessara  Thikheaw; Suchart  Chaiyaroj

Authors

Teepatad Chintapanyakun Department of Nursing Service, Ramathibodi Hospital, Mahidol University
Siwaphan Yutthasaen Department of Nursing Service, Ramathibodi Hospital, Mahidol University
Waranya Phopasert Department of Nursing Service, Ramathibodi Hospital, Mahidol University
Kessara Thikheaw Department of Nursing Service, Ramathibodi Hospital, Mahidol University
Suchart Chaiyaroj Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University

Keywords:

open-heart surgery, post-cardiac surgery patients, postoperative cardiac complications

Abstract

The purpose of this retrospective cohort study was to explore the relationship and factors influencing postoperative complications among patients undergoing open-heart surgery within the first 72 hours. The sample consisted of 345 patients who had undergone open-heart surgery and were admitted to the intensive care unit (ICU) at Ramathibodi Hospital, Mahidol University, between January 1, 2019, and December 31, 2020. Participants were selected using simple random sampling. Data collection instruments included record forms comprising 1) demographic information, 2) comorbidities, and 3) postoperative complications occurring within the first 72 hours after surgery. Data were analyzed using descriptive statistics, Pearson’s product-moment correlation, and hierarchical multiple regression analysis.

The results revealed that the three most common complications among patients undergoing open-heart surgery within the first 72 hours were cardiac arrhythmias (90.72%), myocardial damage (75.94%), and acute kidney injury (50.14%, respectively. Age, comorbidities, New York Heart Association (NYHA) functional classification, cardiopulmonary bypass (CPB) times, and aortic cross-clamp time were moderately positively correlated with complications within the first 72 hours (r = .492, r = .472, r = .375, r = .413, and r = .357, respectively; p < .05). In contrast, left ventricular ejection fraction (LVEF) was moderately negatively correlated with complications (r = -.350, p < .05). Additionally, age, comorbidities, NYHA classification, LVEF, CPB time, and aortic cross-clamp time significantly predicted postoperative complications within the first 72 hours, accounting for 41.3% of the variance (R² = .413, p < .05).

These findings suggest that critical care nurses providing postoperative care for cardiac surgery patients can develop nursing care plans based on preoperative and intraoperative clinical data to prevent potential early complications following open-heart surgery in the ICU setting.

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