摘要
目的分析65岁以上心脏瓣膜手术联合冠状动脉旁路移植术（CABG）患者院内死亡的危险因素。方法回顾性分析2002年2月至2014年9月540例同期行心脏瓣膜手术和CABG患者的临床资料，并进行单因素和多因素logistic分析。结果全组患者院内病死率4．26％。单因素分析提示慢性阻塞性肺疾病（COPD）（P=0．001）、术前最近一次肌酐水平（P=0．043）、不稳定心绞痛（P=0．046）、心绞痛Ⅲ～Ⅳ级（P=0．005）、冠状动脉病变支数（P=0．043）、体外循环时间延长（P=0．003）、术后并发症（P=0．000）是院内死亡的相关危险因素。多因素logistic分析表明COPD（P=0．005，OR=5．598）、体外循环时间延长（P〈0．001，OR=1．011）、二次手术（P〈0．001，OR=15．813）、并发恶性心律失常（P=0．014，OR=4．900）是院内死亡的独立危险因素。结论COPD、体外循环时间延长、二次手术、并发恶性心律失常是导致65岁以上心脏瓣膜手术联合CABG患者院内死亡的独立危险因素。
Objective To analyze the risk factors for in-hospital mortality in patients aged over 65 years undergoing heart valve surgery combined with coronary artery bypass grafting（CABG）. Methods Between February 2002 and September 2014, 540 patients aged over 65 years undergoing heart valve surgery combined with CABG in our institute were retrospectively studied. Univariate analyses and multivariate logistic regression analyses were performed to explore risk factors associated with in-hospital mortality. Results Overall in-hospital mortality was 4.26%. Univariate analysis depicted that chronic obstructive pulmonary disease （COPD） （ P = 0. 001 ）, last serum creatinine （ P = 0. 043 ）, unstable angina （ P = 0. 046 ）, Canadian Cardio- vascular Society Ⅲ - Ⅳ （ P = 0. 005 ） , number of diseased coronary vessels（ P = 0. 043 ） , cardiopulmonary bypass time-delayed （ P = 0. 003 ）, post-operative morbidity（ P = 0. 000 ） had a significant impact on in-hospital mortality. Multivariate logistic re- gression analysis revealed that COPD （ P = O. 005, OR = 5. 598）, CPB time-delayed （ P 〈 0. 001, OR = 1. 011 ）, re-exploration （P 〈 0. 001, OR = 15.813 ） , malignant arrhythmia （P = 0. 014, OR = 4. 900 ） were independent risk factors of in-hospital mortality. Conclusion The present research demonstrates that COPD, CPB time-delayed, re-exploration and malignant ar- rhythmia dramatically impacted the in-hospital mortality of patients aged over 65 years undergoing combined heart valve surgery and CABG.
出处
《中华胸心血管外科杂志》
CSCD
2016年第3期151-154,共4页
Chinese Journal of Thoracic and Cardiovascular Surgery
关键词
心脏瓣膜病
冠状动脉旁路移植术
老年
危险因素
院内死亡
Heart valve disease Coronary artery bypass grafting Aged Risk factors Hospital mortality
