摘要
目的探讨行冠状动脉旁路移植术(coronary artery bypass grafting,CABG)高危冠心病患者院内主要不良事件发生的危险因素。方法560例行CABG高危冠心病患者,院内发生主要不良事件者103例为观察组,未发生主要不良事件者457例为对照组。比较2组一般资料,术前左室射血分数(left ventricular ejection fraction,LVEF),血肌酐水平,欧洲心脏手术风险评分系统(European System for Cardiac Operative Risk Evaluation,EuroSCORE)评分,围术期红细胞输注量及NYHA心功能Ⅲ~Ⅳ级、心律失常、术前90d内发生心肌梗死、冠状动脉病变血管、颈动脉狭窄≥50%、应用正性肌力药物、体外循环(cardiopulmonary bypass,CPB)比率;多因素logistic回归分析高危冠心病患者CABG后发生院内主要不良事件的危险因素。结果观察组术前LVEF[58(52,61)%]低于对照组[59(55,62)%],术前EuroSCORE评分[7(7,8)分]、术前应用正性肌力药物比率(12.61%)、围术期红细胞输注量[6(2,10)u]、CPB比率(42.72%)高于对照组[7(6,8)分、5.03%、2(0,4)u、10.72%](P<0.05);2组年龄,性别比例,吸烟比率,合并糖尿病、高血压、高脂血症、慢性阻塞性肺疾病及心功能NYHAⅢ~Ⅳ级、心律失常、术前90d内发生心肌梗死、左主干病变、多支血管病变、颈动脉狭窄≥50%比率,血肌酐水平比较差异均无统计学意义(P>0.05);多因素logistic回归分析结果显示,CPB(OR=2.577,95%CI:1.340~4.957,P=0.005)、围术期红细胞输注量(OR=1.170,95%CI:1.089~1.257,P<0.001)是高危冠心病患者CABG后发生院内主要不良事件的危险因素,LVEF(OR=0.951,95%CI:0.910~0.994,P=0.026)是其保护因素。结论高危冠心病患者行CABG前调整LVEF,术中尽可能减少CPB应用,围术期减少红细胞输注,可能会降低院内主要不良事件发生率。
Objective To explore the risk factors for in-hospital major adverse events after coronary artery bypass grafting(CABG)in high-risk patients with coronary heart disease.Methods Totally 560 patients with high-risk coronary heart disease receiving CABG were divided into 103 patients with in-hospital major adverse events(observation group)and 457 patients without major adverse events(control group),and were compared the general data,preoperative left ventricular ejection fraction(LVEF),serum creatinine,European System for Cardiac Operative Risk Evaluation(EuroSCORE)score,perioperative red blood cell transfusion,and the percentages of heart function NYHAⅢ-Ⅳ,arrhythmia,myocardial infarction within 90 days before operation,coronary artery disease,carotid stenosis≥50%,application of positive inotropic drugs and cardiopulmonary bypass(CPB).Multivariate logistic regression was used to analyze the risk factors for in-hospital major adverse events.Results The preoperative LVEF was significantly lower in observation group(58(52,61)%)than that in control group(59(55,62)%),and the preoperative EuroSCORE score(7(7,8)),the percentage of preoperative application of positive inotropic drugs(12.61%),perioperative red blood cell transfusion(6(2,10)u)and percentage of CPB(42.72%)were significantly higher than those in control group(7(6,8),5.03%,2(0,4)u,10.72%)(P<0.05).There were no significant differences in the age,sex ratio,smoking rate,complications of diabetes,hypertension,hyperlipidemia,chronic obstructive pulmonary disease,cardiac function NYHAⅢ-Ⅳ,arrhythmia,myocardial infarction within 90 days before operation,left main disease,multivessel disease and carotid stenosis≥50%,as well as serum creatinine level between two groups(P>0.05).Multivariate logistic regression analysis indicated that CPB(OR=2.577,95%CI:1.340-4.957,P=0.005)and perioperative red blood cell transfusion(OR=1.170,95%CI:1.089-1.257,P<0.001)were the risk factors for major adverse events after CABG and preoperative LVEF(OR=0.951,95%CI:0.910-0.994,P=0.026)was the protective factor.Conclusion To adjust preoperative LVEF,minimize the use of CPB and reduce perioperative red blood cell transfusion may reduce the incidence of in-hospital major adverse events after CABG in patients with high-risk coronary heart disease.
作者
张万程
鲁显慧
孙俊杰
胡俊龙
王圣
王顺奎
程兆云
ZHANG Wancheng;LU Xiahui;SUN Junjie;HU Junlong;WANG Sheng;WANG Shunkui;CHENG Zhaoyun(Department of Cardiovascular Surgery,Henan Provincial People’s Hospital,Central China Fuwai Hospital,Central China Fuwai Hospital of Zhengzhou University,Zhengzhou 450003,China)
出处
《中华实用诊断与治疗杂志》
2019年第11期1089-1092,共4页
Journal of Chinese Practical Diagnosis and Therapy
基金
河南省医学科技攻关计划省部共建项目(201601011)
国家临床重点专科项目(2011)
关键词
冠心病
高危
冠状动脉旁路移植术
体外循环
红细胞输注
左室射血分数
coronary heart disease
high risk
coronary artery bypass grafting
cardiopulmonary bypass
blood transfusion
left ventricular ejection fraction
