1 650例男性患者冠状动脉旁路移植术围术期临床回顾性研究

doi:10.3969/j.issn.1006-7795.2013.05.005

摘要/Abstract

摘要：

目的冠状动脉旁路移植术(coronary artery bypass grafting, CABG)是治疗冠状动脉粥样硬化性心脏病(以下简称冠心病)主要手段之一,主要手术方式包括体外循环下冠状动脉旁路移植术(on-pump CABG, ONCABG)和非体外循环下冠状动脉旁路移植术(off-pump CABG, OPCABG)。本文拟通过回顾性分析1 650例男性患者施行OPCABG和不停跳ONCABG临床资料进行两种手术方式的临床效果分析。方法采用首都医科大学附属北京安贞医院麻醉科2007年至2009年CABG数据库的有关数据。比较OPCABG组和不停跳ONCABG组近期疗效,并分别以术后死亡和术后应用连续性肾脏替代治疗(continuous renal replacement treatment, CRRT)为因变量进行Logistic危险因素回归分析。结果 OPCABG组搭桥时间和总手术时间均小于ONCABG组(P<0.01)。OPCABG组搭桥数大于3的病例明显多于ONCABG组(20.9% vs 13.3%) (P<0.01),应用CRRT(1.33% vs 3.98%)和主动脉内球囊反搏(3.23% vs 6.63%)患者的比例较ONCABG组显著减少(P≤0.01),两组术后院内病死率差异无统计学意义。CABG术后发生院内死亡的独立危险因素为术前左室射血分数(left ventricular ejection fraction, LVEF)<40%(P=0.000,OR=8.321)、年龄>70岁(P=0.003,OR=4.870)和术后应用CRRT(P=0.000,OR=45.500)。术后应用CRRT的独立危险因素为术前高血压病史(P=0.049,OR=2.665)、术前肾功能异常(P=0.045,OR=3.598),OPCABG可以减少2/3的术后CRRT的使用率(P=0.008,OR=0.333)。结论 OPCABG可以降低术后CRRT和IABP的使用率,缩短手术时间。因此在年龄>70岁,术前肾脏功能下降,心功能差等患者施行OPCABG手术对早期恢复是有益的。

关键词: 冠状动脉旁路移植术, 连续性肾脏替代治疗, 主动脉内球囊反搏, 病死率, 危险因素

Abstract:

Objective Coronary artery bypass grafting (CABG) is generally considered the principal therapy for patients with coronary heart disease, which consisted of on-pump CABG (ONCABG) or off-pump CABG (OPCABG). To compare the earlier clinical results between heart-beating on-pump and off-pump CABG in 1 650 male patients.Methods The perioperative data of 1 650 male patients who underwent CABG were investigated based on the perioperative CABG database from 2007 to 2009. The earlier clinical results between heart-beating on-pump and off-pump CABG were compared. The risk factors of postoperative in-hospital mortality and CRRT were also identified by multiple logistic regressions.Results The duration of CABG and total operation of OPCABG group were less than those of ONCABG group(P<0.01).There were more cases of grafts >3 (20.9% vs 13.3%)(P<0.01)and less cases of CRRT(1.33% vs 3.98%)and IABP(3.23% vs 6.63%)in OPCABG group. There was no significant difference in in-hospital mortality between two groups. Multivariate analysis demonstrated that preoperative ejection fraction (EF) less than 40% (P=0.000,OR=8.321), more than 70 years (P=0.003,OR=4.870) and postoperative CRRT (P=0.000,OR=45.500) were the independent risk factors of postoperative in-hospital mortality; preoperative hypertension (P=0.049,OR=2.665), preoperative renal dysfunction(P=0.045,OR=3.598) were the independent risk factors, while the usage rate of continuous renal replacement therapy (CRRT) was reduced by two thirds in male patients undergoing off-pump coronary artery bypass grafting. Conclusion OPCABG was a better alternative to heart-beating ONCABG for patients with age>70 years and/or preoperative poor renal function and/or cardiac dysfunction.

Key words: coronary artery bypass grafting, continuous renal replacement treatment, intra-aortic ballon pump, mortality, risk factors

中图分类号:

金沐, 李书闻, 程卫平, 卢家凯. 1 650例男性患者冠状动脉旁路移植术围术期临床回顾性研究[J]. 首都医科大学学报, 2013, 34(5): 660-665.

JIN Mu, LI Shuwen, CHENG Weiping, LU Jiakai. Analysis of coronary artery bypass grafting in 1650 male patients undergoing coronary artery bypass grafting[J]. Journal of Capital Medical University, 2013, 34(5): 660-665.

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