| 1650例男性患者冠状动脉旁路移植术围术期临床回顾性研究 |
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| 引用本文： | 金沐,李书闻,程卫平,卢家凯. 1650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, 0(5): 660-665 |
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| 作者姓名： | 金沐 李书闻 程卫平 卢家凯 |
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| 作者单位： | 首都医科大学附属北京安贞医院麻醉科北京市心肺血管疾病研究所,北京100029 |
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| 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.
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| 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 |
Analysis of coronary artery bypass grafting in 1650 male patients undergoing coronary artery bypass grafting |
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| 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, 0(5): 660-665 |
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| Authors: | JIN Mu LI Shuwen CHENG Weiping LU Jiakai |
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| Affiliation: | (Department of Anesthesiology, Beifing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Belting 100029, China) |
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| 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. |
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| Keywords: | coronary artery bypass, grafting continuous renal replacement treatment intra-aortic ballon pump mortality risk factors |
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