27例冠状动脉旁路移植术死亡病例临床分析  

Clinical analysis of 27 death cases undergoing isolated coronary artery bypass grafting

作　　者：贾名辉 张蔚然[2] 张杨杨[2] 朱晓波[3] 徐骁晗[2] 魏磊[2] 王晓伟[2] 邵永丰[2] 

机构地区：[1]南京市中医院急诊科,南京210001 [2]南京医科大学第一附属医院心胸外科,南京210029 [3]南京医科大学第一临床医学院,南京211100

出　　处：《外科研究与新技术》2014年第2期104-107,共4页Surgical Research and New Technique

基　　金：中华医学会胸心血管外科分会厄尔巴肯科研奖学金(2012)

摘　　要：目的探讨冠状动脉旁路移植术(coronary artery bypass grafting,CABG)院内死亡病例相关危险因素。方法回顾性分析27例单纯CABG死亡病例临床资料,应用中国冠状动脉旁路移植手术风险评估系统(Sino systemfor coronary operative risk evaluation,SinoSCORE)进行手术风险评估,对致死原因、死亡时间、临床危险因素等进行统计学分析。结果 1146例CABG死亡27例死亡率2.36%,其中SinoSCORE评估低危6例,中危5例,高危16例。术中死亡3例,手术48 h内死亡5例,手术48 h后死亡19例。手术48 h内死亡原因为循环衰竭,手术48 h后死亡原因为肺功能衰竭、肾功能衰竭等引起的多脏器功能衰竭。高龄女性死亡患者多因肺部感染引起肺功能衰竭。结论SinoSCORE手术风险评估对手术结果有预测作用,心、肺、肾功能衰竭是主要死亡原因。CABG围手术期应根据患者的特点行个性化治疗,采取积极有效的预防和治疗措施。Objective To explore the risk factors correlated with post CABG(coronary artery bypass grafting)inpatient mortality cases. Methods Data obtained from 27 clinical cases was first evaluated using SinoSCORE to justify surgical risks and then was analyzed with retrospective methodology.Statistical analysis was employed to analyze fatal complication,death time,and clinical risk factors. Results SinoSCORE evaluation showed that 6 cases were categorized as low risk level,while 5 were within moderate level,and 16 cases at a high risk level. Among 1146 cases,the mortality rate was 2.36%. Additionally,3 cases occurred during the surgery,5 cases occurred within 48 h after the surgery(caused by circulatory failure),and 19 cases occurred after 48 h of the surgery(caused by multiple organ failure due to functional failure in lung and renal). The main reason in elder women death cases was due to lung function failure caused by pulmonary infection. Conclusion The SinoSCORE evaluation system provided indicated a predictive effect for the surgical results.The main reason of deaths was caused by the functional failure of heart,lung and renal. Patient based precaution should be awared during the CABG perioperative period in order to provide individualized treatment.

关 键 词：冠状动脉旁路移植术 死亡 危险因素 

分 类 号：R654.2[医药卫生—外科学]