性别和年龄对中国人冠状动脉旁路移植术后住院病死率的影响  

Impact of gender and age on in-hospital mortality after coronary artery bypass graft

作　　者：宫路佳[1] Elke Lehmkuhl 胡盛寿[1] Friederike Kendel Stein Kandle Yong Du 章晏[1] 杜茗[1] 吴清玉 许建屏[1] 孙立忠[1] 朱晓东[1] Vera Regitz-Zagrosek 

机构地区：[1]中国医学科学院中国协和医科大学心血管病研究所阜外心血管病医院心外科,北京100037 [2]柏林德国心脏中心 [3]德国柏林洪堡大学Charité医学院生理研究所 [4]德国柏林Robert-Koch研究所 [5]清华大学第一附属医院 [6]德国柏林洪堡大学Charité医学院心血管研究中心暨柏林德国心脏中心

出　　处：《中华心血管病杂志》2006年第5期415-421,共7页Chinese Journal of Cardiology

基　　金：科技部社会公益研究资金资助(课题名称:心脑血管及主要恶性肿瘤诊治技术规范化操作规程及评价体系研究;编号:2002DIB40092)

摘　　要：目的确定中国人冠状动脉旁路移植术后住院病死率是否存在性别差异以及该差异是否与年龄相关.方法回顾性分析1997年1月1日至2001年12月31日阜外心血管病医院外科全部接受冠状动脉旁路移植术的患者共2682例（男性2316例,女性366例）.按照性别和年龄分组调查它们之间的围手术期并发症及手术后住院病死率的差异.结果女性术前合并主要疾病的比例比男性高,术后并发症多,但她们术前的左心室射血分数较男性好,且冠状动脉病变数量少.然而,女性患者的术后住院病死率是男性的3倍（女性3.01%,男性1.12%,P=0.001）,病死率的性别差异在低龄组更有统计学意义（女性2.6%,男性0.5%,P=0.001,ORs：4.844,95%可信区间：1.549～15.142）,在老年患者中则无统计学意义（女性3.7%,男性2.4%,P=0.383）.结论中国女性冠状动脉旁路移植术的住院病死率高于男性,特别是低龄女性.低龄组女性是住院病死率的独立危险因素.死亡率的性别差异随年龄增加而减少.需要进一步的研究来阐明病死率的性别差异在低龄组更显著的原因.Objective The purpose of this study was to explore the association of gender and age on in-hospital mortality after coronary artery bypass graft （CABG） among the Chinese population. Methods A total of 2682 patients （male： 2316, female： 366） who underwent CABG surgery were retrospectively investigated between January 1st, 1997 and December 31st, 2001 for perioperative risk factors and inhospital mortality rate after CABG. Results Preoperative comorbidity rate and postoperative complication rate were higher in women than that in men, although left ventricular ejection fraction was higher and the number of diseased vessels fewer in women than in men. The in-hospital mortality rate was three times higher in women than that in men （3.01% vs. 1.12%, P =0. 001 ）, especially in the younger age group （2. 6% vs. O. 5%, P =0. 001, risk-adjusted odds ratio 4. 844, 95% CI： 1. 549-15. 142）. In older patients, there was no notable difference in in-hospital mortality between the genders （3.7% for women vs. 2. 4% for men, P =0. 383）. Conclusions Chinese woman, especially in younger age, had a higher in-hospital mortality rate post CABG than that in men, suggesting that younger female gender is an independent risk factor for inhospital mortality after CABG. Future studies are warranted to clarify the underlying mechanisms.

关 键 词：冠状动脉分流术 性别 年龄 医院死亡率 

分 类 号：R654.2[医药卫生—外科学] R542.22[医药卫生—临床医学]