影响冠状动脉旁路移植术手术死亡的危险因素分析  

Risk Factors for Mortality in Coronary Artery Bypass Grafting:Analysis of the Database from a Single Center of China

作　　者：高华炜[1] 郑哲[1] 胡盛寿[1] 周游[1] 

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卫生部心血管疾病再生医学重点实验室心外科,北京100037

出　　处：《中国胸心血管外科临床杂志》2007年第5期321-325,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：国家科技支撑计划资助项目~~

摘　　要：目的探讨影响我国冠状动脉旁路移植术(coronary artery bypass grafting,CABG)手术死亡的危险因素。方法选择北京阜外心血管病医院2002年1月1日至2003年12月31日(以手术日期为准)行CABG的冠心病患者2251例,确定潜在危险因素后,根据潜在危险因素从其临床资料中收集数据,对影响手术死亡的潜在危险因素进行单因素分析和logistic多因素回归分析,最终确立影响我国CABG手术死亡的危险因素,并对分析结果的校准度和分辨能力进行检验。结果全组手术死亡率为1.87%(42/2251),手术时年龄60.3±9.3岁,女性436例(19.4%)。logistic多因素回归分析结果:心源性休克、心律失常、左主干病变>50%、左心室射血分数(LVEF)、二尖瓣反流、肺动脉瓣反流、术前最后一次肌酐值、手术状态(非择期手术)、合并主动脉瘤手术等9个因素是本组CABG手术死亡的独立危险因素。受试者工作特征(Receiver-Operating Characteristic,ROC)曲线检验结果:曲线下面积为0.842。结论通过logistic多因素回归分析得出,心源性休克、心律失常、左主干病变>50%、LVEF、二尖瓣反流、肺动脉瓣反流、术前最后一次肌酐值、手术状态(非择期手术)、合并主动脉瘤手术等9个影响我国患者CABG手术死亡的危险因素。分析结果具有良好的校准度和分辨能力。Objective To assess the risk factors for mortality in coronary artery bypass grafting （CABG）, to supply consultation for medical decision and help for medical monitoring accordingly. Methods The clinical material was from the Fu Wai Heart Hospital. 2 251 cases which had CABG from January 1, 2002 to December 31, 2003 （the operation date） were reviewed. First of all the potential risk variables were identified through literature reviewing and referring other risk models. Then data collection proceeded according to the potential risk factors. Univariate analysis and logistic regression were used to analyse the potential risk factors. Risk factors for mortality were confirmed at last. The calibration and discrimination of the result were tested. Results Coronary operative mortality was 1.87% （42/2 251）. Age was 60.3±9.3 years and 19.4% （436/2 251） were female. Nine variables： cardiogenic shock, arrhythmias, left main disease 〉 50%, left ventricular ejection fraction （LVEF）, mitral regurgitation, pulmonary regurgitation, the lasl preoperative value of serum creatinine, operative slatus and aortic aneurysm surgery were independently correlated with CABG operative mortality. The results of discrimination assessing by area under receiver-operating characteristic （ROC） curve was 0. 842. Conclusion The following risk factors are associated with increased operative mortality ： cardiogenic shock, arrhythmias, left main disease 〉 50 %, LVEF, mitral regurgitation, pulmonary regurgitation, the last preoperative value of serum creatinine, operative status and aortic aneurysm surgery. The result performs well.

关 键 词：冠状动脉旁路移植术 手术死亡 危险因素 

分 类 号：R654.2[医药卫生—外科学]