冠状动脉旁路移植术后低心排血量综合征的危险因素分析与防治  

ANALYSIS AND TREATMENT OF THE RISK FACTORS OF LOW CARDIAC OUTPUT SYNDROME AFTER CORONARY ARTERY BYPASS GRAFTING

作　　者：李淑珍[1] 朱宪明[1] 刘志平[1] 张玉龙[1] 赵龙[1] 王坚[1] 

机构地区：[1]内蒙古医学院附属医院心胸外科,内蒙古呼和浩特010050

出　　处：《内蒙古医学院学报》2009年第5期461-465,共5页Acta Academiae Medicinae Neimongol

基　　金：内蒙古自治区自然科学基金(200607010901)

摘　　要：目的：分析冠状动脉旁路移植（coronary artery bypass grafting,CABG）术后低心排血量综合征（lowcardiac output syndrome,LCOS）发生的危险因素,以预测手术危险性,并探讨主动脉内气囊泵搏（intra-aortic bal-loon pump,IABP）治疗术后LCOS的疗效。方法：选取我院行CABG病例153例,术后发生LCOS 29例,其中药物治疗组11例,IABP治疗组18例,对所有病例中发生LCOS相关危险因素进行多因素logistic回归分析;对药物治疗组和IABP组治疗前后各项心排血指标,及IABP组在球囊反搏前及反搏后2h各项心排血指标进行对照分析。结果：LCOS发生率为19%,与国内外报道（20%-40%）相一致。多单因素分析结果显示,心梗史、心律失常、心功能Ⅲ/Ⅳ级（NYHA分法）、低射血分数（左心功能不全）及合并手术在LCOS组和非LCOS组有明显差异（P〈0.05）,为CABG术后发生LCOS的危险因素。IABP组与药物治疗组比较,IABP组明显改善心排血量,有统计学意义。结论：心梗史、心律失常、心功能Ⅲ/Ⅳ级、低射血分数是LCOS发生的危险因素，IABP是治疗CABG术后严重LCOS最有效、最可靠的治疗方法。Objective：To analyse the risk factors of low cardiac output syndrome（LCOS） after coronary artery bypass grafting （ CABG）, to forecast the risk of the CABG, and to investigate the effect of intra-aortic balloon pump （IABP） in LCOS after CABG. Methods：selected 153 cases of CABG were and among them, the 29 cases of LCOS after CABG were divided into two groups, in Which one was drug treatment group（ 11 cases）, and another was IABP group（ 18 cases ）. The risk factors related to LOCS of all patients were anahsed using multifactor logistic regression analysis, All kinds of cardiac output indices before and after treatment of both drug treatment group and IABP group were contrast analysed. All kinds of cardiac output indices of IABP group before and two hours after treatment of IABP were contrast analtsed. Results：The incidence rate of LCOS was 19% in accordance with the reports（20% -40% ） all the world. The results of muhifactor logistic regression analysis indicated that myocardial infarction history, arrhythmia, heart function Ⅲ/Ⅳ grade, low ejection fraction and concomitant others operation between low cardiac output group and non - low cardiac output group possessed significant difference （ P 〈 0.05 ） , which were risk factors of LCOS after CABG. To compare IABP group and drug treatment group, cardiac output could be raised significantly in IABP group, which possessed statistical significance. Conclusion： Myocardial infarction history, arrhythmia, heart function Ⅲ/Ⅳ grade, low ejection fraction and concomitant others operation were risk factors of LCOS. IABP was a kind of the most effective and safe treatment for LCOS after CABG.

关 键 词：冠状动脉旁路移植术 低心排血量综合征 危险因素 主动脉内气囊泵 

分 类 号：R654.2[医药卫生—外科学]