低射血分数非体外循环冠状动脉旁路移植术患者围术期相关危险因素分析  

Analysis of risk factors in patients with low ejection fraction undergoing off-pump coronary artery bypass surgery

作　　者：董秀华[1] 卢家凯[1] 闫旭明[1] 卿恩明[1] 王义军[1] 任发成[1] 王成彬[1] 王学勇[1] 梁孝平[1] 王慧敏[1] 

机构地区：[1]首都医科大学附属北京安贞医院麻醉科,北京市100029

出　　处：《临床麻醉学杂志》2011年第6期528-531,共4页Journal of Clinical Anesthesiology

摘　　要：目的分析术前合并低射血分数(EF)的非体外循环冠状动脉旁路移植术(OPCABG)患者围术期相关危险因素。方法应用自制OPCABG麻醉数据库,对我院2007年11月至2009年2月2 379例OPCABG患者围术期相关资料进行回顾性分析,以术前EF<40%定义为低EF,将患者分为EF<40%组(n=2 224)与EF≥40%组(n=155)进行单因素分析,再分别以术后死亡、术后透析、术中室颤、术中主动脉内球囊反搏(IABP)以及术中紧急中转心肺转流(CPB)为终点事件,进行单因素与多因素逻辑回归分析。结果术前EF<40%组患者占所有患者的6.5%,经单因素分析,与术前低EF显著相关的危险因素有心肌梗死史、术前室早、房颤、肝功能异常、室壁瘤、合并瓣膜病;经多因素逻辑回归分析,发现术前低EF是术中室颤、IABP以及术后死亡的独立危险因素,但不是术中紧急中转CPB、术后透析的独立危险因素。结论术前合并低EF分别是术中室颤、术中IABP及术后死亡的独立危险因素。Objective To analyse the risk factors in patients with low ejection fraction （EF） undergoing off-pump coronary artery bypass grafting （OPCABG）. Methods Two thousand three hundred and seventy nine patients （from November 2007 to February 2009） undergoing OPCABG were investigated. The patients were divided into two groups according to their preoperative EF values, one group with EF〈40% and another with EF≥40%. The specific risk factors were identified by univariate and multivariate analysis. Results There were totally 155 patients with low EF, the incidence was 6. 5%. Univariate analysis demonstrated that the risk factors were history of myocardial infarction, preoperative ventricular premature, atrial fibrillation, liver dysfunction, aneurysm, combined valvular disease; multivariate analysis demonstrated that preoperative low EF was the independent predictor of postoperative mortality, intraoperative ventricular fibrillation and intraoperative IABP respectively, but not the independent predictor of emergency transit CPB and postoperation dialysis. Conclusion Patients with low EF undergoing OPCABG are the independent predictor of postoperative mortality, intraoperative ventricular fibrillation and intraoperative iABP.

关 键 词：非体外循环冠状动脉旁路移植术 心功能低下 危险因素 

分 类 号：R654.2[医药卫生—外科学]