冠状动脉旁路移植术后低氧血症危险因素研究  

Risk factors and treatment of hypoxemia among patients after coronary artery bypass graft surgery

作　　者：沈立[1] 薛松[1] 汪永义[1] 

机构地区：[1]上海交通大学医学院附属仁济医院心血管外科, 上海市200127

出　　处：《中国心血管病研究》2014年第2期102-106,共5页Chinese Journal of Cardiovascular Research

基　　金：上海市浦东新区卫生局卫生科技资助项目

摘　　要：目的 分析冠状动脉旁路移植术后低氧血症发生的危险因素,探讨其预防和治疗方法.方法 回顾性分析我院198例冠状动脉旁路移植术（CABG）患者,男性140例,女性58例,年龄40～84（66.36±9.29）岁.机械通气（FiO2＞45％）或面罩给氧（氧流量＞6 L/min）,术后PaO2低于[102-（0.33×年龄）]mm Hg者,确诊为低氧血症,对其术前、术中、术后相关因素进行单因素及多因素回归分析.结果 术后低氧64例,低氧发生率32.3％,成功纠正低氧60例,余4例出现多器官功能衰竭死亡,纠治率93.8％.术前、术中、术后单因素分析有统计学意义的因素包括吸烟史、糖尿病病史、术后胸腔积液、术后肺部感染、呼吸机辅助通气时间、血管病变根数、术后24h引流量、RBC输注量、术中液体入量、手术时间、主动脉阻断时间、体外循环时间和术前PaO2.多因素回归分析CABG术后低氧血症的独立危险因素有：术后肺部感染（OR=10.906,95％CI3.082～38.592）、血管病变支数（OR=3.432,95％CI 1.552～7.590）、吸烟史（OR =2.385,95％CI 1.181～4.815）、糖尿病史（OR=2.542,95％CI1.253～5.157）,预测强度依次递减（P＜0.05）.结论 充分认识CABG术后低氧血症的危险因素,合理的围术期处理可有效防治CABG术后低氧.Objective To investigate the risk factors of postoperative hypoxemia in patients undergoing coronary artery bypass grafting surgery and to explore the effective treatments for preventing and treating postopera- tive hypoxemia in patients undergoing CABG. Methods The pre-, intra-, and post-operative materials in 140 males and 58 females patients in a mean age of （66.36±9.29）years who had CABG performed on them in our hos- pital were analyzed retrospectively. Mechanical ventilation （FiO2 over 45%）or mask oxygen supply （over 6 L/min） was administrated following CABG, PaO2 less than [ 102-（0.33xage）]mm Hg was diagnosed as postoperative hy- poxemia. The relative factors of postoperative hypoxemia were tested through descriptive analysis and logistic regres- sion. Results Postoperative hypoxemia occurred in 64 patients （incidence rate 32.3% ）. Sixty of the 64 patients （93.8%） were successfully cured after mechanical ventilation treatment. One way analysis indicated that hypoxemia after CABG was related to smoking history, preoperative diabetes mellitus, pleural effusion after CABG, postopera- tive pulmonary infection, mechanical ventilation time, the number of vessel disease, first 24 h drainage after CABG, red blood cell infusion volume, intraoperative liquid volume, operation time, duration of aortic cross- clamp, duration of cardiopulmonary bypass, preoperative PaO2. Multivariate analysis indicated that postoperative pulmonary infection （OR=10.906, 95% CI 3.082-38.592）, the number of vessel disease （OR=3.432, 95%CI 1.552-7.590）, smoking history（OR=2.385, 95%CI 1.181-4.815） and preoperative diabetes mellitus（OR=2.542, 95%CI 1.253-5.157） were independent risk factors of hypoxemia after CABG（P〈0.05）. Conclusion Proper peri- operative management with increased awareness of risk factors of postoperative hypoxemia may alleviate or avoid the hypoxemia after CABG.

关 键 词：冠状动脉旁路移植术 低氧血症 危险因素 

分 类 号：R654.2[医药卫生—外科学]