单中心2831例非体外循环冠状动脉旁路移植术生存分析：12年随访结果  

Results and predictors of long-term outcomes of off-pump coronary artery bypass grafting： 2831 cases from a single center

作　　者：刘曦[1] 陈彧[1] 赵舟[1] 董穗欣[1] 刘刚[1] 陈生龙[1] 凌云鹏[1] 李辉[1] 廉波[1] 鲍黎明[1] 杨威[1] 

机构地区：[1]北京大学人民医院心脏外科,100044

出　　处：《中华外科杂志》2015年第6期436-441,共6页Chinese Journal of Surgery

摘　　要：目的 探讨非体外循环冠状动脉旁路移植术（CABG）治疗冠心病的预后及影响预后的相关危险因素.方法 回顾性分析2001年1月至2012年12月在北京大学人民医院接受非体外循环CABG的患者共2 831例.其中男性2 099例,女性732例,平均年龄（63±9）岁.采用二元Logistic回归分析筛选出影响围手术期死亡的危险因素.对患者进行长期随访,使用Kaplan-Meier法绘制生存曲线,采用单因素Log-rank检验和Cox回归模型得出影响长期预后的危险因素.结果 2 831例患者接受非体外循环CABG,院内死亡45例,术后顺利出院2 786例.二元Logistic回归分析表明,性别（女）（x2 =4.4,OR =2.307,P =0.035）、周围血管疾病（x2 =17.4,OR=6.616,P=0.000）、心功能[纽约心脏病协会（NYHA分级）]≥Ⅲ级（x2=10.5,OR=3.491,P=0.001）、射血分数≤40％（x2=16.9,OR =5.230,P =0.000）、急诊手术（x2=11.9,OR=5.127,P=0.001）是围手术期死亡的危险因素.对患者进行0 ～ 149个月的随访,平均随访时间（74±44）个月,失访107例,109例患者在随访期内死亡.术后1、3、5、8、10年的累积生存率分别为97.2％、95.5％、94.3％、93.6％、92.1％.单因素分析结果表明,年龄、高血压、肾功能不全、周围血管疾病、既往心肌梗死、心功能（NYHA分级）≥Ⅲ级、射血分数≤40％、急诊手术是影响患者远期生存率的危险因素（x2=8.150～88.241,P＜0.05）.进一步Cox回归分析结果表明：年龄（＞65岁）（x2=12.1,RR=2.295,P=0.000）、肾功能不全（x2 =12.3,RR =3.160,P =0.000）、周围血管疾病（x2=42.5,RR=5.626,P=0.000）、心功能（NYHA分级）≥Ⅲ级（x2=9.1,RR=1.994,P=0.002）、急诊手术（x2=5.5,RR=2.247,P=0.019）是影响患者远期预后的独立危险因素.结论 非体外循环CABG可以获得良好的治疗效果及远期生存率.性别（女）、周围血管疾病、心功能（NYHA分级）≥Ⅲ级、射血分数≤40％及急诊手术是围手术期死亡的危�Objective To describe the long-term survival of off-pump coronary artery bypass grafting （CABG） and to analysis the risk factors of operative mortality and long-term survival.Methods From January 2001 to December 2012,2 831 patients undergoing off-pump CABG in Peking University People＆#39;s Hospital,2 099 cases （74.1%） of them were male,the average age was （63 ±9） years.The perioperative data was retrospectively collected.Binary Logistic regression was used to find the risk factors which affect the operative mortality.Follow-up evaluation was completed regularly.Kaplan-Meier survival curve,Log-rank test and Cox regression model were used to find out factors which affect the long-term result.Results Totally 2 831 patients underwent isolating off-pump CABG,in whom 45 patients died perioperative,2 786 patients discharged successfully.Binary Logistic regression showed that sex （female） （x2 =4.4,OR =2.307,P =0.035）,peripheral vascular disease （x2 =17.4,OR =6.616,P =0.000）,New York Heart Association （NYHA） class grade ≥ 3 （x2 =10.5,OR =3.491,P =0.001）,ejection fraction ≤40% （x2 =16.9,OR =5.230,P =0.000）,emergency surgery （x2 =11.9,OR =5.127,P =0.001） are risk factors of operative mortality.The follow-up time was （74 ± 44） months.Totally 107 patients were lost from follow-up,109 patients died in follow-up.The survival rate at 1,3,5,8 and 10 years was 97.2%,95.5%,94.3%,93.6%,92.1%,respectively.Univariate analysis showed that age （〉 65 years）,hypertension,renal insufficiency,peripheral vascular disease,history of myocardial infarction,NYHA class grade ≥ 3 and emergency surgery were risk factors of the long-term survival （x2 =8.150 to 88.241,P 〈 0.05）.Cox regression analysis showed that age （〉 65 years） （x2 =12.1,RR =2.295,P =0.000）,renal insufficiency （x2 =12.3,RR =3.160,P =0.000）,peripheral vascular disease （x2=42.5,RR=5.626,P=0.000）,NYHA class grade≥3 （x2 =9.1,RR=1.994,P=0.002） and emergency surgery （x2 =5.5,RR =2.247,P =0.019）

关 键 词：冠状动脉旁路移植术 非体外循环 存活率分析 预后 

分 类 号：R654.2[医药卫生—外科学]