冠状动脉旁路移植术治疗ST段抬高心肌梗死的时机选择及术后死亡危险因素分析  

Timing of coronary artery bypass grafting for ST elevation myocardial infarction and risk factors for postoperative death

作　　者：周朝元[1] 付庆林[1] 牛珊珊[1] 张杰[1] 

机构地区：[1]河南省卫辉市新乡医学院一附院心血管外科,卫辉市453100

出　　处：《广西医学》2016年第2期189-193,共5页Guangxi Medical Journal

基　　金：河南省教育厅项目(2011A320009)

摘　　要：目的探讨冠状动脉旁路移植术（CABG）治疗ST段抬高心肌梗死（STEMI）的最佳手术时机以及术后死亡的危险因素。方法回顾性分析213例行CABG的血流动力学稳定的STEMI患者临床资料，根据心肌梗死发生至手术时间将患者分为A组（心肌梗死后7～14d）60例，B组（心肌梗死后15～21d）72例，C组（心肌梗死后≥22d）81例，比较3组患者临床资料、术中及术后情况、死亡情况等，并采用logistic回归分析对可能影响STEMI患者住院期间CABG术后死亡的因素进行单因素及多因素分析。结果213例患者死亡8例，占3．8％，死因为循环衰竭4例，多器官功能衰竭2例，肾衰竭2例。A组、B组、C组发病距手术时间分别为（10．9±1．9）d、（18．2±2．0）d和（27．3±4．4）d（P〉0．05）。A组、B组、C组的病死率分别为5．0％（3／60）、4．2％（3／72）、2．47％（2／81），组间比较差异无统计学意义（P〉0．05）。女性、左心室射血分数〈0．45、磷酸肌酸激酶（CK）〉750U／L为STEMI患者住院期间CABG术后死亡的独立危险因素（P〈0．05），心肌梗死距离手术时间与术后死亡无关（P〉0．05）。结论血流动力学稳定的STEMI患者心肌梗死发生7d后任何时间段行冠脉旁路移植术都是安全的，女性、左心室射血分数〈0．45、CK〉750U／L可能是影响STEMI患者住院期间CABG术后死亡的风险因素。Objective To explore the optimal timing of coronary artery bypass grafting（CABG） for ST elevation myocardial infarction （STEMI） and the risk factors for postoperative death. Methods The clinical data of 213 hemodynamic stable patients with STEMI undergoing CABG were retrospectively analyzed. According to the time interval between onset of myocardial infarction and the operation, the patients were divided into Group A （ n = 60,7 - 14 days after onset）, Group B （ n = 72,15 - 21 days after onset ） and Group C （ n = 81,≥ 22 days after onset）. The general clinical dada, intraoperative and postoperative condition, and the death were compared among the three groups. And univariate and multivariate logistic regression analyses were performed to identify the potential factors influencing the hospitalized death of patients with STEMI after CABG. Results Of 213 patients, 8 were dead, accounting for 3.8%, and the causes including circulatory failure （n = 4）, multiple organ failure （n = 2） and renal failure （n = 2）. The time intervals between onset and the operation of Group A, Group B and Group C were （10.9 ±1.9）days, （18.2 ± 2.0）days and （27.3 ± 4.4） days respectively. The mortalities of Group A, Group B and Group C were 5.0% （3/60） ,4.2% （3/72） and 2.47% （2/81） respectively,but there was no statistical difference among three groups （P 〉0.05）. Female,left ventricular ejection fraction （LVEF） 〈 0.45 and creatine kinase （CK） 〉 750 U/L were the independent risk factors for the hospitalized death of patients with STEMI after CABG （ P 〈 0.05 ）, and the time interval between onset of myocardial infarction and the operation was not related to the postoperative death （P 〉 0.05）. Conclusion For the hemodynamic stable patients with STEMI, it is safe to perform CABG at any time point after 7 days of the onset of myocardial infarction. And female, LVEF 〈 0.45 and CK 〉 750 U/L might be the risk factors for the hospitalized death of patients wi

关 键 词：5T段抬高心肌梗死 冠状动脉移植术 手术时机 术后 死亡 危险因素 

分 类 号：R654.29[医药卫生—外科学]