冠状动脉旁路移植术后老年患者早期肺部并发症危险因素分析  

Risk Factors of Postoperative Early Pulmonary Complications in Elderly Coronary Heart Disease Patients Undergoing Coronary Artery Bypass Grafting

作　　者：唐桂春[1] 徐文红[1] 武智慧[1] 周红[1] 赵颜珍[1] 

机构地区：[1]解放军总医院心血管外科监护室,北京100853

出　　处：《现代生物医学进展》2016年第9期1727-1730,共4页Progress in Modern Biomedicine

基　　金：卫生部医药卫生科技发展项目(W2013GJ09)

摘　　要：目的:探讨老年冠心病(CHD)患者冠状动脉旁路移植术(CABG)后早期肺部并发症危险因素。方法:收集296例在我院接受CABG的老年冠心病患者(≥60岁)的临床资料,按照术后早期是否出现肺部并发症将患者分为肺部并发症组和非肺并发症组,比较两组一般临床资料及相关围术期指标的差异,利用Logistic回归分析探讨影响早期术后肺部并发症的危险因素。结果:296例CABG手术患者中有52例出现肺部并发症(发生率17.6%);两组在年龄、吸烟、体质量指数(BMI)、术前心功能分级、术前左室射血分数(LEVF)、三支病变、左主干病变、体外循环、体外循环时间、主动脉阻断时间、手术时间、术后24 h输红细胞(RBC)量、术后24 h胸腔引流量、术后24 h平均血糖存在统计学差异(P<0.05);年龄(OR=1.137)、BMI(OR=1.636)、术前LEVF(OR=1.733)、左主干病变(OR=1.532)、体外循环(OR=2.134)、术后24 h输RBC量(OR=1.243)、术后24 h平均血糖水平(OR=1.335)是影响术后肺部并发症发生的危险因素(P<0.05)。结论:老年冠心病患者CABG术后早期肺部并发症受到多种因素影响,临床中应当重视此类高危因素,以制定相关干预措施降低肺部并发症的发生率。Objective： To explore the risk factors of postoperative early pulmonary complications in elderly coronary heart disease（CHD） patients undergoing coronary artery bypass grafting（CABG）. Methods： The data of 296 elderly CHD patients（≥60 years） who got CABG in our hospital from January 2013 to May 2015 were collected retrospectively in this study. All patients were divided into pulmonary complication group and non-pulmonary complication group according to the postoperative early postoperative pulmonary complication. The general clinical data and perioperative indicators were compared between two groups. Logistic regression analysis was used to study the risk factors for postoperative early pulmonary complications. Results： Among the 296 cases, pulmonary complications occurred in 52 cases（17.6%）. Single factor analysis showed that there were statistical differences in age, smoking, body mass index（BMI）, preoperative heart function classification, preoperative LEVF, triple vessel lesions and left main coronary artery lesion, cardiopulmonary bypass（CBP）, CBP time and aortic clamping time, operation time, RBC unite within 24 h after operation, drainage volume within24 h after operation, mean blood glucose level within 24 h after operation between the two groups（P〈0.05）. Multivariable logistic regression analysis finally showed that age（OR=1.137）, BMI（OR=1.636）, preoperative LEVF（OR=1.733）, the left main lesion（OR = 1.532）,extracorporeal circulation（OR=2.134）, RBC unite within 24 h after operation（OR=1.243）, mean blood glucose level within 24 h after operation（OR=1.335） were the risk factors of postoperative early pulmonary complications（P〈0.05）. Conclusion： Postoperative early pulmonary complications in elderly CHD patients after CABG were affected by many factors, and much attention should be paid to the risk factors so as to develop the related intervention measures to reduce the incidence of pulmonary complications.

关 键 词：冠心病 冠状动脉旁路移植术 肺部并发症 

分 类 号：R541.4[医药卫生—心血管疾病]