OPCAB患者合并颈动脉狭窄临床危险因素与预后的相关性研究  

Risk factors and prognosis for carotid artery stenosis in patients undergoing off-pump coronary artery bypass grafting

作　　者：王成蒙 王赞鑫[1] 魏民新[1] 

机构地区：[1]天津医科大学总医院心血管外科,300052

出　　处：《天津医药》2016年第6期720-724,共5页Tianjin Medical Journal

基　　金：天津市科技计划项目(14ZCZDSY00023);天津市卫生局科技基金(2013KZ122)

摘　　要：目的研究行非体外循环冠状动脉旁路移植术（OPCAB）患者合并颈动脉狭窄（CAS）的危险因素及对预后的影响.方法回顾性分析2013 年6 月-2015 年6 月择期行OPCAB 治疗的342 例患者的临床资料,依据术前颈动脉超声结果分为CAS 组71 例（单侧或双侧狭窄≥50%）及对照组271 例（狭窄〈50%或无狭窄）,比较2 组基本资料,行多因素Logistic 回归分析CAS 的危险因素.比较2 组术中及术后情况,对术后死亡患者进行危险因素分析.结果2 组患者年龄、吸烟史、高血压病、慢性阻塞性肺疾病（COPD）差异有统计学意义（P〈0.05）.Logistic 回归显示,高龄（OR=1.050,95%CI 1.014-1.086,P〈0.01）、高血压病（OR=2.566,95%CI 1.299-5.071,P〈0.01）、COPD（OR=7.573,95%CI 1.106-51.834,P〈0.05）是OPCAB 合并CAS 的危险因素.有CAS（OR=4.530,95%CI 1.361-15.078,P〈0.05）及经皮冠状动脉介入治疗史（OR=7.685,95%CI 2.289-25.800,P〈0.01）是OPCAB 术后患者死亡的危险因素.结论高龄、高血压病、COPD 是OPCAB 术患者合并CAS 的危险因素,CAS 患者行OPCAB 术后死亡风险较高.Objective To analyze the risk factors and prognosis of carotid artery stenosis (CAS) in patients who under?went off-pump coronary artery bypass grafting (OPCAB). Methods A total of 342 patients scheduled for OPCAB between June 2013 and June 2015 were included in this study. According to results of preoperative duplex ultrasound examination of carotid arteries, patients were divided into CAS group (≥50%stenosis) and control group (<50%stenosis or no stenosis). The risk factors of CAS, death rate and the postoperative complications were compared between two groups. Results There were significant differences in age, smoking history, hypertension and chronic obstructive pulmonary disease (COPD) between two groups (P<0.05). Multivariate logistic regression analysis showed that advanced age (OR=1.050, 95%CI:1.014-1.086, P<0.01), hypertension (OR=2.566, 95%CI:1.299-5.071, P < 0.01) and COPD (OR=7.573, 95%CI:1.106-51.834, P < 0.05) were independent risk factors for CAS in OPCAB surgery. CAS (OR=4.530, 95%CI:1.361-15.078, P<0.05) and the history of percutaneous coronary intervention (OR=7.685, 95%CI:2.289-25.800, P<0.01) were independent risk factors for postop?erative death. Conclusion Risk factors for CAS in patients undergoing OPCAB include advanced age, hypertension and COPD. There is higher risk of death in CAS patients with OPCAB.

关 键 词：冠状动脉旁路移植术 非体外循环 危险因素 颈动脉狭窄 手术后并发症 

分 类 号：R654.2[医药卫生—外科学]