非吻合口狭窄致冠状动脉旁路移植物慢血流危险因素分析  

The Analysis of Risk of Slow Blood Flow in Coronary Artery Bypass Grafting Caused by Non-anastomotic Stenosis

作　　者：吴建涛[1] 王英 池一凡[1] 牛兆倬[1] 生伟[1] 张文峰[1] 李好友 尹红[1] WU Jian-tao;WANG Ying;CHI Yi-fan;NIU Zhao-zhuo;SHENG Wei;ZHANG Wen-feng;LI Hao-you;Yin Hong(The Affiliated Hospital of Qingdao University of Medicine,Qingdao 266071;Department of Otolaryngology,head and neck surgery,Qingdao City Hospital,Medical College of Qingdao University,Qingdao 266071)

机构地区：[1]青岛大学医学院附属青岛市立医院心脏病中心,青岛266071 [2]青岛大学医学院附属青岛市立医院耳鼻喉头颈外科,青岛266071

出　　处：《微循环学杂志》2019年第3期26-30,38,共6页Chinese Journal of Microcirculation

摘　　要：目的:探讨非吻合口狭窄致冠状动脉旁路移植物血流减慢的危险因素。方法:选取2008-06-2018-06本院心血管外科行冠状动脉旁路移植手术(CABG)患者病历资料,90例CABG术后经瞬时血流仪测定移植物血流减慢(移植物静脉桥<15ml/min或动脉桥<10ml/min)患者为慢血流组,130例移植物血流量正常患者为对照组,对比分析两组患者围手术期资料各变量差异。结果:单因素方差分析显示两组患者年龄、使用乳内动脉材料、复合手术、心功能Ⅲ-Ⅳ级、测流量时平均动脉压、术前等待时间、不稳定性心绞痛、术前心包积液及低氧血症等因素差异无统计学意义(P>0.05);两组男性、饮酒、心肌梗死时间(AMI)<7天、高血压、糖尿病、高尿酸血症(HUA)、高脂血症、C反应蛋白(CRP)、体重指数(BMI)>28kg/m^2、肾功能不全、红细胞分布宽度(RDW)、血小板计数(PLT)>200×10^9/L、血红蛋白(HGB)>120g/L、脑血管病史、移植物内径等指标差异有统计学意义(P<0.05);Logistic回归分析结果显示吸烟史、AMI<7天、HUA、高脂血症、糖尿病、CRP、RDW、PLT>200×10^9/L、HGB>120g/L、肾功能不全、BMI>28kg/m^2、脑血管病史为冠状动脉移植物慢血流高危因素(P<0.05)。结论:吸烟史、CRP、BMI>28kg/m2及肾脏损伤等因素是冠状动脉移植物慢血流的危险因素。Objective:To investigate the risk factors of coronary artery bypass graft slow blood flow caused by non-anastomotic stenosis.Method:The medical records of patients undergoing coronary artery bypass grafting(CABG)from June 2008 to June 2018 were analyzed.90 patients with slow blood flow(vein bridge<15ml/min or arterial bridge<10ml/min)were selected as slow flow group and 130 patients with normal graft flow were selected as control group.Patients’perioperative data between the two groups was analyzed.Results:Single factor analysis of variance shows that there was no significant difference in age,material use mammary artery,combined operation,cardiac functionⅢ-Ⅳ,mean arterial pressure at flow rate,waiting time for operation,unstable angina,preoperative pericardial effusion and hypoxemia between the two groups(P>0.05),but there was significant difference in the duration of myocardial infarction was less than 7 days,diabetes,hyperuricemia,hyperlipidemia,CRP,BMI>28kg/m^2,complicated with renal injury,cerebrovascular disease and graft diameter between the two groups(P<0.05).The results of logistic regression analysis showed that the smoking was less than 7 days,hyperuricemia,hyperlipidemia,diabetes,CRP,RDW,PLT>200×10^ 9/L,HGB>120g/L,renal insufficiency,BMI>28kg/m^2 and cerbrovascular disease were high risk factors of coronary artery bypass graft slow blood flow(P<0.05).Conclusion:Smoking history,CRP,BMI>28kg/m^2 and renal injury are risk factors for slow blood flow of coronary artery graft.

关 键 词：冠状动脉旁路移植术 移植物 慢血流 危险因素 LOGISTIC回归分析 

分 类 号：R541.4[医药卫生—心血管疾病]