非体外循环冠状动脉旁路移植术后远期死亡的危险因素分析  

Analysis of risk factors of long-term mortality in patients undergoing off-pump coronary artery bypass

作　　者：武恒朝 王现强 徐海涛 李宝童 孙寒松 WU Heng-chao;WANG Xian-qiang;XU Hai-tao;LI Bao-tong;SUN Han-song(Department of Cardiac Surgery,National Center for Cardiovascular Diseases ami Fuwai Hospital,CAMS and PUMC,Beijing 100037,China)

机构地区：[1]中国医学科学院阜外医院成人心外科一病区,北京市100037

出　　处：《中国心血管病研究》2020年第6期567-569,共3页Chinese Journal of Cardiovascular Research

摘　　要：目的分析非体外循环冠状动脉旁路移植术(OPCAB)后远期死亡的危险因素.方法选取阜外医院2009年10月至2012年9月期间由单一术者施行的单纯OPCAB治疗的595例患者,围手术期的临床资料从阜外医院数据库中提取,远期随访采用电话随访和门诊随访的方式进行.采用单因素和多因素Logistic回归分析与OPCAB远期死亡的相关因素.结果全组患者平均随访时间8年,共有70例患者死亡,远期死亡发生率为11.8%.死亡组与生存组患者在年龄、术前肌酐、高血压、慢性阻塞性肺疾病(COPD)、术前血红蛋白、术前左心室射血分数(LVEF)、围术期输血和外周动脉疾病的差异具有统计学意义(P<0.05).多因素Logistic回归分析结果显示,年龄(OR=1.069,95%CI l.031~1.108,P<0.050)、术前肌酐(OR=1.021,95%CI1.008~1.033,P=0.001)、高血压(OR=2.513,95%CI 1.209~5.221,P=0.014)和COPD(OR=7.140,95%CI2.342~21.768,P=0.001)是OPCAB术后远期死亡的独立危险因素,LVEF(OR=0.948,95%CI 0.920~0.977,P=0.001)是OPCAB术后远期死亡的保护因素,即术前LVEF值越高,远期死亡的风险越低.结论年龄、术前肌酐、高血压、COPD是OPCAB患者远期死亡的独立危险因素,LVEF是保护因素.Objective To analyze the risk factors of long-term mortality in patients undergoing off-pump coronary artery bypass.Methods The data of 595 consecutive patients underwent OPCAB between October 2009 and September 2012 in our hospital were retrospectively analyzed.Long-term follow-up was obtained through phone calls,hospital records and clinical visits.Factors associated with long-term mortality were analyzed by single factor analysis and Logistic regression.Results Over a median of 8.0 years follow-up,a total of 70 patients died(mortality rate was 11.8%).There were significant differences in age,preoperative creatinine,hypertension,chronic obstructive pulmonary disease,preoperative hemoglobin,preoperative left ventricular ejection fraction,perioperative red blood cell transfusion,peripheral arterial disease between death group and nondeath group(all P<0.05).Multivariate hygistic regression analysis indicated that age(OR=1.069,95%CI 1.031-1.108,P<0.05),preoperative creatinine(OR=1.021,95%CI 1.008-1.033,P=0.001),hypertension(OR=2.513,95%CI 1.209-5.221,P=0.014),chronic obstructive pulmonary disease(OR=7.140,95%CI 2.342-21.768,P=0.001)were the risk factors of long-term mortality and the preoperative left ventricular ejection fraction(OR=0.948,95%CI 0.920-0.977,P=0.001)was the protective factor.Conclusion Age,preoperative creatinine,hypertension,chronic obstructive pulmonary disease are risk factors of long-term mortality in patients undergoing OPCAB,preoperative left ventricular ejection fraction is the protective factor.

关 键 词：非体外循环冠状动脉旁路移植术 死亡 危险因素 

分 类 号：R654.2[医药卫生—外科学]