铁缺乏对冠状动脉旁路移植术患者围手术期预后的影响:倾向性评分匹配对比研究  

Impact of iron deficiency on perioperative outcomes in patients undergoing coronary artery bypass grafting:A propensity score matching comparative study

作　　者：周任 施盛[1] 王利民[1] 沈锋 庄瑜[1] 虞敏[1] ZHOU Ren;SHI Sheng;WANG Limin;SHEN Feng;ZHUANG Yu;YU Min(Department of Cardiac and Macrovascular Surgery,Shanghai General Hospital,Shanghai Jiao Tong University,Shanghai 200080,China)

机构地区：[1]上海交通大学附属第一人民医院心脏及大血管外科,上海200080

出　　处：《临床与病理杂志》2021年第8期1776-1781,共6页Journal of Clinical and Pathological Research

基　　金：国家自然科学基金(81300094)。

摘　　要：目的:铁缺乏对心脏手术围手术期结果的影响存在争议,利用倾向性评分匹配(propensity score matching,PSM)探索铁缺乏对冠状动脉旁路移植术(coronary artery bypass grafting,CABG)围手术期的影响。方法:纳入2015年1月至2017年12月于上海交通大学附属第一人民医院心脏及大血管外科行CABG的284例患者,根据血清铁蛋白及转铁饱和度水平,分为铁缺乏组与铁充盈组,收集围手术期资料,利用PSM调整风险,分析围手术期病死率、主要心脑血管不良事件发生率及相关并发症发生率。结果:共68例患者合并铁缺乏(23.9%),铁缺乏组术前血红蛋白水平比铁充盈组显著低下(P<0.05),年龄更大(P<0.05),女性更多(P<0.05),经PSM消除差异,两组围手术期病死率(6.3%vs 1.1%,P=0.083)和主要心脑血管不良事件发生率(6.3%vs 5.4%,P=0.844)相比较,差异无统计学意义。在次要观察终点中,铁缺乏组术后引流量[(952±497)mL vs(796±307)mL,P=0.041]显著增多,其余次要观察终点2组间差异无统计学意义(P>0.05)。结论:CABG患者合并铁缺乏往往表现出更低的血红蛋白水平,且年老及女性患者更多。在排除差异因素后,铁缺乏除导致术后引流量增多以外,对CABG患者围手术期的影响较小。Objective:To explore the impact of iron deficiency on perioperative outcomes of patients undergoing coronary artery bypass grafting(CABG).Methods:A total of 284 patients who underwent CABG in the Department of Cardiovascular and Large Vascular Surgery of the First People’s Hospital Affiliated to Shanghai Jiao Tong University from January 2015 to December 2017 were included.According to the serum ferritin and transferrin saturation levels,they were divided into an iron deficiency group and an iron sufficiency group.The perioperative data were collected and the risk was adjusted by using PSM.The mortality rate,the incidence of major cardiovascular and cerebrovascular adverse events and related complications during perioperative period were analyzed.Results:All the 68 patients were enrolled into iron deficiency group.Compared with the iron sufficiency group,the iron deficiency group was composed of more aged patients,more females,and more anemic patients.After PSM,there was no statistical difference in in-hospital mortality(6.3%vs 1.1%,P=0.083)and major adverse cardiovascular events(6.3%vs 5.4%,P=0.844)between the two groups.Among the secondary observation end points,the postoperative drainage volume in the iron deficiency group[(952±497)mL vs(796±307)mL,P=0.041]was significantly increased,but the differences in the remaining end points were not statistically significant.Conclusion:The patients underwent CABG with iron deficiency showed lower hemoglobin level and consisted of more elders and females.But iron deficiency appears to have little impact on the perioperative outcomes of CABG patients except for increased postoperative drainage.

关 键 词：铁缺乏 冠状动脉旁路移植术 倾向性评分匹配 

分 类 号：R654.2[医药卫生—外科学]