冠状动脉旁路移植术后胸骨哆开发生的相关危险因素分析  

The correlative risk factors of sternal dehiscence in patients undergoing coronary artery bypass grafting

作　　者：王萌 宋衍秋[3] 梁慧敏[1] 陈欣[2] 王联群[2] 王春梅[1] WANG Meng;SONG Yan-qiu;LIANG Hui-min;CHEN Xin;WANG Lian-qun;WANG Chun-mei(School of Nursing,Tianjin Medical University,Tianjin 300070,China;Department of Cardiovascular Surgery,Tianjin Chest Hospital,Tianjin 300222,China;Cardiovascular Institute,Tianjin Chest Hospital,Tianjin 300222,China)

机构地区：[1]天津医科大学护理学院,天津300070 [2]天津市胸科医院心血管外科,天津300222 [3]天津市胸科医院心血管病研究所,天津300222

出　　处：《天津医科大学学报》2022年第4期418-422,共5页Journal of Tianjin Medical University

摘　　要：目的:探讨冠状动脉旁路移植术(CABG)患者术后胸骨哆开(SD)发生的相关危险因素。方法:选取2014年1月至2020年6月于天津市胸科医院择期行CABG,术后发生SD的患者80例(SD组);选择同期手术、同年龄、同性别CABG术后未发生SD的患者160例,按照1:2匹配,作为对照组。比较两组一般临床资料、术前生化指标、既往病史、手术相关指标,对有统计学差异的指标进行多因素条件Logistic回归分析,绘制受试者工作特征(ROC)曲线。结果:SD组体重指数(BMI)(t=4.848,P<0.001)、吸烟患者(χ^(2)=5.245,P=0.022)、术中体外循环(χ^(2)=15.375,P<0.001)、胸部切口感染发生率(χ^(2)=25.920,P<0.001)高于对照组,术前心功能NYHA分级高的患者发生SD比率(χ^(2)=28.467,P<0.001)高于对照组,SD组充血性心衰发生率(χ^(2)=4.709,P=0.030)高于对照组,SD组呼吸机辅助通气时间(t=4.631,P<0.001)显著长于对照组,两组其余指标差异无统计学意义。条件Logistic回归分析结果显示BMI(OR=1.222,95%CI:1.098~1.360,P<0.001)、吸烟(OR=2.012,95%CI:1.005~4.026,P=0.048)、术前心功能差(OR=3.150,95%CI:1.619~6.127,P=0.001)、术中体外循环(OR=4.429,95%CI:1.542~12.721,P=0.001)、胸部切口感染(OR=53.516,95%CI:5.419~528.511,P=0.001)及呼吸机辅助通气时间(OR=1.016,95%CI:1.006~1.027,P=0.005)差异有统计学意义。ROC曲线分析表明,Logistic拟合呼吸机辅助通气时间、BMI、术前NYHA分级、体外循环、吸烟及胸部切口感染六个协变量的整体模型(变量pre_1)ROC曲线下面积为0.833(P<0.001,95%CI:0.775~0.892)。呼吸机辅助通气时间>17.756 h、BMI>26.5 kg/m^(2)、术前NYHA心功能分级≥Ⅲ级时约登指数最大。结论:呼吸机辅助通气时间>17.75 h、BMI>26.5 kg/m^(2)、术前NYHA心功能分级≥Ⅲ级,同时伴有吸烟、使用体外循环及胸部切口感染是CABG患者发生SD的危险因素。Objective:To investigate the risk factors of sternal dehiscence(SD)in patients undergoing coronary artery bypass grafting(CABG).Methods:A total of 80 patients with SD after undergoing CABG at Tianjin Chest Hospital from January 2014 to June 2020 were selected as the subjects,and 160 patients without postoperative SD(1:2 matched according to the simultaneous surgery,same age and same gender)were included in the control group.Patients in the two groups were compared for general clinical data,preoperative biochemical indexes,past medical history,and surgery-related indexes.The indexes with statistical differences were subject to multivariate conditional Logistic regression analysis,and the receiver operating characteristic(ROC)curves were plotted.Results:The body mass index(BMI)(t=4.848,P<0.001),the patients who smoke(χ^(2)=5.245,P=0.022),cardiopulmonary bypass(χ^(2)=15.375,P<0.001),and the incidence of chest incision infection(χ^(2)=25.920,P<0.001)in the SD group were significantly higher than those in the control group.The difference in the preoperative classification of the NYHA cardiac function(χ^(2)=28.467,P<0.001)between the SD group and the control group was statistically significant.The incidence of poor cardiac functionin(χ^(2)=4.709,P=0.030)in the SD group was higher than that in the control group.The duration of mechanical ventilation(t=4.631,P<0.001)in the SD group was significantly longer than that in the control group.The results of multivariate conditional Logistic regression analysis showed that the differences in BMI(OR=1.222,95%CI:1.098-1.360,P<0.001),smoking(OR=2.012,95%CI:1.005-4.026,P=0.048),preoperative classification of the NYHA cardiac function(OR=3.150,95%CI:1.619-6.127,P=0.001),cardiopulmonary bypass(OR=4.429,95%CI:1.542-12.721,P=0.001),chest incision infection(OR=53.516,95%CI:5.419-528.511,P=0.001),and ventilator-assisted ventilation time(OR=1.016,95%CI:1.006-1.027,P=0.005)were statistically significant.As shown in the ROC curve,the corresponding area under the curve of the byparamete

关 键 词：冠状动脉旁路移植术 胸骨哆开 危险因素 

分 类 号：R619.5[医药卫生—外科学]