微创冠状动脉旁路移植术后早期严重低氧血症的高危因素研究  

Risk factors of early severe hypoxemia after minimally invasive coronary artery bypass grafting

作　　者：江雪艳 丁士骜 姜兆磊 杨琦 袁源 梅举 JIANG Xue-yan;DING Shi-ao;JIANG Zhao-lei;YANG Qi;YUAN Yuan;MEI Ju(Department of Cardiothoracic Surgery,Xinhua Hospital Affiliated to Shanghai Jiaotong University,Shanghai 200092,China)

机构地区：[1]上海交通大学附属新华医院心胸外科监护室,上海市200092

出　　处：《中国心血管病研究》2022年第10期904-907,共4页Chinese Journal of Cardiovascular Research

摘　　要：目的探讨微创冠状动脉旁路移植术(coronary artery bypass grafting,CABG)后患者早期严重低氧血症的高危因素及预防策略。方法回顾性分析我院2013年1月至2022年3月微创CABG患者的临床资料,筛选低氧血症患者的相关危险因素并分析其相关性。结果854例微创CABG患者,术后早期严重低氧血症者共141例(16.51%),术后第2天发生率最高。长期吸烟史、合并慢性阻塞性肺病、术前/术后心功能差、单侧肺通气时间长以及体重指数高的患者容易出现术后早期严重低氧血症,手术方式中以左开胸微创冠状动脉旁路移植术式对早期低氧的影响最为明显,其中手术中单侧肺通气时间长短、合并慢性阻塞性肺病、术后心功能三个因素与术后低氧血症的发生呈高度相关。结论微创CABG患者需注意术前慢性肺病的防治,尽量缩短术中单侧肺通气时间,早期干预并改善心功能,可减少术后严重低氧血症的发生。Objective To investigate the risk factors and preventive strategies of early severe hypoxemia in the patients after minimally invasive coronary artery bypass grafting(CABG).Methods The clinical data of the patients with minimally invasive CABG in our hospital from January 2013 to March 2022 were retrospectively analyzed,and the related risk factors of the patients with hypoxemia were screened and their correlations were analyzed.Results Among 854 patients who underwent minimally invasive CABG,141 patients(16.51%)had severe hypoxemia in the early postoperative period,with the highest incidence on the second postoperative day.The long-term smoking history,coexisting chronic obstructive pulmonary disease,poor preoperative/postoperative cardiac function,long unilateral lung ventilation time,and high body mass index were prone to severe hypoxemia in the early postoperative period.Among the surgical methods,minimally invasive bypass surgery with left thoracotomy had the most obvious effect on the early hypoxia.Among these risk factors,the duration of unilateral lung ventilation during operation,coexisting chronic obstructive pulmonary disease,and postoperative cardiac function were highly correlated with the occurrence of the postoperative hypoxemia.Conclusion It should be paid attention to the prevention and treatment of chronic lung disease before the surgery,shortening the time of intraoperative unilateral lung ventilation and intervening early to improve cardiac function for the patients with minimally invasive CABG,which can reduce the occurrence of severe postoperative hypoxemia.

关 键 词：非体外循环 微创性 冠状动脉旁路移植术 低氧血症 高危因素 

分 类 号：R654.2[医药卫生—外科学]