肥胖患者行非体外循环冠状动脉旁路移植术后低氧血症危险因素分析  

Analysis of risk factors for hypoxemia in obese patients after off-pump coronary artery bypass grafting

作　　者：张瑛杰 韩劲松 孙彪 张铭鑫 都业君 ZHANG Ying-jie;HAN Jin-song;SUN Biao;ZHANG Ming-xin;DU Ye-jun(General Hospital of Northern Theater Command,Shenyang 110016,China)

机构地区：[1]北部战区总医院心血管外科,辽宁省沈阳市110016

出　　处：《中国心血管病研究》2022年第10期908-913,共6页Chinese Journal of Cardiovascular Research

摘　　要：目的探讨肥胖患者行非体外循环冠状动脉旁路移植(CABG)术后低氧血症的相关危险因素。方法连续入选2018年11月至2019年11月在北部战区总医院心血管外科择期行单纯非体外循环CABG手术的肥胖患者179例,根据术后是否发生低氧血症将全组患者分为低氧血症组(n=62)与非低氧血症组(n=117),记录并分析两组年龄、性别、合并疾病、超声心动图指标、实验室检测结果及围术期参数,比较两组各项指标的差异性。对具有统计学意义的指标进行多变量logistic回归分析,得出肥胖患者行非体外循环CABG术后低氧血症的独立危险因素。结果共62例患者术后发生低氧血症,发生率为34.6%(62/179)。低氧血症组与非低氧血症组的平均年龄分别[(62.9±5.9)岁比(60.0±9.4)岁,P=0.026],吸烟史占比(58.1%比37.6%,P=0.009),糖尿病占比为(56.5%比39.3%,P=0.028)相比,差异有统计学意义。两组的左心室射血分数(LVEF)[(54.4±5.6)%比(56.6±4.2)%,P=0.003],间接胆红素(TBIL)[(9.9±4.1)mmol/L比(8.8±3.1)mmol/L,P=0.036],总胆红素(IBIL)[(6.7±2.8)mmol/L比(5.6±2.2)mmol/L,P=0.007],N末端B型利钠肽原(NT-ProBNP)[389.0(184.9,780.5)pg/ml比190.6(75.2,327.4)pg/ml,P<0.001]相比,差异有统计学意义,两组之间的其他因素差异无统计学意义(P>0.05)。单因素分析显示,年龄、合并糖尿病、吸烟史、LVEF、TBIL、IBIL、NT-ProBNP、术后血红蛋白等8个因素具有统计学意义(P<0.05),多变量logistic回归分析显示,肥胖患者行非体外循环CABG术后低氧血症的独立影响因素分别是吸烟史、糖尿病、术后血红蛋白。结论吸烟史、糖尿病、术后血红蛋白是肥胖患者行非体外循环CABG术后低氧血症的独立影响因素。Objective To explore the risk factors of hypoxemia after off-pump coronary bypass transplantation coronary artery bypass grafting(CABG)in obese patients.Methods From November 2018 to November 2019 in the northern theater general hospital elective off-pump CABG surgery in cardiovascular surgery 179 obese patients,the whole group into hypoxemia(n=62)and non-hypoxia(n=117),recorded and analyzed the age,sex,combined disease,echocardiographic indicators,the laboratory test results and perioperative parameters.Multivariate logistic regression analysis of statistically significant indicators yielded independent risk factors for hypoxemia in obese patients after off-pump CABG.Results A total of 62 patients had postoperative hypoxemia,with an incidence of 34.6%(62/179).Significant differences in the mean age[(62.9±5.9)years vs.(60.0±9.4)years,P=0.026),smoking history[36(58.1%)vs.44(37.6%),P=0.009],and diabetes mellitus[35(56.5%)vs.46(39.3%),P=0.028]were observed between the two groups.The left ventricular ejection fraction(LVEF)[(54.4±5.6)%vs.(56.6±4.2)%,P=0.003],total bilirubin(TBIL)[(9.9±4.1)mmol/L vs.(8.8±3.1)mmol/L,P=0.036],indirect bilirubin(IBIL)[(6.7±2.8)mmol/L vs.(5.6±2.2)mmol/L,P=0.007],N-terminal brain natriuretic peptide(NT-proBNP)[389.0(184.9,780.5)pg/ml vs.190.6(75.2,327.4)pg/ml,P<0.001]were observed Significant differences between two groups,no difference of the other objects between two groups(P>0.05).The univariate analysis revealed that,age,combined with diabetes mellitus,smoking history,left ventricular ejection fraction(LVEF),total bilirubin(TBIL),indirect bilirubin(IBIL),NT-proBNP,and postoperative hemoglobin(Hb)were statistically significant(P<0.05),After multivariate logistic regression analysis,the independent influencing factors of hypoxemia in obese patients treated after off-pump CABG were smoking history,diabetes mellitus,and postoperative hemoglobin.Conclusion Smoking history,diabetes mellitus,and postoperative hemoglobin are the independent influencing factors of hypoxemia in obese pat

关 键 词：肥胖 非体外循环下冠状动脉旁路移植术 低氧血症 血红蛋白 

分 类 号：R654.2[医药卫生—外科学]