心肺转流对冠状动脉旁路移植术后应用体外膜氧合辅助患者临床结局的影响  

The effect of cardiopulmonary bypass on outcoms of patients receiving extracorporeal membrane oxygenation after coronary artery bypass grafting

作　　者：邵涓涓[1] 邵程程 王粮山 郝星[1] 江瑜[1] 黑飞龙 贾明[1] 侯晓彤[1] Shao Juanjuan;Shao Chengcheng;Wang Liangshan;Hao Xing;Jiang Yu;Hei Feilong;Jia Ming;Hou Xiaotong(Center for Cardiac Intensive Care,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院心脏外科危重症中心,北京100029

出　　处：《中国体外循环杂志》2023年第3期132-135,171,共5页Chinese Journal of Extracorporeal Circulation

基　　金：北京市医院管理中心重点医学专业发展计划(ZYLX202111);北京市医院管理中心“登峰”人才培养计划(FDL20190601);北京市重大疫情防治重点专科项目(京卫医[2021]135号建设类项目)。

摘　　要：目的探讨术中的心肺转流(CPB)等操作是否会对冠状动脉旁路移植手术(CABG)术后接受体外膜氧合(ECMO)辅助患者的临床结局造成影响。方法回顾性分析2016年1月至2022年12月入住首都医科大学附属北京安贞医院心脏外科危重症中心于CABG术后接受ECMO辅助的患者数据,按照术中是否接受CPB辅助分为非体外循环下CABG术(OPCABG)组和CABG组,对两组患者的并发症及临床结局进行统计学分析。结果最终纳入158例CABG术后接受ECMO辅助的患者。OPCABG组和CABG组各有79例患者,年龄中位数分别为64岁和63岁,男性占比79.9%比83.5%。两组患者基线情况无统计学差异(P>0.05)。OPCABG组患者的脱机率为75.9%,院内死亡率为50.6%,CABG组脱机率为62.0%,院内死亡率为58.2%,两组患者之间无统计学差异(P>0.05)。患者的主要并发症为急性肾损伤,在OPCABG组和CABG组患者的发生率分别为62.0%和65.8%;其次为感染,发生率分别为58.2%和59.5%;出血并发症的发生率分别为32.9%和30.4%。两组患者的并发症发生情况并无统计学差异(P>0.05)。结论术中是否接受CPB等操作不会对术后接受ECMO辅助患者的临床结局及相关并发症造成影响。Objective To investigate whether intraoperative cardiopulmonary bypass(CPB)and other procedures can affect the clinical outcomes of patients receiving extracorporeal membrane oxygenation(ECMO)after coronary artery bypass grafting(CABG).Methods The data of patients who received ECMO support after CABG in the Cardiac Critical Care Center of Beijing Anzhen Hospital from January 2016 to December 2022 were retrospectively analyzed.The patients were divided into OPCABG group and CABG group according to whether CPB was performed during the operation.The survival outcomes and complications of the two groups were statistically analyzed,and the clinical outcomes of the two groups were compared.Results A total of 158 patients receiving ECMO support after CABG were included.There were 79 patients each in the OPCABG group and the CABG group.The average age of the 158 patients was 64 years old,and 122 patients(77.2%)were male.The median age of patients in the OPCABG and CABG groups was 64 and 63 years old respectively,and most of them were male(79.9%vs.83.5%).There was no significant difference in the baseline characteristics between the two groups(P>0.05).The dropout rate and in-hospital mortality were 75.9%and 50.6%in the OPCABG group and 62.0%and 58.2%in the CABG group,respectively.There was no significant difference between the two groups(P>0.05).The main complication was acute kidney injury(62.0%vs.65.8%),followed by infection(58.2%vs.59.5%)and bleeding(32.9%vs.30.4%).There was no significant difference in the incidence of complications between the two groups(P>0.05).Conclusions Whether to receive CPB or not during the operation does not affect the clinical outcomes and related complications in patients receiving ECMO support after CABG.

关 键 词：体外膜氧合 心肺转流 非体外循环 冠状动脉旁路移植术 冠心病 

分 类 号：R654.2[医药卫生—外科学]