冠状动脉旁路移植术后低清蛋白血症危险因素与预后  

Risk factors and prognostic value of hypoalbuminemia after coronary artery bypass grafting

作　　者：赵冬 张雪娟[1] 路长鸿 ZHAO Dong;ZHANG Xuejuan;LU Changhong(Deparment of General Medicine,The Affiliated Hospital of Qingdao University,Qingdao 266003,China)

机构地区：[1]青岛大学附属医院综合内科,山东青岛266003 [2]青岛阜外心血管病医院心血管内科

出　　处：《青岛大学学报（医学版）》2024年第1期100-104,共5页Journal of Qingdao University(Medical Sciences)

基　　金：青岛市科技惠民示范引导专项(21-1-4-rkjk-21-nsh)。

摘　　要：目的探讨冠状动脉旁路移植术(CABG)后低清蛋白血症的危险因素及临床预后。方法回顾分析CABG病人483例,定义术后第1天血清清蛋白(ALB)水平较术前下降的差值为△ALB,将△ALB≤7 g/L病人97例归为A组、7 g/L<△ALB≤15 g/L病人298例归为B组、△ALB>15 g/L病人88例归为C组。比较3组病人术前、术中、术后相关资料及术后随访36个月主要不良心血管事件(MACE)发生情况。结果C组合并高尿酸血症的病人数及左室射血分数<40%的病人数高于A、B两组,差异有统计学意义(χ^(2)=6.802~6.857,P<0.05);B、C两组中有介入治疗(PCI)史的病人数高于A组,差异有统计学意义(χ^(2)=8.193,P<0.05);C组术后在ICU停留时间>72 h、CABG当天引流>400 mL、大量失血、输注红细胞、输注血浆、肾损伤等病人占比明显高于A、B两组,差异有统计学意义(χ^(2)=6.741~39.287,P<0.05);C组术后MACE事件发生率高于A、B两组,差异有统计学意义(χ^(2)=8.205,P<0.05)。Cox回归分析中校正多种混杂因素后,病人术前有PCI史(OR=1.670,95%CI=1.091~2.556,P=0.018)及左室射血分数<40%(OR=4.468,95%CI=2.304~8.665,P<0.001)是术后ALB水平减低的独立危险因素,CABG后第1天ALB水平较术前下降程度7 g/L<△ALB≤15 g/L(OR=2.784,95%CI=1.190~6.516,P=0.018)和△ALB>15 g/L(OR=3.487,95%CI=1.373~8.853,P=0.009)是远期MACE的独立预测因素。结论PCI史及左室射血分数<40%是CABG后ALB水平减低的独立危险因素,术后第1天ALB水平较术前下降>7 g/L是CABG预后的预测因素。Objective To investigate risk factors for hypoalbuminemia after coronary artery bypass grafting(CABG)and its association with clinical outcome.Methods A total of 483 patients undergoing CABG were retrospectively analyzed.The diffe-rence in serum albumin(ALB)level between the first day after operation and before operation was defined as△ALB.The patients were divided by△ALB in group A(△ALB≤7 g/L,97 cases),group B(7 g/L<△ALB≤15 g/L,298 cases),and group C(△ALB>15 g/L,88 cases).The three groups were compared in terms of preoperative,intraoperative,and postoperative data and the incidence of major adverse cardiovascular events(MACE)36 months after surgery.Results The percentages of patients with hyperuricemia and patients with left ventricular ejection fraction(LVEF)<40%were significantly higher in group C than in group A and group B(χ^(2)=6.802-6.857,P<0.05).The percentage of patients with a history of percutaneous coronary intervention(PCI)was significantly higher in groups B and C than in group A(χ^(2)=8.193,P<0.05).Group C showed significantly higher proportions of patients with intensive care unit stay more than 72 h,drainage volume more than 400 mL on the day of CABG,massive blood loss,red blood cell transfusion,plasma transfusion,and renal injury compared with groups A and B(χ^(2)=6.741-39.287,P<0.05).The incidence of MACE in group C was significantly higher than that in groups A and B(χ^(2)=8.205,P<0.05).According to the Cox regression analysis adjusting for confounding factors,a PCI history(OR=1.670,95%CI=1.091-2.556,P=0.018)and LVEF<40%(OR=4.468,95%CI=2.304-8.665,P<0.001)before surgery were independent risk factors for a decreased serum ALB level after surgery;7 g/L<△ALB≤15 g/L(OR=2.784,95%CI=1.190-6.516,P=0.018)and it>15 g/L(OR=3.487,95%CI=1.373-8.853,P=0.009)were independent predictors of the occurrence of long-term MACE.Conclusion A PCI history and LVEF<40%are independent risk factors for hypoalbuminemia after CABG.An ALB decrease by>7 g/L on the first day after operation is a predict

关 键 词：低白蛋白血症 冠状动脉分流术 危险因素 预后 

分 类 号：R654.3[医药卫生—外科学]