乌司他丁对非体外循环冠状动脉旁路移植术患者术后肺部并发症的影响  

Effect of ulinastatin on postoperative pulmonary complications in patients undergoing off-pump coronary artery bypass grafting

作　　者：张召 耳建旭[1,2] 翟文倩 任珉[3] 郭志刚 韩建阁 Zhang Zhao;Er Jianxu;Zhai Wenqian;Ren Min;Guo Zhigang;Han Jiange(Department of Anesthesiology,Tianjin Chest Hospital,Tianjin 300222,China;Tianjin Key Laboratory of Cardiovascular Emergency and Critical Care,Tianjin Municipal Science and Technology Bureau,Tianjin 300222,China;Tianjin Cardiovascular Institute,Tianjin 300222,China;Department of Cardiovascular Surgery,Tianjin Chest Hospital,Tianjin 300222,China)

机构地区：[1]天津市胸科医院麻醉科,天津300222 [2]天津市心血管急危重症重点实验室,天津300222 [3]天津市心血管病研究所,天津300222 [4]天津市胸科医院心血管外科,天津300222

出　　处：《中华麻醉学杂志》2024年第3期260-266,共7页Chinese Journal of Anesthesiology

基　　金：恩泽疼痛管理医学研究项目;天津市卫生健康科技项目(TJWJ2023MS027);天津市科技计划项目(20JCZDJC00810)

摘　　要：目的评价乌司他丁对非体外循环冠状动脉旁路移植术(OPCABG)患者术后肺部并发症(PPCs)的影响。方法回顾性收集2021年9月至2023年8月择期行OPCABG患者的病历资料。根据患者术中是否使用乌司他丁分为乌司他丁组与对照组。通过倾向性评分匹配及扩展的Cox比例风险回归模型调整混杂因素。主要结局指标为术后30 d内PPCs发生情况,次要结局指标为ICU停留时间、住院时间及其他不良事件发生情况。结果最终纳入1532例患者,585例(38.2%)患者发生PPCs。与对照组比较,乌司他丁组PPCs发生率降低(匹配前:42.7%vs.35.2%,P=0.004;匹配后:42.2%vs.35.6%,P=0.033),急性肾损伤发生率降低,ICU停留时间、住院时间和其他不良事件发生率差异无统计学意义(P>0.05)。在混杂因素调整前及调整后的Cox比例风险回归模型中,使用乌司他丁后PPCs发生风险降低(调整前HR=0.81,95%CI 0.67~0.99,P=0.004;调整后HR=0.79,95%CI 0.65~0.96,P=0.022)。年龄大于65岁、PPCs高风险患者使用乌司他丁后PPCs发生风险降低(HR=0.667,95%CI 0.542~0.821,P<0.001;HR=0.641,95%CI 0.516~0.812,P<0.001)。结论OPCABG患者术中使用乌司他丁有助于降低PPCs的发生风险。Objective To evaluate the effect of ulinastatin on the postoperative pulmonary complications(PPCs)in the patients undergoing off-pump coronary artery bypass grafting(OPCABG).Methods Medical records from patients scheduled for elective OPCABG from September 2021 to August 2023 were retrospectively collected.The patients were divided into ulinastatin and control groups based on the intraoperative use of ulinastatin.Confounding factors were adjusted using propensity score matching and an extended Cox proportional hazards model.The primary outcome was the development of PPCs within 30 days after surgery,and secondary outcomes included length of stay in intensive care unit,length of hospital stay and occurrence of other adverse events.Results A total of 1532 patients were included in this cohort study,and 585 cases(38.2%)experienced PPCs.Compared with control group,the incidence of PPCs was significantly decreased(before matching:42.7%vs.35.2%,P=0.004;after matching:42.2%vs.35.6%,P=0.033),the incidence of acute kidney injury was decreased and no significant differences were found in the length of stay in intensive care unit,length of hospital stay and incidence of other adverse events in ulinastatin group(P>0.05).In the extended Cox proportional hazard model before and after adjustment for confounding factors,the risk of PPCs was significantly reduced after the use of ulinastatin(HR value before adjustment was 0.81,95%confidence interval[CI]0.67-0.99,P=0.004;the HR value after adjustment was 0.79,95%CI 0.65-0.96,P=0.022).The risk of PPCs was significantly decreased in patients aged>65 yr and at high risk of PPCs after using ulinastatin(HR=0.667,95%CI 0.542-0.821,P<0.001;hR value was 0.641,95%CI 0.516-0.812,P<0.001).Conclusions The intraoperative use of ulinastatin is helpful in decreasing the risk of PPCs in patients undergoing OPCABG.

关 键 词：手术后并发症 胰蛋白酶抑制剂 冠状动脉旁路移植术 非体外循环 

分 类 号：R614[医药卫生—麻醉学]