冠状动脉旁路移植术后引流量的影响因素及与围术期并发症的相关性  

Analysis of influencing factors of tube bleeding and its correlation with perioperative complications after coronary artery bypass grafting

作　　者：李琴[1] 高铭鑫[1] 刘锐[1] 钱思翀 李海洋[1] Li Qin;Gao Mingxin;Liu Rui;Qian Sichong;Li Haiyang(Department of Cardiac Surgery,Beijing Anzhen Hospital,Capital Medical University,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,北京100029

出　　处：《中华胸心血管外科杂志》2024年第3期143-149,共7页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的探讨冠状动脉旁路移植术(CABG)后24 h引流量(心包、胸腔和纵隔)增多的影响因素及与围术期并发症发生的相关性。方法前瞻性观察2018年5月至2021年12月首都医科大学附属北京安贞医院行CABG的冠心病患者, 收集年龄、性别、合并基础病、实验室检查等资料, 超声心动图检查测量患者术前左心室舒张末期内径和射血分数(EF)。记录术中前降支、回旋支、右冠状动脉旁路移植血管平均血流量(MGF)和搏动指数(PI)。收集围术期肌钙蛋白、凝血功能5项、全因死亡、心肌梗死、新发房颤、卒中等临床资料。根据术后24 h引流量分为增多组(引流量>1 000 ml)和正常组(引流量≤1 000 ml)。比较两组患者术前基线资料、CABG术中指标和围术期并发症的差异;分别采用logistic回归、Spearman和线性回归模型分析术后24 h引流量与临床资料的相关性。结果最终纳入304例行CABG的冠心病患者, 分为引流增多组185例(60.9%)和引流量正常组119例(39.1%)。调整年龄、性别和体质量指数后进行多因素logistic回归分析显示, 男性(OR=2.40, 95%CI:1.38~4.18, P=0.002)、卒中史(OR=2.37, 95%CI:1.07~5.26, P=0.034)和心肌梗死史(OR=1.81, 95%CI:1.13~2.91, P=0.014)均可使术后24 h引流量增加。术中前降支(OR=0.99, 95%CI:0.99~1.00, P=0.022)和回旋支(OR=0.99, 95%CI:0.98~1.00, P=0.003)的旁路移植血管平均血流量与术后24 h引流量增多呈显著负相关, 而前降支(OR=1.81, 95%CI:1.26~2.61, P=0.001)、回旋支(OR=1.45, 95%CI:1.07~1.97, P=0.017)和右冠状动脉(OR=1.84, 95%CI:1.29~2.62, P=0.001)的旁路移植血管阻力均与术后24 h引流量增多呈显著正相关。另外, 凝血酶原时间可显著增加术后24 h引流量增多的风险(OR=1.16, 95%CI:1.03~1.30, P=0.018)。线性回归分析显示, 术后ICU滞留与术后24 h引流量呈显著正线性相关(OR=0.17, 95%CI:0.96~4.58, P=0.003), 而术后EF与24 h引流量呈显著负线性相关(OR=-0.25, 95%CI:-Objective To investigate the influencing factors of increased tube bleeding within 24 h after coronary artery bypass grafting(CABG)and its correlation with perioperative complications.Methods This study was a prospective observational study.The patients with CABG surgery were enrolled in Beijing Anzhen Hospital affiliated to Capital Medical University from May 2018 to December 2021.The age,sex,complications,blood tests and other clinical data of outpatients were collected.Left ventricular ejection fraction(EF)and left ventricular enddiastolic diameter(LVED)were detected by echocardiography.MGF and PI of grafts were recorded during CABG.Perioperative troponinⅠ,blood clotting pentathlon,all-cause death,perioperative myocardial fraction,atrial fibrillation and stroke were collected.According to the tube bleeding within 24 h after operation,the patients were divided into increased group(tube bleeding>1000 ml)and normal group(tube bleeding≤1000 ml).The preoperative baseline data,intraoperative indexes and perioperative complications were compared between the two groups.Logistic regression,Spearman and linear regression models were used to analyze the correlation between tube bleeding within 24 h and clinical data.Results 304 patients underwent CABG were enrolled.There were 185 cases(60.9%)in the increased group and 119 cases(39.1%)in the normal group.After adjusting for age,sex and BMI,multivariate logistic regression analysis showed that male(OR=2.40,95%CI:1.38-4.18,P=0.002),history of stroke(OR=2.37,95%CI:1.07-5.26,P=0.034),and history of myocardial infarction(OR=1.81,95%CI:1.13-2.91,P=0.014)could significantly increase the risk of tube bleeding within 24 h after surgery.The average blood flow of the anterior descending branch(OR=0.99,95%CI:0.99-1.00,P=0.022)and the circumflex branch(OR=0.99,95%CI:0.98-1.00,P=0.003)during the operation was significantly negatively correlated with the increase of tube bleeding within 24 h after surgery,while the PI of anterior descending branch(OR=1.81,95%CI:1.26-2.61,P=0.001),ci

关 键 词：冠状动脉旁路移植术 引流量 平均血流量 搏动指数 围术期并发症 

分 类 号：R654.2[医药卫生—外科学]