非体外循环冠脉搭桥术中转体外循环冠脉搭桥患者的临床特征及危险因素  

Clinical Characteristics and Risk Factors in Patients UndergoingConversion from Off-pump Coronary Artery Bypass Grafting toOn-pump Coronary Artery Bypass Grafting

作　　者：王恒 杨菲菲 邵松海 WANG Heng;YANG Feifei;SHAO Songhai(Department of Cardiothoracis Surgery,Pingdingshan Second People’s Hospital,Pingdingshan Henan 467000,China)

机构地区：[1]平顶山市第二人民医院胸心外科,河南平顶山467000

出　　处：《河南医学高等专科学校学报》2024年第6期702-706,共5页Journal of Henan Medical College

摘　　要：目的观察非体外循环冠脉搭桥术(off-pump coronary artery bypass grafting,OPCABG)中转体外循环冠脉搭桥术(on-pump coronary artery bypass grafting,ONCABG)患者的临床特征及危险因素。方法回顾性分析OPCABG并术中紧急中转为ONCABG的90例冠心病(coronary heart disease,CHD)患者的临床资料,将其归为中转组。另选取同期单纯行OPCABG的CHD患者300例设为非体外循环组。观察中转组和非体外循环组患者术前和术中的临床特征,采用多因素logistic回归分析影响OPCABG患者发生紧急中转体外循环的危险因素。结果2组性别、年龄、体质量指数(body mass index,BMI)、糖尿病史、高血压史、高血脂史、慢性阻塞性肺疾病、脑卒中史、外周血管疾病史、左主干病变、前降支病变、回旋支病变、房颤、左乳内动脉使用率、桡动脉使用率比较,差异无统计学意义(P>0.05);中转组心力衰竭史患者、经皮冠状动脉介入术(percutaneous coronary intervention,PCI)史患者、右冠病变患者、3周内心肌梗死史患者占比及桥血管数量高于非体外循环组,且左心室射血分数(left ventricular ejection fraction,LVEF)数据低于非体外循环组,差异有统计学意义(P<0.05)。经多因素logistic回归分析证实,术前心力衰竭史、术前PCI史、术前右冠病变、术前3周内心肌梗死史均是影响OPCABG患者发生紧急中转体外循环的危险因素,均有P<0.05。结论术前心力衰竭史、术前PCI史、术前右冠病变、术前3周内心肌梗死史均是影响OPCABG患者发生紧急中转体外循环的危险因素,临床可通过控制以上危险因素来减少患者中转发生风险。Objective To observe the clinical characteristics and risk factors of patients undergoing off-pump coronary artery bypass grafting(OPCABG)or on-pump coronary artery bypass grafting(ONCABG).Methods The clinical data of 90 patients with coronary heart disease(CHD)who underwent OPCABG and were urgently converted to ONCABG intraoperatively were retrospectively analyzed and categorized into the transit group.Another 300 CHD patients who underwent OPCABG alone in the same period were selected as the non-cardiopulmonary bypass group.The preoperative and intraoperative clinical characteristics of the patients in the two group were observed,and multivariate logistic regression analysis was used to influence the risk factors of emergency transit cardiopulmonary bypass in OPCABG patients.Results There was no statistically significant difference between the 2 groups in terms of gender,age,body mass index(BMI),history of diabetes mellitus,history of hypertension,history of hyperlipidemia,history of chronic obstructive pulmonary disease,history of stroke,history of peripheral vascular disease,left main stem lesion,anterior descending branch lesion,echogenic branch lesion,atrial fibrillation,rate of use of the left internal mammary artery,and rate of use of the radial artery(P>0.05).The history of heart failure,history of percutaneous coronary intervention(PCI),right coronary lesion,percentage of myocardial infarction within 3 weeks and number of bridging vessels in the transit group were higher than those in the non-cardiopulmonary bypass group,and the left ventricular ejection fraction(LVEF)data were lower than those in the non-cardiopulmonary bypass group,and the difference was statistically significant(P<0.05).As confirmed by multifactorial logistic regression analysis,history of preoperative heart failure,history of preoperative PCI,a preoperative right coronary lesion,and a history of myocardial infarction within 3 weeks of surgery were all risk factors for the occurrence of an emergency transfer cardiopulmonary bypass in

关 键 词：冠心病 非体外循环冠脉搭桥术 体外循环冠脉搭桥术 中转 临床特征 危险因素 

分 类 号：R541.4[医药卫生—心血管疾病]