冠状动脉旁路移植术危险因素的预测

摘要

Purpose To assess the predictive risk factors for early morbidity and mortality after coronary artery bypass grafting (CABG). Methods Data from 108 consecutive patients who underwent coronary artery bypass grafting in a single center were retrospectivdy collected. The pre-and intra-operative predictive variables were assessed with chi-square and Logistic stepwise regression analysis to predict early postoperative morbidity and mortality of the patients. Results The predictive risk factors those significantly associated with postoperative heart failure were New York Heart Association class status (NYHA) Ⅲ and Ⅳ, cardiopulmonary hypass time (CPBT) and aortic cross clamping time (ACCT), those significantly associated with postoperative respiratory insufficiency were CPBT and ACCT, and those significantly asosciated with postoperative mortality were NYHA status Ⅲ and Ⅳ, recent myocardial infarction (RMI), CPBT, ACCT and body surface area＜1.80. The predictive risk factors those significantly associated with both postoperative morbidity and mortality were angina CCS class Ⅲ and Ⅳ, RMI, CPBT, cold heart surgery (CHS). Analyzing with Logistic regression, the preoperative angina CCS class (odds ratio, 4.16,95% confident interval 1.07-16.17,P=0.04),CHS(OR,3.68,CI-1.22-11.14,P=0.02)and CPBT ( OR, 1.28, CI-1.02-1.60, P=0.03) were demonstrated to be the predictive risk factors that significantly associated with postoperative morbidity and mortality. Conclusions The preoperative heart function and technique of coronary artery surgery were the most important prdictive risk factors that associated significantly with early postoperative morbidity and mortality.%目的 对冠状动脉旁路移植手术(cABG)的危险因素进行预测。方法 总结了108例接受CABG病人的临床资料，把术前、术中及术后各因素作分级处理及统计分析，预测与术后并发症和死亡率相关的术前和术中危险因素。结果 影响术后心功能衰竭发生的各因素为术前心功能分级(NYHA)Ⅲ、Ⅳ级、体外循环时间(CPBT)和主动脉阻断时间(ACCT)延长；与术后呼吸功能衰竭发生有关的因素为CPBT和ACCT；与术后死亡率有关的因素为体表面积＜1.80 m2，NYHA Ⅲ、Ⅳ级、近期心肌梗死(RMI)、CPBT和ACCT；与术后并发症和死亡率(MM)发生有关的各因素为心绞痛分级Ⅲ、Ⅳ级，RMI，CPBT和低温体外循环。经Logistic多元逐步回归分析，影响术后死亡率发生的决定因素按OR值大小依次为CCSⅢ、Ⅳ级(OR：4.16，P＝0.04)，低温体外循环(OR：3.68，P＝0.02)以及CPBT(OR＝1.28，P＝0.03)。结论 冠心病病人术前心功能和术中手术操作是CABG最重要的因素。