非体外循环冠状动脉旁路血管移植术围术期死亡危险因素分析

摘要

Objective To determine the risk factors of perioperative mortality in patients undergoing off-pump coronary artery bypass grafting surgery (OPCABG).Methods The perioperative data of 2 379 patients undergoing OPCABG were investigated based on the self-made perioperative OPCABG database.The specific risk factors were identified by univariate analysis and multiple logistic regressions.Results Totally 32 patients died perioperatively, the average mortality rate was 1.3％ (male: 19/1 830; female: 13/549).Univariate analysis demonstrated that perioperative continuous renal replacement therapy; preoperative ejection fraction less than 40％ , intraoperative ventricular fibrillation, emergent OPCABG, intraoperative intra-aortic balloon pump, gender, previous myocardial infarction, and age were risk factors contributing to postoperative mortality.Multivariate analysis demonstrated that postoperative continuous renal replacement therapy, preoperative ejection fraction less than 40％ , emergent case and gender were the independent predictors of perioperative mortality in patients undergoing OPCABG.Conclusion Perioperative continuous renal replacement therapy, preoperative ejection fraction less than 40％ , emergent case and gender were the independent predictors of postoperative mortality in patients undergoing OPCABG.An intensive perioperative renal protection, adequate cardiac functional support, improving the quality of perioperative management to emergent and women patients are important aspects for the outcome improving to patients undergoing OPCABG surgery.%目的 分析非体外循环冠状动脉旁路血管移植术(off-pump coronary artery bypass grafting,OPCABG)围术期死亡的危险因素.方法 采用麻醉科OPCABG围术期数据库,回顾性分析了首都医科大学附属北京安贞医院自2007年11月至2009年2月2 379例OPCABG患者围术期资料,将与术中及术后10 d内死亡有统计学意义的单因素进行Logistic回归分析.结果 全组围术期死亡患者32例,病死率为1.3%.单因素分析表明术后应用透析(P<0.01,OR=23.791)、术前射血分数(ejection fraction,EF)<40%(P<0.001,OR=6.903)、术中室颤(P<0.025,OR=5.292)、急诊手术(P=0.009,OR=4.539)、术中应用主动脉内球囊反搏 (intra-aortic ballon pump,IABP)(P=0.009,OR=4.488)、性别(P=0.018,OR=2.312)、术前心肌梗死史(P=0.025,OR=2.180)与年龄(P=0.027)为围术期死亡的危险因素,女性病死率高于男性(男性 19/1 830,女性 13/549).Logistic回归分析显示术后应用透析(P<0.001,OR=26.141)、术前射血分数<40%(P<0.001,OR=8.436)、急诊手术(P=0.003,OR=5.039)与性别(P=0.026,OR=0.418)为围术期死亡的独立危险因素.结论 术后应用透析治疗、性别、术前EF<40%和急诊手术是OPCABG患者围术期死亡的独立危险因素.加强围术期肾保护、积极维护心功能、提高急诊和女性OPCABG患者围术期处理水平,有利于控制OPCABG围术期病死率.