冠状动脉搭桥术后并发多脏器功能障碍综合征的临床分析

摘要

目的:探讨冠状动脉搭桥术(CABG)后发生多脏器功能障碍综合征(MODS)的高危因素、发生MODS患者中导致死亡的危险因素,总结CABG术后MODS病例的临床特点.方法:总结安贞医院2008年8月至2009年10月共276例CABG患者的临床资料,将CABG术后发生与未发生MODS的患者进行对比,总结CABG术后发生MODS的高危因素;将其中并发MODS的患者分为死亡组与存活组,进行比较,回顾性分析导致死亡的高危因素;总结脏器衰竭个数及MODS评分与病死率的关系.结果:CABG术后并发MODS组与未发生MODS组间在:既往有糖尿病、高血压、术前射血分数(EF)＜50%、有近期心肌梗死史,合并搭桥以外其他手术等方面差异有统计学意义;CABG术后并发MODS存活组与死亡组在有近期心肌梗死史及MODS评分两方面差异有统计学意义.脏器衰竭数目在2,3,4时对应的病死率分别是24.5%,38.5%及100%;MODS评分分别为0～5,6～10,＞l0分时,患者的病死率分别为8.2%,l0.2%及57.1%.结论:CABG术后并发MODS的高危因素包括:既往有糖尿病、高血压、术前EF＜50%、有近期心肌梗死史及合并搭桥以外其他手术;死亡的高危因素为有近期心肌梗死史及MODS评分.MODS的病死率随着脏器衰竭数目及MODS评分的增加而升高.%Objective : To investigate the high risk factors, and method for prevention and treatment of multiple organ dysfunction sundrome ( MODS) after coronary artery bypass grafting ( CABG). Methods : From Aug. 2008 to Oct. 2009,276 patients with MODS were enrolled for the study. Patients with MODS were compared with those without MODS, the high risk factors were retrospectirely analyzed. The high risk factors were retrospectively analyzed between the dead and alive patients with MODS. Summarizing the clinical features of patients with MODS. Results : Comparing with patients without MODS , the history of diabetes , hypertension, recent myocardial infarction, LVEF ＜50％ associated with other cardiac surgery were high risk factors for MODS;The history of recent myocardial infarction and higher score of MODS were risk factores for the dead patients with MODS. Mortality was associated with the number of failure organs and the score of MODS. Mortality was 24. 5％ ,38. 5％ and 100％ with the failure orgens 2,3 and 4,it was 8. 2％ ,10. 2％ and 57. 1％ with the score of MODS 0～5 , 6～10 and ＞ 10 respectively. Conclusion : The high risk factors for MODS after CABG are history of diabetes, history of hypertension, histary of recent myocardial infarction, LVEF ％ 50％ associated with other cardiac surgery. The high risk factors for the death of patients with MODS are the scores of MODS and history of recent myocardial infarction. The more dysfunctional organs, the higher mortality.