单中心1098例冠状动脉旁路移植手术患者围手术期危险因素分析

摘要

Objective: To analyze the risk factors for operative mortality in 1 098 cases of coronary artery bypass grafting (CABG) procedures. Methods: A total of 1 098 cases of CABG including 113 cases of left ventricular ejection fraction (LVEF) lower than 35％ from December 1999 through December 2009 were chosen for the retrospective study. Univariate and multivariate stepwise logistic analyses were perfomed based on the data of the whole group to locate the mortality risk factors. Results: Age, acute coronary syndrome, emergent surgery, chronic renal failure (CRF), concomitant peripheral vascular disease, LVEF ≤35％ , left ventricular end diastolic diameter (LVEDD) , moderate to severe mitral regurgitation, aneurysm of the heart wall, aortic regurgitation, mitral repair/replacement, resection of aneurysm, concomitant aortic valve replacement, peri-operative intra-aortic balloon pump (IABP) , left ventricular assist device (LVAD) , and off-pump CABG were the risk factors for the univariate analysis. In the further multivariate regression analysis, off-pump CABG appeared statistically as a protective factor while age, female, emergent surgery, CRF, and the peri-operative application of IABP were the risk factors corespondingly for the whole group. Conclusion: Age, female, emergent surgery, CRF, and the application of IABP, were the risk factors for mortality in the entire group of patients, implicating the necessity of specific and cautious management. CABG concomitant with non-cardiac surgery, concomitant with the treatment of moderate-severe mitral regurgitation and resection of heart wall aneurysm were not the risk factors for peri-operative mortality.%目的:连续进行1 098例冠状动脉旁路移植术(coronary artery bypass grafting,CABG),其中包括113例左室射血分数(left ventricular ejection fraction,LVEF)低于35%的病例,分析与围手术期死亡相关的危险因素.方法:回顾性采集北京大学第一医院心脏外科1999年12月至2009年12月1 098例CABG手术临床资料,对全组患者分别进行单因素分析和Logistic多因素回归分析,筛选死亡相关危险因素.结果:对全组病例进行单因素分析,影响预后的危险因素是年龄、急性冠脉综合征、急诊手术、术前慢性肾功能不全、合并周围血管病变、左室射血分数(LVEF) ≤35%、左室舒张末内径(left ventricular end diastolic diameter,LVEDD)、中度以上的二尖瓣返流、室壁瘤形成、主动脉瓣返流、同期二尖瓣成形或置换、室壁瘤切除、同期主动脉瓣置换、围手术期使用主动脉内球囊反搏(in-tra-aortic balloon pump,IABP)、使用左心辅助装置(left ventricular assist device,LVAD)和非体外循环下(off-pump)CABG手术等;进行多因素回归分析时,非体外循环下off-pump CABG对于围手术期的预后倾向于是保护性因素;而年龄、性别(女性)、急诊手术、术前慢性肾功能不全和围术期使用IABP是明确的危险因素.结伦:年龄、女性、急诊手术、术前慢性肾功能不全和围手术期使用IABP,对于全部患者是与预后相关的危险因素,需特别注意并谨慎处理;CABG同期合并其他非心脏手术以及同期处理中度以上的二尖瓣返流和室壁瘤切除、左室重建均不是影响围手术期预后的危险因素.