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    冠脉搭桥术后短期死亡的围手术期危险因素分析

    Perioperative factors associated wiith short-term mortality among patients undergoing isolated coronary artery bypass grafting

    • 摘要: 目的 冠脉搭桥是一种治疗严重冠脉病变的有效手段,但手术后短期内有较高的死亡率,本研究的目的是筛选出与冠脉搭桥手术后短期死亡相关的围手术期危险因素 方法 入选从2008年1月到2013年12月之间在南京市第一医院进行冠脉搭桥手术的患者,观察期限为30天,筛选出术前、术中、术后与死亡有关的危险因素。结果 共顺序入选2808例冠脉搭桥手术患者,30天死亡率为1.5%(n=42),logistic 回顾分析显示,女性(P=0.0013, OR=0.2577, 95% CI 0.1128~0.5889), 射血分数降低 (P=0.0247, OR=0.9617, 95% CI 0.9294~0.9950),术后乳酸水平 (P<.0001, OR=1.3115, 95% CI 1.1809~1.4566) 术中输注更多的红细胞数量(P<0.001, OR=1.1606, 95% CI 1.1128~1.2105) 和短期死亡率相关,ROC曲线分析显示受试者工作特征曲线下面积AUC=0.8566 (95% CI 0.7786~0.9347)。结论 冠脉搭桥手术患者短期死亡率相对较高,女性、低射血分数、术后乳酸水平高、术中更多的红细胞输注与短期死亡率独立相关,而β受体阻滞剂等药物未发现与术后死亡率降低有关。

       

      Abstract: Objectives: Coronary artery bypass grafting (CABG) is an effective approach for patients with severe coronary artery disease, which has a relatively high mortality rate. The aim of the present study was to identify the perioperative factors that are significantly associated with short-term mortality among patients undergoing isolated CABG. Methods: From Jun 2008 to Dec 2012, patients undergoing isolated CABG in Nanjing First Hospital were included. They were observed for a period of 30 days, and pre-, intra- and postoperative variables were used to identify significant predictors of mortality. Results: A total of 2,808 consecutive patients who underwent isolated CABG surgery were reviewed. The overall short-term mortality rate was 1.5% (42 out of 2,808).Multivariate logistic regression analyses showed that female sex (P=0.0013, OR=0.2577, 95% CI 0.1128~0.5889), ejection fraction (EF) (P=0.0247, OR=0.9617, 95% CI 0.9294~0.9950), lactic acid (P<.0001, OR=1.3115, 95% CI 1.1809~1.4566) and more blood units transfused (P<0.001, OR=1.1606, 95% CI 1.1128~1.2105) were associated with short-term mortality among patients who underwent CABG. Receiver operating characteristic curve analysis showed that the area under the curve was 0.8566 (95% CI 0.7786~0.9347). Conclusions: The overall mortality was relatively high, and female sex, lower EF, high levels of lactic acid and more blood units transfused were independent factors associated with mortality, whereas beta-blockers and other agents were not associated with better survival.

       

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