摘要
目的探讨影响非体外循环冠状动脉旁路移植术（OPCAB）患者住院死亡的相关危险因素。方法选择中国医科大学第一医院2007年11月至2008年11月冠心病行OPCAB患者215例,男171例,女44例;年龄40-85岁,70岁以上47例,均为3支血管病变患者。对215例患者进行单因素分析,取α=0.40,进入逐步logistic回归分析,分析影响OPCAB患者住院死亡的相关危险因素。结果住院死亡6例,病死率为2.79%（6/215）;无肾功能不全及呼吸衰竭发生,二次开胸止血发生率为4.65%（10/215）,10例二次开胸止血患者均治愈。209例患者顺利出院,随访1年,均生存。logistic多元回归分析结果显示：心功能分级（NYCA）Ⅲ级、Ⅳ级[OR=42.116,95%CI（3.319,534.465）,P=0.004],术后呼吸机使用时间[OR=1.007,95%CI（1.001,1.013）,P=0.028]为影响OPCAB患者住院死亡的独立危险因素。结论 OPCAB治疗冠心病3支血管病变的方法安全有效,心功能Ⅲ级、Ⅳ级,术后呼吸机使用时间是影响OPCAB的独立死亡相关危险因素,但需要进一步的大样本研究。
Objective To explore the in-hospital mortality-related risk factors in the patients undergoing off-pump coronary artery bypass grafting（OPCAB）.Methods We retrospectively analyzed the clinical data of 215 patients undergoing OPCAB in our hospital from November 2007 to November 2008.There were 171 males and 44 females aged between 40 and 85 years old. Among them,there were 47 patients older than 70 years old.All of them were coronary artery disease（CAD） patients with triple vessel disease.We adopted univarialble analysis and logistic multivariable regression analysis to screen the risk factors for the mortality of OPCAB.Results Six patients died in hospital after OPCAB with a mortality rate of 2.79%（6/215）.No renal dysfunction or respiratory failure occurred.The rate of reoperation for bleeding was 4.65%（10/215） and all the 10 patients having undergone reoperation were alive.A total of 209 patients were all alive after 1-year follow-up.The results of logistic multivariable regression analysis showed that New York Heart Association（NYHA） Ⅲ and Ⅳ heart function（OR=42.116,95% CI 3.319 to 534.465,P=0.004） and mechanical ventilation duration（OR=1.007,95%CI 1.001 to 1.013,P=0.028） were independent risk factors for in-hospital mortality of OPCAB.Conclusion OPCAB is an effective and safe treatment for CAD with triple vessel disease.NYHA Ⅲ and Ⅳ heart function and mechanical ventilation time after OPCAB are the risk factors for OPCAB in-hospital mortality,yet,needs further study with large sample.
出处
《中国胸心血管外科临床杂志》
CAS
2010年第6期470-474,共5页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
