中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

术前左心功能与冠状动脉旁路移植围术期并发症相关性分析的病例对照研究

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目的 探讨行冠状动脉旁路移植术(CABG)患者术前左心功能损害程度与围术期并发症的相关性。 方法 回顾性分析 2015 年 11 月至 2016 年 10 月我院行 CABG 192 例患者的临床资料,根据术前左室射血分数(LVEF)将患者分为 3 组:LVEF≤35% 为左心功能严重损害组[23 例,男 15 例、女 8 例,年龄(63.91±5.36)岁];35%<LVEF<50% 为左心功能中度损害组[24 例 , 男 20 例 、 女 4 例 , 年 龄(66.29±6.03)岁];LVEF≥50% 为左心功能正常组[145 例,男 86 例、女 59 例,年龄(66.60±6.41)岁]。对 3 组患者的围术期数据进行对比分析。 结果 192 例患者中,术后死亡 8 例(4.17%),其中严重损害组 4 例(17.39%)、正常组 4 例(2.76%)。单因素分析结果表明:术前 LVEF≤35%,术前经皮冠状动脉介入治疗史,术中辅助循环时间,术后低心排血量,急性肾功能损害,持续性肾脏替代治疗(CRRT)均与冠状动脉粥样硬化性心脏病患者外科治疗围术期死亡率显著相关。其中,术前 LVEF≤35% 和术后 CRRT 是独立预测因素。左心功能严重损害组与另 2 组(LVEF>35%)相比,术后死亡及其他并发症差异有统计学意义。 结论 术前左心功能严重损害(LVEF≤35%)的 CABG 患者,围术期的死亡率和并发症发生率显著高于左心功能正常(LVEF≥50%)的患者。重视高危患者围术期相关因素,密切监测心排血量的变化,及时进行个体化评估和处置,采用积极的辅助循环主动脉内球囊反搏和 CRRT 血管外超滤技术是提高这类高危患者围术期生存率的关键。

Objective To identify the relationship between preoperative left ventricular dysfunction and perioperative risk factors in coronary artery bypass grafting (CABG). Methods The clinical data of 192 patients who underwent CABG from November 2015 to October 2016 were analyzed retrospectively. The patients were divided into three groups by preoperative left ventricular ejection fraction (LVEF) in echocardiography: a serious left ventricular dysfunction group (LVEF≤35%, 23 patients, 15 males and 8 females at age of 63.91±5.36 years), a moderate left ventricular dysfunction group (35%<LVEF<50%, 24 patients, 20 males and 4 females at age of 66.29±6.03 years) and a normal left ventricular function group (LVEF≥50%, 145 patients, 86 males and 59 females at age of 66.60±6.41 years). Results The overall mortality was 4.16% (8/192), 17.39% (4/23) in patients with LVEF≤35% and 2.76% (4/145) in those with LVEF≥50%. Preoperative LVEF≤35%, hypoxia, assisted circulation, acute kidney injury (AKI) and postoperative continuous renal replacement therapy (CRRT) were risk factors of perioperative mortality in coronary artery surgery. LVEF≤35% and CRRT were independent preditors of mortality. There were significant differences in mortality and postoperative complications between the serious left ventricular dysfunction group and other two groups. Conclusion Postoperative mortality and complications are obviously serious in the patients with LVEF≤35%. We should pay more attention to preoperative risk factors. Postoperative individual manipulation, intra-aortic balloon pump and CRRT can enhance survival of those patients.

关键词: 术前左心功能严重损害; 冠状动脉旁路移植术; 围术期处理

Key words: Preoperative left ventricular dysfunction; coronary artery bypass grafting; perioperative manipulation

引用本文: 王颍骅, 杨敏. 术前左心功能与冠状动脉旁路移植围术期并发症相关性分析的病例对照研究. 中国胸心血管外科临床杂志, 2018, 25(5): 406-410. doi: 10.7507/1007-4848.201705039 复制

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