[1]佟鑫 吴笛* 苏华田 刘长江 曲颖 赵斌 赵佳媛 李艳玲 谢海龙 霍冬艳 卢德华.影响非体外循环下冠状动脉旁路移植手术预后的多因素分析[J].中国微创外科杂志,2015,15(10):872-875.
　Tong Xin,Wu Di,Su Huatian,et al.Risk Factors of Off-pump Coronary Artery Bypass Grafting Surgery: a Multivariate Analysis[J].Chinese Journal of Minimally Invasive Surgery,2015,15(10):872-875.
点击复制

影响非体外循环下冠状动脉旁路移植手术预后的多因素分析()
分享到：

《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
15
期数:
2015年10期
页码:
872-875
栏目:
临床论著
出版日期:
2015-10-20

文章信息/Info

Title:
Risk Factors of Off-pump Coronary Artery Bypass Grafting Surgery: a Multivariate Analysis
作者:
佟鑫 吴笛* 苏华田 刘长江 曲颖 赵斌 赵佳媛 李艳玲 谢海龙 霍冬艳 卢德华
（吉化集团公司总医院ICU，吉林132021）
Author(s):
Tong Xin;  Wu Di;  Su Huatian;  et al.
Department of Intensive Care Unit, General Hospital of China National Petroleum Corporation in Jilin, Jilin 132021, China
关键词:
B型脑钠肽; C反应蛋白; 乳酸; 冠状动脉旁路移植手术
Keywords:
B type natriuretic peptide; C reactive protein; Lactic acid; Off-pump coronary artery bypass grafting surgery
分类号:
R654.2
文献标志码:
A
摘要:
目的探讨影响非体外循环下冠状动脉旁路移植手术患者预后的危险因素，如术前B型脑钠肽（BNP）、C反应蛋白（CRP）、动脉血乳酸等，为判断预后提供依据。方法回顾性分析我院心外科2011年7月~2014年10月非体外循环下冠状动脉旁路移植手术50例资料，术前1周内行超声检查测定左室射血分数、左心房内径，术前1天进行静脉血BNP、CRP、动脉血乳酸检测。根据术后住院时间是否超过3周或死亡，将患者分为预后良好组和预后不良组，对可能影响预后的因素如冠脉病变情况、术前BNP、C反应蛋白、乳酸、左室射血分数、左心房内径等进行单因素分析。并对P＜0.05的因素进一步做logistic回归分析。结果单因素分析显示，与预后良好组相比，预后不良组术前BNP高［(169.97±67.72) ng/L vs. (101.89±37.47) ng/L, t=4.765, P=0.000］，CRP高［(17.51±7.72) mg/L vs. (7.79±3.85) mg/L, t=6.590, P=0000］，乳酸高［(1.85±0.32) mmol/L vs. (1.43±0.35) mmol/L, t=4.701, P=0.000］，左心房内径大［(35.60±0.97) mm vs. (32.99±1.80) mm, t=6.470, P=0.000］，左室射血分数低(46.58%±2.26% vs. 52.84%±3.50%, t=-7.782, P=0000），差异有显著性。经logistic回归分析，上述指标均为影响非体外循环下冠状动脉旁路移植手术患者预后的因素（OR=1.026、1.381、30.664、8.947、0.317，P=0.001、0.000、0.000、0.002、0.000)。结论术前BNP、CRP、乳酸对非体外循环下冠状动脉旁路移植手术患者的预后评估有一定的临床价值。
Abstract:
ObjectiveTo find the risk factors of off-pump coronary artery bypass grafting surgery (OPCABG), such as preoperative B type natriuretic peptide (BNP), C reactive protein (CRP), lactic acid (LAC), etc. , providing the evidence for judging prognosis.MethodsA retrospective analysis was made on 50 OPCABG patients from July 2011 to October 2014. Patients’ left ventricular ejection fraction (LVEF) and left atrial diameter (LAD) one week before the operation and the BNP, CRP, LAC levels one day before operation were monitored. The patients were divided into good prognosis group and poor prognosis group according to whether the postoperative hospitalization duration was over three weeks or they died. A single factor analysis was made on factors affecting the prognosis, such as coronary situation, preoperative BNP, CRP, LAC, LVEF, and LAD between the two groups. Then a logistic regression analysis was conducted among P<0.05 factors.ResultsAccording to the single factor analysis, as compared with the good prognosis group, patients in the poor prognosis group had higher BNP ［(169.97±67.72) ng/L vs. (101.89±37.47) ng/L, t=4.765, P=0.000］, higher CRP ［(17.51±7.72) mg/L vs. (7.79±3.85) mg/L, t=6.590, P=0.000］, higher LAC ［(1.85±0.32) mmol/L vs. (1.43±0.35) mmol/L, t=4.701, P=0.000］ and higher LAD levels ［(35.60±0.97) mm vs. (32.99±1.80) mm, t=6.470, P=0.000］ and lower LVEF levels (46.58%±2.26% vs. 52.84%±3.50%, t=-7.782, P=0.000) before the operation, with significant differences. According to the logistic regression analysis, the above factors all could affect the prognosis of the OPCABG patients (OR=1.026, 1.381, 30.664, 8.947, and 0.317, respectively, P=0.001,0.000,0.000,0002，and 0.000,respectively).ConclusionPreoperative BNP, CRP, and LAC can be used to predict the outcomes of OPCABG.

参考文献/References:

[1]孙笑天，庞烈文.冠状动脉旁路移植术的现况与展望.上海医药，2012，33（2）：11-14.
[2]朱建国，胡波，李辉，等.非体外循环下冠状动脉旁路移植术体会.实用医药杂志，2013,30（4）：310-311.
[3]张蔚然.心脏手术风险预测方法的研究进展.中国胸心血管外科临床杂志，2014,21（3）：402-410.
[4]尹海平.胺碘酮治疗老年室性心律失常的临床疗效及安全性分析.中国老年学杂志，2010，30(10)：1422-1423.
[5]Li Y，Zheng Z，Hu S.The Chinese coronary artery bypass grafting registry study：analysis of the national multicentre database of 9248 patients.Heart，2009，95(14)：1140-1144.
[6]胡盛寿，郑哲.国人冠状动脉旁路移植术风险评估的研究概况.中华胸心血管外科杂志，2011，27（2）：65-66.
[7]徐枫，梅运清.冠状动脉旁路移植术后并发症危险因素研究进展.外科研究与新技术，2013,2（4）：267-270.
[8]刘高利，马黎明,邹承伟,等.B型脑钠肽在冠状动脉旁路移植术后的变化规律及临床意义.检验医学与临床，2013，10（22）：2947-2951.
[9]Eagle KA,Guyton RA,Davidoff R,et al.ACC/AHA 2004 guide-line update for coronary artery bypass graft surgery: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guideline.Circulation，2004，110(14):e340.
[10]王进,肖锋,李岩,等.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.北京大学学报(医学版)，2011，43（1）：134-139.

备注/Memo

备注/Memo:
基金项目：吉林市科技计划项目（201233130）*通讯作者，E-mail：wudi19814567@sina.com
更新日期/Last Update: 2016-02-03