不停跳冠状动脉旁路移植术后低氧血症的临床研究

Clinical research on hypoxemia in patients after off-pump coronary artery bypass grafting

目的分析不停跳冠状动脉旁路移植术(off-pump coronary artery bypass,OPCAB)后低氧血症的相关因素及其处理措施。方法159例OPCAB患者术后发生低氧血症36例,对低氧血症患者的年龄、术前心功能、手术时间与非低氧血症患者组进行相关性分析。结果低氧血症在年龄大于70岁(含70岁),术前左室射血分数(leftventricular ejection fraction,LVEF)小于55%的发生率分别为31.8%和40.1%,与小于70岁和术前LVEF大于55%的患者相比有显著性差异,另外,低氧血症组手术时间较非低氧血症手术时间显著延长。低氧血症患者经双水平正压无创通气(biphasic positive airway pressure ventilation,BIPAP)顺利纠正31例,气管插管,呼吸机辅助呼吸后好转2例,气管切开治疗好转1例,气管切开治疗无效死亡2例。结论OPCAB术后低氧血症在高龄、术前心功能低下、手术时间长患者容易发生,应用BIPAP辅助呼吸、抗感染、强心等措施可有效纠正术后低氧血症。

Objective To analyze the relative factors of hypoxemia in patients after off-pump coronary artery bypass grafting and to study the treatment of hypoxemia. Methods Among the 159 patiems investigated, 36 patients suffered from post-operative hypoxemia, and relative-analysis of age, preoperative LVEF, and operation-time in the group of patients of hypoxemia were reviewed. Results The incidence of hypoxemia in the group of patients exceeding 70 year-old and preoperative LVEF less than 55% were 31.8%, 40.1% respectively, there was significant difference as compared with groups of age below 70 year-old and preoperative LVEF over 55 % ; also operation time of hypoxemia group was significant longer than non- hypoxemia group. 31 eases were successfully corrected with BIPAP （biphasic positive airway pressure） ventilation, 2 cases were corrected with tracheal intubation, 2 cases were curred and 1 died among 3 cases with tracheotomy. Conclusion Hypoxemia after off-pump coronary artery bypass grafting is proved to occur in patiems with advanced-age, lower-LVEF and longer-operation time＇ and can be corrected likely with BIPAP ventilation, anti-infection and enhancement of heart-function.