体外循环心脏术后死亡危险因素分析

Risk factors of death postcardiac surgery undergoing cardiopulmonary bypass

目的探讨体外循环心脏术后死亡可能的危险因素。方法回顾性分析江苏省苏北人民医院从2005年3月至2006年6月体外循环心脏手术36例患者的临床资料。死亡组人选标准：（1）体外循环心脏手术患者；（2）术前心功能Ⅰ～Ⅲ级；（3）术前无其它脏器功能不全；（4）术后28d内患者死亡；其中死亡组6人，存活组30例。调查内容包括：（1）术前因素：性别，年龄，术前诊断，术前NYHA分级，APACHEⅡ评分，左室舒张末内径。（2）术中因素：手术时间，主动脉阻断时间。（3）术后因素：出血量，机械通气时间，以及术后6h血流动力学及氧代谢指标：心率（HR），中心静脉压（CVP），肺动脉嵌顿压（PAWP），心输出量指数（CI），动脉血乳酸，动脉氧分压（PaO2），混合静脉血氧饱和度（SvO2），氧输送指数（DO2I），氧耗指数（VO2I），全身氧提取率（O2ext）。所有数据应用SPSS10．0 for windows统计学软件包进行统计学分析。首先应用单因素相关分析，筛选出两组有显著差异的参数，然后再对这些参数进行多元回归分析，从中找出体外循环心脏术后死亡的独立危险因素。结果单因素相关分析显示两组间APACHEⅡ评分，左室舒张末内径，主动脉阻断时间，机械通气时间，动脉血乳酸，SvO2等差异有统计学意义（P〈0．05）。多元回归分析显示左室舒张末期内径，动脉血乳酸是体外循环心脏术后死亡的两个独立危险因素（P〈0．05）。结论左室舒张末期内径和动脉血乳酸可以作为评价体外循环心脏术后预后的重要指标。

Objective To find out some possible risk factors of death postcardiac surgery undergoing cardiopulmonary bypass. Method Totally 36 patients, who underwent postcardiotomy undergoing cardiopulmonary bypass in Subei Hospital of Jiangsu Provience from March 2005 to June 2006, were retrospectively analyzed. The criteria for the selection of patients were as follow： （1） patients underwent on-pump cardiopulmonary bypass; （2） patients with heart function in Ⅰ- Ⅲ degree; （3） all patients didn＇ t have organ dysfunction before operation （4） patients died within 28 days postcardiotomy. Therefore, 6 patients who died were admitted as death group, the other 30 patients were admitted as control group. The analysis included： （1） preoperative factors, including gender, age, diagnosis preoperative, NYHA grade, APACHE Ⅱ score, left ventricular enddiastolic diameter. （2） operative factors ： operation time, block aorta time. （3） postoperation factors ：hemorrhage volume, mechanical ventilation time, and factors of hemodynamics and oxygen metabolism 6 hour postoperative： heart rote （HR）, central venous pressure （CVP）, pulmonary arteria wedged pressure （PAWP）, cardiac output index （CI）, arterial blood lactic acid, partial pressure of oxygen （PaO2）, mixed venous oxygen saturation （SvO2）, oxygen delivery index （DO2I）, oxygen comsume index （VO2I）, oxygen extraction ratio （O2ext）. Comparisons between two group was made with SPSS10.0 for windows. Firstly, the data were analyzed with process of single variable analysis and some parameters, which showed the significant difference, were sorted out from two groups. Then these parameters were put to the LOGISTIC regression analysis. Consequently, the independent risk factors of death of postcardiac surgery could be found. Results The single variable analysis showed that the parameters of APACHE Ⅱscore, left ventricular end-diastolic diameter, block aorta time, mechanical ventilation time, arterial blood lactic acid, SvO2 had significant difference betwen groups （ P 〈 0.05）. The LOGISTIC regression showed that left ventricular end-diastolic diameter and arterial blood lactic acid are the two independent risk factors of death （ P 〈 0.05）. Conclusions Arterial lactatemia and left ventricular enddiastolic diameter can be used to predict the prognosis of postcardiotomy tmdergoing cardiopulmonary bypass.