体外循环冠状动脉旁路移植术后低氧血症的危险因素分析

Analysis on the risk factors of hypoxemia after coronary artery bypasses grafting along with cardiopulmonary bypasses

目的通过分析体外循环冠状动脉旁路移植术后低氧血症的危险因素，探讨体外循环冠状动脉旁路移植术后低氧血症的发生规律及特点。方法我院2007年5月至2009年5月行体外循环冠状动脉旁路移植术483例，对86例术后发生低氧血症患者的相关因素进行单因素和多因素分析。结果单因素分析显示：低氧血症组与非低氧血症组高龄（≥65岁）、长期吸烟、糖尿病、慢性阻塞性肺气肿、术前左心室射血分数〈45％、过度肥胖、血制品输入≥1000ml等比例差异均有统计学意义（x^2值分别为12．632、15．517、6．833、16．723、9．383、9．668、18．427，P均〈0．05）；多因素分析显示：术前肺功能异常、体外循环时间过长（≥2h）、血制品输入≥1000ml、低蛋白血症以及肺部感染是术后低氧血症发生的独立危险因素（OR分别为9．912、15．658、9．716、7．673、3．835，95％Cl分别为1．217-87．522、1．946-109．256、1．338-36．837、1．925—105．516、1．219—6．593）。结论体外循环冠状动脉旁路移植术后低氧血症是围术期多种因素共同作用的结果，提高对围术期低氧血症危险因素的认识，正确指导临床预防与治疗，可以避免术后低氧血症的发生。

Objective To analyze the risk factors of hypoxemia after coronary artery bypasses grafting （CABG） along with cardiopulmonary bypasses and to understand the regular pattern and characteristics of hypoxemia after CABG. Methods The risk factors of hypoxemia were studied by one way analysis and multivariate logistic regression analysis in 86 patients with hypoxemia after CABG along with cardiopulmonary bypass. Results One way analysis indicated that hypoxemia after CABG along with cardiopulmonary bypass was related to senility （ ≥ 65 years ） , smoking history, diabetes mellitus, chronic obstructive pulmonary disease （ COPD）, left ventricular ejection fraction （ LVEF 〈 45 % ）, obesity before operation, transfusion （ ≥ 1000 ml ） ; multivariate analysis indicated that pulmonary dysfunction before operation, longer extracorporeal circulation time （ ≥2 h）, hypoalbuminemia and pulmonary infection were independent risk factors of hypoxemia after CABG along with cardiopulmonary bypass. Conclusion Multiple risk factors contributed to hypoxemia after CABG along with cardiopulmonary bypass. Increase the awareness of risk factors of perioperative hypoxemia may guide the prevention and treatment, even alleviate or avoid the hypoxemia postoperatively.