吸烟及戒烟对冠状动脉旁路移植术后早期结果的影响

The Influence of Smoking on Early Outcomes in Patients With Coronary Artery Bypass Graft Surgery

目的：研究吸烟及戒烟对冠状动脉旁路移植术（CABG）后早期结果的影响。方法：回顾性分析我院2004—01至2005—12行CABG2570例患者资料，其中有吸烟情况记录者共2486例，按照术前吸烟情况分为吸烟组（1457例）和不吸烟组（1029例），其中吸烟组根据术前1个月是否戒烟分为戒烟者（409例）及未戒烟者（1048例），采用Logistic多因素回归分析吸烟及戒烟与住院期间术后早期并发症及死亡率的关系。结果：与不吸烟组相比，吸烟组接受CABG时年龄较小，男性患者占比例更高，体重指数较高，心肌梗死史高，合并慢性阻塞性肺病史高，较少合并高血压病及高脂血症，合并二尖瓣反流史低，射血分数低，较少应用体外循环，差异均有统计学意义（P〈0．001～0．05）。吸烟组与不吸烟组比较术后肺部并发症发生率高（3．2％VS1．6％），呼吸机辅助时间增加（8h vs 6h），差异均有统计学意义（P均〈0．05）。多因素回归分析表明吸烟组（包括术前戒烟和未戒烟患者）发生肺部并发症的风险为不吸烟组的1．91倍（95％可信区间1．03—3．56）；未戒烟者发生肺部并发症的风险为不吸烟组的2．30倍（95％可信区间1．19～4．46），差异均有统计学意义（P均〈0．05）；其他术后早期并发症的发生吸烟组与不吸烟组间比较差异均无统计学意义（P均〉0．05）。结论：吸烟组患者术后肺部并发症明显增加，呼吸机辅助时间延长，术前未戒烟患者术后并发症显著增加。应鼓励患者及早戒烟，戒烟有助于减少CABG后并发症的发生。

Objective ： To assess the influence of smoking on early outcomes in patients undergoing coronary artery bypass graft（CABG） surgery. Methods ： A total of 2 570 consecutive patients who underwent CABG in our hospital from January 2004 to December 2005 were retrospectively analyzed. We retrieved 2 486 patients for their smoking status, there were 1 029 nonsmokers and 1 457 smo- kers,in which 409 patients stopped smoking 1 month before the operation（former smokers）and 1 048 patients were current smo- kers. We compared the early outcomes after CABG between former smokers, current smokers and nonsmokers. Results： Smokers had the younger age, more male gender, with higher BMI, more history of myocardial infarction, and chronic obstructive pulmonary disease,less history of mitral insufficiency, less rates of hypertension and hyperlipidemia,lower left ventri- cular ejection fraction and less rate of on pump CABG, P 〈 0.05 respectively. Smokers had the higher rate of postoperative pulmo- nary complication compared with nonsmokers （ 3.2 % vs. 1.6 % ） and longer ventilation time （ 8h vs. 6h ）, P 〈 O. 05 respectively. The odds ratio（OR） for developing postoperative pulmonary complication for smokers vs. nonsmokers was 1.91 （95 % CI, 1.03 - 3.56）, and the OR for developing postoperative pulmonary complication for current smokers vs. nonsmokers was 2. 30 （95% CI,1. 19 - 4.46） ,P 〈 0. 05 respectively. The other postoperative complications had 110 statistic difference between smokers and nonsmokers ,P 〉 0. 05 respectively. Conclusion： Smoking is associated with significant pulmonary complieations and longer ventilation time in patients after CABG,the patients should stop smoking as early as possible to reduce CABG complications.