代谢综合征对不停跳冠状动脉旁路移植围术期的影响

The perioperative effects of metabolic syndrome on the off-pump coronary artery bypass

目的探讨代谢综合征（metabolic syndrome，MS）对不停跳冠状动脉旁路移植（OPCABG）围术期的影响。方法2009年8月至2010年3月，连续1060例OPCABG病人分为MS组与非MS组，比较两组的病死率、房颤发生率、多器官衰竭评分（MODS）、心脏外科术后评分（PSCS）、PaO2／FiO2以及心率×中心静脉压／平均动脉压（pressure—adjusted heart rate，PAHR）。结果MS对OPCABG的病死率、房颤发生率、脑卒中、IABP和ECMO、透析的使用率无影响。但手术当天，MS组的MODS评分为2．57±1．62，PSCS评分为4．27±2．15，显著高于非MS组的2．15±1．65，3．92±2．29，P〈0．05；PaO2／FiO2在MS组为249．23±110．99，显著低于非MS组的283．33±114．35，P〈0．01；MS组的PAHR为9．98±3．54，显著高于非MS组的9．23±3．88，P〈0．05。手术后第1天，MS组的MODS评分为3．05±1．64，显著高于非MS组的2．82±1．72，P〈0．05；Pa02／FiO2在MS组为277．11±122．99，显著低于非MS组，318．47±143．84，P〈0．05。结论MS对OPCABG的病死率、房颤发生率、脑卒中、IABP和ECMO、透析的使用率无影响，但在术后当天和术后第1天，MS可以对OPCABG病人的呼吸和循环系统产生短暂的负面影响。

Objective Metabolic syndrome （MS）, a disorder involving inuhiple metabolic abnormalities such obesity, hypertension, diabetes or abnormal glucose tolerance and dyslipidemia, has been observed in many patients receiving coronary artery, bypass procedures. In this study we try. to examine the perioperative effects of metabolic syndrome on the off-pump coronary artery bypass （OPCABG）. Methods A prospective study was conducted in 1060 consecutive OPCABG patients who were admited to Beijing Anzhen Hospital from July 2009 to March 2010. The patients were grouped as MS group and non-MS group according to the diagnostic criteria for Chinese metabolic syndrome. The outcomes such as mortality, atrial fibrillation, stroke, staying in ICU for more than three days, use of IABP, ECMO, dialysis, multiple organ dysfimction score （MODS）, postoperative score for cardiac surgery. （PSCS） , PaO2/FiO2 , heart rate x central venous pressure/mean artery pressure （ pressure-adjusted heart rate, PAHR）,renal and liver function, platelets, and the dosage of vasoactive agents were analyzed and compared between the two groups by X2 test or t test. Results Three hundred and eighty-nine cases were diagnosed with MS among 1060 cases with OPCABG. In the MS group, 17 cases stayed in ICU for more than 3 days, 2 cases died, 76 had atrial fibrillation, 3 had stroke, 18 cases were treated with intra-aortic balloon counterpulsation （IABP）. In the non-MS group, 47 cases stayed in 1CU for more than 3 days, 12 cases died, 148 had atrial fibrillation, 3 had stroke, 48 cases were treated with- IABP, 3 cases received ECMO and 4 cases received dialysis. No significant difference between MS group and non-MS group was identified in the aspects of mortality, atrial fibrillation, stroke, duration of more than three days in ICU, the use of IABP, ECMO, dialysis after OPACBG based on the x2 test（P 〉 0.05）. However, on the operative days, the MODS and PSCS in MS group were significantly higher than that in non-MS group （P 〈0.05）. MODS 2.57 ±1. 62 in MS group vs. 2. 15 ± 1.65 in non-MS group, PSCS 4.27 ±2.15 in MS group vs. 3.92 ±2.29 in non-MS group. PaO2/FiO2 in MS group was significantly lower than that in non-MS group （249.23 ±110.99 vs. 283.33 ± 114.35 ） , P 〈 0. 01. PAHR in MS group was significantly higher than that in non-MS group （9.98 ± 3.54 vs. 9.23 ±3.88 ）, P 〈 0.05. On the first postoperative days, the MODS in MS group was also significandy higher than that in non-MS group （3.05 ±1.64 vs. 2.82 ±1.72）, P 〈0.05. PaO2/FiO2 in MS group was significantly lower than that in non-MS group （ 277.11 ± 122.99 vs. 318.47± 143.84 ） , P 〈 0.05. ConcluSion MS was not a predictor for death, atrial fibrillation, stroke, duration of more than three days in ICU, the use of IABP, ECMO, dialysis after OPACBG. However, MS had a temporary adverse effect on the respiratory and circulatory systems on the operative day and the first postoperative day after OPCABG.