冠状动脉旁路移植术后低氧血症的相关因素分析

Risk factors of postoperative hypoxemia in patients undergoing coronary artery bypass grafting

目的探讨冠状动脉旁路移植术(coronary artery bypasses grafting,CABG)后发生低氧血症的相关危险因素。方法对2007年1月至2009年6月接受单纯CABG的患者共288例的术前、术中、术后资料进行回顾性分析。将CABG术后在机械通气(FiO2>45%)或面罩加鼻导管供氧(氧流量6 L/min)条件下,PaO2低于[102-(0.33×年龄)]mmHg者,确诊为低氧血症。结果 288例CABG患者中,78例(27.08%)发生术后低氧血症。CABG术后发生低氧血症的独立危险因素有:术前慢性阻塞性肺部疾病史(OR=8.531,95%CI 3.136～23.210)、术前急性心肌梗死史(OR=3.351,95%CI 1.539～7.296)、术前糖尿病(OR=3.108,95%CI 1.439～6.713)。结论慢性阻塞性肺部疾病史、术前急性心肌梗死史、术前糖尿病是CABG术后发生低氧血症的3个独立危险因素。

Objective To investigate the risk factors of postoperative hypoxemia in patients undergoing coronary artery bypass grafting （CABG）. Methods Two hundred and eighty eight patients received CABG from January 2007 to June 2009 in our hospital. Mechanical ventilation （Fit2 over 45 % ） or mask oxygen supply （over 6 L/min）was administrated following CABG; PaO2 less than [ 102 - （ 0. 33 × age ） ] mmHg was diagnosed as postoperative hypoxemia. The relative factors of postoperative hypoxemia were tested through descriptive analysis and logistic regression. Results The incidence rate of postoperative hypoxemia in this series was 27.08 %. According to descriptive analysis and logistic regression, the independent risk factors of postoperative hypoxemia were as follows： underlying chronic pulmonary diseases （ OR = 8. 531, 95% CI 3. 136 - 23. 210）, preoperative acute myocardial infarction （OR =3. 351, 95% CI 1. 539-7.296）, diabetes （OR =3. 108, 95% CI 1.439- 6.713 ）. Conclusion Chronic pulmonary diseases, acute myocardial infarction and diabetes are independent risk factors for postoperative hypoxemia following CABG.