冠状动脉旁路移植术后延长辅助通气与远期心原性死亡的相关性研究

Relationship Between Prolonged Mechanical Ventilation After Coronary Artery Bypass Grafting and Long-term Mortality of Cardiac Death

目的：分析冠状动脉旁路移植术（CABG）后患者延长机械通气（PMV）与远期心原性死亡的相关性研究。方法：回顾性分析我院2006-01-01至2008-12-31行单纯CABG术的4022例患者，按机械通气时间分为常规辅助通气时间≤12h组（常规组，n=1764），助辅通气时间〉12h组（PMV组，n=2205），远期随访终点事件：全因死亡、心原性死亡、主要心脑血管不良事件（MACCE）、心绞痛发作、因心脏病再次入院，多因素Cox回归分析PMV与终点事件发生之间的关系。结果：PMV组较常规组比较，PMV与远期随访心原[生死亡（HR=2．54，95％CI1．14．5．66）、因心脏病再次人院（HR=1．36，95％CI1．10～1．69）的风险升高，差异有统计学意义（P〈0．05）；PMV与远期随访心绞痛发作（HR=1．29，95％C10．99～1．68）的风险临界相关（P=0．05）；PMV与远期随访全因死亡（HR=1．38，95％C10．83～2．29）和MACCE事件（HR=1．20，95％C10．93～1．55）的风险，差异无统计学意义（P〉0．05）。结论：PMV显著增加了患者远期心原性死亡及因心脏病再次人院的风险。

Objective： To analyze the relationship between prolonged mechanical ventilation （PMV） after coronary artery bypass grafting （CABG） and long-term mortality of cardiac death. Methods： A total of 4022 consecutive patients undergoing isolated CABG in our hospital from 2006-01 to 2008- 12 were retrospectively analyzed. The patients were divided into 2 groups, Conventional group, n=1764 patients with mechanical ventilation time ≤12 hours and PMV group, n=2205 patients with mechanical ventilation time 〉12hours. Multivariate Cox regression analysis was conducted to analyze the relationship between PMV and the long-term endpoint events including all-cause death, cardiac death, major adverse cardiac and cerebrovascular events （MACCE）, angina and re-hospitalization rate. Results： Compared with Conventional group, PMV group presented the higher rates of cardiac death （HR=2.54, 95%CI 1.14-5.66） and re-hospitalization rate （HR=1.36, 95% CI 1.10-1.69） both P〈0.05. PMV patients had the critical correlation to angina occurrence （HR=1.29, 95%CI 0.99-1.68）, P=0.05, had no correlation to all-cause death （HR=1.38, 95%CI 0.83-2.29） and MACCE （HR=1.20, 95%CI 0.93-1.55） both P〉0.05. Conclusion： PMV obviously increased the long-term cardiac death rate and re-hospitalization rate in patients with cardiovascular disease.