312例非体外循环冠状动脉旁路移植术的危险因素评价

Assessment of mortality risk factors in 312 cases undergoing off pump coronary artery bypass graft surgery

目的 分析与探讨 312例非体外循环冠状动脉旁路移植术 (OPCAB)危险因素评价的特点。方法 1999年 10月～ 2 0 0 1年 6月连续 312例OPCAB手术 ,死亡 7例。通过回顾性分析临床资料 ,采用不同形式的单因素分析法和多元逐步回归分析 ,筛选出死亡相关的危险因素。结果 急症手术、左心室射血分数、慢性肾功能不全、糖尿病和机械通气时间依次是本组OPCAB手术的死亡相关危险因素 ,其相对危险度分别是 2 0 718、0 94 2、19 36 6、3 82 1、1 0 2 9。年龄、性别、二次手术、心肌梗死 1周内等属于常规冠状动脉旁路移植术 (cCABG)的危险因素不构成OPCAB手术的危险因素。结论 OPCAB手术较cCABG手术危险因素减少 ,体现出OPCAB手术良好的微创效果 ,但该结果尚有待于大规模多中心的综合评价验证。

Objective To relate mortality risks to clinical characteristics in 312 patients undergoing off pump coronary artery bypass graft surgery Methods We selected 312 consecutive cases of off pump coronary artery bypass graft surgery from October 1999 to June 2001, of which 7 deaths happened Univariate analyses were performed to evaluate the associations between death and different selected factors Significant factors were included in a stepwise logistic regression analysis Results Emergency procedures, left ventricular ejection fraction, chronic renal dysfunction, diabetes mellitus, ventilation time were found to be risk factors of mortality, whose odds ratios were 20 718, 0 942, 19 366, 3 821 and 1 029 respectively Age, sex, redo surgery, recent (<1 week) myocardial infarction and some other factors were excluded statistically, some of which contributed to mortality in conventional coronary artery bypass graft surgery Conclusion The decrease of the number of risk factors showed the good early results in OPCAB due to its minimal invasiveness A large scale multiple center assessment will be required