非体外循环下冠状动脉旁路移植术中应用正性肌力药物的相关因素

Predictors of positive inotropic drug use in patients undergoing concomitant coronary artery bypass graft without cardiopulmonary bypass

目的：观察和分析冠状动脉旁路移植手术（coronary artery bypass graft，CABG）中应用正性肌力药物的相关因素。方法： 以2012年1月-2013年12月在北京市大兴区人民医院心脏中心接受非体外循环下CABG的患者630（男351，女279）例为研究对象。按术中是否应用正性肌力药物分为应用组（n=330）和未应用组（n=300）。通过回顾原始病历收集临床资料。需要应用正性肌力药物被定义为使用多巴胺剂量超过5 μg/（kg·min）、任何剂量的肾上腺素或去甲肾上腺素、米力农。结果： 确定了3个应用正性肌力药物的独立的相关因素：①心脏指数（CI）≤2.5 L/（min·m2）；②左室射血分数（LVEF）≤35%； ③左室舒张末压（LVEDP）≥25 mmHg。结论： CI≤2.5 L/（min·m2）、LVEF≤35%和LVEDP≥25 mmHg是增加非体外循环下CABG中应用正性肌力药物风险的独立相关因素。

AIM：To identify the demographic, clinical, laboratory, echocardiographic and hemodynamic factors that are associated with the use of inotropic drugs in patients undergoing concomitant coronary artery bypass graft without cardiopulmonary bypass. METHODS： The study included 630 patients [male 351, female 279; average age （68.6±9.7） years] who underwent concomitant coronary artery bypass graft at our hospital from January 2012 to December 2013. Positive inotropic drug support was given in 330 patients and was not given in 300 patients. All data were collected retrospectively after reviewing original medical records. Inotropic support was defined as the use of dopamine≥5 μg/（kg·min）, any dose of epinephrine or norepinephrine and milrinone at the separation from cardiopulmonary bypass. RESULTS： The study identified three significant and independent predictors of inotrope use： cardiac index 2.5 L/（min·m2）, LVEF 35% and LVEDP≥25 mmHg. CONCLUSION： Cardiac index 2.5 L/（min·m2）, LVEF 35% and LVEDP≥25 mmHg are independent predictors of inotropen use.