患者吸烟情况与冠脉旁路移植术后早期结果的相关性

Correlation analysis of smoking on early outcomes in patients with coronary artery bypass graft surgery

目的:探讨患者吸烟情况与冠脉旁路移植术(CABG)术后早期结果的相关性。方法:对我院2010年1月至2012年12月间接受CABG的患者共489例行回顾性分析,根据患者术前是否吸烟分为吸烟组(n=276),不吸烟组(n=213)。根据术前戒烟情况将吸烟组分为戒烟亚组(n=81),未戒烟亚组(n=195)。结果:(1)吸烟组患者体质指数、高血压、高脂血症、心肌梗死病史、合并COPD史显著高于不吸烟组,吸烟组平均年龄、左心室射血分数显著低于对照组(均P<0.05),戒烟亚组与未戒烟亚组上述指标比较无统计学差异(P>0.05)。(2)去除COPD患者分析发现,不吸烟组患者术后肺部并发症、呼吸机辅助时间显著低于吸烟组,戒烟亚组患者术后肺部并发症、呼吸机辅助时间显著低于未戒烟亚组(均P<0.05)。(3)Logistic多因素分析显示患者住院期间肺部并发症与患者吸烟情况相关(P<0.05)。结论:吸烟可以影响CABG患者早期预后,患者术后肺部并发症增加,呼吸机辅助时间延长,应鼓励CABG患者术前及早戒烟,降低术后并发症。

Objective To investigate the correlation analysis of smoking on early outcomes in patients with coronary artery bypass graft surgery. Methods 489 patients undergoing CABG in our hospital from January 2010 to December 2012 were analyzed retrospectively. Subjects were divided into smoking group （n = 276）, non-smoking group （n = 213）. According to the condition of patients will quit smoking, smoking group was divided into two subgroups： quit-smoking group （n=81）, not quit-smoking group （n=195）. Results BMI, hypertension, hyperlipidemia, myocardial infarction, chronic obstructive pulmonary disease history were significantly higher than that of non-smoking group, the average age of left ventricular ejection fraction was significantly lower than that of the control group （P 〈 0.05）. But there were no significant differences between sub groups （P 〉 0.05）. If the COPD patients were excluded from the research, postoperative pulmonary complications, the time of mechanical ventilation of non-smoking groups was significantly lower than the smoking group; pulmonary complications , ventilation time of quit-smoking subgroups was significantly lower than not quit-smoking group （P 〈 0.05）. Multivariate Logistic analysis showed that the period of hospitalization in patients with pulmonary complications is related with smoking status （P〈0.05）. Conclusions Smoking may increase the effect of pulmonary complications and postoperative mechanical ventilation period. Patients with CABG should be encouraged to stop smoking as soon as possible, so as to reduce the postoperative complications.