冠脉旁路移植术后血管麻痹综合征9例分析

Analysis of 9 cases of vasoplegic syndrome after coronary artery bypass grafting

目的探讨不同手术方式下冠脉旁路移植术（coronary artery bypass grafting,CABG）后血管麻痹综合征（vasoplegic syndrome,VS）的发生率。方法回顾性总结1999年12月至2013年12月253例CABG患者的临床资料,对体外循环（on-pump-CABG）和非体外循环下手术（off-pump-CABG）患者VS的发生率进行统计分析。结果共9例患者出现VS,发生率为3.6%。应用去甲肾上腺素峰值剂量为0.05~0.2μg/（kg·min）,平均0.098μg/（kg·min）;应用时间72~264 h,平均151 h;入住ICU 5~12 d,平均7.7 d;应用主动脉球囊反搏3例。存活6例,死亡3例,死亡率为33.3%。其中体外循环下手术97例中出现VS 7例,发生率为7.2%;非体外循环下手术156例中出现VS 2例,发生率为1.3%,2组比较差异有统计学意义（P〈0.05）。结论 CABG后VS治疗上需要较大剂量的血管活性药物,应用时间较长,虽然发生率低,但死亡率较高。非体外循环下CABG VS发生率比体外循环下发生率较低,应尽量选择非体外循环下CABG以减少VS的发生。

Objective To discuss the occurrence rate of vasoplegic syndrome （VS） with different operation methods after coronary artery bypass grafting （CABG）. Methods A total of 253 hospitalized patients with CABG were retrospec-tively analyzed from December 1999 to December 2013. All patients were divided into the on-pump-CABG group and the off-pump-CABG group. The occurrence of VS was analyzed statistically. Results Nine patients （3.6%） suffered from VS. The peak dosage of norepinephrine was （0.05~0.2）μg/（kg·min） [with the mean of 0.098μg/（kg·min）]. The application time of norepinephrine was 72~264 h （with the mean of 151 h）, and the ICU stay length was 5~12 d （with the mean of 7.7 d）. Three patients were treated by IABP. Six patients were cured, 3 patients died. Seven patients suffered VS in the group of 97 cases with on-pump-CABG, the incidence of VS was 7.2%. Two patients suffered VS in the group of 156 cases with off-pump-CABG, the occurrence rate of VS was 1.3%. The occurrence rate of the two groups was statistically significant （P〈0.05）. Conclusion VS has a high death rate even though it is in low occurrence rate. Large dosage of vasopressors is ef-fective for VS. The incidence of VS in the group of off-pump-CABG is lower than that of the group of on-pump-CABG. Off-pump-CABG should be the priority when compared with the on-pump-CABG in reducing the occurrence rate of VS.