老年患者冠状动脉旁路移植术后桥血管闭塞相关危险因素分析

Analysis of related risk factors for bypass graft occlusion in elderly patients after coronary artery bypass grafting

目的探讨冠状动脉旁路移植术后近期（1年）桥血管闭塞的相关危险因素，为术后预防桥血管闭塞提供依据。方法对接受冠状动脉旁路移植术治疗的l97例患者临床资料进行分析，分析桥血管闭塞发生率及相关危险因素。结果197例患者中，发生桥血管闭塞28例，发生率为14．2％；体质指数≥24kg／m^2患者桥血管闭塞发生率，明显高于体质指数〈24kg／m。患者（20．0％比9．8％，χ^2=4．106，P=0．043）。吸烟（22．4％比10．8％，χ^2=4．534，P=0．033）、高血压（21．2％比3．8％，χ^2=11．735，p=0．001）、高脂血症（31．1％比9．2％，χ^2=13．658，P〈0．001）、糖尿病（23．4％比9．8％，χ^2=6．615，P=0．010）、外周血管疾病（25．5％比10．7％，χ^2=6．486，P=0．011）和脑血管疾病患者（26．3％比11．3％，χ^2=5．656，P=0．017）桥血管闭塞发生率均明显升高。吸烟、糖尿病、高脂血症、外周血管疾病和脑血管疾病为桥血管闭塞的独立危险因素。结论冠状动脉旁路移植术后近期发生桥血管闭塞危险因素众多，针对危险因素，特别是独立危险因素采取相应的防治措施，可有效降低患者术后桥血管闭塞风险。

Objective To explore the related risk factors for bypass graft occlusion in patients within 1 year after coronary artery bypass grafting, in order to provide the basis for the prevention of postoperative bypass graft occlusion. Methods Clinical data of 197 cases treated with coronary artery bypass grafting were collected, and the incidence rate of bypass graft occlusion and its related risk factors were analyzed. Results Graft occlusion occurred in 28 （14.2%） of 197 patients. The incidence rate of bypass graft occlusion were much higher in patients with BMI ≥24 kg/m^2 , smoking, hypertension, hyperlipemia, diabetes, peripheral vascular diseases and cerebrovascular disease than in patients with BMI 〈24 kg/m^2 , non-smoking, patients without hypertension, hyperlipemia, diabetes, peripheral vascular diseases or cerebrovascular disease （20.0% vs. 9.8%, 22.4% vs. 10.8%, 21.2% vs. 3.8%, 31.1% vs. 9.2%, 23,4% vs. 9.8%, 25.5% vs. 10.7%, 26.3% vs. 11.3%, χ^2= =4. 106, 4. 534, 11. 735, 13. 658, 6. 615, 6. 486, 5. 656, respectively, P=0. 043, 0. 033, 0. 001, %0. 001, 0. 010, 0. 011, 0. 017）. Smoking, diabetes, hyperlipidemia, peripheral vascular diseases and cerebrovascular disease were the independent risk factors for bypass graft occlusion. Conclusions Many risk factors are related with short-term postoperative bypass graft occlusion in patients with coronary artery bypass grafting. The corresponding control measures should be conducted to decrease the risk of postoperative bypass graft occlusion, aiming directly at the risk factors, especially the independent risk factors.