心脏手术后机械循环辅助发生骨筋膜室综合征的危险因素分析

Risk factors of osteofascial compartment syndrome under mechanical circulatory support after cardiac surgery

目的研究心脏手术后应用机械循环辅助发生骨筋膜室综合征的危险因素，预测并减少不良事件的发生。方法回顾性分析我院2013年1月至2015年12月经股动脉置管建立机械循环辅助的患者348例。根据下肢缺血肿胀发生情况分为骨筋膜室综合征发生组33例，未发生组315例。对比两组患者的年龄、性别、体质量指数（BMI）、吸烟史、糖尿病、高血压、高脂血症、下肢血管狭窄病变、辅助装置个数（2／1）、是否存在持续性低射血分数（EF≤0．40）、是否持续应用大量缩血管药物（去甲肾上腺素）、是否存在持续低氧、辅助应用时间等因素，并进行相关性分析。结果单因素分析筛选后，通过fo—gistic回归分析，高脂血症（OR=6．18，P=0．02）、外周血管狭窄（OR=5．27，P=0．01）、辅助装置个数（2／1）（OR=4．49，P=0．02）、持续性低射血分数（OR=23．84，P〈0．01）、持续应用大量缩血管药物（OR=24．28，P〈0．01）、持续性低氧（OR=16．76，P=0．01）、辅助应用时间（OR=0．71，P=0．01）与骨筋膜室综合征的发生有明显相关性，而年龄、性别、BMI、吸烟史、糖尿病、高血压等因素与骨筋膜室综合征的发生无明显相关性。结论既往有高脂血症病史、外周血管狭窄病变的心脏外科术后患者，同时合并持续低射血分数、持续应用大量缩血管药物、持续低氧及辅助应用时间长，更易发生骨筋膜室综合征。对于这类患者应多关注、尽早给予临床干预，避免严重并发症的发生。

Objective Analysis of risk factors of osteofascial compartment syndrome under mechanical circulatory support after cardiac surgery, to predict and reduce adverse events. Methods 348 patients under mechanical circulatory support were retrospectively analeyzed in this study from Janurary 2013 to December 2015. According to the occurrence of lower limb ische- mia and swelling, 33 cases had osteofascial compartment syndrome and 315 cases had none. Two groups were compared by age, sex, body mass index（BMI）, history of smoking, diabetes, hypertension, hyperlipemia, lower extremity vascular steno- sis, auxiliary device number（2/1 ）, whether persistent low ejection fraction（ EF ~0.40） exists, whether the blood vessel con- traction medicine（ norepinephrine ） was persistently and massively applied, whether persistent hypoxia exists, the time of me- chanical support and other factors. Results The logistic regression analysis showed there was correlation between hyperlipemia （ OR = 6.18, P = 0.02 ）, lower extremity vascular stenosis （ OR = 5.27, P = 0.01 ）, auxiliary device number （2/1） （ OR = 4. 49, P = 0.02）, persistent low ejection fraction（ EF ≤0.40） （ OR = 23.84, P 〈 0.01 ）, the blood vessel contraction medicine （ norepinephrine ） was persistently and massively applied （ OR = 24.28, P 〈 0.01 ）, persistent hypoxia （ OR = 16.76, P = 0.01 ）, the time of mechanical support （ OR = 0.71, P = 0.01 ）, while there was no obvious correlation with age, sex, BMI, history of smoking, diabetes, hypertension, age, etc. Conclusion The patients who have the history of hyperlipemia and low- er extremity vascular stenosis, combine with tow auxiliary devices, persistently low ejection fraction , persistently and massively applied the blood vessel contraction medicine（ norepinephrine ）, persistent hypoxia, mechanical support with long time will be easy to get osteofascial compartment syndrome. We should pay more attention to preventing serious complication happen earlier.