单纯冠状动脉旁路移植术围术期主动脉内球囊反搏应用的预后分析

Outcomes of intra-aortic balloon pump support in isolated coronary artery bypass grafting patients

目的对单纯冠状动脉旁路移植术(CABG)围术期主动脉内球囊反搏(IABP)应用情况进行回顾性分析,分析IABP辅助患者院内死亡的高危因素。方法入选2008年1月至2015年12月阜外医院单纯CABG使用IABP辅助发生院内死亡及生存出院的患者临资料,比较死亡与存活患者入院一般情况、术前合并症、术中及术后情况、IABP辅助情况等临床特点,通过Logistic回归分析导致院内死亡的独立危险因素。结果 8年间阜外医院单纯CABG共15 764例,围术期IABP植入共313(0.21%)例,院内死亡44例,死亡率为14.06%。IABP相关并发症总体发生率为2.56%,无IABP相关死亡。IABP应用院内死亡的独立危险因素分析显示高龄(年龄>65岁)[OR=2.32,95%可信区间(95%CI):1.096~4.923,P=0.047]、住院时间长(OR=0.941,95%CI:0.873~0.970,P<0.001)、呼吸机时间长(OR=1.02,95%CI:1.068~1.451,P=0.041)、并发症(OR=26.929,95%CI:1.240~15.196,P<0.001)、同时行体外膜肺氧合(ECMO)辅助(OR=5.661,95%CI:9.943~72.93,P<0.001)为院内死亡的独立危险因素。结论 IABP是高危CABG患者有效、安全的机械循环辅助装置,IABP相关的并发症发生率低。CABG围术期IABP应用死亡的独立危险因素为高龄、呼吸机时间及住院时间长、并发症的出现以及同时行ECMO辅助。

Objective The objective of this research was to analyze the outcomes of intra-aortic balloon pump（ IABP） support in isolated coronary artery bypass grafting（ CABG）. Methods The clinical data of isolated CABG patients underwent IABP insertion from January 2008 to December 2015 were retrospectively analyzed.The incremental risk factors of in-hospital death and clinical characteristics were compared in non-survivors and survivors. Data were analyzed with univariate analysis and logistic regression. Results During the 8-year period,313 isolated CABG patients underwent IABP insertion.The overall mortality for patients was 14.06%. Complications rate of IABP was 2.56%. No patients died due to complications. Higher age,length of the ventilatory support and hospital stay,combination with extracorporeal membrane oxygenation were found to be the risk factors of in-hospital death in patients with IABP support. Conclusion These data indicate that IABP is a valuable and safe option in high-risk CABG patients. IABP complication rates are generally low.There is an increased risk of in-hospital death in isolated CABG patients underwent IABP insertion with a higher age（ 65 years）,long time ventilatory support and hospital stay,combination with extracorporeal membrane oxygenation.