冠状动脉搭桥术后短期死亡的围手术期危险因素分析

An analygis of perioperative risk factors associated with short- term mortality of patients undergoing coronary artery bypass grafting

目的筛选出与冠状动脉搭桥手术后短期死亡相关的围手术期危险因素。方法人选从2008年1月-2013年12月在南京医科大学附属南京医院进行冠状动脉搭桥手术的患者，观察期限为30天，筛选出术前、术中、术后与死亡有关的危险因素。结果共顺序入选2808例冠状动脉搭桥手术患者，30天病死率为1．5％（42／2808）。logistic回归分析显示，女性（P=0．0013，OR=0．2577）、射血分数降低（P=0．0247，OR=0．9617）、术后乳酸水平（P〈0．01，OR=1．3115）、术中更多的红细胞输注（P〈0．01，OR=1．1606）和短期病死率相关。ROC曲线分析显示受试者工作特征曲线下面积AUC=0．8566。结论冠状动脉搭桥手术患者短期病死率相对较高，女性、低射血分数、术后乳酸水平高、术中更多的红细胞输注与短期病死率独立相关，而B受体阻滞剂等药物未发现与术后病死率降低有关。

Objective To screen out the perioperative risk factors associated with short - term mortality of patients undergoing coronary artery bypass grafting （CABG）. Methods Patients receiving CABG in the Affiliated Nanjing Hospi- tal of Nanjing Medical University from June 2008 to December 2013 were included. They were observed for 30 days, and pre - , intra - and postoperative variables were used to screen out the risk factors of mortality. Results A total of 2808 patients who consecutively underwent CABG surgery were reviewed. The overall shortterm mortality rate was 1.5% （42/2808）. Multivariate logistic regression analysis showed that female （P = 0. 0013, OR = 0.2577 ） , low ejection fraction （EF） （ P = 0. 0247, OR = 0. 9617）, high levels of post - operative lactic acid （P 〈 0. 01, OR = 1. 3115 ） and more blood units transfused during surgery （P 〈 0. 01, OR = 1. 1606 ） were associated with short - term mortality of CABG patients. Receiver operating characteristic （ROC） curve analysis showed that the area under the curve （AUC） was 0. 8566. Conclusions The overall mortality of CABG patients is relatively high, and female, low EF, high levels of post -operative lactic acid and more blood units transfused during surgery are independent factors associated with mortality, whereas β - blockers and other agents are not associated with reduced mortality.