行冠状动脉旁路移植术的冠心病患者存在主动脉病变和外周动脉狭窄的情况及其影响因素研究

Incidence and Influencing Factors of Aortic Lesions and Peripheral Artery Stenosis in Patients with Coronary Heart Disease underwent Coronary Artery Bypass Grafting Surgery

背景冠心病患者常同时存在主动脉病变及外周动脉病变,若合并全身血管病变会影响患者的手术及预后。既往研究缺少对行冠状动脉旁路移植术(CABG)的冠心病患者合并全身血管病变的系统性描述,且少有分析其危险因素及防控措施的研究。目的分析行CABG的冠心病患者存在主动脉病变和外周动脉狭窄的情况及其影响因素。方法选取2018年1—10月于中国医学科学院阜外医院行CABG的冠心病患者共129例,根据是否存在明显主动脉病变分为A组(n=79)和B组(n=50);根据是否存在明显外周动脉狭窄分为C组(n=50)和D组(n=79)。比较A组与B组、C组与D组患者的一般资料、日常饮食调查问卷(NA)评分、焦虑状态评估量表(SAS)评分、抑郁状态评估量表(SDS)评分、匹茨堡睡眠质量指数量表(PSQI)评分、国际体力活动量表(IPAQ)评分、Fagerstorm烟碱依赖量表评分。存在明显主动脉病变或外周动脉狭窄的影响因素采用单因素及多因素Logistic回归分析。结果129例患者中存在明显主动脉病变79例(61.2%)。行多因素Logistic回归分析,结果显示,年龄〔OR=1.123,95%CI(1.061,1.187)〕、饮酒史〔OR=2.684,95%CI(1.144,6.299)〕是行CABG的冠心病患者存在明显主动脉病变的影响因素(P<0.05)。129例患者中存在明显外周动脉狭窄50例(38.8%)。行多因素Logistic回归分析,结果显示,年龄〔OR=1.052,95%CI(1.001,1.1.05)〕、NA3评分〔OR=0.367,95%CI(0.162,0.833)〕是行CABG的冠心病患者存在明显外周动脉狭窄的影响因素(P<0.05)。A组患者存在明显外周动脉狭窄发生率高于B组(P<0.05)。结论行CABG的冠心病患者中存在明显主动脉病变及明显外周动脉狭窄的发生率为61.2%、38.8%,年龄、饮酒史是患者存在明显主动脉病变的危险因素,年龄是患者存在明显外周动脉狭窄的危险因素,动物内脏摄入是患者存在明显外周动脉狭窄的保护因素。

Background Patients with coronary heart disease(CHD)often have both aortic lesions and peripheral arterial lesions,if combined with systemic vascular disease will affect the surgical risk and prognosis of patients.Previous studies lacked a systematic description of systemic vascular disease in patients undergoing coronary artery bypass grafting(CABG),and few studies analyzed risk factors and prevention measures.Objective To analyze incidence and influencing factors of aortic lesions and peripheral arterial lesions in patients with CHD who underwent CABG.Methods A total of 129 patients with CHD who underwent CABG in Fuwai Hospital,CAMS and PUMC from January to October 2018 were selected,they were divided into group A(n=79)and group B(n=50)according to presence or absence of obvious aortic lesions,while were divided into group C(n=50)and group D(n=79)according to presence or absence of obvious peripheral arterial stenosis.Comparison of general information,NA score,SAS score,SDS score,PSQI score,IPAQ score,Fagerstorm nicotine dependence scale score between group A and group B,group C and group D.Multivariate Logistic regression analysis was used to analyze the influencing factors of obvious aortic lesions and peripheral arterial stenosis.Results Among the 129 patients,79 patients(61.2%)had obvious aortic lesions.Multivariate Logistic regression analysis showed that,age〔OR=1.123,95%CI(1.061,1.187)〕and history of drinking〔OR=2.684,95%CI(1.144,6.299)〕were influencing factors for obvious aortic lesions in patients with CHD underwent CABG(P<0.05).Among the 129 patients,50 patients(38.8%)had obvious peripheral artery stenosis.Multivariate Logistic regression analysis results showed that,age〔OR=1.052,95%CI(1.001,1.1.05)〕and NA3 score〔OR=0.367,95%CI(0.162,0.833)〕were influencing factors for obvious peripheral artery stenosis in patients with CHD underwent CABG(P<0.05).Peripheral arterial stenosis in group A was statistically significantly higher than that in group B(P<0.05).Conclusion The incidence of aortic disease and peripheral arterial disease is 61.2%and 38.8%in patients with CHD underwent CABG.Age and history of drinking are risk factors for obvious aortic lesions,and age is risk factor for obvious peripheral arterial stenosis,animal by-products intake is a protective factor in patients with obvious peripheral artery stenosis.