冠状动脉旁路移植术后二次开胸止血相关危险因素分析

Analysis of risk factors related to postoperative bleeding after coronary artery bypass grafting

目的探讨冠状动脉旁路移植术后发生二次开胸止血的相关危险因素.方法回顾性分析我院心脏大血管外科在2016年1月至2019年5月行冠状动脉旁路移植术治疗的患者217例,收集患者一般资料(年龄、性别和合并症)、术前口服抗凝药、左心室射血分数、术前停用抗血小板药物时间<5 d、手术时间、体外循环时间、是否同期置换瓣膜、出血部位、自体血输血量和ACT值等,对各项观察指标进行单因素和Logistic多因素分析.结果术后发生二次开胸止血患者21例,其中术后2h内二次开胸6例,4h以内10例,6h以内5例.Logistic单因素分析显示,术前停用抗血小板药物<5 d和体外循环时间>5 h与术后二次开胸发生有关.Logistic多因素分析显示,术前停用抗血小板药物<5 d(P=0.001,OR=1.262)是影响患者术后二次开胸的独立危险因素.结论术前停用抗血小板药物<5 d和体外循环时间>5 h与术后二次开胸发生有关,术前停用抗血小板药物<5 d是术后发生二次开胸的独立危险因素.

Objective To explore the risk factors of postoperative bleeding after coronary artery bypass grafting.Methods A retrospective analysis of 217 patients who underwent coronary artery bypass grafting from January 2016 to may 2019 in our hospital was made.The general information(age,gender and comorbidities),anticoagulants,lefi ventricular ection fraction,antiplatelet drug withdrawal time<5 days,operation time,cardiopulmonary bypass time,whether valve replacement at the same time,the location of bleeding,autotransfusion volume and act value were recorded and analyzed by single factor and Logistic analysis.Results There were 21 patients with secondary thoracotomy for hemostasis.including 6 patients with within 2 hours,10 patients within 4 hours and 5 patients within 6 hours.Logistic univariate analysis showed that the bleeding was related to the discontinuation of antiplatelet drugs<5 days and CPB time>5 hours.Logistic multivariate analysis showed that the discontinuation of antiplatelet drugs<5 days(P=0.001.OR=1.262)were independent risk factor for the bleeding.Conclusion It is related to the ocurence of the bleeding that the antiplatelet drugs are stopped less than 5 days before operation and the time of cardiopulmonary bypass is more than 5 hours.It is an independent risk factor for the occurrence of the bleeding that the antiplatelet drugs are stopped less than 5 days before operation.