中重度左心室收缩功能不全患者613例非体外循环冠状动脉旁路移植术分析

Off-pump coronary artery bypass grafting of 613 patients with moderate or severe left ventricular systolic dysfunction

目的:回顾性分析613例中重度左心室收缩功能不全患者的外科治疗过程,总结治疗经验。方法:分析2009年1月至2019年12月期间,接受非体外循环冠状动脉旁路移植术患者的临床资料,筛选中重度左心室收缩功能不全患者为观察组(LVEF≤40%,n=613),与对照组(LVEF>40%,n=8 709)患者进行单因素分析,以在院死亡为终点事件将有统计学意义的单因素进行多因素Logistic回归分析并进行讨论。结果:两组合并中重度左心室收缩功能不全患者术前BMI、入院高血压、糖尿病史、心肌梗死病史、肌酐水平、心律失常(心房扑动/心房颤动)及使用主动脉内球囊反搏(IABP)差异有统计学意义,术中、术后治疗数据中输血比率、数量、使用IABP、呼吸机使用时间、ICU停留时间、院内病死率,差异有统计学意义(P均<0.05)。Logistic回归分析显示术前使用IABP(OR=4.001,95%CI:1.405~11.006)是本组患者术后死亡的危险因素。结论:中重度左心室收缩功能不全患者具有更多的术前合并病史、更不佳的临床状态,需要更复杂的术前治疗措施。术前使用IABP是出现术后死亡的危险因素。围术期疗效仍较为满意,高危患者的筛选、充分的血运重建、术后更加谨慎、完善的呼吸循环支持并有效降低严重并发症的发生率是改善预后的重点。

Objective: To analyze the surgical treatment of 613 patients with moderate or severe left ventricular systolic dysfunction and summarize the clinical experience. Methods: The data of patients who received off-pump coronary artery bypass grafting from January 2009 to December 2019 in the General Hospital of Northern Theater Command were analyzed. The patients with moderate or severe left ventricular systolic dysfunction were selected as the observation group(LVEF ≤ 40%, n=613) and the control group(LVEF>40%), n=8709), the medical materials of the patients were analyzed by single factor analysis, and the single factor Logistic regression analysis was conducted to discuss. Results: There were statistical differences in preoperative BMI, hypertension, diabetes mellitus, myocardial infarction history, creatinine level, arrhythmia(atrial flutter/fibril-ation) and preoperative use of intra-aortic balloon pump(IABP) in patients with moderate or severe left ventricular systolic dysfunction. There were significant differences in mechanical ventilation, ICU stay and hospital mortality(P<0.05). Logistic regression analysis showed that preoperative IABP(OR=4.001, 95% CI: 1.405-11.006) was an independent risk factor for postoperative mortality. Conclusions: Patients with moderate or severe left ventricular systolic dysfunction have more preoperative history and worse clinical status and need more complex preoperative treatment. Preoperative IABP is an independent risk factor for postoperative mortality. The key points to improve the prognosis are to identify high-risk patients, sufficient revascularization, better respireatory,hemodynamic support and reduce the incidence of serious complications effectively.