术前心力衰竭程度与非体外循环冠状动脉旁路移植术后远期预后关系研究

The relationship between preoperative heart failure degree and long-term prognosis after off-pump coronary artery bypass grafting

目的探讨术前心力衰竭程度对单纯行非体外循环冠状动脉旁路移植术(OPCAB)后患者远期预后的预测价值,以及影响患者远期预后的术前相关因素。方法选取2015年1月1至12月31日于北部战区总医院心血管外科治疗的385例行择期单纯OPCAB的患者为研究对象。对其进行随访观察及回顾性分析。术后远期存活通过电话或门诊随访方式进行。根据患者远期存活情况分为A组和B组进行进一步分析。以受试者工作特征曲线(ROC)确定术前血浆脑利钠肽(BNP)预测单纯行OPCAB患者术后远期死亡的截断值。应用Kaplan-Meier生存曲线比较两组患者远期存活状态。结果术后随访(5.25±0.25)年,其中,存活350例(A组),病死35例(B组),病死率为9.1%(35/385)。B组患者的术前血浆BNP水平高于A组,差异有统计学意义(P<0.05)。ROC曲线分析显示,预测单纯行OPCAB术后患者远期死亡的术前血浆BNP最佳截断值为762.45 pg/ml。Kaplan-Meier生存分析结果显示,BNP>762.45 pg/ml患者的术后远期存活率为77.2%(71/92),低于BNP≤762.45 pg/ml的95.2%(279/293),差异有统计学意义(P<0.05)。COX比例风险回归模型分析显示,根据截断值的术前血浆BNP分组在模型中的风险比=3.219(95%可信区间:1.570~6.599,P>0.001),说明术前血浆BNP水平可以作为独立预测因子很好地反映单纯行OPCAB后患者的远期预后情况。结论术前心力衰竭程度(即血浆BNP水平)具有独立预测单纯行OPCAB患者术后远期死亡的价值。当术前血浆BNP>762.45 pg/ml时,患者术后远期预后较差,死亡风险增加。

Objective To investigate the predictive value of preoperative heart failure degree on long-term prognosis of patients undergoing off-pump coronary artery bypass grafting(OPCAB)alone,and the preoperative related factors affecting long-term prognosis of patients.Methods A total of 385 patients undergoing elective OPCAB treatment in the cardiovascular surgery department of General Hospital of Northern Theater Command from January 1 to December 31,2015 were selected as the study subjects.To conduct follow-up observation and retrospective analysis.The long-term survival follow-up after operation was carried out by telephone or outpatient follow-up.Patients were divided into group A and group B for further analysis according to the long-term survival.The cut-off value of preoperative plasma brain natriuretic peptide(BNP)in predicting postoperative long-term death in patients treated with OPCAB alone was determined by receiver operating characteristic curve(ROC).Kaplan-meier survival curve was used to compare the long-term survival status of the two groups.Results The postoperative follow-up was(5.25±0.25)years.Among them,350 cases(group A)survived and 35 cases(group B)died.The fatality rate was 9.1%(35/385).The preoperative plasma BNP level in group B was higher than that in group A,and the difference was statistically significant(P<0.05).ROC curve analysis showed that the best cut-off value of preoperative plasma BNP was 762.45 pg/ml for predicting long-term death of patients treated with OPCAB alone.Kaplan-meier survival analysis showed that the long-term survival rate of patients with BNP>762.45 pg/ml was 77.2%(71/92),which was lower than 95.2%(279/293)of patients with BNP≤762.45 pg/ml,and the difference was statistically significant(P<0.05).COX proportional risk regression model analysis showed that the risk ratio of preoperative plasma BNP based on truncation value in the model was 3.219(95% confidence interval:1.570-6.599,P>0.001),indicating that preoperative plasma BNP level could be used as an independent predictor to well reflect the long-term prognosis of patients treated with OPCAB alone.Conclusion The degree of preoperative heart failure(ie plasma BNP level)has the value of independently predicting the long-term death of patients undergoing off-pump coronary artery bypass graft surgery.When the preoperative plasma BNP>762.45 pg/ml,the long-term prognosis after surgery is poor,and the risk of death increases.