非体外循环下冠状动脉旁路移植术后低心排血量综合征危险因素分析

Analysis of risk factors for low cardiac output syndrome after off-pump coronary artery bypass grafting

目的 探讨非体外循环下冠状动脉旁路移植术(off-pump coronary artery bypass grafting,OPCABG)后低心排血量综合征(low cardiac output syndrome,LCOS)的发生率及危险因素。方法 回顾性收集2018年1月至2020年12月在青岛大学附属医院心血管外科行OPCABG患者的临床资料,根据术后是否发生并确诊为低心排血量综合征将患者分为LCOS组和非LCOS组,详细统计并比较两组患者的临床基本特征,计算患者LCOS的发病率。采用多因素logistic回归模型分析患者OPCABG术后发生LCOS的危险因素。结果本文共纳入765例患者,LCOS组(n=58)和非LCOS组(n=707),OPCABG术后早期LCOS的发生率为7.58%。两组患者在术前心律失常、心绞痛发作、支架术后再狭窄、脑血管病变、肺部病变、颈椎血管病变、病变支数、左前降支病变程度、右回旋支病变程度、左室射血分数(EF)、左室射血分数、左室舒张末期内径、术中失血量的差异均有统计学意义(P <0.05)。多因素logistic回归分析结果显示:术前心律失常(OR=6.315,95%CI:1.404~28.396,P=0.016)、心绞痛发作(OR=9.214,95%CI:2.153~39.424,P=0.003)、脑梗死(OR=3.523,95%CI:1.246~9.962,P=0.018)、肺部病变(OR=5.505,95%CI:1.997~12.733,P=0.001)、颈动脉狭窄或闭塞(OR=35.588,95%CI:11.874~106.662,P <0.001)是OPCABG患者术后发生LCOS的独立危险因素。结论 术前心律失常、心绞痛发作、脑梗死、肺部病变、颈动脉狭窄或闭塞是孤立OPCB术后发生LCOS的独立危险因素。

Objective To investigate the incidence and risk factors of low cardiac output syndrome(LCOS)after off-pump coronary artery bypass grafting(OPCABG). Methods The clinical data of patients with OPCABG in the Department of Cardiovascular Surgery,Affiliated Hospital of Qingdao University from January2018 to December 2020 were collected retrospectively. According to the diagnosis of aftersurgery,patients were divided into LCOS group and non-LCOS group. The basic clinical characteristics of the two groups were recorder and compared,and the incidence of LCOS was calculated. Multivariate Logistic regression model was used to analyze the risk factors for LCOS after OPCABG. Results A total of 765 patients were included,LCOS group(n = 58)and non-LCOS group(n = 707). The incidence of early LCOS after OPCABG was 7.58%. There were significant differences in preoperative arrhythmia,angina pectoris,restenosis after stent,cerebrovascular disease,pulmonary lesion,cervical vascular lesion,number of diseased branches,degree of left anterior descending artery disease,degree of right circumflex artery lesion,left ventricular ejection fraction(EF),left ventricular ejection fraction,left ventricular end-diastolic diameter and intraoperative blood loss between the two groups. Multivariate Logistic regression analysis showed that preoperative cardiac arrhythmia(OR = 6.315,95%CI:1.404 ~ 28.396,P = 0.016),angina pectoris(OR = 9.214,95%CI:2.153 ~ 39.424,P = 0.003),cerebral infarction(OR = 3.523,95%CI:1.246 ~ 9.962,P = 0.018),pulmonary disease(OR = 5.505,95%CI:1.997 ~ 12.733,P = 0.001),carotid stenosis or occlusion(OR = 35.588,95%CI:11.874 ~ 106.662,P < 0.001)was an independent risk factor for postoperative LCOS in patients with OPCABG. Conclusion Preoperative arrhythmia,angina pectoris,cerebral infarction,pulmonary lesion,carotid stenosis or occlusion were independent risk factors for LCOS after isolated OPCB.