冠状动脉旁路移植术后发生严重胸腔积液的多因素Logistic回归分析

Logistic regression analysis of pleural effusion associated complications and prognostic effects after coronary artery bypass transplantation

目的:探讨冠状动脉旁路移植(coronary artery bypass grafting,CABG)术后出现需要引流胸腔积液的危险因素以及对预后的影响。方法:回顾性分析2021年1月1日至2021年12月30日,北京安贞医院接受CABG手术,术后72h~30d内出现胸腔积液的患者,按照是否接受穿刺引流分为引流组及非引流组,对其术前、术后的临床资料进行分析,评估引流组发生的危险因素。结果:共纳入545例患者,平均年龄为(63.6±10.1)岁,其中男性392例(71.9%)。术后接受胸腔积液引流的发生率为24.2%(132/545)。引流组患者术后住院时间平均延长3.1d[(10.5±3.3)vs.(7.5±2.0)d,P<0.01],死亡率差异无统计学意义。多元二分类Logistic回归分析结果显示,年龄≥65岁(OR=0.211,95%CI:0.063~0.710,P=0.012),术前LVEF<50%(OR=0.242,95%CI:0.151~0.388,P<0.001),有创通气时间>48h(OR=0.190,95%CI:0.113~0.321,P<0.001)以及术后新发心房颤动(OR=0.585,95%CI:0.366~0.933,P=0.024)是术后发生需要引流胸腔积液的危险因素。结论:CABG术后需要引流的胸腔积液患者住院时间更长,年龄≥65岁、术前LVEF<50%、接受超过48h有创通气、术后新发心房颤动是CABG术后需要引流的胸腔积液的危险因素,应对存在此危险因素的CABG术后患者积极关注胸腔积液情况,以改善预后。

Objective:To investigate the risk factors of pleural effusion requiring drainage after coronary artery bypass grafting(CABG)and its influence on prognosis.Methods:Patients who received CABG surgery in Beijing Anzhen Hospital from January 1,2021 to December 30,2021 and developed pleural effusion within 72h to 30d after surgery were divided into drainage group and non-drainage group according to whether they received puncture drainage or not.Clinical data before and after surgery were retrospectively analyzed to evaluate the risk factors in the drainage group.Results:A total of 545 patients were included,with an average age of(63.6±10.1)years,including 392 males(71.9%).The incidence of postoperative pleural effusion drainage was 24.2%(132/545).The average length of postoperative hospital stay in the drainage group was extended by 3.1d[(10.5±3.3)vs.(7.5±2.0)d,P<0.0],and there was no significant difference in mortality.Multivariate binary Logistic regression analysis showed that age≥65 years old(OR=0.211,95%CI:0.063-0.710,P=0.012),preoperative left ventricular ejection fraction<50%(OR=0.242,95%CI:0.151-0.388,P<0.001),Invasive ventilation time>48 hours(OR=0.190,95%CI:0.113-0.321,P<0.001)and postoperative new atrial fibrillation(OR=0.585,95%CI:0.366-0.933,P=0.024)were risk factors for postoperative drainage of pleural effusion.Conclusions:Patients with pleural effusion requiring drainage after CABG surgery have longer hospital stay,age≥65 years old,preoperative left ventricular ejection fraction<50%,receiving invasive ventilation for more than 48h,and postoperative new atrial fibrillation are risk factors for pleural effusion requiring drainage after CABG surgery.Patients with such risk factors should be actively concerned about pleural effusion after CABG surgery,to improve the prognosis.