冠状动脉旁路移植患者术前心理状况对低氧血症发生的影响

Influence of preoperative psychological status on hypoxemia in patients undergoing coronary artery bypass grafting

目的探讨冠状动脉旁路移植术(CABG)术后患者发生低氧血症的危险因素,以及术前心理状态对低氧血症发生的影响。方法回顾性分析2018年6月至2021年10月入住本院心血管外科的成年患者,根据术后氧合指数将患者分为低氧血症组和非低氧血症组。采用医院焦虑抑郁量表评估患者的术前心理状态,当任一子量表评分大于7分时即认为存在焦虑抑郁状态,纳入心理障碍组,反之则纳入心理正常组。结果本研究共纳入148例患者,其中45例术后出现低氧血症,发生率为30.4%。术前存在焦虑抑郁状态的患者共有70例,占47.3%。心理障碍组中低氧血症的发生率为40%(28/70),显著高于心理正常组的21.8%(17/78)(P<0.05)。术后24 h心理障碍组患者的氧合指数显著低于心理正常组(P<0.05)。年龄、术前合并慢性阻塞性肺病(COPD)、术前焦虑抑郁、手术时间被发现与低氧血症的发生密切相关(P<0.05),而进一步通过logistics回归分析证实术前合并COPD、术前焦虑抑郁、手术时间是低氧血症发生的独立危险因素(P<0.05)。当CABG患者术前出现焦虑抑郁后,其机械通气时间及ICU停留时间会显著高于心理状态正常患者(P<0.05)。结论低氧血症在患者行CABG术后发生率高,术前焦虑抑郁状态是其独立危险因素,及早的干预治疗有助于改善早期氧合状态以及临床预后。

Objective The present study intends to investigate the risk factors for hypoxemia in patients undergoing coronary artery bypass grafting(CABG)and the influence of preoperative psychological status on the occurrence of hypoxemia.Methods Adult patients who underwent CABG surgery in our department from June 2018 to October 2021 were analyzed retrospectively.According to the postoperative oxygenation index,the patients were divided into hypoxemia group and non-hypoxemia group.Hospital Anxiety and Depression Scale(HADS)was used to evaluate the preoperative psychological status of the patients.When any subscale score was more than 7 points,the patients were considered to have anxiety and depression and were included in the psychological disorder group,while the others were included in the psychological normal group.Results A total of 148 patients were included in this study,of which 45 developed postoperative hypoxemia,with an incidence of 30.4%.Seventy patients(47.3%)had anxiety and depression before operation.The incidence of hypoxemia in the psychological disorder group was 40%(28/70),which was significantly higher than 21.8%(17/78)in the psychological normal group(P<0.05).The oxygenation index of patients in psychological disorder group was significantly lower than that in psychological normal group 24 hours after operation(P<0.05).Age,preoperative COPD,preoperative anxiety and depression and operating time were found to be closely related to the occurrence of hypoxemia(P<0.05),and further logistic regression analysis confirmed that preoperative COPD,preoperative anxiety and depression and operating time were independent risk factors for the occurrence of hypoxemia(P<0.05).When postoperative hypoxemia occurred in CABG patients,the risk of secondary intubation and IABP implantation was significantly increased(P<0.05).The mechanical ventilation time and ICU stay time of patients in the hypoxemia group were also significantly higher than those in the non-hypoxemia group(P<0.05).Conclusuion The incidence of hypoxemia after CABG is high,and preoperative anxiety and depression is an independent risk factor for hypoxemia.Early intervention is helpful to improve the early oxygenation status and clinical prognosis.