成人先天性心脏病患者外科手术治疗联合冠状动脉旁路移植术后再入院的相关因素

Influencing factors of readmission in adult congenital heart disease patients after surgical treatment combined with coronary artery bypass grafting

目的探讨成人先天性心脏病(ACHD)患者行外科手术治疗联合冠状动脉旁路移植术(CABG)后再入院情况的相关因素。方法选择2004年5月至2021年10月在武汉亚洲心脏病医院行外科手术治疗联合CABG术的ACHD患者为研究对象。病例组为再次入院的患者(20例),按1:3配对原则,选择性别、民族相同、年龄相近的未再次入院患者为对照组(60例)。对两组患者临床资料进行比较,根据单因素和条件Logistic回归分析影响ACHD患者外科手术治疗联合CABG术后再入院的相关因素。结果单因素分析显示,两组入院途径、体质量指数(BMI)、糖尿病、左心室射血分数、国际标准化比值(INR)、纽约心脏协会分级、美国麻醉医师协会分级、手术时间、主动脉阻断时间、体外循环平均指数、总供给晶体量比较,差异有统计学意义(t/Z/χ^(2)=4.208、6.475、4.096、-2.790、-2.159、-2.559、-2.629、-3.918、-2.439、-2.652、-2.045,P<0.05)。条件回归分析显示,BMI、INR和手术时间是影响ACHD患者行外科手术治疗联合CABG术后再入院的危险因素[OR(95%CI)=1.289(1.095~1.516)、5.926(2.253~15.589)、1.004(1.000~1.007),P<0.05]。结论对于行外科手术治疗联合CABG的ACHD患者,BMI、INR和手术时间是导致患者术后再入院的相关因素,医护人员应尽早采取针对性的干预措施。

Objective To investigate the influencing factors of readmission in adult congenital heart disease(ACHD)patients underwent surgical treatment combined with coronary artery bypass grafting(CABG).Methods Clinical data of ACHD patients who underwent surgical treatment combined with CABG in Wuhan Asian Heart Hospital from May 2004 to October 2021 were collected.The case group consisted of readmitted patients(20 cases).According to the 1:3 pairing principle,non-readmitted patients of the same gender,ethnicity and similar age were selected as the control group(60 cases).Univariate and conditional Logistic regression were used to analyze the factors influencing readmission of patients with ACHD after surgical treatment combined with CABG.Results Univariate analysis showed that way of admission,body mass index(BMI),diabetes,left ventircular ejection fraction,international normalized raito(INR),New York Heart Association classification,American Society of Anesthesidogist classification,operation time,cardiopulmonary by pass mean index,total supply of carystals in the two groups were signif icantly different(t/z/χ^(2)=4.208,6.475,4.096,-2.790,-2.159,-2.559,-2.629,-3.918,-2.439,-2.652,-2.045;P<0.05).Conditional Logistic regression showed that BMI,INR and operation time were influencing factors for readmission of patients with ACHD after surgical treatment combined with CABG[OR(95%CI)=1.289(1.095-1.516),5.926(2.253-15.589),1.004(1.000-1.007);P<0.05).Conclusion BMI,INR,and operation time are related factors for postoperative readmission in patients with ACHD undergoing surgical treatment combined with CABG,and early targeted interventions should be taken by health care providers.