肺动脉漂浮导管监测对老年患者冠状动脉旁路移植术预后的影响

Effect of pulmonary artery floating catheter monitoring on the prognosis of coronary artery bypass grafting in elderly patients

目的 探讨肺动脉漂浮导管监测对老年患者冠状动脉旁路移植术预后的影响。方法 回顾性分析2019年1—12月首都医科大学附属北京安贞医院连续收入的择期行冠状动脉旁路移植术的711例老年患者,根据术中是否置入肺动脉漂浮导管,分为行肺动脉漂浮导管治疗组(PAC组,278例)和未行肺动脉漂浮导管治疗组(非PAC组,433例),比较2组患者术后不良事件发生情况。采用多元Logistic回归分析评估肺动脉漂浮导管置入对老年患者冠状动脉旁路移植术预后的影响。结果 711例接受冠状动脉旁路移植术的老年患者中,共11例患者发生院内死亡。其中PAC组3例(1.1%),非PAC组8例(1.8%),单因素分析结果显示2组间术后院内死亡、心肌梗死、术后新发心房颤动、脑血管意外、急性肾功能衰竭、出血导致的再次手术、感染发生率比较差异均无统计学意义(均P>0.05)。采用Logistic回归模型对混杂因素进行调整后,PAC组患者住院死亡率低于非PAC组(校正后比值比为0.199,95%置信区间:0.042~0.939,P=0.041),差异有统计学意义。但2组在心肌梗死、术后新发心房颤动、脑血管意外、急性肾功能衰竭、出血导致的再次手术及感染等并发症方面比较,差异均无统计学意义(均P>0.05)。结论 对接受冠状动脉旁路移植术的老年患者,术中应用肺动脉漂浮导管对改善住院死亡率是有益的。

Objective To investigate the effect of pulmonary artery floating catheter monitoring on the prognosis of coronary artery bypass grafting(CABG)in elderly patients.Methods A total of 711 elderly patients undergoing elective CABG admitted to Beijing Anzhen Hospital,Capital Medical University from January to December 2019 were retrospectively analyzed.Patients were divided into PAC group(278 cases)and non-PAC group(433 cases)according to whether pulmonary artery floating catheter was inserted during the operation.The incidence of postoperative adverse events was compared between the two groups.Multivariate Logistic regression analysis was used to evaluate the effect of pulmonary artery floating catheter placement on the prognosis of elderly patients undergoing CABG.Results There were 11 in-hospital deaths in 711 elderly patients undergoing CABG.Among them,there were 3 cases(1.1%)in PAC group and 8 cases(1.8%)in non-PAC group.Univariate analysis showed that there were no significant differences in the incidence of in-hospital death,myocardial infarction,postoperative new-onset atrial fibrillation,cerebrovascular accident,acute renal failure,reoperation due to bleeding,and infection between the two groups(all P>0.05).After adjusting for confounding factors by Logistic regression model,the in-hospital mortality of PAC group was lower than that of non-PAC group(adjusted odds ratio:0.199,95%confidence interval:0.042-0.939,P=0.041).However,there were no significant differences in myocardial infarction,postoperative new-onset atrial fibrillation,cerebrovascular accident,acute renal failure,reoperation due to bleeding and infection between the two groups(all P>0.05).Conclusion In elderly patients undergoing CABG,the use of intraoperative pulmonary artery floating catheter is beneficial in improving in-hospital mortality.