A nursing protocol targeting risk factors for reducing postoperative delirium in patients following coronary artery bypass grafting:Results of a prospective before-after study

Objective: The results of postoperative delirium (POD) warrant testing for prevention. The purpose of this study was to determine whether a nursing intervention targeting risk factors could decrease the inci-dence of POD among patients who had coronary artery bypass grafting (CABG) in China.Methods: A prospective before-after study was conducted between April 2014 and April 2015. A nursing delirium intervention protocol targeting risk factors for delirium was performed for 141 patients un-dergoing CABG in a cardiothoracic ICU from November 2014 to April 2015. Intervention consisted of screening for delirium risk factors, followed by targeted risk factor modification, including pain control, early catheter removal, patient orientation using the 5W1H procedure, increased family visits, mini-mizing care-related interruptions, comfortable nursing and monitoring for sleeping difficulties. Out-comes of the Intervention Group were compared with those of the Control Group for 137 CABG patients from April 2014 to October 2014. Delirium was assessed using the confusion assessment method for the intensive care unit (CAM-ICU). The sample size was justified by PASS2000, based on previous data of delirium incidence in our institution (30%). Main results: Delirium incidence during the first seven postoperative days was significantly lower in the Intervention Group at 13.48%(19/141) vs. 29.93%(41/137) for the Control Group (x2=11.112, P=0.001). In addition, POD in the Intervention Group occurred between the 3rd and 6th postoperative days, while POD in the Control Group mainly occurred on the first three days postoperatively. Delirium in the Intervention Group occurred later than delirium in the Control Group (x2=12.743, P<0.001). Length of ICU stay was reduced significantly (Z= -6.026, P<0.001). Conclusion: The application of a nursing protocol targeting risk factors in this study seems to be asso-ciated with a lower incidence of POD in patients after CABG. This finding suggests that managing the predictors properly is one of the effective strategies to prevent delirium.

Risk factors for acute kidney injury following coronary artery bypass graft surgery in a Chinese population and development of a prediction model

BACKGROUND Acute kidney injury(AKI)after coronary artery bypass graft(CABG)surgery is associated with significant morbidity and mortality.This retrospective study aimed to establish a risk score for postoperative AKI in a Chinese population.METHODS A total of 1138 patients undergoing CABG were collected from September 2018 to May 2020 and divided into a derivation and validation cohort.AKI was defined according to the Kidney Disease Improving Global Outcomes(KDIGO)criteria.Multivariable logistic regression analysis was used to determine the independent predictors of AKI,and the predictive ability of the model was determined using a receiver operating characteristic(ROC)curve.RESULTS The incidence of cardiac surgery–associated acute kidney injury(CSA-AKI)was 24.17%,and 0.53%of AKI patients required dialysis(AKI-D).Among the derivation cohort,multivariable logistic regression showed that age≥70 years,body mass index(BMI)≥25 kg/m2,estimated glomerular filtration rate(eGFR)≤60 mL/min per 1.73 m2,ejection fraction(EF)≤45%,use of statins,red blood cell transfusion,use of adrenaline,intra-aortic balloon pump(IABP)implantation,postoperative low cardiac output syndrome(LCOS)and reoperation for bleeding were independent predictors.The predictive model was scored from 0 to32 points with three risk categories.The AKI frequencies were as follows:0-8 points(15.9%),9-17 points(36.5%)and≥18 points(90.4%).The area under of the ROC curve was 0.730(95%CI:0.691-0.768)in the derivation cohort.The predictive index had good discrimination in the validation cohort,with an area under the curve of 0.735(95%CI:0.655-0.815).The model was well calibrated according to the Hosmer-Lemeshow test(P=0.372).CONCLUSION The performance of the prediction model was valid and accurate in predicting KDIGO-AKI after CABG surgery in Chinese patients,and could improve the early prognosis and clinical interventions.

Incidence &Risk Factors Associated with Carotid Disease in Patients Undergoing Coronary Artery Bypass Grafting Surgery

Objective: The purpose of this study was to evaluate the true incidence and the risk factors associated with carotid disease in the sitting of high risk patients undergoing coronary artery bypass graft (CABG) using carotid duplex scan and to find out if routine preoperative carotid duplex scan is needed among all these patients. Methods: This retrospective study included 402 consecutive patients who underwent bilateral carotid duplex scan admitted for CABG during the period from January 2006 to December 2008. We excluded patients in cardiogenic shock who were taken to operating room emergently. Results: The prevalence of associated risk factors showed diabetes mellitus recorded the highest (93.3%) whereas peripheral vascular disease the lowest (1.7%), hypertension (89.3%), dyslipidemia (72.6%), smoker (21.1%), left main disease (4.7%), and previous stroke (3%). Patients undergoing CABG has high incidence of carotid disease (68.7%) and severe stenosis is more in patients aged 60 and above (13.5%) versus (2.3%) in age 60, previous stroke and left main disease). Conclusion: This study showed that carotid screening is recommended for all patients who are undergoing CABG due to high incidence of carotid disease.

Risk Factors for Mortality of Patients Waiting for Elective Coronary Artery Bypass Graft Surgery

Background: Insufficient capacity for cardiac surgery results in extensive waiting time for patients requiring coronary artery bypass grafting (CABG). Previous studies have reported a consequence of an increased risk of mortality while waiting for CABG. Identification of risk factors for mortality is important in patients waiting for CABG. Objectives: To assess mortality rates and identify risk factors for mortality of patients waiting for CABG. Methods: This retrospective cohort study was done on patients waiting for elective CABG in dr. Kariadi General Hospital from January 2018 to December 2020. Identification of risk factors associated with mortality was done on patients who were waiting for CABG using logistic regression methods. Results: There were 162 patients fulfilling the criteria, with a mean waiting time for surgery of 9.8 months. While waiting for CABG surgery, 32 (19.7%) patients died of any cause. Independent risk factors for death while waiting for CABG included left ventricular ejection fraction ≤ 45% (OR 4.75;95% CI 1.76 - 12.78;p = 0.002), left main disease (OR 4.12;95% CI 1.50 - 11.27;p = 0.006), serum creatinine ≥ 1.5 mg/dl (OR 3.71;95% CI 1.41 - 9.74;p = 0.008), and a number of coronary artery disease risk factors ≥ 3 (OR 3.34;95% CI 1.24 - 8.99;p = 0.017). Conclusions: Long waiting time for CABG is associated with a high mortality rate which is influenced by left ventricular ejection fraction ≤ 45%, left main disease, serum creatinine ≥ 1.5 mg/dl, and a number of coronary arteries disease risk factors ≥ 3.

Predictive risk factors for prolonged stay in intensive care unit in patients undergoing coronary artery bypass grafting surgery

Objective To describe the preoperative factors of prolonged intensive care unit length of stay after coronary artery bypass grafting. Methods From 1997 to 2009, 1318 patients underwent isolated CABG in our hospital. Retrospective analysis was performed on these cases. Univariate and multivariate analyses

Predictive risk factors associated with prolonged stay in the intensive care unit for patients undergoing coronary artery bypass grafting surgery

Objective The rate of post-operative complications has been increased with the changes in patients’age,prolonged duration,more severe and diffused lesions,and more patients with complications in recent years. We try to identify the risk factors associated with prolonged stay in the intensive care unit (ICU) after coronary artery bypass graft surgery (CABG) . Methods 1623 patients who received CABG surgery in Beijing Anzhen Hospital

Risk score for predicting abdominal complications after coronary artery bypass grafting

BACKGROUND Although early abdominal complications after coronary artery bypass grafting(CABG)with cardiopulmonary bypass(CPB)are rare,the associated mortality remains high.AIM To develop a risk score for the prediction of early abdominal complications after CABG with CPB.METHODS This retrospective study was performed in the Federal State Budgetary Establishment“Federal Center of Cardiovascular Surgery”of the Ministry of Health of Russia(the city of Chelyabinsk)and included data of 6586 patients who underwent CABG with CPB during 2011-2017.The risk factors taken for evaluation were compared between patients with early abdominal complications(n=73)and without them(n=6513).We identified the most important risk factors and their influence on the development of early abdominal complications after CABG with CPB.RESULTS Gender and the presence of postinfarction cardiosclerosis,chronic kidney disease,or diabetes in the anamnesis did not affect the occurrence of abdominal complications.The leading risk factors of the early abdominal complications after CABG with CPB were multifocal atherosclerosis,extracorporeal membrane oxygenation,intra-aortic balloon pump,atrial fibrillation,perioperative myocardial infarction,and the need for resternotomy in the postoperative period.The average value of the predicted probability was 0.087±0.015 in patients with early abdominal complications after CABG with CPB and 0.0094±0.0003 in patients without these complications.The percentage of correct classification turned out to be 98.9%.After calculating a score for each of the leading risk factors,we counted a total score for each particular patient.The highest risk was noted in patients with a total score of 7 or more.CONCLUSION The developed score predicts the risk of early abdominal complications after CABG with CPB and makes it possible to stratify patients by risk groups.

Predictors of post coronary artery bypass grafting atrial fibrillation

Objective： To investigate the incidence and relative risk factors of post coronary artery bypass grafting（post-CABG） atrial fibrillation （AF）. Methods： 312 patients with CABG were reviewed and divided into an AF group and a non-AF group. Statistical analysis was used to compare the data between the two groups and screen for risk factors of post-CABG AF. Results： 103/312 （33.01%） patients developed post-CABG AF. Univariate analysis showed that patients in AF group compared with those in non-AF group were more likely to have advanced age （≥ 70 years）, early postoperative withdrawal of β-blockers, hypertension, left atrial enlargement （≥40 mm）, a history of AF, prolonged p-wave duration （≥ 120 ms） and increased number of grafts （≥13）. Multivariate logistic regression analysis showed that advanced age （≥70 years）, early postoperative withdrawal of β-blockers, hypertension, left atrial enlargement （≥40 mm） and a history of AF were highly related to post-CABG AF. Conclusion： The incidence of AF in patients following CABG was 33.01% in this study. Advanced age, early postoperative withdrawal of 13-blockers, hypertension, left atrial enlargement and a history of AF were independent risk factors of post-CABG AF.

Inotropic Requirement in Patients Undergoing Coronary Artery Bypass Grafting (CABG) in RSUP Dr. Hasan Sadikin Bandung in 2014-2016

Inotropic agents are indicated to treat ventricular dysfunction that frequently found post-CABG surgery. However, the use of inotropic isn’t free from disadvantageous side effects and is related to higher morbidity and mortality in post-CABG surgery patients. Several risk factors are known to affect higher need for inotropic agents’?post-CABG surgery. This study aims to discover the inotropic?requirement in patients undergoing CABG surgery based on age, sex, preoperative left ventricular ejection?fraction?(LVEF),?comorbidities,?cross clamping time (CCT), and cardiopulmonary bypass (CPB) duration in Hasan Sadikin General Hospital Bandung in 2014-2016. This study is a descriptive cross-sectional study done retrospectively through medical records. This study found the inotropic?requirement?post-CABG surgery was?130 patients (74.3%). The inotropic?requirement?based on age was?28 patients (80.0%) > 65 years old,?112 patients (75.7%) were?male, 18 patients (66.7%) were?female, 19 patients (100%) with ?LVEF, 41?patients (85.4%) with DM, 20 patients (90.9%) with CKD, 44?patients (93.6%) with >90 minute CCT, 37?patients (90.2%) with >120 minute duration CPB. In conclusion, there was a higher inotropic?requirement in?patients with age > 65 years?old,?preoperative LVEF??comorbidities,?CPB duration > 120 minutes and CCT > 90 minutes.

Identifying coronary artery bypass grafting patients at high risk for adverse long-term prognosis using serial health-related quality of life assessments

Background:Patients who undergo coronary artery bypass grafting(CABG)are known to be at a significant risk of experiencing long-term adverse events,emphasizing the importance of regular assessments.Evaluating health-related quality of life(HRQoL)serves as a direct method to gauge prognosis.Our objective is to ascertain the prognostic significance of consecutive HRQoL assessments using the Physical Component Summary(PCS)and Mental Component Summary(MCS)derived from the Short-Form 36(SF-36)health survey in CABG patients.Methods:The study population consisted of 433 patients who underwent isolated elective CABG at Fuwai Hospital between 2012 and 2013.SF-36 assessments were conducted during both the hospitalization period and follow-up.The primary endpoint of the study was all-cause mortality,while the secondary outcome was a composite measure including death,myocardial infarction,stroke,and repeat revascularization.We assessed the relationships between the PCS and MCS at baseline,as well as their changes during the first 6 months after the surgery(referred to asΔPCS andΔMCS,respectively),and the observed outcomes.Results:The patients were followed for an average of 6.28 years,during which 35 individuals(35/433,8.1%)died.After adjusting for clinical variables,it was observed that baseline MCS scores(hazard ratio[HR]for a 1-standard deviation[SD]decrease,1.57;95%confidence interval[CI],1.07-2.30)andΔMCS(HR for a 1-SD decrease,1.67;95%CI,1.09-2.56)were associated with all-cause mortality.However,baseline PCS scores andΔPCS did not exhibit a significant relationship with all-cause mortality.Notably,there was a dose-response relationship observed betweenΔMCS and the likelihood of all-cause mortality(HRs for the 2nd,3rd and 4th quartiles compared to the 1st quartile,0.33,0.45 and 0.11,respectively).Conclusions:Baseline MCS and changes in MCS were independent predictors for long-term mortality of CABG.Better mental health status and recovery indicated better prognosis.

Risk factors for mortality after coronary artery bypass grafting in patients with low left ventricular ejection fraction

Background We managed to assess and confirm the risk factors for mortality after coronary artery bypass grafting （CABG） operations so as to map out the proper guidance of surgical strategy especially in patients with low left ventncular ejection fraction （LVEF） in domestic polyclinic like ours. Methods Five hundred and forty-eight consecutive patients underwent CABG from December 1999 through August 2005 were analyzed retrospectively. Eighty-nine cases had an LVEF of 40% or less. All together twenty-two candidate factors were evaluated for their association with perioperative death using univariate and multivariate stepwise Logistic analysis. Results When data from all the patients who had undergone CABG were taken into account, LVEF, left ventricular end diastolic diameter （LVEDD）, mitral regurgitation, aneurysm of the heart wall, mitral repair/replacement, resection of aneurysm, concomitant aortic valve replacement, and perioperative intra-aortic balloon counter-pulsation （IABP）, left ventricular assist device （LVAD） and cardiopulmonary bypass （CPB） all showed an association with perioperative death in univariate analysis, while an LVEF of 〉40%, on the other hand, appeared to be a protective factor. In multivariate analysis, moderate to severe mitral regurgitation, aneurysm of the heart wall, repair of septal perforation and aortic regurgitation were proved to be risk factors. When the analysis was restricted to patients with an LVEF of 40% or less, such variables as age, LVEDD, mitral regurgitation, mitral repair/replacement, IABP, and CPB were qualified as risk factors in a univariate analysis. Age, moderate mitral regurgitation, aneurysm of the heart wall, CPB, left main coronary artery disease and female were associated with pefioperative death in a multivariate logistic regression analysis. Conclusions Concerning the prognosis, patients who undergo CABG would have different risk factors when data from all the enrolled patients or data from patients with LVEF≤40% is compared. This is because low LVEF is itself an important risk factor. Regarding the low LVEF patients, the aggressive treatments including correction of mitral regurgitation and resection of aneurysm of the heart wall concomitant with CABG should be taken into account while planning the operative strategy to ensure the perioperative safety and prognosis.

Risk factors for vasoplegic syndrome after coronary artery bypass grafting

The etiology of vasoplegic syndrome （VS） is not completely elucidated and the clinical im- portance remains speculative. Methods Twenty-four patients who underwent coronary artery bypass grafting and developed VS were compared with 48 control patients without VS in a 2：1 case control study. Cases and controls were matched by gender, age （ ± 5 years old） and operation date （ ±1 week）. Results The inde- pendent predictors of VS were lower ejection fraction （OR 10.75, 95% CI 2.93-39.44, when LVEF 〈 0.45） and diuretic use （OR 8.98, 95% CI 2.59-31.10） in logistic regression analysis. Conclusion lower ejection fraction （ 〈 0.45） and diuretic use are independent risk factors for VS occurrence.

冠脉搭桥术后急性应激障碍危险因素分析及风险预测模型的构建

目的:探究冠脉搭桥术后急性应激障碍(ASD)的危险因素并构建风险预测模型。方法:收集2022年5月至2023年5月在郑州大学第一附属医院行冠脉搭桥术的患者320例,根据术后1周内ASD发生情况分为ASD组(n=116)和非ASD组(n=204)。比较两组一般资料,采用Logistic回归模型分析ASD的危险因素,构建列线图模型并评价模型对ASD的预测性能。结果:Logistic回归分析显示,年龄≥45岁,文化程度文盲与小学、初中、高中与中专,性格内向,术前重度胸痛与心功能分级Ⅲ-Ⅳ级是ASD发生的危险因素[OR(95%CI)分别为1.678(1.028~2.739)、2.399(1.187~4.848)、2.994(1.442~6.218)、2.842(1.460~5.531)、3.037(1.591~5.800)、2.254(1.219~4.168)、4.200(2.537~6.953),P<0.05]。列线图模型预测冠脉搭桥术后ASD的ROC曲线的AUC(95%CI)为0.698(0.638~0.758),提示模型预测冠脉搭桥术后ASD的准确性较好。结论:年龄≥45岁,文化程度文盲与小学、初中、高中与中专,性格内向,术前重度胸痛与心功能分级Ⅲ-Ⅳ级是ASD发生的危险因素;基于上述因素建立的风险预测模型具有较好的预测性能。

冠状动脉旁路移植术术后谵妄的危险因素分析及预测模型的建立

目的探讨冠状动脉旁路移植术(CABG)术后谵妄发生的危险因素,并建立风险预测模型。方法回顾性收集首都医科大学附属北京安贞医院冠心病外科中心2022年1月至2023年6月1067例行CABG患者的临床资料。采用重症监护病房(ICU)意识模糊评估法(CAM-ICU)评估患者术后谵妄的发生,将患者分为谵妄组和非谵妄组。对比2组患者的临床特征,采用单因素分析和多因素二元Logistic回归分析确定影响谵妄发生的独立危险因素,建立预测谵妄风险的列线图模型,绘制受试者工作特征(ROC)曲线评估谵妄模型的预测价值。结果1067例患者中谵妄组133例,谵妄发生率为12.5%,年龄(62±10)岁,男性97例;非谵妄组934例,年龄(62±9)岁,男性704例。使用SPSS 22.0软件随机抽取747例患者作为试验组,剩余320例患者作为内部验证组。多因素Logistic回归分析结果显示,初中以下学历、术前睡眠障碍、糖尿病史、左心室射血分数(LVEF)≤45%、轻度贫血、低蛋白血症、体外循环以及呼吸机使用≥48 h是试验组患者CABG术后发生谵妄的独立危险因素(均P<0.05)。经ROC验证显示试验组曲线下面积(AUC)为0.736(95%置信区间:0.682~0.739),Hosmer-Lemeshow拟合优度检验显示风险预测模型具有较好拟合度,P=0.748。经内部验证该评分预警系统AUC为0.754(95%置信区间:0.690~0.819),Hosmer-Lemeshow拟合优度检验同样显示该模型预测准确性较好,P=0.808。结论谵妄是CABG术后常见的并发症之一,低学历、术前睡眠障碍、体外循环及长时间使用呼吸机等都是CABG术后谵妄发生的独立危险因素。

冠状动脉旁路移植患者术后疲劳发展轨迹及影响因素研究

目的探讨冠状动脉旁路移植术(coronary artery bypass grafting,CABG)患者术后疲劳发展轨迹及其影响因素。方法采用便利抽样法,选取2022年10月-2023年8月在我院心脏外科行CABG的145例患者为研究,随访过程中剔除18例,最终共纳入124例患者。分别在出院前1 d及出院后1、2、4个月采用一般资料调查表、中文版多维疲劳量表(multidimensional fatigue inventory-20,MFI-20)及Barthel指数评定量表对患者术后疲劳水平进行追踪调查,利用潜类别增长模型(latent class growth model,LCGM)识别潜在的术后疲劳轨迹类别,采用多分类logistic回归分析患者术后疲劳轨迹类别的影响因素。结果患者术后MFI-20得分随时间呈下降趋势(F=310.039,P<0.001),得分从出院前1 d(58.44±8.65)分降至出院后4个月(36.92±9.89)分;最终识别出3种术后疲劳轨迹类别,根据其特征分别命名为中至轻度明显下降组、中度缓慢下降组、重至中度缓慢下降组,分别占比53.2%、32.3%、14.5%。单因素分析显示:有无心肌梗死病史、有无脑卒中病史、NYHA心功能分级、术后ICU停留天数、术后左室射血分数(LVEF)、红细胞计数、血红蛋白、总胆固醇、低密度脂蛋白、日常生活活动能力与术后疲劳轨迹类别有关(均P<0.05);多因素logistic回归分析显示:术后ICU停留天数、有无心肌梗死病史、NYHA心功能分级、有无脑卒中病史、日常生活活动能力是CABG患者术后疲劳轨迹类别的主要影响因素(均P<0.05)。结论CABG患者术后疲劳发展轨迹存在异质性,医护人员应根据不同变化轨迹制定针对性护理措施,积极改善可控因素,缓解患者术后疲劳程度。

非体外循环冠状动脉搭桥术后谵妄的DynNom预测模型构建

目的基于DynNom动态评分构建非体外循环冠状动脉搭桥术后谵妄预测模型。方法收集2020年6月至2023年6月于江苏省人民医院行非体外循环冠状动脉搭桥术的265例患者临床资料,根据术后谵妄发生情况将患者分为谵妄组(n=61)和非谵妄组(n=204)。采用单因素和多因素Logistic回归法分析非体外循环冠状动脉搭桥术后谵妄的危险因素,并建立DynNom预测模型。结果非体外循环冠状动脉搭桥术后谵妄的发生率为23.02%(61/265)。两组糖化血红蛋白(HbA1c)、简易智力状态检查量表(MMSE)评分、营养风险筛查2002(NRS2002)评分、左室射血分数(LVEF)、酸碱平衡紊乱和电解质紊乱比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,HbA1c≥7%、MMSE评分<27分、NRS2002评分≥3分、LVEF<50%、酸碱平衡紊乱和电解质紊乱是非体外循环冠状动脉搭桥术后谵妄的独立危险因素(P<0.05)。DynNom预测模型评估结果显示,C-index指数为0.747(95%CI 0.711~0.783),校准曲线贴近理想曲线,受试者工作特征(ROC)曲线下面积(AUC)为0.753(95%CI 0.721~0.785),当DynNom模型预测值在10%~79%范围时,患者的净获益率>0。结论基于HbA1c≥7%、MMSE评分<27分、NRS2002评分≥3分、LVEF<50%、酸碱平衡紊乱和电解质紊乱构建的DynNom预测模型对非体外循环冠状动脉搭桥术后谵妄的发生风险具有一定的预测价值。

冠状动脉旁路移植术后低清蛋白血症危险因素与预后

目的探讨冠状动脉旁路移植术(CABG)后低清蛋白血症的危险因素及临床预后。方法回顾分析CABG病人483例,定义术后第1天血清清蛋白(ALB)水平较术前下降的差值为△ALB,将△ALB≤7 g/L病人97例归为A组、7 g/L<△ALB≤15 g/L病人298例归为B组、△ALB>15 g/L病人88例归为C组。比较3组病人术前、术中、术后相关资料及术后随访36个月主要不良心血管事件(MACE)发生情况。结果C组合并高尿酸血症的病人数及左室射血分数<40%的病人数高于A、B两组,差异有统计学意义(χ^(2)=6.802~6.857,P<0.05);B、C两组中有介入治疗(PCI)史的病人数高于A组,差异有统计学意义(χ^(2)=8.193,P<0.05);C组术后在ICU停留时间>72 h、CABG当天引流>400 mL、大量失血、输注红细胞、输注血浆、肾损伤等病人占比明显高于A、B两组,差异有统计学意义(χ^(2)=6.741~39.287,P<0.05);C组术后MACE事件发生率高于A、B两组,差异有统计学意义(χ^(2)=8.205,P<0.05)。Cox回归分析中校正多种混杂因素后,病人术前有PCI史(OR=1.670,95%CI=1.091~2.556,P=0.018)及左室射血分数<40%(OR=4.468,95%CI=2.304~8.665,P<0.001)是术后ALB水平减低的独立危险因素,CABG后第1天ALB水平较术前下降程度7 g/L<△ALB≤15 g/L(OR=2.784,95%CI=1.190~6.516,P=0.018)和△ALB>15 g/L(OR=3.487,95%CI=1.373~8.853,P=0.009)是远期MACE的独立预测因素。结论PCI史及左室射血分数<40%是CABG后ALB水平减低的独立危险因素,术后第1天ALB水平较术前下降>7 g/L是CABG预后的预测因素。

冠状动脉旁路移植术后高敏心肌肌钙蛋白水平与预后危险因素评估价值的临床研究进展

冠状动脉旁路移植术(CABG)是治疗冠心病的有效手段,但手术风险及术后并发症的存在使得预后评估显得尤为重要。高敏心肌肌钙蛋白作为心肌损伤的重要生物标志物,在CABG后患者预后评估中发挥重要作用。现综述近年来关于CABG后高敏心肌肌钙蛋白水平与预后危险因素评估价值的研究进展,旨在为临床实践和预后评估提供科学依据。

影响冠状动脉旁路移植术后患者发生认知功能障碍的风险因素

目的探讨影响冠状动脉旁路移植(CABG)术后患者发生认知功能障碍的风险因素及预防策略。方法研究对象回顾性选自于2021年3月至2023年6月在平顶山市第二人民医院接受CABG治疗的患者151例的临床资料,依据简易精神状态评价量表(MMSE)分为46例认知功能障碍组,105例非认知功能障碍组。比较两组患者临床资料指标,影响CABG术后患者发生认知功能障碍的危险因素采用多因素Logistic回归分析法进行分析,并对应构建受试者工作特征曲线(ROC)预测模型。结果认知功能障碍组与非认知功能障碍组进行比较,合并高血压、合并糖尿病的患者占比、年龄、狭窄程度(Gensini)评分、血清尿酸(UA)水平相对较高,手术时间、ICU时间则较长(P<0.05)。多因素Logistic回归分析结果显示,年龄偏高、合并高血压、合并糖尿病、Gensini评分偏高、手术时间偏长、ICU时间偏长、血清UA水平偏高是影响CABG术后患者发生认知功能障碍的独立风险因素(OR=1.514、1.445、1.484、1.514、1.527、1.418、1.594,均P<0.05)。ROC曲线分析结果显示曲线下面积为0.818,95%CI:0.744~0.878,敏感度为92.68%,特异度为61.62%。结论影响CABG术后患者发生认知功能障碍的风险因素包括年龄偏高、合并高血压、合并糖尿病、Gensini评分偏高、手术时间偏长、ICU时间偏长、血清UA水平偏高,为CABG术后认知功能障碍的早期预警提供新的思路,临床可据此进行有针对性的干预手段,从而减少术后认知功能障碍情况的发生。

非体外循环冠脉搭桥术中转体外循环冠脉搭桥患者的临床特征及危险因素

目的观察非体外循环冠脉搭桥术(off-pump coronary artery bypass grafting,OPCABG)中转体外循环冠脉搭桥术(on-pump coronary artery bypass grafting,ONCABG)患者的临床特征及危险因素。方法回顾性分析OPCABG并术中紧急中转为ONCABG的90例冠心病(coronary heart disease,CHD)患者的临床资料,将其归为中转组。另选取同期单纯行OPCABG的CHD患者300例设为非体外循环组。观察中转组和非体外循环组患者术前和术中的临床特征,采用多因素logistic回归分析影响OPCABG患者发生紧急中转体外循环的危险因素。结果2组性别、年龄、体质量指数(body mass index,BMI)、糖尿病史、高血压史、高血脂史、慢性阻塞性肺疾病、脑卒中史、外周血管疾病史、左主干病变、前降支病变、回旋支病变、房颤、左乳内动脉使用率、桡动脉使用率比较,差异无统计学意义(P>0.05);中转组心力衰竭史患者、经皮冠状动脉介入术(percutaneous coronary intervention,PCI)史患者、右冠病变患者、3周内心肌梗死史患者占比及桥血管数量高于非体外循环组,且左心室射血分数(left ventricular ejection fraction,LVEF)数据低于非体外循环组,差异有统计学意义(P<0.05)。经多因素logistic回归分析证实,术前心力衰竭史、术前PCI史、术前右冠病变、术前3周内心肌梗死史均是影响OPCABG患者发生紧急中转体外循环的危险因素,均有P<0.05。结论术前心力衰竭史、术前PCI史、术前右冠病变、术前3周内心肌梗死史均是影响OPCABG患者发生紧急中转体外循环的危险因素,临床可通过控制以上危险因素来减少患者中转发生风险。