冠状动脉旁路移植术后低氧血症的临床观察

目的 观察冠状动脉旁路移植术后低氧血症的发生率,探讨术后低氧血症的相关危险因素,总结术后低氧血症的有效防治措施.方法 对2006-2012年在该院以及阜外心血管病医院进修期间行冠状动脉旁路移植术的128例患者的术前、术中、术后资料进行回顾性分析.在机械通气（FiO2＞45%）或面罩加鼻导管供氧（氧流量6 L·min^-1）条件下,冠状动脉旁路移植术后PaO2低于102-（0.33×年龄）mmHg]者,确诊为低氧血症.结果 128例冠状动脉旁路移植术（CABG）患者,术后共发生不同程度的低氧血症35例,发生率为27.34%（35/128）.术后低氧血症的发生率随着患者年龄的增大而逐渐增高.低氧血症大多发生在术后第 1 天.患者为急诊手术、有吸烟史、合并高血压、合并肺部疾病、有急性心肌梗死史及有主动脉阻断与术后低氧血症的发生有显著相关（P＜0.05）.结论 预防低氧血症的发生和及时纠正低氧血症可提高冠状动脉旁路移植术成功率.

Clinical observation and preventive treatment of postoperative hypoxemia in patients undergoing coronary artery bypass grafting

Objective To observe the occurrence rate of postoperative hypoxemia in patients undergoing coronary artery bypass grafting （CABG） ,to discuss the related risk factors and to summarize the effective preventive treatment measures of postoperative hypoxemia. Methods A total of 128 patients received CABG from 2006 to 2012 in our hospital and Beijing Fuwai hospital. The preoperative, intrao-perative and postoperative clinical data were retrospectively analyzed. Mechanical ventilation （FiO2 over 45% ） or mask oxygen supply （ over 6 L ·min^-1） was administrated following CABG;PaO2 less than 102 - （0.33 × age） ] mmHg was diagnosed as postoperative hypox-emia. Results The incidence rate of postoperatively hypoxemia was 27.34% （ 35/128 ）. The incidence rate of postoperative hypoxemia was increased gradually with the increase of the age of patients. Most of postoperative hypoxemia happened in the first day after operation. There were significant correlations between emergency operation, smoking history, combined hypertension and pulmonary disease, acute myocardial infarction history and aortic cross clamp and the incidence rate of postoperative hypoxemia（ P 〈 0.05 ）. Conclusion Preven-ting the incidence of hypoxemia and correcting the hypoxemia timely can improve the success rate of CABG.