Associated vascular lesions in patients undergoing coronary artery bypass grafting

Atherosclerotic involvement of extracoronary arteries in patients undergoing myocardial revascularization can cause severe postoperative complications and increase postoperative mortality. Between January and November 1998, routine preoperative echo-Doppler study of carotid vessels, abdominal aorta and iliac-femoral arteries was performed in all patients undergoing coronary artery bypass grafting (CABG) at our institution, in order to assess the prevalence and the degree of associated vascular lesions. Correlations between echo-Doppler findings, angiographic patterns of coronary lesions and atherosclerotic risk factors were analyzed in all cases. Among 302 patients undergoing CABG, 186 (61.6%) had carotid disease, with a haemodynamically significant stenosis (>70%) of internal carotid in 31 (10.2%). Twenty-three patients had asymptomatic severe carotid disease. A significant correlation between severity of coronary disease and prevalence of severe carotid disease was found (p = 0.02). An abdominal aortic dilatation (diameter > 25 mm) was found in 20 cases (6.6%), with a diameter >35 mm in 7 patients (2.3%), 6 with triple-vessel coronary disease, and 1 with double-vessel disease. Atherosclerotic lesions of iliac-femoro-popliteal axis were found in 165 (54.6%) patients, with a strong correlation to the severity of coronary disease (p = 0.02); lesions were haemodynamically significant (> 70%) in 48 (15.8%) cases. Symptoms of carotid and peripheral vascular disease are no reliable predictors of perioperative risk in patients undergoing CABG. Non-invasive complete arterial investigation should be routinely performed in these patients, in order to plan the most suitable operative approach and to prevent perioperative vascular complications.     

Carotid artery involvement in patients of atherosclerotic coronary artery disease undergoing coronary artery bypass grafting

BACKGROUND: Patients with concomitant critical carotid and coronary artery disease are at risk of major neurological events while undergoing coronary artery bypass grafting. The presence of carotid artery stenosis increases the stroke rate in the perioperative period. In an effort to reduce the stroke rate, many institutions perform routine preoperative noninvasive assessment of the carotid arteries. METHODS AND RESULTS: We analyzed the clinical and laboratory data of 1,200 patients who underwent coronary artery bypass surgery in the last 2 years. Carotid Doppler was normal in 186 patients (15.5%), and showed <30% stenosis in 796 (66.3%), 30%-50% in 110 (9.2%), 50%-70% stenosis in 64 (5.3%) and critical (>70%) stenosis in 44 (3.7%) patients. Conventional risk factors such as hypercholesterolemia, hypertension, smoking and family history were not independent predictors of carotid artery stenosis. However, diabetes as a risk factor had a significant association with carotid artery disease (79.6% v. 43.8%, p<0.02). There was a trend towards increased prevalence of carotid artery stenosis in patients with > or = 2 risk factors (84.3% v. 68.8%). Patients with significant carotid artery stenosis had severe coronary artery disease (triple-vessel disease 93.3%, left main coronary artery disease 12.0%). Out of 44 patients with critical carotid artery stenosis, 27 were subjected to carotid angiography. Doppler findings correlated well with angiography. Seventeen patients underwent carotid artery intervention. None had any perioperative neurological events. A total of 5 (0.4%) patients had a major stroke. Coronary artery bypass grafting was done in 27 patients with critical stenosis without any intervention. The stroke rate (11.1%) was higher in these patients compared to patients with < 70% carotid artery disease or post-carotid intervention (2.5%) patients. Thus, untreated >70% carotid artery stenosis was associated with a higher stroke rate. CONCLUSIONS: Doppler screening of the carotid artery is helpful in detecting the subgroup of patients at increased risk of stroke. Patients with critical carotid artery stenosis should be subjected to angiography. Prophylactic intervention may reduce the occurrence of stroke in the perioperative period.     

左西孟旦对老年冠状动脉旁路移植术患者生存及预后的影响

目的探讨左西孟旦对老年冠状动脉旁路移植术(CABG)患者生存及预后的影响。方法 84例行择期CABG术的老年冠心病患者,随机分为治疗组44例,对照组40例。治疗组于体外循环前10 min开始应用左西孟旦,持续24 h;对照组用等量生理盐水代替左西孟旦。监测平均动脉压(MAP)、肺毛细血管楔压(PCWP)、混合静脉血氧饱和度(SvO2)、体循环阻力指数(SVRI)、心脏指数(CI)。比较2组患者术后低心排血量综合征(LCOS)发生率、重症监护室(ICU)停留时间、呼吸机辅助时间、主动脉内球囊反搏使用率和去甲肾上腺素使用率。术后随访180天,比较2组患者的无事件生存率。结果治疗组术后2、24 h的CI和MAP水平均显著高于对照组(P0.05),SVRI和PCWP显著低于对照组(P0.05)。治疗组术后LCOS发生率、ICU停留时间、呼吸机辅助时间和去甲肾上腺素使用率均显著低于对照组(P0.05)。术后180天无事件生存率,治疗组为88.5%,对照组为67.1%,经Log-rank检验显示2组患者无事件生存率存在显著差异(P0.05)。结论左西孟旦可以改善老年CABG患者术后血流动力学指标,预防和治疗术后LCOS,提高术后无事件生存率,改善患者临床预后。     

非体外循环下冠状动脉搭桥术的麻醉管理

目的 :总结 2 8例非体外循环下多支冠状动脉搭桥术的麻醉管理。方法 :术前依据患者心脏功能及全身状况 ,给予营养心肌、扩冠、降压、利尿等治疗。采用静吸复合麻醉 ,气管插管控制呼吸 ,在非体外循环下行冠状动脉搭桥术。结果 :手术期间 4例血压过低 ,2例 ST段显著抬高伴室性心律失常 ,改为体外循环辅助下手术 ,余 2 2例术中血流动力学平稳。术毕非体外循环组 2 2例 6～ 8h内拔管 ,明显少于体外循环组 （10～ 16h）。 2 8例预后良好 ,无麻醉并发症。结论 :维持血流动力学平稳和心肌氧供需平衡 ,是非体外循环下冠状动脉搭桥术麻醉的关键     

早期活动强化策略对老年冠状动脉旁路移植术患者预后的影响

目的 探究早期活动强化策略对老年冠状动脉旁路移植术患者预后的影响.方法 选取老年冠状动脉旁路移植术后患者57例.随机数表法分为对照组28例和干预组29例.对照组采取早期活动常规策略,干预组给予早期活动强化策略.比较两组出院时和出院后1个月6 min步行试验结果、精神状态、生存质量、睡眠质量和健康状况.比较两组重症监护室...     

Myocardial oxygen balance and cardiopulmonary bypass in patients undergoing coronary artery bypass grafting

The frequency of anaerobic myocardial metabolism was studied in 14 patients undergoing coronary artery bypass surgery during enflurane-supplemented high-dose fentanyl anesthesia and compared with other clinical monitors of myocardial ischemia including the configuration of the pulmonary capillary wedge pressure (PCWP) and electrocardiographic findings. Hemodynamic parameters, coronary sinus blood flow, myocardial oxygen and lactate extractions, and a seven-lead ECG were recorded before and after cannulation of the aorta and vena cava, during total cardiopulmonary bypass (CPB) in a vented heart, during rewarming after global myocardial ischemia and cold cardioplegia, and 15 minutes after coming off bypass. The cannulation for CPB induced no changes in the central or coronary hemodynamics, but four patients had abnormal lactate metabolism. Two of these also had ST segment depression, and two had prominent AC waves on the PCWP tracing. Coronary sinus blood flow and myocardial oxygen extraction were maintained at the beginning of CPB, but lactate extraction decreased markedly or turned to lactate production, and ECG changes indicating myocardial ischemia were seen in five patients. During rewarming and after CPB, all patients had abnormal lactate metabolism despite decreased myocardial oxygen extraction, adequate coronary perfusion pressure, and adequate coronary sinus blood flow. During these periods most patients also had cardiac conduction disturbances that made the interpretation of the ST segment impossible. Only one patient had clearly abnormal AC and V waves on the PCWP tracing after CPB. Two patients had ECG evidence of a perioperative myocardial infarction, but they had no significant clinical consequences. Four patients had a fascicular block at discharge. These results indicate that anaerobic myocardial metabolism is common during and after CPB, and that associated myocardial ischemia cannot always be reliably detected by changes in the ECG or the PCWP tracings.     

Analysis of mortality in low-risk patients undergoing coronary artery bypass grafting

Aim

The aims of this study were to determine the early mortality rate in low-risk coronary artery bypass graft (CABG) patients and examine the causes of death, to identify problems that could be avoided in future surgeries.

Methods

All low-risk patients (EuroSCORE ≤ 2) who died after CABG were included. Their peri-operative information was meticulously studied by internal and independent external reviewers to identify causes of death, which were classified as: cardiac or non-cardiac; and a further division as: (1) non-preventable, (2) preventable (technical error), and (3) preventable (system error).

Results

Early mortality was 0.93% (24/2 570). Eleven patients (45.8%) were classified as preventable deaths. In six of them the main problem was identified as graft thrombosis, which was secondary to a technical error of either the harvesting or anastomosis of the left internal mammarian artery. There were also five system errors identified as delays in the treatment of an identified and potentially reversible problem.

Conclusions

Correction of technical and system errors, such as harvesting of the left internal mammarian artery, haemostasis during surgery, and establishing standard protocols for the transfer of patients from ward to intensive care units will eventually lead to improvement in both the quality of care and patient outcomes, even in low-risk groups.     

Clinical and angiographic correlates of short- and long-term mortality in patients undergoing coronary artery bypass grafting

Differences in the clinical and angiographic factors associated with short- and long-term outcomes in patients undergoing coronary artery bypass grafting (CABG) are less known. Accordingly, differences were examined in clinical and angiographic correlates of short- and long-term mortality after CABG in 8,229 patients undergoing initial CABG enrolled in the Duke Cardiovascular Disease Database (1995 to 2002). Logistic regression and Cox proportional hazard modeling were performed to determine independent correlates of 30-day and long-term mortality. Death occurred in 2.4% at 30 days and 17.6% beyond 30 days at a median follow-up of 6 years in patients who underwent CABG. Multivariable models identified older age, lower left ventricular ejection fraction, lower or higher body mass index, cerebrovascular disease, lack of internal mammary artery use, and lower cholesterol to be associated with increased risk of both events. Although hemodynamic status (preoperative myocardial infarction, New York Heart Association class, and cardiogenic shock), female gender, and minority race were associated with 30-day death; co-morbid conditions (serum creatinine, chronic lung disease, diabetes, previous heart failure, peripheral vascular disease, and left main disease) were associated with increased long-term (beyond 30 days) death (c indexes 0.76 and 0.79 for the short- and long-term mortality models, respectively). In conclusion, our study suggested that correlates of acute and long-term death were different in patients undergoing CABG. These differences should be kept in context when counseling patients undergoing CABG and may help facilitate targeted strategies to improve short- and long-term mortality risks after CABG.     

白细胞介素-8基因多态性与老年人非体外循环下冠状动脉旁路移植术预后的相关性

目的 研究白细胞介素-8(IL-8)在围手术期的变化及其与基因多态性关系,探讨心脏手术后炎性反应与预后的相关性.方法 术前分析IL-8(-251A>T)基因多态性.并于术前、术后4 h、24 h、72 h获取血液标本检测细胞因子.同时记录手术情况及对应时间点患者肌钙蛋白T(TnT)、肌酸激酶同工酶(CKMB)和血肌酐等生化指标.结果 145名患者首次接受择期非体外循环下冠状动脉旁路移植术,术后患者血浆IL-8水平上升,术后4 h水平最高(18.0[8.4,37.1]ng/L,P=0.000),术后3 d已下降至接近术前水平.其中-251AA基因型患者术后4 h IL-8水平产量升高(33.1[16.6,49.5]ng/L)(P=0.035).IL-8-251AA基因型患者,TnT和CKMB水平于术后4 h高于AT和TT基因型患者(TnT:0.53[0.43,4.92]ng/ml,P=0.037;CKMB:41.5[28.8,65.5]U/L,P=0.025);AA基因型患者血肌酐水平于术后24 h升高(93.1[76.4,121.5]μmol/L,P＝0.021).手术后呼吸机使用>1 d或术后住院时间>14 d患者,术后4 h IL-8水平升高(P=0.036,0.038).应用Logistic回归方法对术后出现呼吸机使用>1 d,术后住院>14 d等危险因素进行回归分析发现,IL-8-251AA患者呼吸机使用>1 d(OR＝11.80,95% CI:1.87～74.48),术后住院>14 d(OR=38.00,95% CI:4.15～347.87)风险增加.结论 非体外循环下冠状动脉旁路移植术会引起机体炎性反应.IL-8-251AA基因型患者术后炎性反应程度及预后风险增加,手术后炎性反应程度和预后与遗传背景有关.     

依托咪酯对非体外循环冠状动脉旁路移植术患者血流动力学及应激反应的影响

目的:观察依托咪酯用于非体外循环冠状动脉旁路移植术(OPCABG)患者,麻醉对血流动力学及应激反应的影响。方法:选择择期行OPCABG的患者60例,随机分为试验组(E组,n=30)和对照组(P组,n=30)。两组患者以相同的方法进行麻醉诱导插管后,E组采用依托咪酯0.3~0.6mg·kg-1·h-1持续静脉输注,P组用丙泊酚3~5mg·kg-1·h-1持续静脉输注,同时复合舒芬太尼维持麻醉。记录并比较两组患者术中血流动力学的变化以及术前术后血皮质醇和IL-6、IL-10的变化。结果:两组患者术中HR、SBP、DBP及MAP与入室后(T0)相比均显著下降(P<0.05),P组下降幅度明显大于E组;除开胸骨后(T2)外,E组术中各时间点SBP显著高于P组(P<0.05);术中血管活性药物的用量P组大于E组。手术(T2’)及手术结束时(T3’)E组血COR与入室后(T0’)相比显著下降,组间差异有统计学意义(P<0.05)。两组患者IL-6、IL-10均于术中显著升高(P<0.01),组间比较,差异无统计学意义。结论:与丙泊酚相比,依托咪酯用于OPCABG可获得更稳定的血流动力学,并可减少术中血管活性药的用量;其对肾上腺皮质的抑制作用于术后24小时恢复至术前水平,术中各时点皮质醇水平虽降低,但都在正常范围内。     

70岁及以上冠状动脉旁路移植患者临床特征分析

目的 观察70岁及以上冠状动脉旁路移植术(CABG)患者的手术危险因素特点及手术效果.方法 回顾分析我院2000年1月至2009年4月施行CABG的426例患者的临床资料,其中70～82岁组118例,24～69岁组308例,将两组患者手术危险因素、并发症及手术效果进行对比研究.结果 70～82岁组术前危险因素为女性、慢性阻塞性肺疾病、外周血管病变、心功能Ⅳ级、需静脉硝酸甘油治疗的不稳定心绞痛、左心室射血分数＜30%的比例、术后严重并发症的发生率、手术病死率、移植血管数和在重症监护病房时间均较24～69岁组高(P＜0.05);70～82岁组患者并存瓣膜病变和采用左乳内动脉桥较24～69岁组少,分别为16例(13.6%)和152例(49.4%),差异有统计学意义(P＜0.05).结论 我国70岁及以上患者手术危险因素组成特点与国外有区别,尽管施行CABG严重并发症发生率和手术病死率较高,但并未明显延长患者的手术恢复时间.

Abstract：

Objective To analyze the clinical characters in old patients undergoing coronary artery bypass grafting (CABG). Methods The clinical data of 426 patients undergoing CABG from January 2000 to April 2009 in our hospital were retrospectively analyzed. One hundred eighteen patients were 70-82 years old (older group), 308 patients were 24-69 years old (younger group). The perioperative risk factors, surgical complication and outcomes between the two groups were compared.Results The older group had higher incidences of post-operative complications than younger group.Pre-operative risk factors included the female, chronic obstructive pulmonary disease, peripheral vessel disease, New york heart association(NYHA) class Ⅳ, unstable angina requiring intravenous nitrates until arrival in the anaesthetic room, left ventricular ejection fraction ＜30%. The older group showed higher incidences of postoperative severe complication, operative mortality, and more grafts and longer time in intensive care unit (ICU), and had lower incidents of valve disease and less use of left internal mammary artery [16 patients (13. 6%) vs. 152 patients (49.4%), all P＜0. 05].Conclusions The many CABG risk factors in China are different from those in the western countries.Although the higher incidents of postoperative severe complication and higher operative mortality are found in the older patients, the recovery period after operation isn't obviously prolonged. The operative outcomes are satisfactory.     

Prospective evaluation of glucose metabolism in patients undergoing coronary artery bypass grafting

INTRODUCTION: Disturbances of glucose metabolism are associated with increased risk of ischaemic heart disease (IHD). It is not uncommon that IHD and its complications precede diagnosis of glucose metabolism disturbances. Since publication of the American Diabetes Association's 2004 Guidelines for the assessment of glucose metabolism, no prospective evaluation of prevalence of carbohydrate metabolism disorders in patients referred for coronary artery bypass grafting (CABG) has been performed. AIM: Evaluation of prevalence of glucose balance disturbances in consecutive patients with stable IHD who underwent elective CABG procedures. METHODS: Prospective analysis of glucose metabolism was carried out on a group of 117 consecutive IHD patients (including 31 women) aged below 80 years, selected for elective CABG surgery. In all patients, history assessment and physical examination as well as basic biochemical studies and resting echocardiography were performed. Additionally, in all individuals without previous diagnosis of diabetes mellitus, oral glucose tolerance test (OGTT) was carried out. RESULTS: History analysis revealed glucose balance disturbances in 35 (29.9%) patients, including diabetes mellitus in 33 (28.2%) subjects and impaired glucose tolerance in 2 (1.7%) individuals. Based on OGTT results, among the remaining 82 (70.1%) subjects without previously known glucose metabolism disturbances 4 (3.4%) patients had abnormal fasting glycaemia, 32 (27.4%) subjects had impaired glucose tolerance, and diabetes mellitus was diagnosed in 12 (10.3%) individuals. No impaired glucose balance was found in only 34 (29.1%) examined subjects. CONCLUSIONS: Over 70% of all patients undergoing elective CABG procedure presented various forms of carbohydrate metabolism disturbances that were not diagnosed previously. Thus, it seems that the assessment of glucose regulation should be mandatory in all patients undergoing elective CABG surgery.     

Preoperative aspirin administration improves oxygenation in patients undergoing coronary artery bypass grafting

OBJECTIVES: Release of thromboxane (Tx) A(2) by platelets may be one of multiple factors that are responsible for lung injury after cardiopulmonary bypass, leading to pulmonary vasoconstriction and impaired oxygenation. In experimental models, the inhibition of Tx receptor or its production improved lung function. The use of aspirin, which is used widely in the treatment of ischemic heart disease because of its antiplatelet activity, is usually discontinued a week before the patient undergoes the operation to restore normal platelet hemostatic function. The purpose of this study was to determine the relationship between the time of cessation of aspirin before coronary artery bypass surgery, and postoperative oxygenation and bleeding. DESIGN: A prospective clinical study comparing the effect of aspirin on postoperative oxygenation in patients who had been treated or had not been treated with aspirin. SETTING: Tx levels in the pericardial fluid, oxygenation, and bleeding were compared between the two groups. PATIENTS: Thirty-two patients with coronary artery disease who were undergoing coronary artery bypass grafting. Fourteen of these patients received aspirin until the day of the operation, whereas 18 patients stopped receiving aspirin at least 1 week before undergoing the operation.Main results: Mean (+/- SD) Tx levels in the pericardial fluid were significantly lower in the aspirin group (117 +/- 47 pg/mL) compared to those in the control group (1,306 +/- 2,048 pg/mL; p = 0.02). The duration of ventilation after the operation was significantly longer in the nonaspirin group (9.6 +/- 5.6 h vs 3.8 +/- 1.4 h, respectively; p = 0.0004). Po(2) reached a higher level while patients breathed 100% O(2) in the aspirin group (235 +/- 54 mm Hg vs 176 +/- 27 mm Hg, respectively; p = 0.001). The mean amount of bleeding during the first 24 h after surgery was increased in the aspirin group (710 +/- 202 mL) compared with the nonaspirin group (539 +/- 143 mL; p = 0.01), but these patients did not require more transfusions. CONCLUSIONS: The administration of aspirin until the operation may improve oxygenation with only a slight increase in bleeding. This improvement is probably mediated by antiplatelet activity and Tx inhibition by aspirin.     

186例老年冠心病患者是、否体外循环下冠脉旁路移植术的比较

目的:比较老年冠心病患者体外循环与非体外循环下冠状动脉旁路移植术的疗效。方法:A组选择87例65岁以上的老年患者在体外循环下行冠状动脉旁路移植术(CCABG);B组选择79例65岁以上的老年患者在非体外循环下行冠状动脉旁路移植术(OPCABG)。结果:B组死亡率低于A组(P<0.05),术后胸腔引流量明显少于A组(P<0.05)。结论:老年冠心病患者行冠状动脉旁路移植术是安全的。     

343例体外循环冠状动脉旁路移植术早期疗效分析

目的:探讨体外循环冠状动脉旁路移植术(CCABG)的早期疗效。方法:采集CCABG 343例临床资料,对全组患者术后死亡率、并发症发生率进行统计学分析,死亡危险因素采用logistic多元回归分析。结果:全组实际手术死亡23例(6.7%),2次开胸止血21例(6.1%);新发心房颤动21例(6.1%);新发室性心律失常32例(9.3%);低心排综合征13例(3.1%);围手术期心肌梗死8例(2.3%);呼吸衰竭6例(1.7%);脑血管意外3例(0.9%);肾功能不全9例(2.6%);男性、年龄及术前心源性休克史可能为围手术期死亡的独立危险因素。结论:CCABG安全、可靠,早期疗效令人满意。     

高龄冠心病患者行冠状动脉旁路移植术的临床分析

目的对接受冠状动脉旁路移植术(CABG)的高龄冠心病患者的临床特点进行分析,评价其手术方式和治疗效果。方法回顾性分析我院2012年6月至2014年5月接受CABG的19例高龄冠心病患者的临床特点,其中男性15例,女性4例,年龄80~91岁,平均(82.7±3.3)岁,体外循环下CABG 14例,非体外循环下CABG 3例,体外循环辅助心脏不停跳2例。旁路移植血管数(3.2±1.1)支。结果接受CABG的高龄患者合并疾病多,15例为不稳定型心绞痛,16例有心肌梗死病史。本组患者围术期死亡1例。术后有52.6%的患者发生心房颤动,另外急性肾损伤(31.6%)、心功能不全(42.1%)、慢性贫血(42.1%)、低蛋白血症(47.4%)等发生率也较高。结论高龄患者合并疾病多、病情危重,术前需细致评估,围术期尤其需精细管理,出院后适当增加随诊频率。     

Renal insufficiency and long-term mortality and incidence of myocardial infarction in patients undergoing coronary artery bypass grafting.

AIMS: To evaluate the impact of renal insufficiency (RI) on long-term mortality and incident myocardial infarction (MI) in patients undergoing coronary artery bypass grafting (CABG). METHODS AND RESULTS: All patients (n = 6575) without dialysis-dependent RI undergoing a first isolated CABG during 1980-1995 at the Karolinska hospital who survived 30 days post-operatively were included. Estimated glomerular filtration rate (eGFR) was related to the incidence of MI and all-cause mortality within 5 years. There were 628 deaths and 496 incident MIs during follow-up. After multivariable adjustment, patients with mild (eGFR 60-90 mL/min), moderate (eGFR 30-60 mL/min), and severe (eGFR <30 mL/min) RI had an increased mortality within 5 years post-CABG; hazard ratio (HR) 1.2 [95% confidence interval (CI) 1.0-1.6], HR 1.8 (95% CI 1.3-2.4), and HR 5.2 (95% CI 3.1-8.6), respectively, compared with patients with normal renal function (eGFR >90 mL/min). In patients with moderate and severe RI, there was an increased incidence of MI; HR 1.5 (95% CI 1.1-2.1) and HR 3.5 (95% CI 1.8-6.8), respectively. There were no gender differences. CONCLUSION: Already mild RI predicts late all-cause mortality after coronary artery bypass grafting (CABG), and moderate and severe RI is associated with an increased long-term incidence of MI post-CABG.     

导致冠状动脉旁路移植术后低氧血症的原因分析

目的 总结冠状动脉旁路移植术后出现低氧血症的相关原因,探讨防治措施.方法 选取我院2008-2013年于心外科行冠状动脉旁路移植术（CABG）的100例患者,对其手术资料进行分析.低氧血症的诊断标准为：排除贫血等因素导致的氧分压降低情况后,在机械通气（FiO2＞45％）或面罩联合鼻导管吸氧（氧流量6 L/min）的情况下供氧,冠状动脉旁路移植术后患者的氧分压仍低于[102-（0.33×年龄）mmHg]的患者.结果 100例冠状动脉旁路移植术患者,术后共有30例出现不同程度的低氧血症症状,发生率为30％（30/100）.随着年龄的增大术后低氧血症的发生率不断升高.低氧血症多在术后第1天出现,急诊手术、有吸烟史,以及合并高血压、糖尿病、心梗、肺部疾病是低氧血症发病的危险因素（P＜0.05）.结论 对冠状动脉旁路移植术后的低氧血症要做好充分的预防,发现后及时纠正,可提高手术治疗的效果.