体外循环下冠状动脉旁路移植术后患者发生低心排血量综合征危险因素分析

目的探讨冠状动脉粥样硬化性心脏病(coronary heart disease,CHD)患者行体外循环(cardiopulmonary bypass,CPB)下冠状动脉旁路移植(coronary artery bypass grafting,CABG)术后并发低心排血量综合征(low cardiac output syndrome,LCOS)的相关危险因素以及对其临床预后的影响。方法回顾性分析2005年6月至2017年6月于安徽医科大学第一附属医院心脏大血管外科行CABG术的310例患者的临床资料,根据术后是否发生LCOS,分为LCOS组和对照组。收集所有患者的术前及术中资料,采用单因素分析和Logistic回归分析对LCOS的危险因素进行统计分析。结果40例患者发生术后LCOS,发生率为12.9%。单因素分析结果表明,患者术前年龄>60岁(P=0.019)、血肌酐浓度(P<0.001)、既往经皮冠状动脉介入治疗(P=0.001)、心律失常(P<0.001)、左心室射血分数(left ventricular ejection fraction,LVEF)<45%(P<0.001),术中CPB时间>100 min(P=0.009)、失血量>800 mL(P=0.005)、移植桥血管流量(P=0.032)及多支血管病变(P=0.0031)与LCOS有关。将上述因素纳入到二分类Logistic回归分析,结果显示心律失常(OR=5.802,95%CI:2.290~14.699,P=0.000)、LVEF<45%(OR=7.139,95%CI:2.620~19.452,P=0.000),术中CPB时间>100 min(OR=3.211,95%CI:1.243~8.292,P=0.016)、多支血管病变(OR=5.698,95%CI:2.746~13.567,P=0.002)及失血量>800 mL(OR=0.427,95%CI:0.193~0.948,P=0.036)是LCOS发生的独立危险因素。结论术前心律失常、LVEF<45%,术中CPB时间>100 min及失血量>800 m L是CHD患者CABG术发生LCOS的独立危险因素。

Risk factors for low cardiac output syndrome in patients undergoing coronary artery bypass grafting under cardiopulmonary bypass

Objectives To explore the risk factors of low cardiac output syndrome(LCOS)after coronary artery bypass grafting(CABG)under cardiopulmonary bypass(CPB)in patients with coronary heart disease(CHD).MethodsA total of 310 patients with CHD who received CABG were enrolled from June 2005 to June 2017 in The First Affiliated Hospital of An Hui Medical University.The patients with LCOS after CABG were selected as LCOS group and the rest patients without LCOS were selected as control group.The medical data before and during surgery was analyzed by both univariate analysis and Logistic regression analysis.ResultsThere were significant differences for serum concentration of creatinine(Cr)(P<0.001),age>60 years(P=0.019),duration of CPB>100 min during surgery(P=0.009),history of percutaneous coronary intervention(PCI)(P=0.001),arrhythmia(P<0.001),left ventricular ejection fraction(LVEF)<45%(P<0.001),blood lost>800 m L(P=0.005),blood flow of graft(P=0.032)and multivessel disease(P=0.003)between the two groups.It was further found by Logistic regression analysis based on univariate analysis that arrhythmia(OR=5.802,95%CI:2.290-14.699,P=0.000),LVEF<45%(OR=7.139,95%CI:2.620-19.452,P=0.000),duration of CPB>100 min during surgery(OR=3.211,95%CI:1.243-8.292,P=0.016),blood loss>800 m L(OR=0.427,95%CI:0.193-0.948,P=0.036)and multivessel disease(OR=6.698,95%CI:2.746-13.567,P=0.002)were independent risk factors of LCOS after surgery in patients with CHD.Conclusions Arrhythmia and LVEF<45%before surgery,duration of CPB>100 min and blood loss>800 mL during surgery were independent risk factors of LCOSafter CABG for patients with CHD.