冠心病合并糖尿病患者冠状动脉旁路移植术长期预后及危险因素的探讨

目的 探讨糖尿病及其合并症对冠状动脉旁路移植术长期预后的影响。方法 将226例连续行冠状动脉主路移植术的冠心病患者分为糖尿病组（116例）和非糖尿病组（110例），应用多变量分析方法分析两组患者术前及术后的临床特征，并随访术后总死亡率及心脏性死亡的发生率，探讨糖尿病组心脏性死亡的预测因素。结果 两组术前及术后的临床特征、既往心肌梗死病史及冠状动脉病变支数等差异无显著性。结果 两组术前及术后的临床特征、既往心肌梗死病史及冠状动脉病变支数等差异无显著性。平均随访3.5年总死亡率两组差异无显著性，但心脏性死亡的发生率糖尿病组明显高于非糖尿病组（15％与3％，P＜0.01）。糖尿病和术后低左室射血分数与心脏性死亡的发生率密切相关（95％可信区间1.29-15.20)。糖尿病组的心脏性主要是猝死、心力衰竭和心肌梗死。术后低左室射血分数、女性及糖尿病肾病是主要预测因素。结论 冠心病合并糖尿病患者冠状动脉旁路移植术长期预后不良，特别在低左室射血分数、女性及糖尿病肾病患者心脏性死亡的发生率高，预后差。应加强对糖尿病患者冠状动脉旁路移植术后心、肾功能障碍的治疗。

Risk factors for long-term outcome of coronary artery disease complicated with diabetes mellitus after coronary artery bypass surgery

Objective To evaluate the influence of diabetes mellitus and its complications on the long term outcome of coronary artery bypass surgery(CABG) Methods 226 consecutive patients with coronary artery disease treated by CABG were divided into diabetes mellitus group(116 cases) and non diabetes mellitus group(110 cases) The preoperative and postoperative clinical characteristics, clinical investigations, overall mortality and cardiac deaths for 3 5 years were studied by multivariate analysis The related risk factors of cardiac deaths in diabetes mellitus group were discussed Results The number of diseased coronary arteries, left ventricular ejection fraction(LVEF), frequency of preoperative infarction, number of grafts, use of arterial conduit and overall mortality were not significantly different between the diabetes mellitus group and non diabetes mellitus group The study showed higher cardiac mortality in diabetes mellitus group than that in non diabetes mellitus group (15% vs 3%, P <0 05) Major causes of cardiac deaths in diabetes mellitus group were sudden death, pump failure and acute myocardial infarction Additionally, multivariate analysis in diabetes mellitus group identified that postoperative low LVEF, female and diabetic nephropathy were independent predictors of late cardiac deaths Conclusion The patients of coronary artery disease complicated with diabetes mellitus have a worse long term outcome after CABG, especially when associated with low LVEF, female and diabetic nephropathy Intensive treatments of myocardial infarction, heart failure and nephropathy are all essential to improve the long term outcome after CABG