1516例男性患者非体外循环冠状动脉旁路移植术中应用主动脉内球囊反搏危险因素Logistic分析

目的:非体外循环冠状动脉旁路移植术(OPCABG)是治疗冠心病主要手段之一。本文拟通过回顾性Logistic分析1 516例施行OPCABG男性患者,术中应用主动脉内球囊反搏(IABP)的独立危险因素,为此类患者提供手术依据和前瞻性判断。方法:采用麻醉科2007年11月至2009年2月OP-CABG围术期数据库,回顾性分析了1 516例记录齐全的男性患者OPCABG围术期资料。以术中应用IABP为因变量,将有统计学意义的单因素进行Logistic回归分析并评价各影响因素的作用大小。结果:术前射血分数(EF)<40%(OR=4.946,P=0.001)、搭桥数>3支(OR=2.340,P=0.007)、左主干病变(OR=2.857,P=0.001)、急诊(OR=4.816,P=0.001)和术中发生心房颤动(P=0.001,OR=12.188)为围术期应用IABP的独立危险因素。结论:术前EF<40%、旁路移植血管数>3支、左主干病变、急诊和术中发生心房颤动为术中应用IABP的独立危险因素,提示在遇到这类患者时,及早在术前应用IABP,对于OPCABG患者是有益的。

Logistic-analysis of risk factors in 1 516 male patients with intra-aortic balloon pump insertion undergoing off-pump coronary artery bypass grafting

Objective:To determine the risk factors of intra-aortic balloon pump(IABP) insertion in male patients undergoing off-pump coronary artery bypass Grafting(OPCABG).Methods:The perioperative data of 1 516 male patients undergoing OPCABG were investigated based on the perioperative OPCABG database from Nov 2007 to Feb 2009.The risk factors were identified by multiple logistic regressions.Results:Multivariate analysis demonstrated that preoperative ejection fraction(EF) <40%(OR=4.946,P=0.000),more than 3 grafts(OR=2.340,P=0.007),left main stenosis(OR=2.857,P=0.001),emergency CABG(OR=4.816,P=0.000) and intraoperative atrial fibrillation(OR=12.188,P=0.000) were the independent risk factors of IABP insertion in male patients undergoing off-pump coronary artery bypass grafting.Conclusion:This study shows EF<40%,more than 3 grafts,left main stenosis,emergency CABG and intraoperative atrial fibrillation are predominant influence of IABP insertion for OPCABG.Early IABP insertion was recommended for such patients undergoing coronary artery bypass grafting.