本文選題：主動脈內(nèi)氣囊泵 + 冠狀動脈疾病�。� 參考：《中國循環(huán)雜志》2017年03期

【摘要】：目的:探討主動脈內(nèi)球囊反搏(IABP)置入時機(jī)對高危冠心病患者行冠狀動脈(冠脈)旁路移植術(shù)(CABG)的短期效果評價和危險因素分析。方法:回顧性分析我院2010-01至2015-12收治并應(yīng)用IABP輔助CABG的197例高危冠心病患者,男性91例(46.2%),平均動脈壓為(70.3±8.2)mm Hg(1 mm Hg=0.133 k Pa)。根據(jù)IABP置入時間分為術(shù)前置入組(n=89)和術(shù)中、術(shù)后置入組(n=108)。比較兩組圍手術(shù)期情況,以及機(jī)械通氣率、重癥監(jiān)護(hù)室停留時間,Kaplan-Meier生存分析評價兩組的生存情況,并應(yīng)用Logistic回歸分析術(shù)后30天死亡的危險因素,應(yīng)用受試者工作特征性(ROC)曲線和約登指數(shù)評估危險因素對病死率的最佳預(yù)測閾值和相應(yīng)的敏感性和特異性。結(jié)果:197例患者的主動脈阻斷時間為(86.7±37.3)min,體外循環(huán)平均時間為(147.3±18.4)min。兩組間年齡、性別比例、肌酸激酶同功酶、肌鈣蛋白I、肌酐、平均動脈壓、歐洲心臟手術(shù)風(fēng)險評估系統(tǒng)評分等均無顯著差異(P0.05)。術(shù)前置入組與術(shù)中、術(shù)后置入組比較,術(shù)后48 h心肌酶峰值明顯降低(mmol/L,130.6±25.4 vs149.7±18.2),機(jī)械通氣時間(h,81.5±10.3 vs 107.9±11.5)、總住院時間(d,21.3±4.1 vs 27.7±9.4)顯著減少,急性腎損傷(3.4%vs23.1%)、腦并發(fā)癥(5.6%vs 19.4%)和術(shù)后30天死亡率(4.5%vs 36.1%)的發(fā)生率降低,差異均有統(tǒng)計學(xué)意義(P0.05)。Kaplan-Meier生存分析顯示術(shù)前置入組患者的中位生存時間較術(shù)中、術(shù)后置入組顯著延長(d,27.9±1.2 vs 16.5±2.2,P0.05),Logistic回歸分析發(fā)現(xiàn)再置入IABP(比值比=2.37,95%可信區(qū)間:1.42~5.72,P=0.01)為預(yù)測術(shù)后30天病死率的重要因素。ROC曲線顯示再次置入IABP預(yù)測患者術(shù)后30天病死率的敏感性為75.3%,特異性為67.4%。結(jié)論:對于高危CABG的患者,術(shù)前置入IABP輔助治療有助于降低術(shù)后心肌酶峰值,縮短呼吸機(jī)支持時間和總住院時間,降低短期病死率。再次置入IABP是短期死亡的危險因素。
[Abstract]:Objective : To investigate the short - term effect evaluation and risk factors of coronary artery bypass grafting ( CABG ) in patients with high risk coronary heart disease ( CHD ) in patients with high risk coronary heart disease . Results : In 197 patients with high risk CABG , the incidence of myocardial enzyme was significantly decreased ( P < 0.05 ) , and the average time of hospitalization ( d , 21.3 鹵 1.4 vs 16.5 鹵 2.2 , P = 0.01 ) was significantly decreased ( P < 0.05 ) . The results showed that the patients with high risk CABG had a higher sensitivity of 75.3 % and a specificity of 67.4 % . Conclusion : In patients with high risk CABG , the postoperative mortality rate was significantly decreased ( P = 2.37 , 95 % CI : 1.42 锝，

本文編號：1767304