邱宗利

【摘要】 目的：观察分析影响冠状动脉旁路移植术手术死亡的危险因素，对预防检查和治疗方案提供针对性的帮助和改善。方法：回顾性分析本院心血管科2010年1月-2013年12月收治住院并接受冠状动脉旁路移植术的137例冠心病患者的临床资料，选择可能导致患者死亡的危险因素为研究对象并调查收集资料，进行单因素与多因素分析，选出影响冠状动脉旁路移植术手术死亡的危险因素。结果：137例接受冠状动脉旁路移植术的患者手术中有5例患者死亡，占总数的3.65%。单因素与多因素分析显示影响术后死亡的危险因素包括：年龄、围手术期心肌梗死、心功能不全、室壁瘤、心力衰竭、左主干病变大于50%、心律失常、肺动脉瓣反流、二尖瓣反流、心源性休克、左心室射血分数、术前血红蛋白值、术前肌酐值和合并主动脉瘤手术。手术前后针对带有以上单个或多个危险因素的患者进行重点监测，以减少患者死亡率。结论：影响冠状动脉旁路移植术手术死亡的危险因素较多，需及时干预。

【关键词】 冠状动脉旁路移植术； 死亡率； 危险因素； 分析

【Abstract】 Objective：To observe and analyze the risk factors for operative mortality in patients with coronary artery bypass grafting surgery and to provide targeted assistance to improve preventive inspection and treatment programs.Method：The clinical data of 137 coronary heart disease patients received coronary artery bypass grafting in department of cardiology in our hospital from January 2010 to December 2013 were retrospectively analyzed.The risk factors that may lead to death in patients were selected as research objects，and collected and investigated the materials，univariate and multivariate were analyzed，risk factors for operative mortality in coronary artery bypass grafting surgery were selected.Result：5 patients died in 137 coronary heart disease patients，accounted for 3.65%，univariate and multivariate analysis showed that risk factors for operative mortality in coronary artery bypass grafting surgery including：age，perioperative myocardial infarction，cardiac insufficiency，ventricular aneurysm，heart failure，left main artery lesions more than 50%，arrhythmia，pulmonary regurgitation，mitral regurgitation，cardiogenic shock，left ventricular ejection fraction，the preoperative hemoglobin value，preoperative creatinine values and coalescence of aortic aneurysm surgery.Before and after surgery，patients with single or multiple risk factors were focused on and monitored to reduce mortality.Conclusion：There are many risk factors for operative mortality in coronary artery bypass grafting surgery and need to intervene timely.

【Key words】 Coronary artery bypass grafting surgery； Mortality rate； Risk factors； Analysis

First-authors address：The First Affiliated Hospital of Nanyang Medical College，Nanyang 473000，China

doi：10.3969/j.issn.1674-4985.2014.18.026

冠状动脉旁路移植术又称为冠状动脉搭桥术，是临床上治疗冠状动脉疾病常用术式，是从患者手臂、胸部或者腿部取一条血管建立在冠状动脉狭窄的近端和远端之间，帮助血液绕过狭窄部位从近端到达远端，以改善心肌梗塞、心肌缺血的状态[1]。冠状动脉旁路移植术已经成为治疗心肌缺血和冠状动脉狭窄最为有效的方法，成功率高，对患者创伤小；……