Konstantinov B A, Bazylev V V, Belov Iu V, Kizyma A G
Khirurgiia (Mosk). 2008(5):4-10.
Retrospective study analysis concerning the prevalence of risk factors for unfavorable outcomes after coronary operations in patients with peripheral arterial atherosclerosis is presented. Meta-analysis of individual risk factors was carried out. Frequency of complications after coronary shunting in patients with various concomitant diseases is evaluated. The multifactorial relative risk affecting hospital lethality is defined. The study includes 131 patients with generalized atherosclerosis, which have underwent myocardial revascularization at the first stage (the main group) and at the second stage have been operated on abdominal aorta and peripheral arteries. 1128 patients without peripheral arterial atherosclerosis have made the control group. They underwent only coronary shunting. All patients were treated from December of 1994 till June of 2006. Relying on the results of the study cumulative relative risk for unfavorable outcomes after revascularization is 1.8 times higher in patients from the main group than in patients from the control group, and the risk for primary complications is 2.03 times higher. Concomitant atherosclerotic arterial involvement among cardiosurgical patients is associated with high risk for stroke in postoperative period. In case of chronic renal failure risk factors are cumulated. In the main group lethality made 5% , which was higher as compared with the control group. Correlation of such risk factors as heart failure and renal failure (creatinine level more than 1.8 mg/dl) with lethality has been revealed among patients from the main group. Lethality risk raises in 5.30 times in the presence of heart failure in medical history, and raises in 13.15 times in case of initially elevated creatinine level. Age of patient didn't have any influence on lethality in early postoperative period.
本文呈现了一项关于外周动脉粥样硬化患者冠状动脉手术后不良结局风险因素患病率的回顾性研究分析。对个体风险因素进行了荟萃分析。评估了患有各种伴随疾病的患者冠状动脉分流术后并发症的发生率。确定了影响医院死亡率的多因素相对风险。该研究纳入了131例患有全身性动脉粥样硬化的患者,他们在第一阶段接受了心肌血运重建(主要组),第二阶段接受了腹主动脉和外周动脉手术。1128例无外周动脉粥样硬化的患者作为对照组。他们仅接受了冠状动脉分流术。所有患者于1994年12月至2006年6月接受治疗。根据研究结果,主要组患者血运重建后不良结局的累积相对风险比对照组患者高1.8倍,主要并发症的风险高2.03倍。心脏外科患者中并存的动脉粥样硬化累及与术后中风的高风险相关。在慢性肾功能衰竭的情况下,风险因素会累积。主要组的死亡率为5%,高于对照组。在主要组患者中,已揭示心力衰竭和肾衰竭(肌酐水平超过1.8mg/dl)等风险因素与死亡率的相关性。有心力衰竭病史时,死亡风险增加5.30倍,初始肌酐水平升高时,死亡风险增加13.15倍。患者年龄对术后早期死亡率没有任何影响。