Naunheim K S, Fiore A C, Arango D C, Pennington D G, Barner H B, McBride L R, Harris H H, Willman V L, Kaiser G C
Department of Surgery, St. Louis University Medical Center, MO 63110-0250.
Ann Thorac Surg. 1989 Apr;47(4):569-74. doi: 10.1016/0003-4975(89)90435-9.
Unstable angina pectoris is a broad, nonspecific diagnosis encompassing a wide variety of clinical syndromes. The intravenous administration of nitroglycerin preoperatively is indicative of a more acute clinical situation, and allows for selection and analysis of a more homogeneous patient population. We reviewed the results of coronary artery bypass grafting for unstable angina defined as angina necessitating intravenous administration of nitroglycerin preoperatively. There were 129 patients (83 men and 46 women) with a mean age of 63.2 years (range, 36 to 86 years). Complications included operative death in 6.2%, postoperative low cardiac output in 11%, and perioperative myocardial infarction in 9%. Twenty perioperative variables were analyzed to identify risk factors for these end points. For operative death, age (p less than 0.05), cross-clamp time (p less than 0.05), and cardiopulmonary bypass time (p less than 0.001) were significant in the univariate analysis, but only age (p less than 0.05, F = 4.6) was an independent predictor using multivariate analysis (stepwise linear regression). For low cardiac output, univariate analysis demonstrated that cross-clamp time (p less than 0.01), preoperative use of an intraaortic balloon for angina (p less than 0.05), left ventricular score (p less than 0.05), number of diseased coronary vessels (p less than 0.05), and cardiopulmonary bypass time (p less than 0.001) were significant variables. However, only use of an intraaortic balloon for angina (p less than 0.0001, F = 14.3) and left ventricular score (p less than 0.005, F = 11.1) were significant independent predictors in the multivariate model. For perioperative myocardial infarction, only diabetes requiring insulin (p less than 0.005) was a significant predictor.
不稳定型心绞痛是一个宽泛的、非特异性的诊断，涵盖了多种临床综合征。术前静脉注射硝酸甘油表明临床情况更为危急，这有助于选择和分析更具同质性的患者群体。我们回顾了因术前需要静脉注射硝酸甘油的不稳定型心绞痛而进行冠状动脉旁路移植术的结果。共有129例患者（83例男性和46例女性），平均年龄63.2岁（范围为36至86岁）。并发症包括手术死亡6.2%、术后低心排血量11%和围手术期心肌梗死9%。分析了20个围手术期变量以确定这些终点的危险因素。对于手术死亡，单因素分析中年龄（p<0.05）、阻断时间（p<0.05）和体外循环时间（p<0.001）具有显著意义，但多因素分析（逐步线性回归）中只有年龄（p<0.05，F=4.6）是独立预测因素。对于低心排血量，单因素分析表明阻断时间（p<0.01）、术前因心绞痛使用主动脉内球囊（p<0.05）、左心室评分（p<0.05）、病变冠状动脉血管数量（p<0.05）和体外循环时间（p<0.001）是显著变量。然而，多因素模型中只有因心绞痛使用主动脉内球囊（p<0.0001，F=14.3）和左心室评分（p<0.005，F=11.1）是显著的独立预测因素。对于围手术期心肌梗死，只有需要胰岛素治疗的糖尿病（p<0.005）是显著预测因素。
