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对177例行单纯冠状动脉搭桥术并接受主动脉内球囊反搏治疗患者的院内死亡危险因素分析。

Analysis of risk factors for in-hospital mortality in 177 patients who underwent isolated coronary bypass grafting and received intra aortic balloon pump.

作者信息

Samanidis George, Kanakis Meletios, Balanika Marina, Khoury Mazen

机构信息

Second Department of Cardiac Surgery, Onassis Cardiac Surgery Center, Athens, Greece.

Department of Pediatric and Congenital Heart Surgery, Onassis Cardiac Surgery Center, Athens, Greece.

出版信息

J Card Surg. 2021 Apr;36(4):1460-1465. doi: 10.1111/jocs.15437. Epub 2021 Feb 18.

Abstract

BACKGROUND AND AIM OF THE STUDY

Intra-aortic balloon pump (IABP) is the most commonly used device for circulatory support of patients with heart disease. The aim of this study evaluated the risk factors for outcomes of patients who underwent isolated coronary bypass grafting and received IABP.

METHODS

One hundred-seventy-seven patients underwent isolated coronary bypass grafting and received intraoperative IABP. All perioperative data were recorded. The primary end-point was in-hospital mortality, while the secondary end-points were the length of intensive care unit (ICU) stay and hospital length of stay (LOS).

RESULTS

In-hospital mortality was 5.6% (10 patients). Multivariable logistic regression analysis showed that the risk factors for in-hospital mortality were preoperative plasma creatinine level and cardiopulmonary bypass (CPB) time (for both p < .05). Multivariable linear regression analysis showed that postoperative acute kidney injury (AKI), immediate plasma troponin after operation, numbers of grafts, and CPB time were predicted the hospital LOS, while postoperative AKI, preoperative left ventricular ejection fraction, and immediate plasma troponin after operation were predicted the lengths of ICU stay.

CONCLUSION

Our analysis showed that increased preoperative plasma creatinine, postoperative renal dysfunction, and CPB time negatively affected the outcomes of patients who received intraoperative IABP insertion.

摘要

研究背景与目的

主动脉内球囊反搏(IABP)是心脏病患者循环支持最常用的装置。本研究旨在评估接受单纯冠状动脉搭桥术并使用IABP患者预后的危险因素。

方法

177例患者接受单纯冠状动脉搭桥术并在术中使用IABP。记录所有围手术期数据。主要终点为住院死亡率,次要终点为重症监护病房(ICU)住院时间和住院时长(LOS)。

结果

住院死亡率为5.6%(10例患者)。多变量逻辑回归分析显示,住院死亡率的危险因素为术前血浆肌酐水平和体外循环(CPB)时间(两者p均<0.05)。多变量线性回归分析显示,术后急性肾损伤(AKI)、术后即刻血浆肌钙蛋白、移植血管数量和CPB时间可预测住院时长,而术后AKI、术前左心室射血分数和术后即刻血浆肌钙蛋白可预测ICU住院时长。

结论

我们的分析表明,术前血浆肌酐升高、术后肾功能不全和CPB时间对术中接受IABP置入患者的预后有负面影响。

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