Yu Hai-Yan, Bai Yun-Peng, Song Xu-Chen, Miao Fang, Guo Xiao-Ling, Wang Xing, Su Wen-Ling
Department of Endocrinology, Tianjin Chest Hospital, Tianjin, 300070, People's Republic of China.
Department of Cardiac Surgery, Tianjin Chest Hospital, Tianjin, 300070, People's Republic of China.
J Multidiscip Healthc. 2024 Feb 7;17:573-583. doi: 10.2147/JMDH.S447534. eCollection 2024.
This study aims to explore the factors linked to the occurrence of acute pulmonary thromboembolism (PE) within a cohort of patients exhibiting hypoxic saturation (oxygen saturation levels falling below 93%), subsequent to undergoing off-pump coronary artery bypass grafting (OPCABG).
A retrospective case-control study was conducted. A total of 296 patients met the inclusion and exclusion criteria, divided into PE group (100 cases) and non-PE group (196 cases) according to whether they had PE or not. The preoperative and postoperative information of patients were collected and statistically analyzed.
The results from a multivariate logistic regression analysis indicated the following factors were independently linked to PE following OPCABG: history of smoking (OR = 3.019, 95% CI, 1.437-6.634, = 0.004), preoperative arterial oxygen partial pressure ≤78.9 mmHg (OR = 3.686, 95% CI, 1.708-8.220, = 0.001), presence of postoperative lower extremity deep venous thrombosis (OR = 4.125, 95% CI, 1.886-9.310, < 0.001), elevated postoperative D-dimer levels >6.76 mg/l (OR = 8.078, 95% CI, 3.749-18.217, <0.001), postoperative NT-BNP levels (OR = 1.001, 95% CI: 1.000-1.001, = 0.011), and elevated postoperative pulmonary arterial pressure >33.0 mmHg (OR = 10.743, 95% CI: 3.422-37.203, < 0.001). The developed nomogram exhibited a high predictive accuracy with an area under the curve of 0.913 (95% CI: 0.878-0.948).
When patients have a history of preoperative smoking, decreased preoperative arterial oxygen pressure, postoperative lower limb DVT, increased postoperative pulmonary artery pressure, and elevated postoperative D-Dimer and NT pro-BNP levels, it is recommended to take perioperative preventive measures, timely diagnostic evaluation, and if necessary, anticoagulant treatment. In addition, the results of this study may improve the diagnostic sensitivity of medical staff for postoperative PE in OPCABG, thereby increasing the detection rate and potentially reducing the need for excessive medical imaging procedures.
本研究旨在探讨在接受非体外循环冠状动脉搭桥术（OPCABG）后出现低氧饱和度（氧饱和度水平低于93%）的患者队列中，与急性肺血栓栓塞症（PE）发生相关的因素。
进行了一项回顾性病例对照研究。共有296例患者符合纳入和排除标准，根据是否发生PE分为PE组（100例）和非PE组（196例）。收集患者术前和术后信息并进行统计分析。
多因素logistic回归分析结果表明，以下因素与OPCABG术后的PE独立相关：吸烟史（OR = 3.019，95%CI，1.437 - 6.634，P = 0.004）、术前动脉血氧分压≤78.9 mmHg（OR = 3.686，95%CI，1.708 - 8.220，P = 0.001）、术后存在下肢深静脉血栓形成（OR = 4.125，95%CI，1.886 - 9.310，P < 0.001）、术后D - 二聚体水平升高>6.76 mg/l（OR = 8.078，95%CI，3.749 - 18.217，P < 0.001）、术后NT - BNP水平（OR = 1.001，95%CI：1.000 - 1.001，P = 0.011）以及术后肺动脉压升高>33.0 mmHg（OR = 10.743，95%CI：3.422 - 37.203，P < 0.001）。所构建的列线图显示出较高的预测准确性，曲线下面积为0.913（95%CI：0.878 - 0.948）。
当患者有术前吸烟史、术前动脉血氧压力降低、术后下肢深静脉血栓形成、术后肺动脉压升高以及术后D - 二聚体和NT - pro - BNP水平升高时，建议采取围手术期预防措施、及时进行诊断评估，必要时进行抗凝治疗。此外，本研究结果可能提高医护人员对OPCABG术后PE的诊断敏感性从而提高检出率，并可能减少不必要的医学影像检查。
