中国综合临床
中國綜閤臨床
중국종합림상
CLINICAL MEDICINE OF CHINA
2010年
2期
139-141
,共3页
姜辉%王辉山%汪曾炜%朱洪玉%陶登顺%张南滨%朱瑞武
薑輝%王輝山%汪曾煒%硃洪玉%陶登順%張南濱%硃瑞武
강휘%왕휘산%왕증위%주홍옥%도등순%장남빈%주서무
冠状动脉旁路移植术%消化道出血%危险因素
冠狀動脈徬路移植術%消化道齣血%危險因素
관상동맥방로이식술%소화도출혈%위험인소
Coronary artery bypass grafting%Gastrointestinal bleeding%Risk factors
目的 通过对冠状动脉旁路移植术后发生消化道出血的情况进行分析,以确定其发生的危险因素及防治方法.方法 2001年8月至2005年5月共行冠状动脉旁路移植术582例,6例术后发生消化道出血,其中,上消化道出血5例,急性肠系膜缺血坏死出血1例.按照术后有无消化道出血将其分为2组:消化道出血组6例,对照组576例.比较2组术前、术中和术后的临床资料及用逐步逻辑回归分析的方法确定术后消化道出血的危险因素.结果 582例中6例术后发生消化道出血,发生率为1%,全部治愈.消化道出血组年龄≥70岁、术前高血压、术前脑血管病变、术前心肌梗死、心功能分级(NYHA)≥Ⅲ级、术后低心排的概率明显高于对照组(分别为66.7%与21.0%,100%与51.7%,33.3%与8.7%,83.3%与32.1%,50.0%与13.5%,33.3%与7.8%,P均<0.05);消化道出血组年龄明显大于对照组[(72.00±4.15)岁与(62.53±9.31)岁,P<0.05],左心室射血分数明显低于对照组[(55.67±6.50)%与(64.64±9.53)%,P<0.05],术后输血量明显多于对照组[(1115.00±689.89)ml与(663.44±505.34)ml,P<0.05],术后住院时间明显长于对照组[(50.67±41.59)d与(17.42±9.14)d,P<0.01].用逐步逻辑回归分析表明术后消化道出血的危险因素:年龄≥70岁,术前心肌梗死,术前心功能分级≥Ⅲ级(OR值分别为10、948、9.11、11.53,P均<0.05).结论 冠状动脉旁路移植术后消化道出血的早期诊断较困难,评估患者有无发生消化道出血的危险因素有利于进行预防、早期诊断、早期治疗,早期诊断、早期治疗对降低病死率至关重要.
目的 通過對冠狀動脈徬路移植術後髮生消化道齣血的情況進行分析,以確定其髮生的危險因素及防治方法.方法 2001年8月至2005年5月共行冠狀動脈徬路移植術582例,6例術後髮生消化道齣血,其中,上消化道齣血5例,急性腸繫膜缺血壞死齣血1例.按照術後有無消化道齣血將其分為2組:消化道齣血組6例,對照組576例.比較2組術前、術中和術後的臨床資料及用逐步邏輯迴歸分析的方法確定術後消化道齣血的危險因素.結果 582例中6例術後髮生消化道齣血,髮生率為1%,全部治愈.消化道齣血組年齡≥70歲、術前高血壓、術前腦血管病變、術前心肌梗死、心功能分級(NYHA)≥Ⅲ級、術後低心排的概率明顯高于對照組(分彆為66.7%與21.0%,100%與51.7%,33.3%與8.7%,83.3%與32.1%,50.0%與13.5%,33.3%與7.8%,P均<0.05);消化道齣血組年齡明顯大于對照組[(72.00±4.15)歲與(62.53±9.31)歲,P<0.05],左心室射血分數明顯低于對照組[(55.67±6.50)%與(64.64±9.53)%,P<0.05],術後輸血量明顯多于對照組[(1115.00±689.89)ml與(663.44±505.34)ml,P<0.05],術後住院時間明顯長于對照組[(50.67±41.59)d與(17.42±9.14)d,P<0.01].用逐步邏輯迴歸分析錶明術後消化道齣血的危險因素:年齡≥70歲,術前心肌梗死,術前心功能分級≥Ⅲ級(OR值分彆為10、948、9.11、11.53,P均<0.05).結論 冠狀動脈徬路移植術後消化道齣血的早期診斷較睏難,評估患者有無髮生消化道齣血的危險因素有利于進行預防、早期診斷、早期治療,早期診斷、早期治療對降低病死率至關重要.
목적 통과대관상동맥방로이식술후발생소화도출혈적정황진행분석,이학정기발생적위험인소급방치방법.방법 2001년8월지2005년5월공행관상동맥방로이식술582례,6례술후발생소화도출혈,기중,상소화도출혈5례,급성장계막결혈배사출혈1례.안조술후유무소화도출혈장기분위2조:소화도출혈조6례,대조조576례.비교2조술전、술중화술후적림상자료급용축보라집회귀분석적방법학정술후소화도출혈적위험인소.결과 582례중6례술후발생소화도출혈,발생솔위1%,전부치유.소화도출혈조년령≥70세、술전고혈압、술전뇌혈관병변、술전심기경사、심공능분급(NYHA)≥Ⅲ급、술후저심배적개솔명현고우대조조(분별위66.7%여21.0%,100%여51.7%,33.3%여8.7%,83.3%여32.1%,50.0%여13.5%,33.3%여7.8%,P균<0.05);소화도출혈조년령명현대우대조조[(72.00±4.15)세여(62.53±9.31)세,P<0.05],좌심실사혈분수명현저우대조조[(55.67±6.50)%여(64.64±9.53)%,P<0.05],술후수혈량명현다우대조조[(1115.00±689.89)ml여(663.44±505.34)ml,P<0.05],술후주원시간명현장우대조조[(50.67±41.59)d여(17.42±9.14)d,P<0.01].용축보라집회귀분석표명술후소화도출혈적위험인소:년령≥70세,술전심기경사,술전심공능분급≥Ⅲ급(OR치분별위10、948、9.11、11.53,P균<0.05).결론 관상동맥방로이식술후소화도출혈적조기진단교곤난,평고환자유무발생소화도출혈적위험인소유리우진행예방、조기진단、조기치료,조기진단、조기치료대강저병사솔지관중요.
Objective Analyzing risk factors for gastrointestinal bleeding(GIB) after coronary artery bypass grafting(CABG). Methods 582 cases undergoing CABG from August 2001 to May 2005 were divided into two groups (GIB group ,n=6 ;control group,n=576) . Preoperative , operative and postoperative clinic data were com-pared. Results The ratio of over-aging(age greater than 70), hypertension, cerebrovascular disease, myocardial in-fraction,heart function (NYHA) over Ⅲ and postoperative low output syndrome (LOS) in GIB group were signifi-cantly higher than that in control group;age, blood transfusion and hospitalized time were significantly higher and left ventricular ejective fraction was significantly lower in GIB group than that in control group. Age over 70,history of myocardial infraction and heart function (NYHA) over Ⅲ were selected as risk factors of GIB after CABG by step-wise logistic regression analysis. Conclusions It is very useful for precaution, early diagnosis and early therapy of GIB after CABG to evaluate if patients have the risk factors of GIB after CABG before operations.
