CAJ | 학술논문

目的探讨非体外循环冠状动脉旁路移植术(CABG)治疗冠心病的预后及影响预后的相关危险因素.方法回顾性分析2001年1月至2012年12月在北京大学人民医院接受非体外循环CABG的患者共2 831例.其中男性2 099例,女性732例,平均年龄(63±9)岁.采用二元Logistic回归分析筛选出影响围手术期死亡的危险因素.对患者进行长期随访,使用Kaplan-Meier法绘制生存曲线,采用单因素Log-rank检验和Cox回归模型得出影响长期预后的危险因素.结果 2 831例患者接受非体外循环CABG,院内死亡45例,术后顺利出院2 786例.二元Logistic回归分析表明,性别(女)(x2 =4.4,OR =2.307,P =0.035)、周围血管疾病(x2 =17.4,OR=6.616,P=0.000)、心功能[纽约心脏病协会(NYHA分级)]≥Ⅲ级(x2=10.5,OR=3.491,P=0.001)、射血分数≤40％(x2=16.9,OR =5.230,P =0.000)、急诊手术(x2=11.9,OR=5.127,P=0.001)是围手术期死亡的危险因素.对患者进行0 ～ 149个月的随访,平均随访时间(74±44)个月,失访107例,109例患者在随访期内死亡.术后1、3、5、8、10年的累积生存率分别为97.2％、95.5％、94.3％、93.6％、92.1％.单因素分析结果表明,年龄、高血压、肾功能不全、周围血管疾病、既往心肌梗死、心功能(NYHA分级)≥Ⅲ级、射血分数≤40％、急诊手术是影响患者远期生存率的危险因素(x2=8.150～88.241,P＜0.05).进一步Cox回归分析结果表明:年龄(＞65岁)(x2=12.1,RR=2.295,P=0.000)、肾功能不全(x2 =12.3,RR =3.160,P =0.000)、周围血管疾病(x2=42.5,RR=5.626,P=0.000)、心功能(NYHA分级)≥Ⅲ级(x2=9.1,RR=1.994,P=0.002)、急诊手术(x2=5.5,RR=2.247,P=0.019)是影响患者远期预后的独立危险因素.结论非体外循环CABG可以获得良好的治疗效果及远期生存率.性别(女)、周围血管疾病、心功能(NYHA分级)≥Ⅲ级、射血分数≤40％及急诊手术是围手术期死亡的危险因素.年龄(＞ 65岁)、肾功能不全、周围血管疾病、心功能(NYHA分级)≥Ⅲ级及急诊手术是影响术后生存率的独立危险因素. 目的探討非體外循環冠狀動脈徬路移植術(CABG)治療冠心病的預後及影響預後的相關危險因素.方法迴顧性分析2001年1月至2012年12月在北京大學人民醫院接受非體外循環CABG的患者共2 831例.其中男性2 099例,女性732例,平均年齡(63±9)歲.採用二元Logistic迴歸分析篩選齣影響圍手術期死亡的危險因素.對患者進行長期隨訪,使用Kaplan-Meier法繪製生存麯線,採用單因素Log-rank檢驗和Cox迴歸模型得齣影響長期預後的危險因素.結果 2 831例患者接受非體外循環CABG,院內死亡45例,術後順利齣院2 786例.二元Logistic迴歸分析錶明,性彆(女)(x2 =4.4,OR =2.307,P =0.035)、週圍血管疾病(x2 =17.4,OR=6.616,P=0.000)、心功能[紐約心髒病協會(NYHA分級)]≥Ⅲ級(x2=10.5,OR=3.491,P=0.001)、射血分數≤40％(x2=16.9,OR =5.230,P =0.000)、急診手術(x2=11.9,OR=5.127,P=0.001)是圍手術期死亡的危險因素.對患者進行0 ～ 149箇月的隨訪,平均隨訪時間(74±44)箇月,失訪107例,109例患者在隨訪期內死亡.術後1、3、5、8、10年的纍積生存率分彆為97.2％、95.5％、94.3％、93.6％、92.1％.單因素分析結果錶明,年齡、高血壓、腎功能不全、週圍血管疾病、既往心肌梗死、心功能(NYHA分級)≥Ⅲ級、射血分數≤40％、急診手術是影響患者遠期生存率的危險因素(x2=8.150～88.241,P＜0.05).進一步Cox迴歸分析結果錶明:年齡(＞65歲)(x2=12.1,RR=2.295,P=0.000)、腎功能不全(x2 =12.3,RR =3.160,P =0.000)、週圍血管疾病(x2=42.5,RR=5.626,P=0.000)、心功能(NYHA分級)≥Ⅲ級(x2=9.1,RR=1.994,P=0.002)、急診手術(x2=5.5,RR=2.247,P=0.019)是影響患者遠期預後的獨立危險因素.結論非體外循環CABG可以穫得良好的治療效果及遠期生存率.性彆(女)、週圍血管疾病、心功能(NYHA分級)≥Ⅲ級、射血分數≤40％及急診手術是圍手術期死亡的危險因素.年齡(＞ 65歲)、腎功能不全、週圍血管疾病、心功能(NYHA分級)≥Ⅲ級及急診手術是影響術後生存率的獨立危險因素.
목적 탐토비체외순배관상동맥방로이식술(CABG)치료관심병적예후급영향예후적상관위험인소.방법 회고성분석2001년1월지2012년12월재북경대학인민의원접수비체외순배CABG적환자공2 831례.기중남성2 099례,녀성732례,평균년령(63±9)세.채용이원Logistic회귀분석사선출영향위수술기사망적위험인소.대환자진행장기수방,사용Kaplan-Meier법회제생존곡선,채용단인소Log-rank검험화Cox회귀모형득출영향장기예후적위험인소.결과 2 831례환자접수비체외순배CABG,원내사망45례,술후순리출원2 786례.이원Logistic회귀분석표명,성별(녀)(x2 =4.4,OR =2.307,P =0.035)、주위혈관질병(x2 =17.4,OR=6.616,P=0.000)、심공능[뉴약심장병협회(NYHA분급)]≥Ⅲ급(x2=10.5,OR=3.491,P=0.001)、사혈분수≤40％(x2=16.9,OR =5.230,P =0.000)、급진수술(x2=11.9,OR=5.127,P=0.001)시위수술기사망적위험인소.대환자진행0 ～ 149개월적수방,평균수방시간(74±44)개월,실방107례,109례환자재수방기내사망.술후1、3、5、8、10년적루적생존솔분별위97.2％、95.5％、94.3％、93.6％、92.1％.단인소분석결과표명,년령、고혈압、신공능불전、주위혈관질병、기왕심기경사、심공능(NYHA분급)≥Ⅲ급、사혈분수≤40％、급진수술시영향환자원기생존솔적위험인소(x2=8.150～88.241,P＜0.05).진일보Cox회귀분석결과표명:년령(＞65세)(x2=12.1,RR=2.295,P=0.000)、신공능불전(x2 =12.3,RR =3.160,P =0.000)、주위혈관질병(x2=42.5,RR=5.626,P=0.000)、심공능(NYHA분급)≥Ⅲ급(x2=9.1,RR=1.994,P=0.002)、급진수술(x2=5.5,RR=2.247,P=0.019)시영향환자원기예후적독립위험인소.결론 비체외순배CABG가이획득량호적치료효과급원기생존솔.성별(녀)、주위혈관질병、심공능(NYHA분급)≥Ⅲ급、사혈분수≤40％급급진수술시위수술기사망적위험인소.년령(＞ 65세)、신공능불전、주위혈관질병、심공능(NYHA분급)≥Ⅲ급급급진수술시영향술후생존솔적독립위험인소.
Objective To describe the long-term survival of off-pump coronary artery bypass grafting (CABG) and to analysis the risk factors of operative mortality and long-term survival.Methods From January 2001 to December 2012,2 831 patients undergoing off-pump CABG in Peking University People's Hospital,2 099 cases (74.1％) of them were male,the average age was (63 ±9) years.The perioperative data was retrospectively collected.Binary Logistic regression was used to find the risk factors which affect the operative mortality.Follow-up evaluation was completed regularly.Kaplan-Meier survival curve,Log-rank test and Cox regression model were used to find out factors which affect the long-term result.Results Totally 2 831 patients underwent isolating off-pump CABG,in whom 45 patients died perioperative,2 786 patients discharged successfully.Binary Logistic regression showed that sex (female) (x2 =4.4,OR =2.307,P =0.035),peripheral vascular disease (x2 =17.4,OR =6.616,P =0.000),New York Heart Association (NYHA) class grade ≥ 3 (x2 =10.5,OR =3.491,P =0.001),ejection fraction ≤40％ (x2 =16.9,OR =5.230,P =0.000),emergency surgery (x2 =11.9,OR =5.127,P =0.001) are risk factors of operative mortality.The follow-up time was (74 ± 44) months.Totally 107 patients were lost from follow-up,109 patients died in follow-up.The survival rate at 1,3,5,8 and 10 years was 97.2％,95.5％,94.3％,93.6％,92.1％,respectively.Univariate analysis showed that age (＞ 65 years),hypertension,renal insufficiency,peripheral vascular disease,history of myocardial infarction,NYHA class grade ≥ 3 and emergency surgery were risk factors of the long-term survival (x2 =8.150 to 88.241,P ＜ 0.05).Cox regression analysis showed that age (＞ 65 years) (x2 =12.1,RR =2.295,P =0.000),renal insufficiency (x2 =12.3,RR =3.160,P =0.000),peripheral vascular disease (x2=42.5,RR=5.626,P=0.000),NYHA class grade≥3 (x2 =9.1,RR=1.994,P=0.002) and emergency surgery (x2 =5.5,RR =2.247,P =0.019) were independent risk factors that affect the longterm survival.Conclusions Sex (female),peripheral vascular disease,NYHA class grade ≥ 3,ejection fraction ≤ 40％,emergency surgery are risk factors of operative mortality.Age (＞ 65 years),renal insufficiency,peripheral vascular disease,NYHA class grade ≥ 3 and emergency surgery are independent risk factors that affect the long-term survival.Off-pump CABG has favorable perioperative and long-term outcome,and it definitely is a very safe and effective technique for coronary artery revascularization.