回顾分析1290例OPCAB手术EuroSCORE高预测风险与低手术死亡率的关系

山东大学学报(医学版) ›› 2011, Vol. 49 ›› Issue (7): 109-.

回顾分析1290例OPCAB手术EuroSCORE高预测风险与低手术死亡率的关系

王春，谷天祥，于洋，宋来春，张玉海，房勤

中国医科大学附属第一医院心脏外科，沈阳 110001

收稿日期:2011-02-25 出版日期:2011-07-10 发布日期:2011-07-10
通讯作者: 谷天祥，教授，博士研究生导师，主要从事心血管疾病外科治疗的基础与临床研究。 E-mail: cmugtx@sina.com
作者简介:王春(1979- )，博士，讲师，主要从事成人心血管疾病的外科治疗。
基金资助:
辽宁省教育厅基金资助项目(2004C050); 辽宁省科学技术计划资助项目(2006401013-2)。

Retrospective analysis of the relationship between high risk predicted by EuroSCORE and low operative mortality in 1290 cases of OPCAB surgery

WANG Chun, GU Tian-xiang, YU Yang, SONG Lai-chun, ZHANG Yu-hai, FANG Qin

The Department of Cardiac Surgery, the First Hospital of China Medical University, Shenyang 110001, China

Received:2011-02-25 Online:2011-07-10 Published:2011-07-10

摘要/Abstract

摘要：

目的回顾性分析1290例不停跳冠状动脉旁路移植术(OPCAB)预测死亡风险和实际手术死亡率的变化趋势，评价OPCAB对高危冠心病患者的治疗价值。方法 1290例中男762例，女528例。21～88岁，平均（63.2±9.1）岁。病例分为1998～2003年和2004～2009年两组。1998年1月至2003年12月完成OPCAB手术456例，男302例，女154例，平均年龄（58.1±6.9）岁。2004年1月至2009年12月完成OPCAB手术834例，男492例，女342例，平均年龄（64.3±8.5）岁。统计两组病例的手术死亡率、远端吻合口数目、欧洲心脏手术危险评估系统（EuroSCORE）分值的平均分、并发症率（包括围术期心梗、脑卒中、新发房颤、急性肾功能衰竭、呼吸功能不全等）、ICU时间、带气管插管时间，进行组间比较。结果全组病例远端吻合口人均（3.28±0.81）个， ICU时间（68.8±5.14）h，带气管插管时间（16.3±4.5）h，并发症率11.3%，手术死亡率4.42%，EuroSCORE平均值（4.68±2.57）。两组在手术死亡率、远端吻合口数目、EuroSCORE平均值、并发症率、ICU时间、带气管插管时间等方面比较，有统计学差异(P<0.05)。EuroSCORE平均值从1998年的1.7上升到2009年的7.2，手术死亡率由8.6%下降至3.13%。结论 EuroSCORE在预测OPCAB的死亡风险中具有重要作用。预测死亡风险显著升高而手术死亡率明显下降，与OPCAB手术适应证不断扩大、技术的完善和发展、严密的围术期监护和治疗有着密切关系。

关键词: 冠心病；欧洲心脏手术危险评估系统；冠状动脉旁路移植术

Abstract:

Objective To investigate the predicted risk of death and actual mortality in 1290 cases of off-pump coronary artery bypass grafting (OPCAB) and the clinical value of OPCAB in high-risk patients with coronary heart disease. Methods In 1290 cases, there were 762 males and 528 females aged from 21 to 88 years, with an average at 63.2±9.1 years. All cases were divided into 1998-2003 or 2004-2009 groups. From January 1998 to December 2003, there were 456 OPCAB surgeries, including 302 males and 154 females (mean age 58.1±6.9 years). From January 2004 to December 2009, there were 834 OPCAB surgeries, including 492 males and 342 females (mean age 64.3±8.5 years). The mortality, number of distal anastomosis, the average EuroSCORE, the complication rate (including perioperative myocardial infarction, stroke, new atrial fibrillation, acute renal failure, and respiratory insufficiency), ICU stay and tracheal intubation time were compared between the two groups. Results The average distal anastomosis was 3.28±0.81. The complication rate was 11.3% and operative mortality was 4.42%. ICU time, tracheal intubationtime and average EuroSCORE were 68.8±5.14 hours, 16.3±4.5 hours and 4.68±2.57, respectively. Between the two groups, the operative mortality, number of distal anastomosis, average EuroSCORE, the complications rate, ICU time and tracheal intubation time were significantly different. Mean EuroSCORE increased from 1.7 in 1998 to 7.2 in 2009, but mortality decreased from 8.6% to 3.13%. Conclusions The EuroSCORE plays an important role in predicting the risk of death in OPCAB. Contrary to the increased predictive risk of death, the actual OPCAB operative mortality significantly decreased. This phenomenon should be attributed to the expanded indications of surgery, technology development and comprehensive perioperative care and treatment.

Key words: coronary heart disease; European System for Cardiac Operative Risk Evaluation; Off-Pump Coronary Artery Bypass Grafting

中图分类号:

R654.2

王春，谷天祥，于洋，宋来春，张玉海，房勤 . 回顾分析1290例OPCAB手术EuroSCORE高预测风险与低手术死亡率的关系[J]. 山东大学学报(医学版), 2011, 49(7): 109-.

WANG Chun, GU Tianxiang, YU Yang, SONG Lai-chun, ZHANG Yu-hai, FANG Qin. Retrospective analysis of the relationship between high risk predicted by EuroSCORE and low operative mortality in 1290 cases of OPCAB surgery[J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2011, 49(7): 109-.

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