本文關(guān)鍵詞： 女性的性別因素 心臟搭橋 院內(nèi)死亡 高齡因素 流行病學(xué) 循證醫(yī)學(xué)　出處：《首都醫(yī)科大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：目的目前國際上關(guān)于性別因素與搭橋術(shù)后院內(nèi)死亡率的研究多數(shù)研究對象都為歐美人群,沒有針對中國患者的大樣本觀察性研究。同時仍然缺乏強有力的循證醫(yī)學(xué)證據(jù)證明女性自身的性別因素與其較高的院內(nèi)死亡率獨立相關(guān)。為了填補以上研究空白,我們設(shè)計了本次研究,詣在全面系統(tǒng)地探討女性自身的性別因素能否成為行心臟搭橋患者,尤其是在北京地區(qū)行搭橋手術(shù)的中國患者,院內(nèi)死亡的獨立風(fēng)險因素。方法在流行病學(xué)部分,我們連續(xù)入選從2007年1月1日到2012年12月31日所有在北京地區(qū)單獨行心臟搭橋的中國患者,并同時應(yīng)用多元邏輯回歸以及傾向性評分探討中國女性患者的性別因素是否與其院內(nèi)死亡獨立相關(guān)。在循證醫(yī)學(xué)部分,我們著眼于全球,為患者的性別因素是否影響其短期預(yù)后提供循證醫(yī)學(xué)證據(jù)。結(jié)果在流行病學(xué)部分,本次研究涉及到的所有連續(xù)5年在北京單獨行心臟搭橋的中國患者共計35173人,其中男性患者26926人,女性患者8247人。女性患者的年齡顯著高于男性患者(64.9±7.8歲vs.61.0±9.4歲,P0.0001)。相較于男性患者,女性患者大多入院伴隨高血壓病史(70.56%vs57.76%,P0.0001),糖尿病病史(36.15%vs 27.61%,P0.0001),不穩(wěn)定性心絞痛(49.05%vs 42.30%,P0.0001),反流性食管炎(0.78%vs 0.51%,P=0.0056)。而男性患者更多入院伴隨術(shù)前心肌梗死病史(21.31%vs 12.82%,P0.0001),頸動脈狹窄病史(1.21%vs 0.91%,P=0.0257)以及大隱靜脈曲張(0.17%vs 0.07%,P=0.0425)。我們發(fā)現(xiàn),盡管女性患者的院內(nèi)死亡率高于男性患者(1.62%vs 1.30%,P=0.0248),但是女性自身的性別因素并不是導(dǎo)致患者院內(nèi)死亡率增加的獨立風(fēng)險因素(OR:0.933,95%CI 0.759-1.147),而患者的年齡因素是導(dǎo)致患者院內(nèi)死亡率增加的獨立風(fēng)險因素(OR:1.071,95%CI 1.058-1.083),即患者年齡越大,行搭橋手術(shù)院內(nèi)死亡的風(fēng)險就越高。經(jīng)過傾向性評分匹配后,女性自身的性別因素依然不是導(dǎo)致患者院內(nèi)死亡率增加的獨立風(fēng)險因素(OR:1.051,95%CI 0.698-1.583),而患者的年齡因素仍然是導(dǎo)致患者院內(nèi)死亡率增加的獨立風(fēng)險因素(OR:1.079,95%CI 1.049-1.111)。在循證醫(yī)學(xué)部分,我們一共納入文獻21篇,包含患者201,465人。研究發(fā)現(xiàn)女性患者搭橋術(shù)后院內(nèi)死亡率比男性患者高81%(OR:1.81 95%CI:1.57-2.08,Z=8.32,P0.001),但是具有顯著的異質(zhì)性(I2=72.4%,P0.001)。Meta回歸顯示女性患者的年齡因素是異質(zhì)性的重要來源。因此我們納入65歲以上的患者,亞組分析發(fā)現(xiàn)高齡患者女性患者搭橋術(shù)后院內(nèi)死亡率與男性患者的差異不具有統(tǒng)計學(xué)意義(OR:1.26 95%CI:0.98-1.65,Z=1.84,P=0.066)且不具有異質(zhì)性(I2=0.0%,p=0.96)。結(jié)論無論是在北京地區(qū)行搭橋手術(shù)的中國患者,還是著眼于全球搭橋患者,女性自身的性別因素均不是影響其預(yù)后的獨立風(fēng)險因素,而她們的高齡因素與其術(shù)后較高的院內(nèi)死亡率獨立相關(guān)。
[Abstract]:Objective at present, most of the international studies on gender factors and hospital mortality after bypass grafting are conducted in Europe and the United States. There is no large sample of observational studies of Chinese patients. There is still no strong evidence-based medical evidence that women's own gender factors are independently associated with their higher hospital mortality. . We designed this study to explore comprehensively and systematically whether women's own gender factors can be used as cardiac bypass patients, especially in China who underwent bypass surgery in the Beijing area. Methods in the epidemiology section, we continued to select all Chinese patients who underwent cardiac bypass grafting in the Beijing area from January 1st 2007 to December 31st 2012. At the same time, we used multiple logic regression and tendentiousness score to explore whether the gender factors of Chinese female patients were independent of their in-hospital mortality. In the Evidence-based Medicine section, we focused on the whole world. Provide evidence-based medical evidence for whether gender factors affect short-term prognosis of patients. The results are in the epidemiology section. The study involved a total of 35173 Chinese patients, including 26926 men, who underwent cardiac bypass surgery in Beijing for five consecutive years. The age of female patients was significantly higher than that of male patients (64.9 鹵7.8 years old, vs.61.0 鹵9.4 years old, P 0.0001). Most female patients were admitted to hospital with a history of hypertension (70.56 vs 57.76) and diabetes mellitus (36.15 vs 27.61%). P0.0001, unstable angina pectoris 49.05 vs 42.30P0.0001, reflux esophagitis 0.78 vs 0.51%. The male patients were more likely to be admitted with preoperative myocardial infarction history (21.31 vs 12.82 P 0.0001). The history of carotid artery stenosis was 1.21 vs 0.91 and the ratio of varicose vein 0.17 to 0.07 was 0.04257.We found. Although the nosocomial mortality rate of female patients was higher than that of male patients 1.62% vs 1.30% (P < 0.0248). But women's own sex factor is not the independent risk factor that leads to the increase of hospital mortality rate of patients, or: 0.933 95 CI 0.759-1.147). The age factor of the patient was the independent risk factor for the increase in hospital mortality, OR: 1.071 / 95, CI 1.058-1.083, that is, the older the patient was. The higher the risk of death in the hospital after bypass surgery, the higher the risk of death. After the bias score was matched, women's own gender factors were still not independent risk factors for increased in-hospital mortality, OR: 1.051. 95 CI 0.698-1.583, and the patient's age is still the independent risk factor for increased hospital mortality, OR: 1.079. 95 CI 1.049-1.111. In the evidence-based medicine section, we included a total of 21 articles, including 201 patients. 465 people. The study found that the hospital mortality rate of female patients after bypass grafting was 81% higher than that of male patients. P 0.001, but with significant heterogeneity of 72.4%. The age factor of female patients was an important source of heterogeneity, so we included patients over 65 years of age. Subgroup analysis showed that there was no significant difference between the mortality rate of female patients and male patients after bypass grafting. There was no significant difference between the mortality rate of female patients and that of male patients (OR: 1.26 95 CI: 0.98-1.65). Conclusion Chinese patients undergoing bypass surgery in Beijing area have no heterogeneity (P = 0.96) and have no heterogeneity (P < 0.05). Conclusion: there is no significant difference between the two groups and there is no significant difference between the two groups. Conclusion No matter in Beijing area, there are many Chinese patients undergoing bypass surgery. However, women's gender factors were not independent risk factors for their prognosis, and their old age factors were independently related to their higher hospital mortality after surgery.
【學(xué)位授予單位】：首都醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R654.2

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