本文選題：冠脈搭橋 + 低氧血癥　； 參考：《河南科技大學(xué)》2015年碩士論文

【摘要】：目的:研究分析冠脈搭橋患者術(shù)前戒煙時(shí)間長(zhǎng)短對(duì)術(shù)后低氧血癥發(fā)生率的影響,為醫(yī)護(hù)人員的術(shù)前健康教育提供理論依據(jù)。方法:1.以2012年9月至2014年9月在我院心血管外科行冠脈搭橋術(shù)且術(shù)前有吸煙史的患者為研究對(duì)象,入院時(shí)按照術(shù)前戒煙時(shí)間分為戒煙0天、戒煙1~30天、戒煙31~60天、戒煙61~90天、戒煙90天五組。收集五組患者資料,包括一般資料:年齡、體重、文化程度等;吸煙史:吸煙年支數(shù)、術(shù)前戒煙時(shí)間;臨床資料:左室射血分?jǐn)?shù)(EF值)、肺功能(肺通氣儲(chǔ)量)、是否合并高血壓、是否合并糖尿病、術(shù)中搭橋支數(shù)、手術(shù)時(shí)間。五組患者均采用德國(guó)GEMpremier3000血?dú)鈾C(jī)進(jìn)行動(dòng)脈血氧分壓的測(cè)量分析。由重癥監(jiān)護(hù)室經(jīng)過(guò)專業(yè)培訓(xùn)的護(hù)士進(jìn)行動(dòng)脈血的采集監(jiān)測(cè),手術(shù)前半小時(shí)測(cè)氧分壓1次,手術(shù)當(dāng)天入重癥監(jiān)護(hù)室后12小時(shí)內(nèi)每1小時(shí)測(cè)氧分壓1次,12小時(shí)后每4小時(shí)測(cè)氧分壓1次。以動(dòng)脈血氧分壓[102-(0.33×年齡)]mm Hg為標(biāo)準(zhǔn),術(shù)后氧分壓出現(xiàn)1次小于[102-(0.33×年齡)]mm Hg即為出現(xiàn)低氧血癥,記錄五組患者術(shù)后7天內(nèi)低氧血癥發(fā)生情況。2.使用SPSS 16.0軟件進(jìn)行統(tǒng)計(jì)學(xué)分析,符合正態(tài)分布的計(jì)量資料以`c±s表示,組間比較若方差齊采用兩個(gè)獨(dú)立樣本t檢驗(yàn),若方差不齊選用t'檢驗(yàn)。計(jì)數(shù)資料采用例數(shù)(百分比)表示,組間比較采用χ2檢驗(yàn)。因?yàn)閱我蛩胤治鰶](méi)有考慮到因素與因素之間的相互影響,故我們選取logistic回歸模型進(jìn)行獨(dú)立危險(xiǎn)因素分析,同時(shí)在此基礎(chǔ)上為了減少統(tǒng)計(jì)分析中重要因素的缺失,我們將單因素分析中P0.1的所有危險(xiǎn)因素帶入了建立的多因素logistic回歸模型中,應(yīng)用stepwise法以α=0.05,P0.05認(rèn)為有統(tǒng)計(jì)學(xué)意義,逐步篩選出獨(dú)立的危險(xiǎn)因素。同時(shí),對(duì)五組患者術(shù)后低氧血癥發(fā)生率進(jìn)行組與組χ2檢驗(yàn),采用蒙特卡洛法進(jìn)行χ2界值的調(diào)整,減少犯Ⅰ類錯(cuò)誤的概率,分析五組患者術(shù)后低氧血癥發(fā)生率是否有差別,以P0.05為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:1.年齡(OR=1.036;95%CL,0.911-0.991;P=0.004)、體重(OR=2.135;95%CL,1.034-1.067;P=0.017)、吸煙年支數(shù)(OR=0.277;95%CL,0.161-0.467;P0.001)、戒煙時(shí)間(OR=3.510;95%CL,1.971-6.271;P0.001)是術(shù)后發(fā)生低氧血癥的獨(dú)立危險(xiǎn)因素。2.五組患者術(shù)后低氧血癥發(fā)生率分別為:59.26%、55.56%、27.58%、22.73%、15.62%。戒煙0天組低氧血癥發(fā)生率高于戒煙1~30天組(χ2=4.984,P0.05)、戒煙31~60天組(χ2=5.842,P0.05)、61~90天組(χ2=9.108,P0.05)、90天組(χ2=10.42,P0.05),差異有統(tǒng)計(jì)學(xué)意義;戒煙1~30天組低氧血癥發(fā)生率高于31~60天組(χ2=5.728,P0.05)、61~90天組(χ2=6.606,P0.05)、90天組(χ2=12.162,P0.05),差異有統(tǒng)計(jì)學(xué)意義;戒煙31~60天組低氧血癥發(fā)生率與61~90天組(χ2=0.156,P0.05)和戒煙90天組(χ2=1.298,P0.05)差異無(wú)統(tǒng)計(jì)學(xué)意義。戒煙61~90天組低氧血癥發(fā)生率和戒煙90天組(χ2=0.436,P0.05)差異無(wú)統(tǒng)計(jì)學(xué)意義。結(jié)論:1.年齡、體重、戒煙時(shí)間、吸煙年支數(shù)是冠脈搭橋患者術(shù)后低氧血癥的獨(dú)立危險(xiǎn)因素。2.CABG患者術(shù)前戒煙時(shí)間越長(zhǎng),術(shù)后低氧血癥發(fā)生率越低,建議CABG患者術(shù)前戒煙時(shí)間在病情允許的情況盡可能的增長(zhǎng)。3.建議CABG患者術(shù)前應(yīng)戒煙,短時(shí)間的戒煙可降低術(shù)后低氧血癥發(fā)生率。戒煙1~2月與3月CABG患者術(shù)后低氧血癥發(fā)生率無(wú)差別。4.冠脈搭橋術(shù)前不同戒煙時(shí)間段對(duì)術(shù)后低氧血癥發(fā)生率影響有差別,對(duì)術(shù)前吸煙的冠脈搭橋患者進(jìn)行及時(shí)有效的戒煙干預(yù)有利于降低術(shù)后低氧血癥發(fā)生率。
[Abstract]:Objective: To study and analyze the effect of the time of smoking cessation on the incidence of postoperative hypoxemia in patients with coronary artery bypass grafting, and to provide a theoretical basis for the health education of the medical and nursing staff. 1. the patients who underwent coronary artery bypass surgery in cardiovascular surgery in our hospital from September 2012 to September 2014 were the subjects of the history of smoking. The time before smoking cessation was divided into 0 days of smoking cessation, 1~30 days of smoking cessation, smoking cessation for 31~60 days, smoking cessation 61~90 days, smoking cessation for 90 days and five groups. Collecting five groups of patients' data including age, weight, cultural degree, smoking history, the time of smoking, the time of smoking cessation before operation, the clinical data: the left ventricular ejection fraction (EF value), lung function (lung ventilation reserve), and the combination of high blood The five groups of patients were analyzed by the German GEMpremier3000 blood gas machine for arterial oxygen partial pressure. The arterial blood was collected and monitored by the nurses trained in the intensive care unit. The oxygen partial pressure was measured 1 times before the operation, and the day after the operation was 12 small after the intensive care unit. The oxygen partial pressure was measured 1 times every 1 hours and 1 times every 4 hours after 12 hours. The oxygen partial pressure [102- (0.33 x age)]mm Hg was the standard, the oxygen partial pressure was less than [102- (0.33 x)]mm Hg, which appeared hypoxemia, and the occurrence of hypoxemia in five groups of patients within 7 days after operation was recorded by SPSS 16 software. The measurement data that conforms to the normal distribution is expressed in `c + s. If the variance is two independent sample t tests, if the variance is not homogeneous, the t'test is selected. The number of data uses the number of cases (percentage), and the group is compared with the x 2 test. Because the single factor analysis does not take into account the mutual influence between the factors and the factors, we choose the single factor analysis. In order to reduce the loss of important factors in statistical analysis, we take the logistic regression model for the analysis of independent risk factors. In order to reduce the lack of important factors in the statistical analysis, we bring all the risk factors of P0.1 into the established multi factor Logistic regression model in the single factor analysis, and apply the stepwise method with alpha =0.05 and P0.05 to think that there are statistical significance and gradually screening. There was an independent risk factor. At the same time, the incidence of postoperative hypoxemia in five groups of patients was set and chi chi 2 test, using the Monte Carlo method to adjust the value of chi chi 2, to reduce the probability of type I error, and to analyze the incidence of postoperative hypoxemia in the five groups, and the difference was statistically significant with the difference of P0.05. Results: 1. age (OR=1.036; 9). 5%CL, 0.911-0.991; P=0.004), body weight (OR=2.135; 95%CL, 1.034-1.067; P=0.017), smoking year support (OR=0.277; 95%CL, 0.161-0.467; P0.001). The time of smoking cessation was an independent risk factor for postoperative hypoxemia: the incidence of postoperative hypoxemia in five groups of patients: 59.26%, 55.56%, 27.58%, 22.73%, 15.6, respectively. The incidence of hypoxemia in 2%. smoking cessation group was higher than that in 1~30 days group (x 2=4.984, P0.05), 31~60 day group (x 2=5.842, P0.05), 61~90 days group (x 2=9.108, P0.05), 90 days group (chi 2=10.42, P0.05), the difference was statistically significant, and the incidence of hypoxemia was higher than that in the group (chi square, 90), 90 days Group (x 2=12.162, P0.05), the difference was statistically significant; the incidence of hypoxemia in 31~60 days group was no significant difference between 61~90 days group (x 2=0.156, P0.05) and 90 days of smoking cessation group (x 2=1.298, P0.05). There was no significant difference between the incidence of hypoxemia and the 90 day group (chi 2=0.436, P0.05) of smoking cessation group. Conclusion: 1. age, weight, caution. Smoking time, the number of years of smoking is an independent risk factor for postoperative hypoxemia in patients with coronary artery bypass grafting (.2.CABG), the longer the time of smoking cessation before operation, the lower the incidence of postoperative hypoxemia, it is suggested that the time of smoking cessation before operation in CABG patients is as much as possible.3. suggest that the patients of CABG should give up smoking before operation, and the short time to quit smoking can reduce the operation. The incidence of postoperatively hypoxemia. The incidence of postoperative hypoxemia in patients with smoking cessation 1~2 months and March CABG was not different from that of.4. before coronary bypass surgery. The incidence of postoperative hypoxemia was different.
【學(xué)位授予單位】：河南科技大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R654.2

【參考文獻(xiàn)】

相關(guān)期刊論文 前3條

1 張貞雄,謝立剛,劉進(jìn);冠脈搭橋術(shù)后低氧血癥發(fā)生率調(diào)查與原因分析[J];山東醫(yī)藥;2001年02期

2 馮書(shū)梅;;冠狀動(dòng)脈旁路移植術(shù)后并發(fā)低氧血癥病人的觀察及護(hù)理[J];護(hù)理研究(下旬版);2006年12期

3 汪萍;郭蘭;古良;吳桂蘭;;冠心病介入術(shù)后患者吸煙狀況調(diào)查[J];心血管康復(fù)醫(yī)學(xué)雜志;2013年01期

，

本文編號(hào)：2064827