發(fā)布時(shí)間：2018-12-31 17:56

【摘要】：目的本研究旨在分析影響心包剝脫術(shù)短期及長(zhǎng)期轉(zhuǎn)歸的圍術(shù)期危險(xiǎn)因素。方法回顧自2009年3月至2014年7月在阜外心血管病醫(yī)院進(jìn)行心包剝脫術(shù)的95個(gè)病例,收集患者的術(shù)前、術(shù)中及術(shù)后數(shù)據(jù)。通過(guò)電話(huà)隨訪患者術(shù)后長(zhǎng)期轉(zhuǎn)歸。利用t檢驗(yàn)、卡方檢驗(yàn)及Kaplan-Meier等方法檢驗(yàn)危險(xiǎn)因素與轉(zhuǎn)歸是否存在聯(lián)系。結(jié)果入組95例,隨訪83例(87.4%),平均年齡42.26±14.49歲,男性68人(71.5%)。術(shù)后30天內(nèi)21名患者出現(xiàn)并發(fā)癥(22.1%),3名患者死亡(3.2%)。隨訪中1名患者病死。統(tǒng)計(jì)學(xué)分析顯示影響心包剝脫術(shù)術(shù)后短期并發(fā)癥的危險(xiǎn)因素包括：心包炎病因(P=0.035)、伴隨其它心臟手術(shù)(P=0.022)、術(shù)前NYHA分級(jí)(P=0.026)、體外循環(huán)(P=0.001)、術(shù)終高糖血癥(P=0.016)。預(yù)測(cè)術(shù)后短期并發(fā)癥的最佳術(shù)終血糖截?cái)嘀凳?.36mmol/L(敏感度50%,特異度78.7%)。Kaplan-Meier法顯示影響長(zhǎng)期轉(zhuǎn)歸的危險(xiǎn)因素包括心包炎病因(P=0.024)、心功能分級(jí)(P=0.013)、ASA分級(jí)(P=0.005)、術(shù)后并發(fā)癥(P=0.013)、術(shù)后低心排綜合征(P=0.014)及術(shù)終血糖7.36mmool/L(P=0.012)。多因素分析顯示術(shù)前心功能分級(jí)可作為預(yù)測(cè)術(shù)后長(zhǎng)期轉(zhuǎn)歸的的獨(dú)立危險(xiǎn)因素(HR 3.985,95%CI 1.852-8.573,P=0.000)。結(jié)論心臟手術(shù)后心包炎、術(shù)前NYHA Ⅳ級(jí)、術(shù)終高糖血癥(7.36mmol/L)影響患者術(shù)后短期及長(zhǎng)期轉(zhuǎn)歸。此外,伴隨其它心臟手術(shù)及體外循環(huán)與術(shù)后短期并發(fā)癥發(fā)生相關(guān)。ASA分級(jí)、術(shù)后并發(fā)癥及術(shù)后低心排綜合癥與長(zhǎng)期轉(zhuǎn)歸相關(guān)。本研究為心包剝脫術(shù)圍術(shù)期管理提供臨床依據(jù)。
[Abstract]:Objective to analyze the perioperative risk factors influencing the short-and long-term outcome of pericardiectomy. Methods from March 2009 to July 2014, 95 patients who underwent pericardiectomy in Fuwei Cardiovascular Hospital were reviewed and the data were collected before, during and after operation. Patients were followed up by telephone for a long time after operation. T test, chi-square test and Kaplan-Meier were used to test the relationship between risk factors and outcome. Results there were 95 cases in the group, 83 cases (87.4%) were followed up, the average age was 42.26 鹵14.49 years old, 68 cases (71.5%) were male. Complications occurred in 21 patients (22.1%) and death in 3 patients (3.2%) 30 days after operation. One patient died during follow-up. Statistical analysis showed that the risk factors for short-term complications after pericardiectomy included pericarditis (P0. 035), other cardiac surgery (P0. 022), preoperative NYHA grade (P0. 026), cardiopulmonary bypass (P0. 001). Postoperative hyperglycemia (P0. 016). The best end blood glucose cut-off value for predicting short-term postoperative complications was 7.36mmol/L (sensitivity 50%, specificity 78.7%). The risk factors affecting long-term outcome were revealed by Kaplan-Meier method, including pericarditis (P0. 024). Cardiac function grading (P0. 013), ASA), postoperative complications (P0. 013), postoperative low cardiac output syndrome (P0. 014) and postoperative blood glucose 7.36mmool/L (P0. 012). Multivariate analysis showed that preoperative cardiac function grading could be used as an independent risk factor to predict long-term postoperative outcome (HR 3.98595 CI 1.852-8.573P0. 000). Conclusion pericarditis after cardiac surgery, preoperative NYHA grade 鈪，

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