术后功能障碍/衰竭的风险指数:严重依赖脉压高血压
Solomon Aronson1, Manuel L Fontes, Yinghui Miao
1Duke University Medical Center, Durham, NC, USA. diane@iref.org
Circulation
|February 7, 2007
概括
冠状动脉旁路移植手术后的急性损伤是常见的和昂贵的. 手术前脉压是脏并发症的新发现的独立风险因素,除了年龄和心脏病之外.
科学领域:
- 心血管外科心血管外科
- 腎臟病學 (nephrology) 是一種醫學專業.
- 关键护理医学 关键护理医学
背景情况:
- 冠状动脉旁路移植手术 (CABG) 后的急性损伤与高死亡率和医疗费用增加有关.
- 识别可修改和不可修改的风险因素对于改善患者的治疗结果至关重要.
研究的目的:
- 确定CABG后术后综合症 (功能障碍和/或衰竭) 的独立风险因素.
- 开发和验证一个风险指数来预测这些事件.
主要方法:
- 一项前性,描述性研究,涉及4801名接受心肺绕道心肺动脉血管造影术的患者.
- 在2381名患者的队列中分析预测变量,并在2420名患者的单独队列中进行验证.
- 统计分析以确定风险因素和术后事件之间的关联.
主要成果:
- 术后综合症的总发病率为4.8% (231名患者).
- 独立的危险因素包括晚年 (>75岁),充血性心力衰竭,先前心肌梗塞,先前存在的脏病,手术内使用异型药物,心动脉内气球插入,长期心肺绕道 (>2小时),以及手术前脉压升高.
- 脉压每增加20mmHg至40mmHg以上,就会增加1.49倍的脏复合病的几率 (P=0.001).
- 患有脉压高血压 (>80 mm Hg) 的患者患脏相关死亡的风险增加了三倍.
结论:
- 已知风险因素显著预测CABG后的并发症.
- 术前脉压是术后综合症的独立和显著预测指标,突出其在风险评估中的重要性.
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