术前贫血 - - 在隔离冠状动脉旁路移植术后,是否会影响术后的结果?
Sufina Shales1, Patralekha Das1, Paramita Auddya Ghorai1
1Department of Cardiac Surgery, Narayana Health, NH Rabindranath Tagore International Institute of Cardiac Sciences, 124, EM Bypass, Mukundapur, Kolkata, 700099 India.
Indian journal of thoracic and cardiovascular surgery
|June 26, 2024
概括
手术前的贫血,定义为血红素<33%,是常见的在接受非抽动冠状动脉旁路移植 (OPCAB) 的患者. 虽然它不是30天死亡率的独立预测因素,但它显著增加了输血和功能衰竭的风险.
科学领域:
- 心血管外科心血管外科
- 麻醉学 麻醉学
- 关键护理医学 关键护理医学
背景情况:
- 术前贫血是预定进行冠状动脉旁路移植的患者经常出现的并发症.
- 关于手术前贫血影响的研究结果存在矛盾,部分原因是贫血的定义不同.
研究的目的:
- 评估手术前贫血对非抽动冠状动脉旁路移植 (OPCAB) 后患者结果的独立影响.
主要方法:
- 对4957名接受隔离OPCAB手术的患者 (2015-2020年) 的回顾性分析.
- 中度至重度贫血的定义:根据世卫组织的指导方针,血红蛋白<11g/dl (血红素克里特<33%).
- 多变量逻辑回归用于评估血红素<33%对30天死亡率和其他不良结果的独立影响.
主要成果:
- 12.8%的患者血红素值<33%.
- 血位<33%与更高的30天死亡率 (2%与0.9%相比),增加输血需求 (p<0.0001),功能衰竭 (p<0.0001),气管切除术 (p=0.012) 和再输管 (p=0.006) 相关.
- 多变量分析显示血红素<33%作为输血 (OR 1.80) 和功能衰竭 (OR 3.06) 的独立风险因素,但不是30天死亡率 (OR 1.47,p=0.26).
结论:
- 手术前贫血 (血红素值<33%) 是患者接受隔离,初级,选择性OPCAB的不良结果的重要危险因素.
- 它独立地预测了需要输血的需要和手术后功能衰竭的发生.
- 血红素<33%对30天死亡率的区分值是中度的 (AUC为0.63).
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