摘要目的 分析非体外冠状动脉旁路移植术(OPCAB)后患者住重症监护病房(ICU)时间延长的危险因素.方法 将2008年1月至2010年5月间247例施行非体外冠状动脉旁路移植手术患者,根据术后住ICU时间是否延长(住ICU时间延长定义为≥5 d)分为两组,Ⅰ组34例,术后住ICU时间延长; Ⅱ组213例,术后住ICU时间未延长.先对各变量进行单因素分析,然后将单因素分析有意义的变量纳入Logistic回归进行多因素分析. 结果术后住ICU时间延长34例. 单因素分析结果显示:Ⅰ组中年龄、手术时间、糖尿病及心律失常发生率均大于或长于Ⅱ组,心功能、左心室射血分数(LVEF)均低于或差于Ⅱ组(P＜0.05).Logistic多因素分析结果显示:术前年龄≥70岁(OR=17.736)、LVEF≤0.50(OR=5.850)、糖尿病(OR=4.081)为术后住ICU时间延长的独立危险因素.结论 临床上可根据术前年龄、LVEF、糖尿病预测术后住ICU时间是否延长.对具有上述危险因素的患者采取相应的预防措施,可降低术后并发症发生率和病死率.

abstractsObjective To analyze risk factors for prolonged stay in intensive care unit after off-pump coronary artery bypass grafting. Methods Between January 2008 and May 2010, 247 consecutive patients undergone off-pump coronary artery bypass grafting were divided into two groups based on if their length of ICU stay more than 5 days (prolonged stay in ICU was defined as 5 days or more). GroupⅠ:Thirty-four patients required prolonged ICU stay. Group Ⅱ: 213 patients did not require prolonged ICU stay. Univariate and multivariate analysis (logistic regression) were used to identify the risk factors.Results Thirty-four patients required prolonged ICU stay. Univariate risk factors showed age, the operation time, incidence of diabetes millitus and arrhythmia of groupⅠwere higher or longer than those of groupⅡ. The heart function, left ventricular ejection fraction (LVEF) in groupⅠwere worse than those in groupⅡ(P<0.05). Logistic regression identified that preoperative age≥70(OR=17.736), LVEF≤0.50(OR=5.850), diabetes melllitus(OR=4.081) were final risk factors for prolonged ICU stay. Conclusions Prolonged ICU stay after off-pump CABG can be predicted through age, LVEF, diabetes melllitus. The patients with these risk factors need corresponding preoperative care and postoperative care to reduce mortality, morbidity and avoid prolonged ICU stay after off-pump CABG.