术前戒烟时间对择期冠脉搭桥患者术后低氧血症发生率的影响

发布时间：2018-06-25 05:38

本文选题：冠脉搭桥 + 低氧血症　；参考：《河南科技大学》2015年硕士论文

【摘要】：目的:研究分析冠脉搭桥患者术前戒烟时间长短对术后低氧血症发生率的影响,为医护人员的术前健康教育提供理论依据。方法:1.以2012年9月至2014年9月在我院心血管外科行冠脉搭桥术且术前有吸烟史的患者为研究对象,入院时按照术前戒烟时间分为戒烟0天、戒烟1~30天、戒烟31~60天、戒烟61~90天、戒烟90天五组。收集五组患者资料,包括一般资料:年龄、体重、文化程度等;吸烟史:吸烟年支数、术前戒烟时间;临床资料:左室射血分数(EF值)、肺功能(肺通气储量)、是否合并高血压、是否合并糖尿病、术中搭桥支数、手术时间。五组患者均采用德国GEMpremier3000血气机进行动脉血氧分压的测量分析。由重症监护室经过专业培训的护士进行动脉血的采集监测,手术前半小时测氧分压1次,手术当天入重症监护室后12小时内每1小时测氧分压1次,12小时后每4小时测氧分压1次。以动脉血氧分压[102-(0.33×年龄)]mm Hg为标准,术后氧分压出现1次小于[102-(0.33×年龄)]mm Hg即为出现低氧血症,记录五组患者术后7天内低氧血症发生情况。2.使用SPSS 16.0软件进行统计学分析,符合正态分布的计量资料以`c±s表示,组间比较若方差齐采用两个独立样本t检验,若方差不齐选用t'检验。计数资料采用例数(百分比)表示,组间比较采用χ2检验。因为单因素分析没有考虑到因素与因素之间的相互影响,故我们选取logistic回归模型进行独立危险因素分析,同时在此基础上为了减少统计分析中重要因素的缺失,我们将单因素分析中P0.1的所有危险因素带入了建立的多因素logistic回归模型中,应用stepwise法以α=0.05,P0.05认为有统计学意义,逐步筛选出独立的危险因素。同时,对五组患者术后低氧血症发生率进行组与组χ2检验,采用蒙特卡洛法进行χ2界值的调整,减少犯Ⅰ类错误的概率,分析五组患者术后低氧血症发生率是否有差别,以P0.05为差异有统计学意义。结果:1.年龄(OR=1.036;95%CL,0.911-0.991;P=0.004)、体重(OR=2.135;95%CL,1.034-1.067;P=0.017)、吸烟年支数(OR=0.277;95%CL,0.161-0.467;P0.001)、戒烟时间(OR=3.510;95%CL,1.971-6.271;P0.001)是术后发生低氧血症的独立危险因素。2.五组患者术后低氧血症发生率分别为:59.26%、55.56%、27.58%、22.73%、15.62%。戒烟0天组低氧血症发生率高于戒烟1~30天组(χ2=4.984,P0.05)、戒烟31~60天组(χ2=5.842,P0.05)、61~90天组(χ2=9.108,P0.05)、90天组(χ2=10.42,P0.05),差异有统计学意义;戒烟1~30天组低氧血症发生率高于31~60天组(χ2=5.728,P0.05)、61~90天组(χ2=6.606,P0.05)、90天组(χ2=12.162,P0.05),差异有统计学意义;戒烟31~60天组低氧血症发生率与61~90天组(χ2=0.156,P0.05)和戒烟90天组(χ2=1.298,P0.05)差异无统计学意义。戒烟61~90天组低氧血症发生率和戒烟90天组(χ2=0.436,P0.05)差异无统计学意义。结论:1.年龄、体重、戒烟时间、吸烟年支数是冠脉搭桥患者术后低氧血症的独立危险因素。2.CABG患者术前戒烟时间越长,术后低氧血症发生率越低,建议CABG患者术前戒烟时间在病情允许的情况尽可能的增长。3.建议CABG患者术前应戒烟,短时间的戒烟可降低术后低氧血症发生率。戒烟1~2月与3月CABG患者术后低氧血症发生率无差别。4.冠脉搭桥术前不同戒烟时间段对术后低氧血症发生率影响有差别,对术前吸烟的冠脉搭桥患者进行及时有效的戒烟干预有利于降低术后低氧血症发生率。
[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.
【学位授予单位】：河南科技大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R654.2

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