Risk factors for postoperative hypoxemia in patients undergoing coronary artery bypass grafting: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

YU Jintian ¹ ,  ZHANG Aiqin ² , CHEN Junshan ¹

1. Department of Intensive Care Unit, Jinling Hospital Affiliated to Medical College of Nanjing University (Eastern Theater General Hospital), Nanjing, 210002, P.R.China;
2. The Outpatient Department, Jinling Hospital Affiliated to Medical College of Nanjing University (Eastern Theater General Hospital), Nanjing, 210002, P.R.China;

Corresponding author：

ZHANG Aiqin, Email: aq09z@126.com

Keywords：

Coronary artery bypass grafting; Postoperative hypoxemia; Risk factors; Meta-analysis

DOI：

10.7507/1672-2531.201812107

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objectives To systematically review the risk factors of postoperative hypoxemia in patients undergoing coronary artery bypass grafting.Methods PubMed, EBCO, The Cochrane Library, CNKI, VIP and WanFang Data databases were electronically searched to collect case-control studies and cohort studies on the risk factors of postoperative hypoxemia in patients undergoing coronary artery bypass grafting from inception to December 2018. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software.Results A total of 20 articles were included, including 3 926 patients. The results of meta-analysis showed that: age (OR=2.94, 95%CI 0.81 to 5.07, P=0.007), body mass index (OR=1.94, 95%CI 0.77 to 3.12, P=0.001), smoking (OR=2.72, 95%CI 1.68 to 4.42, P<0.000 1), diabetes history (OR=1.63, 95%CI 1.37 to 1.93, P<0.000 01), preoperative lung diseases (OR=4.11, 95%CI 1.64 to 10.28, P=0.003), complicated ventricular aneurysm (OR=1.57, 95%CI 1.12 to 2.21, P=0.01), left ventricular end-diastolic diameter (OR=1.28, 95%CI 0.12 to 2.44, P=0.03), aortic occlusion time (OR=13.25, 95%CI 4.93 to 21.57, P=0.002), operation time (OR=9.33, 95%CI 5.36 to 13.30, P<0.000 01), number of bypass branches (OR=0.19, 95%CI 0.02 to 0.36, P=0.03), intraoperative infusion volume (OR=383.46, 95%CI 282.16 to 484.76, P<0.000 01) and postoperative pulmonary infection (OR=6.00, 95%CI 3.83 to 9.42, P<0.000 01) were the risk factors for postoperative hypoxemia in patients undergoing coronary artery bypass grafting. Preoperative ejection fraction (OR=−2.60, 95%CI −4.56 to −0.64, P=0.009) and preoperative partial oxygen pressure (OR=−3.14, 95%CI −4.72 to −1.56, P=0.000 1) were the protective factors for postoperative hypoxemia.Conclusions Current evidence shows that age, body mass index, smoking, diabetes history, preoperative lung diseases, complicated ventricular aneurysm, left ventricular end-diastolic diameter, aortic occlusion time, operation time, number of bypass branches, intraoperative infusion volume and postoperative pulmonary infection are risk factors for postoperative hypoxemia in patients undergoing coronary artery bypass grafting. Due to limited quality and quantity of included studies, the above conclusion is required to be assessed by further studies.

Citation： YU Jintian, ZHANG Aiqin, CHEN Junshan. Risk factors for postoperative hypoxemia in patients undergoing coronary artery bypass grafting: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2019, 19(10): 1163-1169. doi: 10.7507/1672-2531.201812107 Copy

1.	高润霖. 冠心病疾病负担—中国出路. 中国循环杂志, 2017, (1): 1-4.
2.	柳尧林. 冠状动脉搭桥术113例临床分析. 现代医药卫生, 2010, 26(8): 1123-1124.
3.	Magruder JT, Kashiouris M, Grimm JC, et al. A predictive model and risk score for unplanned cardiac surgery intensive care unit readmissions. J Card Surg, 2015, 30(9): 685-690.
4.	许卫江, 陈祖君, 肖红艳, 等. 体外循环冠状动脉旁路移植术后低氧血症的危险因素分析. 中国综合临床, 2011, 27(3): 249-252.
5.	Cota GF, de Sousa MR, Fereguetti TO, et al. Efficacy of anti-leishmania therapy in visceral leishmaniasis among HIV infected patients: a systematic review with indirect comparison. PLoS Negl Trop Dis, 2013, 7(5): e2195.
6.	符竣, 陈绪发, 陶凉, 等. 腔内吻合技术在Bentall手术中的应用. 中国胸心血管外科临床杂志, 2011, 18(6): 571-573.
7.	伍进. 冠脉搭桥术后低氧血症的相关因素分析. 郑州: 郑州大学, 2006.
8.	孙益峰, 梅运清, 王玺胜, 等. 不停跳冠状动脉旁路移植术后低氧血症的临床研究. 同济大学学报(医学版), 2007, 28(5): 83-86.
9.	姚陈一. 冠状动脉旁路移植术后低氧血症相关危险因素分析及治疗. 上海: 上海交通大学, 2008.
10.	Ji Q, Mei Y, Wang X, et al. Study on the risk factors of postoperative hypoxemia in patients undergoing coronary artery bypass grafting. Circ J, 2008, 72(12): 1975-1980.
11.	文红英, 邓力, 苟静, 等. 影响冠状动脉旁路移植术后低氧血症的因素及护理措施. 护士进修杂志, 2010, 25(21): 1949-1950.
12.	冯靖, 季强, 梅运清, 等. 冠状动脉旁路移植术后低氧血症的相关因素分析. 同济大学学报(医学版), 2012, 33(5): 53-57.
13.	从长伟, 曹建西, 乔晨晖, 等. 非体外循环冠状动脉旁路移植术后低氧血症相关因素分析. 河南外科学杂志, 2012, 18(3): 2-4.
14.	王志刚, 宫本晶. 冠状动脉旁路移植术后低氧血症相关因素的回顾性分析. 现代医药卫生, 2012, 28(18): 2770-2772.
15.	汤俊毅, 李文灿, 陶选, 等. 冠状动脉旁路移植术后低氧血症的临床观察. 安徽医药, 2013, 17(9): 1546-1547.
16.	Santos NP, Mitsunaga RM, Borges DL, et al. Factors associated to hypoxemia in patients undergoing coronary artery bypass grafting. Rev Bras Cir Cardiovasc, 2013, 28(3): 364-70.
17.	沈亮, 陆晨希, 仲崇俊. 非体外循环下冠状动脉旁路移植术后低氧血症的危险因素分析. 解放军医学院学报, 2014, 35(1): 49-51, 91.
18.	沈立, 薛松, 汪永义. 冠状动脉旁路移植术后低氧血症危险因素研究. 中国心血管病研究, 2014, 12(2): 102-106.
19.	Shi S, Gao Y, Wang L, et al. Elevated free fatty acid level is a risk factor for early postoperative hypoxemia after on-pump coronary artery bypass grafting: association with endothelial activation. J Cardiothorac Surg, 2015, 10: 122.
20.	杨红伟, 高文根, 夏云龙, 等. 冠脉搭桥术后低氧血症发生的危险因素及规律. 中国老年学杂志, 2016, 36(22): 5597-5599.
21.	任飞, 韩涛, 李春平, 等. 冠脉搭桥术后低氧血症的危险因素分析. 福建医药杂志, 2016, 38(1): 16-19.
22.	赵义荣. 冠脉搭桥术后并发低氧血症的高危因素. 临床医药文献电子杂志, 2017, 4(18): 3441-3442.
23.	史令炘. 冠状动脉旁路移植术后低氧血症的相关因素分析. 苏州: 苏州大学, 2018.
24.	郭炯. 非体外循环下冠状动脉搭桥术后低氧血症的危险因素分析及肺复张治疗. 郑州: 郑州大学, 2018.
25.	Rohde SL, Baker RA, Tully PJ, et al. Preoperative and intraoperative factors associated with long-term survival in octogenarian cardiac surgery patients. Ann Thorac Surg, 2010, 89(1): 105-111.
26.	党海明, 宋跃, 曹剑, 等. 肺复张对预防老年非体外冠状动脉旁路移植术后患者肺部并发症的作用. 中国心血管杂志, 2013, 18(3): 198-201.
27.	刘文辉, 石桂葆. 胸部手术后早期低氧血症的危险因素分析. 临床肺科杂志, 2011, 16(1): 106-107.
28.	徐倩. 老年住院患者共病与多重用药的分析. 昆明: 昆明医科大学, 2017.
29.	黄思纳, 欧斌, 张剑彬. Stanford A型主动脉夹层术后重度低氧血症的危险因素分析. 岭南心血管病杂志, 2018, 24(4): 433-436.
30.	Aizawa K, Sakano Y, Ohki S, et al. Obesity is a risk factor of young onset of acute aortic dissection and postoperative hypoxemia. Kyobu Geka, 2013, 66(6): 437-44.
31.	Sheng W, Yang HQ, Chi YF, et al. Independent risk factors for hypoxemia after surgery for acute aortic dissection. Saudi Med J, 2015, 36(8): 940-6.
32.	Arabaci U, Akdur H, Yigit Z. Effectors of smoking on pulmonary functions and arterial blood gases following coronary artery surgery in Turkish patients. Jpn Heart, 2003, 44(1): 61-72.
33.	Rodrigues CDA, Moreira MM, Lima NMFV, et al. Risk factors for transient dysfunction of gas exchange after cardiac surgery. Rev Bras Cir Cardiovasc, 2015, 30(1): 24-32.
34.	Weynand B, Jonckheere A, Frans A, et al. Diabetes mellitus induces a thickening of the pulmonary basal lamina. Respiration, 1999, 66: 14-19.
35.	Hsu H, Lai HC, Liu TJ. Factors causing prolonged mechanical ventilation and perioperative morbidity after robot-assisted coronary artery bypass graft surgery. Heart and Vessels, 2018.
36.	Polyzogopoulou E, Bikas C, Danikas D, et al. Baseline hypoxemia as a prognostic marker for pulmonary complications and outcome in patients with acute pancreatitis. Dig Dis Sci, 2004, 49(1): 150-154.
37.	杨晓平, 孔德玲, 姚婕, 等. 重症胸外伤并发急性呼吸窘迫综合征的相关危险因素分析. 中国医学前沿杂志(电子版), 2017, 9(10): 113-116.
38.	蔡伟, 林瑟芬, 张远婵, 等. 影响重症胰腺炎预后的早期危险因素分析. 现代消化及介入诊疗, 2012, 17(2): 71-73.
39.	Omar ML, John DP, Vinod H. Does the number of gafts influence surgeon choice and patient benefit of off-pump over conventional on-pump coronary artery revascularization in multivessel coronary artery disease? Ann Thorac Surg, 2007, 84(5): 1485-1495.
40.	金沐, 李书闻, 卢家凯, 等. 1516例男性患者非体外循环冠状动脉旁路移植术中应用主动脉内球囊反搏危险因素Logistic分析. 心肺血管病杂志, 2013, 32(4): 479-482.
41.	孙广龙, 曹向戎, 张健群. 非体外循环冠状动脉旁路移植术后低氧血症相关因素分析. 心肺血管病杂志, 2011, 30(5): 411-413.
42.	Hughes CG, Weavind L, Banerjee A, et al. Intraoperative risk factors for acute respiratory distress syndrome in critically ill patients. Anesth Analg, 2010, 111(2): 464-467.

1. 高润霖. 冠心病疾病负担—中国出路. 中国循环杂志, 2017, (1): 1-4.
2. 柳尧林. 冠状动脉搭桥术113例临床分析. 现代医药卫生, 2010, 26(8): 1123-1124.
3. Magruder JT, Kashiouris M, Grimm JC, et al. A predictive model and risk score for unplanned cardiac surgery intensive care unit readmissions. J Card Surg, 2015, 30(9): 685-690.
4. 许卫江, 陈祖君, 肖红艳, 等. 体外循环冠状动脉旁路移植术后低氧血症的危险因素分析. 中国综合临床, 2011, 27(3): 249-252.
5. Cota GF, de Sousa MR, Fereguetti TO, et al. Efficacy of anti-leishmania therapy in visceral leishmaniasis among HIV infected patients: a systematic review with indirect comparison. PLoS Negl Trop Dis, 2013, 7(5): e2195.
6. 符竣, 陈绪发, 陶凉, 等. 腔内吻合技术在Bentall手术中的应用. 中国胸心血管外科临床杂志, 2011, 18(6): 571-573.
7. 伍进. 冠脉搭桥术后低氧血症的相关因素分析. 郑州: 郑州大学, 2006.
8. 孙益峰, 梅运清, 王玺胜, 等. 不停跳冠状动脉旁路移植术后低氧血症的临床研究. 同济大学学报(医学版), 2007, 28(5): 83-86.
9. 姚陈一. 冠状动脉旁路移植术后低氧血症相关危险因素分析及治疗. 上海: 上海交通大学, 2008.
10. Ji Q, Mei Y, Wang X, et al. Study on the risk factors of postoperative hypoxemia in patients undergoing coronary artery bypass grafting. Circ J, 2008, 72(12): 1975-1980.
11. 文红英, 邓力, 苟静, 等. 影响冠状动脉旁路移植术后低氧血症的因素及护理措施. 护士进修杂志, 2010, 25(21): 1949-1950.
12. 冯靖, 季强, 梅运清, 等. 冠状动脉旁路移植术后低氧血症的相关因素分析. 同济大学学报(医学版), 2012, 33(5): 53-57.
13. 从长伟, 曹建西, 乔晨晖, 等. 非体外循环冠状动脉旁路移植术后低氧血症相关因素分析. 河南外科学杂志, 2012, 18(3): 2-4.
14. 王志刚, 宫本晶. 冠状动脉旁路移植术后低氧血症相关因素的回顾性分析. 现代医药卫生, 2012, 28(18): 2770-2772.
15. 汤俊毅, 李文灿, 陶选, 等. 冠状动脉旁路移植术后低氧血症的临床观察. 安徽医药, 2013, 17(9): 1546-1547.
16. Santos NP, Mitsunaga RM, Borges DL, et al. Factors associated to hypoxemia in patients undergoing coronary artery bypass grafting. Rev Bras Cir Cardiovasc, 2013, 28(3): 364-70.
17. 沈亮, 陆晨希, 仲崇俊. 非体外循环下冠状动脉旁路移植术后低氧血症的危险因素分析. 解放军医学院学报, 2014, 35(1): 49-51, 91.
18. 沈立, 薛松, 汪永义. 冠状动脉旁路移植术后低氧血症危险因素研究. 中国心血管病研究, 2014, 12(2): 102-106.
19. Shi S, Gao Y, Wang L, et al. Elevated free fatty acid level is a risk factor for early postoperative hypoxemia after on-pump coronary artery bypass grafting: association with endothelial activation. J Cardiothorac Surg, 2015, 10: 122.
20. 杨红伟, 高文根, 夏云龙, 等. 冠脉搭桥术后低氧血症发生的危险因素及规律. 中国老年学杂志, 2016, 36(22): 5597-5599.
21. 任飞, 韩涛, 李春平, 等. 冠脉搭桥术后低氧血症的危险因素分析. 福建医药杂志, 2016, 38(1): 16-19.
22. 赵义荣. 冠脉搭桥术后并发低氧血症的高危因素. 临床医药文献电子杂志, 2017, 4(18): 3441-3442.
23. 史令炘. 冠状动脉旁路移植术后低氧血症的相关因素分析. 苏州: 苏州大学, 2018.
24. 郭炯. 非体外循环下冠状动脉搭桥术后低氧血症的危险因素分析及肺复张治疗. 郑州: 郑州大学, 2018.
25. Rohde SL, Baker RA, Tully PJ, et al. Preoperative and intraoperative factors associated with long-term survival in octogenarian cardiac surgery patients. Ann Thorac Surg, 2010, 89(1): 105-111.
26. 党海明, 宋跃, 曹剑, 等. 肺复张对预防老年非体外冠状动脉旁路移植术后患者肺部并发症的作用. 中国心血管杂志, 2013, 18(3): 198-201.
27. 刘文辉, 石桂葆. 胸部手术后早期低氧血症的危险因素分析. 临床肺科杂志, 2011, 16(1): 106-107.
28. 徐倩. 老年住院患者共病与多重用药的分析. 昆明: 昆明医科大学, 2017.
29. 黄思纳, 欧斌, 张剑彬. Stanford A型主动脉夹层术后重度低氧血症的危险因素分析. 岭南心血管病杂志, 2018, 24(4): 433-436.
30. Aizawa K, Sakano Y, Ohki S, et al. Obesity is a risk factor of young onset of acute aortic dissection and postoperative hypoxemia. Kyobu Geka, 2013, 66(6): 437-44.
31. Sheng W, Yang HQ, Chi YF, et al. Independent risk factors for hypoxemia after surgery for acute aortic dissection. Saudi Med J, 2015, 36(8): 940-6.
32. Arabaci U, Akdur H, Yigit Z. Effectors of smoking on pulmonary functions and arterial blood gases following coronary artery surgery in Turkish patients. Jpn Heart, 2003, 44(1): 61-72.
33. Rodrigues CDA, Moreira MM, Lima NMFV, et al. Risk factors for transient dysfunction of gas exchange after cardiac surgery. Rev Bras Cir Cardiovasc, 2015, 30(1): 24-32.
34. Weynand B, Jonckheere A, Frans A, et al. Diabetes mellitus induces a thickening of the pulmonary basal lamina. Respiration, 1999, 66: 14-19.
35. Hsu H, Lai HC, Liu TJ. Factors causing prolonged mechanical ventilation and perioperative morbidity after robot-assisted coronary artery bypass graft surgery. Heart and Vessels, 2018.
36. Polyzogopoulou E, Bikas C, Danikas D, et al. Baseline hypoxemia as a prognostic marker for pulmonary complications and outcome in patients with acute pancreatitis. Dig Dis Sci, 2004, 49(1): 150-154.
37. 杨晓平, 孔德玲, 姚婕, 等. 重症胸外伤并发急性呼吸窘迫综合征的相关危险因素分析. 中国医学前沿杂志(电子版), 2017, 9(10): 113-116.
38. 蔡伟, 林瑟芬, 张远婵, 等. 影响重症胰腺炎预后的早期危险因素分析. 现代消化及介入诊疗, 2012, 17(2): 71-73.
39. Omar ML, John DP, Vinod H. Does the number of gafts influence surgeon choice and patient benefit of off-pump over conventional on-pump coronary artery revascularization in multivessel coronary artery disease? Ann Thorac Surg, 2007, 84(5): 1485-1495.
40. 金沐, 李书闻, 卢家凯, 等. 1516例男性患者非体外循环冠状动脉旁路移植术中应用主动脉内球囊反搏危险因素Logistic分析. 心肺血管病杂志, 2013, 32(4): 479-482.
41. 孙广龙, 曹向戎, 张健群. 非体外循环冠状动脉旁路移植术后低氧血症相关因素分析. 心肺血管病杂志, 2011, 30(5): 411-413.
42. Hughes CG, Weavind L, Banerjee A, et al. Intraoperative risk factors for acute respiratory distress syndrome in critically ill patients. Anesth Analg, 2010, 111(2): 464-467.

Chinese Journal of Evidence-Based Medicine

Risk factors for postoperative hypoxemia in patients undergoing coronary artery bypass grafting: a meta-analysis

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content