这项研究的目的是分析患有稳定性冠状动脉疾病(CAD)的虚弱患者的发生率和记忆特征,并评估虚弱在围手术期和冠状动脉旁路移植术(CABG)后早期生存期的并发症和不良结局的发展中的作用。
方法:该研究纳入了387例患者,这些患者因预定的原发性CABG入院。七项问卷,“PRISMA-7”,用于在手术前识别虚弱的老年患者。我们将研究样本分为两组,考虑到调查结果:没有虚弱的患者,n0=300(77.5%),和虚弱的病人,n1=87(22.5%)。记忆和实验室数据,手术干预的结果,围手术期和早期并发症,并对不良结局进行分析。
结果:我们在手术前检测到22.5%的CAD患者虚弱。根据记忆数据以及临床旁和术中发现,有衰弱和无衰弱的患者组具有可比性.CABG的术中和术后早期显示出差异。因此,术后节律紊乱(19.5%vs.10.5%,p=0.025,V=0.115)和短暂性脑缺血发作/中风(5.7%vs.1.3%,分别为p=0.031,V=0.122)在虚弱的患者中发生的频率更高。其他术中和术后早期并发症的发生频率组间差异无统计学意义。在虚弱的患者组中,记录了由于术后早期缺血导致的四个致命结局,在没有虚弱的患者中,记录了一个致命的结果(4.5%vs.0.3%,p=0.010,V=0.156)。在为期一年的随访中,历史上虚弱的存在是死亡率的预测因子(11.5%与0.6%,p分别为0.001,V=0.290)。
结论:脆弱的存在可以作为CAD患者预后不良的独立预测因子,CABG围手术期和术后早期生存期。在手术风险评估中应考虑到这一点。
The aim of this study was to analyze the incidence and anamnestic characteristics of frail patients with stable coronary artery disease (CAD) and to evaluate the role of frailty in the development of complications and adverse outcomes in the perioperative period and early survival period after coronary artery bypass grafting (CABG).
METHODS: The study included 387 patients admitted to the clinic for a scheduled primary CABG. A seven-item questionnaire, \"PRISMA-7\", was used to identify frail elderly patients before the procedure. We divided the study sample into two groups, taking into account the results of the survey: patients without frailty, n0 = 300 (77.5%), and patients with frailty, n1 = 87 (22.5%). The anamnestic and laboratory data, outcome of the surgical intervention, perioperative and early complications, and adverse outcomes were analyzed.
RESULTS: We detected frailty in 22.5% of the patients with CAD before the procedure. According to the anamnestic data and paraclinical and intraoperative findings, the groups of patients with and without frailty were comparable. The differences were revealed in the intraoperative and early postoperative periods of CABG. Thus, postoperative rhythm disturbances (19.5% vs. 10.5%, p = 0.025, V = 0.115, respectively) and transient ischemic attacks/stroke (5.7% vs. 1.3%, p = 0.031, V = 0.122, respectively) occurred significantly more often among the frail patients. There were no significant differences between the groups in the frequency of other intraoperative and early postoperative complications. In the group of frail patients, four fatal outcomes due to early postoperative ischemia were recorded, and among patients without frailty, one fatal outcome was recorded (4.5% vs. 0.3%, p = 0.010, V = 0.156, respectively). At the 1-year follow-up visit, the presence of frailty in history served as a predictor of mortality (11.5% vs. 0.6%, p ˂ 0.001, V = 0.290, respectively).
CONCLUSIONS: The presence of frailty can be used as an independent predictor of an unfavorable prognosis in patients with CAD, both in the perioperative and early survival period after CABG. It should be taken into account during surgical risk assessment.