Razi Journal of Medical Sciences
مجله علوم پزشکی رازی
RJMS
Medical Sciences
http://rjms.iums.ac.ir
39
journal39
2228-7043
2228-7051
en
jalali
1397
11
1
gregorian
2019
2
1
25
11
online
1
fulltext
fa
بررسی عوامل تعیینکننده مرگ و میر بیماران به دنبال عمل جراحی بای پس عروق کرونر در بیمارستان سیدالشهداء ارومیه
Evaluation of determinants of mortality in patients undergoing coronary artery bypass graft surgery in Urmia Seyed-al-Shohada Heart Center
قلب و عروق
Cardio Muscular Disease
پژوهشي
Research
<strong><span style="color:#0070C0;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">زمینه و هدف: </span></span></span></strong><span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">بیماریهای</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">قلبی</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">- عروقی</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">علت</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">اصلی</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">مرگ</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">و</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">میر در ایران و سایر کشورهای جهان است. در مورد عوامل</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">خطر</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">و</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">علل</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">مرگ</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">و</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">میر بیماران</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">به دنبال</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">عمل</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">جراحی</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">بای</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">پس</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">عروق</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">کرونر (</span></span></span><span dir="LTR"><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:10.0pt;">CABG</span></span></span></span><strong><span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">-</span></span></span></strong> <span dir="LTR"><span style="color:black;"><span style="font-family:times new roman,serif;"><span style="font-size:10.0pt;">Coronary artery bypass grafting</span></span></span></span><span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">) اتفاقنظر</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">وجود</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">ندارد و هدف مطالعه</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">حاضر</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">تعیین این</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">عوامل میباشد.</span></span></span><br>
<strong><span style="color:#0070C0;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">روش کار:</span></span></span></strong> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">در</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">مطالعه</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">مورد</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">شاهدی</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">گذشتهنگر</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">و در</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">فاصله</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">زمانی</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">78</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">ماهه، اطلاعات بالینی قبل و حین عمل بیماران با جراحی</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">بای</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">پس</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">عروق</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">کرونر</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">که</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">طی</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">30</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">روز</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">بعد</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">از</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">عمل</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">فوت</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">کرده</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">بودند (گروه</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">مورد، 36 بیمار) با گروه</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">شاهد</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">به</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">تعداد</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">144</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">نفر</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">از</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">بیمارانی که</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">به دنبال</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">جراحی</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">فوت</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">نکرده</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">بودند،</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">ثبت و آنالیز گردید.</span></span></span><span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;"></span></span></span><br>
<strong><span style="color:#0070C0;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">یافتهها:</span></span></span></strong><span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;"> میزان</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">مرگ</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">ومیر</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">در</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">طی</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">این</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">فاصله</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">زمانی 29/1%</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">بود. سن بالا،</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">جنس مؤنث،</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">درگیری هر سه رگ کرونری،</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">بیماری انسدادی مزمن ریوی،</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">درگیری شریان اصلی کرونری چپ، نارسایی دریچه میترال،</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">جراحی</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">اورژانسی،</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">شرایط</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">بحرانی</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">قبل</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">از</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">عمل،</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">سطح</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">هموگلوبین پایین،</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">شمارش گلبول سفید خون بالا،</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">آرتریوپاتی</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">خارج</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">قلبی،</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">میانگین</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">زمان</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">کلامپ</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">آئورتی بالا،</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">هیپرتانسیون پولمونری،</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">زمان</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">بای</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">پس</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">قلبی</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">ریوی بالا،</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">استفاده</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">از</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">بالون</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">پمپ</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">داخل</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">آئورتی،</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">استفاده</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">از اینوتروپ و</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">استفاده از</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">ضربانساز قلبی</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">ارتباط</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">معنیداری</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">با</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">مرگ</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">و</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">میر</span></span></span> <span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">داشتند.</span></span></span><br>
<strong><span style="color:#0070C0;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">نتیجهگیری:</span></span></span></strong><span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;"> جراحی اورژانس در شرایط بحرانی قبل از عمل، بهویژه در زنان مسن با کوموربیدیتیهای متعدد، مرگ و میر بالایی دارد. ارزیابی قبل از عمل و اصلاح عواملی مانند کم خونی، کنترل عوامل التهابی و مشکلات ریوی و کم کردن طول مدت جراحی جهت کاهش مرگ و میر بعد از جراحی کمککننده خواهد بود</span></span></span><span style="color:black;"><span style="font-family:b mitra;"><span style="font-size:10.0pt;">.</span></span></span><br>
<br>
<strong>Background:</strong> Cardiovascular diseases are the leading cause of mortality in Iran and in the world. There is a controversy about risk factors and causes of mortality following Coronary Artery Bypass Graft (CABG) surgery and the purpose of this study is to determine these factors.<br>
<strong>Methods:</strong> In the retrospective case-control study, from March 2010 to July 2016 preoperative and intraoperative clinical data's of CABG patients were obtained and analyzed. Case group included 36 patients who died during the 30 days after operation and control group included 144 patients who had not died after surgery.<br>
<strong>Results:</strong> The mortality rate during this interval was 1.29% (36/2774). Old age, female sex, three vessel disease, chronic obstructive pulmonary disease, left main involvement, mitral valve regurgitation, emergency surgery, preoperative critical condition, low hemoglobin level, high white blood cell count, peripheral vascular disease, high aortic cross clamping time, pulmonary hypertension, high cardiopulmonary bypass time, intra-aortic balloon pump placement and use of inotrope and pacemaker had a significant relationship with mortality.<br>
<strong>Conclusion:</strong> Emergency surgery has a high mortality in the patients with preoperative critically ill conditions, especially in older women with multiple comorbidities. Preoperative precise assessment and correcting factors such as anemia, controlling inflammatory and pulmonary diseases, and reducing the duration of surgery is recommended to reduce mortality after surgery.
بیماری شریان کرونری , بای پس عروق کرونری , مرگ ومیر
Coronary artery disease,Coronary artery bypass grafting,Mortality
23
33
http://rjms.iums.ac.ir/browse.php?a_code=A-10-2636-1&slc_lang=fa&sid=1
Behnam
Askari
بهنام
عسکری
askaribehnam@ymail.com
3900319475328460043207
3900319475328460043207
Yes
Urmia University of Medical Sciences, Urmia, Iran
دانشگاه علوم پزشکی ارومیه، ارومیه، ایران
Hamid
Mehdizadeh
حمید
مهدی زاده
hamidmehdizadeh44@gmail.com
3900319475328460043208
3900319475328460043208
No
Urmia University of Medical Sciences, Urmia, Iran
دانشگاه علوم پزشکی ارومیه، ارومیه، ایران
safa
koomasi
صفا
کوماسی
safakoomasi1992@yahoo.com
3900319475328460043209
3900319475328460043209
No
Urmia University of Medical Sciences, Urmia, Iran
دانشگاه علوم پزشکی ارومیه، ارومیه، ایران